Background: Studies from the West have demonstrated that ready-to-eat cereals (RTECs) are a common form of breakfast and more likely to be consumed by children. This study aimed to investigate the breakfast eating pattern and RTECs consumption among schoolchildren in Kuala Lumpur. Methods: In this cross-sectional study, a total of 382 schoolchildren, aged 10 and 11 years old, were recruited from seven randomly selected primary schools in Kuala Lumpur. Information on socio-demographics, breakfast eating patterns, and perceptions of RTECs and dietary intake (24-hour dietary recalls) were obtained. Results: Among the respondents, only 22% of them consumed breakfast on a regular basis. The most commonly eaten food by children at breakfast was bread (27.2%), followed by biscuits (22.2%) and RTECs (20.5%). The majority of them (93%) reported that they consumed RTECs sometimes during the week. Chocolate RTECs (34.1%), corn flake RTECs (30.3%), and RTECs coated with honey (25.1%) were the most popular RTECs chosen by children. Respondents who consumed RTECs showed a significantly higher intake in calories, carbohydrate, vitamin A, vitamin B1, vitamin B2, vitamin B3, folate, vitamin C, calcium, iron, and fibre (P < 0.05), compared to those who skipped breakfast and those who had breakfast foods other than RTECs. Conclusion: The lower levels of breakfast consumption among schoolchildren in Kuala Lumpur need serious attention. RTEC is a nutritious food which is well accepted by a majority of the schoolchildren in Kuala Lumpur. Nutrition intervention should be conducted in the future to include a well-balanced breakfast with the utilisation of RTECs for schoolchildren.

White and whole meal breads have been classified as high glycemic index (GI) foods which in turn produce the greatest rise in blood glucose. One of the commercial bread products in Malaysia known as Brown breads (BB) has been recently marketed as a healthy choice for diabetics due to its low GI value. This study was conducted to examine the effect of BB when eaten with different fillings on blood glucose response among healthy individuals and to describe the influences of these fillings in reducing blood glucose response. Five test meals using BB (BB eaten with baked beans, BB eaten with vegetable, BB eaten with apple, BB eaten with roast chicken and BB eaten with seaweeds) had been prepared for this study. Postprandial blood glucose response was determined for each test meal and reference food (glucose) that contained 50 g carbohydrate respectively. A total of 21 healthy subjects were recruited by advertisement to participate. Only 20 subjects (15 males, 5 females, Mean + SD Age : 24.4 + 3.7 years; BMI 23.4 + 3.0 kgm-2) completed this study. After an overnight fast, subjects consumed BB eaten with fillings according to the assigned group given and three repeated tests of reference food (glucose). Fasting capillary blood glucose samples were taken at time 0 and at 15, 30, 45, 60, 90 and 120 min respectively after the meal began. The blood glucose response was obtained by calculating the incremental area under the curve (AUC). Blood glucose response after consuming reference food (251.8 + 12.1 mmol.min/L) was significantly higher than all the test meals (p < 0.05). Among the test meals, BB eaten with baked beans produced the highest rise in blood glucose (97.0 + 16.9 mmol.min/L) whereas BB eaten with seaweeds demonstrated the lowest response in blood glucose (33.3 + 6.5 mmol.min/L) and the difference was statistically significant (p < 0.05). The postprandial blood glucose response after ingestion of BB when eaten with vegetable was 73.3 + 19.1 mmol.min/L followed by BB eaten with apple (58.9 + 12.2 mmol.min/L) and BB eaten with roast chicken (56.5 + 10.1 mmol.min/ L). Generally, BB when eaten with fillings produced a slow rise in blood glucose response than the reference food. Combining this BB with fillings had the effect of reducing the postprandial blood glucose further.

Printed educational material is the primary mode of communication in public health education. However, there is a scarcity of studies that evaluate the acceptance towards printed educational materials in Malaysia. Therefore, this study was conducted with the aim of evaluating existing printed nutrition educational materials regarding childhood obesity for use in nutrition education or health promotion programme. This study was conducted in two stages. Stage 1 involved a survey of existing printed nutrition educational materials related to childhood obesity and pilot testing on questionnaires that was developed. Whereas Stage 2 was the evaluation of the acceptance of subjects towards existing printed educational materials and changes in knowledge level after reading the materials. Likert scale from 1 (very not satisfactory) to 5 (very satisfactory) was used in the evaluation. Subjects in this study comprised 67 individuals who were educational and health professionals (n = 7), adults (n = 30) and children (n = 30). In this study, adults were given a booklet that focused on prevention and management of childhood obesity such as complications of childhood obesity and food preparation. Children received a booklet that focused on food pyramid, importance of breakfast, physical activity and so on and a poster that focused on healthy food choices. The professionals were given all three printed materials. This study found that the acceptance of subjects towards content, illustrations, tables and fi gures, colour, organization of picture, organization of content, language and font size of the three printed educational materials are variety, which ranged from not satisfactory to very satisfactory. Mean satisfaction score of booklet targeted at adult population was 3.9 ± 0.5 while mean satisfaction score of booklet targeted at children population was 4.3 ± 0.4 and poster was 3.9 ± 0.9. Knowledge score of the professionals increased from 88.6 ± 11.2% to 95.5 ± 3.2% after reading the educational materials. The knowledge score of adults also increased signifi cantly (p < 0.001) from 67.7 ± 13.6% to 84.8 ± 15.9%; among children, knowledge score signifi cantly increased (p < 0.001) from 65.3 ± 14.4% to 84.0 ± 11.4%. In conclusion, the existing printed educational materials were well-accepted and were able to increase the knowledge level of target population. Therefore, the printed educational materials are suitable to be used in any health education program related to childhood obesity

The global prevalence of overweight and obesity among children has increased rapidly in the recent decades, includingin Malaysia. Thus, development of effective interventions to prevent childhood obesity in Malaysia is urgently needed.This paper describes the study design of a 12-week multi-component, school-based nutrition education programme aimedat managing childhood obesity. The objective of Juara Sihat™ is to determine the effectiveness of a nutrition educationprogramme in improving anthropometric status, knowledge, attitude and practice (KAP) of nutrition, eating habits andphysical activity level among overweight and obese children. This quasi-experimental study involves two primary schoolsin Kuala Lumpur with similar demographic characteristics. Eligibility criteria of research participants are overweightand obese children aged 9 to 11 years. The main components of the Juara Sihat™ intervention are nutrition educationclasses on healthy eating and active lifestyle; physical activity sessions; and active involvements of parents and teachers.The control school does not receive any interventions. The primary outcome is BMI-for-age z-score, while other outcomesinclude waist circumference, body fat percentage, KAP of nutrition score, dietary intake, physical activity level, sedentarybehaviour and biochemical profile. Outcome measures will be assessed at three intervals: baseline, post-intervention 1(3-month follow-up), and post-intervention 2 (6-month follow-up). The Juara Sihat™ programme represents a promisingapproach to examining the effectiveness of a school-based childhood obesity intervention with strong empowerment ofParents’ and Teachers’ Association (PTA). We anticipate that this study may provide insights towards the development ofmore effective strategies in formulating childhood obesity interventions.

Introduction: The consumption of processed food is increasing in developing countries. Nutrition labels on food packaging are important for the education of consumers, particularly adolescents, to help them make healthier food choices. However, there is evidence to suggest that adolescents generally do not use nutrition labels. This study aims to explore the personal factors that influence the practice of Malaysian adolescents in reading nutrition labels. Methods: The participants were adolescents, aged 13-16 years, from five public schools in Negeri Sembilan. Five semi-structured focus group discussions (FGDs) were conducted. The participants discussed their personal views, knowledge and perceptions regarding the use of nutrition labels and food selection. Data gathered from the FGDs were coded through thematic analysis using the NVivo software. Results: While the participants were familiar with nutrition labels, their usage was relatively low during food selection due to the lack of interest in nutrition information, past experiences, hunger and cravings, time constraints and the taste of the food. The main reasons for using nutrition labels were health consciousness and their curiosity about specific nutrition information provided on the labels. The majority of participants believed that information provided on the labels was accurate because it was provided by reliable institutions. There was also misperception among some participants, mixing up nutrition labels with list of ingredients and the expiry dates. A few participants were unconvinced by the labels and stated that the labels provided misleading information. Conclusion: Personal factors such as knowledge, misperception, awareness and trust significantly impact how adolescents read nutrition labels.

Introduction: Obesity and physical inactivity among schoolchildren are among the most challenging health problems inMalaysia. The present study aimed to evaluate the sustainedimpact of Juara Sihat programme on physical activity leveland anthropometric status at 18-month post-intervention.Method: Participants of Juara Sihat (n=55) were followed-upat 18 months after completion of the intervention. JuaraSihat intervention was implemented over 12 weeks andfocused on four key components: (i) five one-hour nutritioneducation classes, (ii) four one-hour physical activityeducation sessions, (iii) family involvement, and (iv)empowerment of Parents and Teachers Association.Anthropometric variables (body mass index, body fatpercentage and waist circumference) were measured andphysical activity level was evaluated by using PhysicalActivity Questionnaire for Children (PAQ-C) at baseline (P0),immediately upon completion of intervention (P1), atthree-month post-intervention (P2), and at 18-month postintervention(P3). Analyses of repeated measures analysisof covariance (ANCOVA) with intention-to-treat principlewere applied.Results: Sustained effects were found in BMI-for-age z-scorewhich showed a reduction (P0 2.41±0.84 vs P3 2.27±0.81)and physical activity level which showed positiveimprovements (P0 2.46±0.62 vs P3 2.87±0.76) at 18 monthsafter intervention was completed. Body fat and waistcircumference had increased over the same time period.Conclusion: Overall, this study successfully demonstratedsustained intervention effects of Juara Sihat intervention onBMI-for-age z-score and physical activity, but not on body fatpercentage and waist circumfere

Obesity among school children has now reached an alarming level in most developing countries, including Malaysia. Thus, numerous strategies to curb the rising of obesity focusing on school children have been taking place. However, this issue management is complex, and a holistic approach is needed to address it comprehensively. This scoping review aimed to identify the characteristics of obesity interventions conducted among school children in Malaysia as a principal recommendation to develop a comprehensive obesity intervention. Arksey and O'Malley’s framework used to guide the scoping review process. Published articles on intervention studies conducted for school children in Malaysia from 2007 to 2020 retrieved based on keyword using the selected electronic and local databases. The NVivo 12 Plus software used to place findings in the systematic framework matric form and evidence tables. The final results reported in descriptive tables. Eighteen studies only reviewed among 3417 extracted articles. Thirteen aspects of the characteristics of the interventions identified. The influence of environmental intervention (family and school communities) on children lifestyle identified as a research gap. Combined environmental interventions and educational guides with technology application recognised as one of the potential components for future obesity intervention design amongst school children.

Behavioural change interventions for weight loss have been found to be effective in the short term, but their long-term effectiveness remains a question. The objective of this study was to evaluate the effectiveness of the 36 weeks F.E.A.T program combining behavioural changes of healthy eating and physical activity. A quasi-experimental study of overweight adults was conducted in Malacca. A total of 53 subjects (mean age 47.4 ± 7.2 years) completed the program in three stages. In the first stage (T1: weeks 1–12), the intervention group (n = 28) participated in the F.E.A.T program activities, while the control group (n = 25) did not receive the intervention. In the second stage (T2: weeks 13-24), the activity was supervised and monitored by the peer support group. Sustainability of activity was measured at the third stage (T3: weeks 25-36). The effectiveness of the program was measured by changes in dietary intake, physical activity score, body weight, body mass index (BMI), waist circumference (WC) and body fat percentage at T0 (pre-intervention), T1, T2 and T3. All parameters showed significant interaction effects (time*group) except for energy intake. The intervention group showed significant decreases from T0 to T3 for energy intake (-14.3%), body weight (-4.3%), BMI (-4.2%), WC (-10.5%) and body fat percentage (-3.6%). While physical activity level increased by 109.6% for the intervention group. There were no significant differences in all of these parameters among the control group. The results show the effectiveness of the F.E.A.T program on dietary status and physical activity changes during the 36-week of intervention period.

Introduction: The culture of eating out among Malaysians has substantially increased in recent years due to the urbanisation of the society. Frequent eating out has been linked with reduced quality of diet, reduced intake of micronutrients, and increased weight gain. This study aims to explore specific factors on the perceptions and behaviours related to eating out from the perspective of parents. Methods: A qualitative study was carried out among 27 informants from various ethnicities and locations in Peninsular Malaysia. All sessions were audio-recorded, fully transcribed and analysed using thematic content analysis. Results: The main overarching theme that surfaced from this study was the role of parents in shaping the practice of eating out. Time constraints due to parents’ work commitments, the availability of various food outlets, increase in family bonding time and food preferences were recurring themes revealed by informants as facilitating factors to eating out. Other emerging themes, such as hygiene of food premises and cost of food, posed as barriers to eating out. Conclusion: These findings offered a better understanding on the eating out practices of a family from the parents’ perspective. Information as such could be incorporated in strategies to enhance the promotion of healthy eating and nutrition interventions that aim to inculcate healthy food choices while eating out.

Introduction: Designing an effective and comprehensive weight reduction intervention requires an understanding of the motivating factors and barriers to losing weight. This study explored the motivating factors and barriers to weight reduction through the experiences, emotions and ideas shared among suburban overweight and obese Malay adults. Methods: In this qualitative study, 23 overweight or obese Malay adults aged 30-59 years old were divided into three focus group discussion (FGD). The Socio-Ecological Model (SEM), consisting of four levels (intrapersonal, interpersonal, community, and policy) was utilised in this study. Results: The motivating factors were: (1) Intrapersonal level: self-awareness, health concern, self-confidence, and desire to have good physical appearance, (2) Interpersonal level: social support from family and friends, (3) Community level: availability and accessibility of physical activity facilities and health information, and (4) Policy level: healthy lifestyle programme. The barriers were: (1) Intrapersonal level: lack of knowledge about diet, physical limitations, lack of self-control, and emotion/mood, (2) Interpersonal level: spouse and children, career or housework commitment, (3) Community level: lack of neighbourhood safety, and availability and accessibility of outside foods, and (4) Policy level: availability and accessibility of outside foods. Conclusion: Eight factors were identified as motivating factors and barriers for weight reduction practices. Support from family and friends should be considered when developing an effective and comprehensive weight loss programme as it was both a motivating factor as well as a barrier.