Attaining higher peak bone mass and strength in early life stage is critical for reducing risk of osteoporosis or lower bone mass later in life. Genetic factors such as race and gender are mostly responsible for the variability and timing of reaching peak bone mass. In general, Asians have lower areal bone mineral density and would reach peak bone mass earlier when they are compared to Caucasians. Among different lifestyle factors, strong evidence is only available for positive effects of dietary calcium and physical exercise on bone accretion. Studies showed that the calcium intake of Chinese population at all ages is well below the recommended intake levels. To develop peak bone mass and strength to reach their genetic potentials, achieving adequate calcium and vitamin D intake through promoting dietary intake and/or supplementation, are strongly recommended, especially in Chinese adolescents.

Introduction: Evidence showed considerable variability of health risk factors within different socioeconomic groups. This study aimed to characterise dietary intakes by total household income among a sample of Malaysian pre-adolescents in urban Kuala Lumpur. Methods: Baseline data of 243 healthy, pre-adolescent children between 9 and 11 years old including socio-demographic background (gender, ethnicity, and total household monthly income), anthropometry (body weight and height), and 7-day diet histories were collected. Secondary analysis was performed on dietary intakes to quantify food groups based on the Malaysian Dietary Guidelines and NOVA classification systems besides nutrients. Differences and associations between total monthly household income categories with anthropometry and dietary intakes were tested using independent t-test/Mann-Whitney U (depending on normality) and chi-square tests, respectively. Results: Most children in this study population had dietary intakes below the recommended serving sizes for five food groups, except meat/poultry (195.2±107.2%) and fish (110.1±106.3%) and consumed about 32% of energy from ultra-processed foods (NOVA food group 4). While there was no difference in dietary intake between the bottom 40% with the middle 40% and high 20% household income groups, the percentage of energy contributed by NOVA food group 4 (processed fats/oils, condiments, and sauces) was higher in the bottom 40% households (p=0.024). Conclusion: Most pre-adolescent children in this study, regardless of household income, did not meet dietary recommendations and ate diets comprised of less nutritious foods. Comprehensive approaches that aim to improve dietary patterns and reduce the risk of diet-related chronic diseases are warranted.