Introduction: The nutritional status of children with Attention-Deficit/Hyperactivity Disorder (ADHD) and Down Syndrome (DS) is influenced by multiple food environment determinants. However, the precise relationship between food environment determinants and nutritional outcomes in these children remains unclear. This study aimed to understand the food environment determinants that are associated with the intake and nutritional status of these children in Malaysia, Lao PDR, and Indonesia. Methods: This cross-sectional study involved 7- to 18-year-old students with ADHD and DS in three Southeast Asian countries. Sociodemographic characteristics, dietary habits, and repeated 24-hour food recall data were collected through a structured questionnaire. Anthropometric data were obtained through direct measurements and analysed using the WHO AnthroPlus software. Further analyses were done using descriptive statistics and chi-square tests. Results: Total participants were 284 children, comprised of 37.7% with ADHD and 62.3% with DS; 62.3% of the children were boys and 37.7% were girls. Among the food environment determinants collected during the study, monthly household income and school food assistance status had significant associations (p<0.05) with BMI-for-age z-score category and total energy, protein, zinc, and calcium intakes. While the country, type of residence, and type of school had significant associations with total energy, protein, zinc, and calcium intakes. Conclusions: Food environment determinants, particularly household income and access to school food assistance, significantly influence the nutritional status and intake of children with ADHD and Down Syndrome. Thus, strengthening inclusive nutrition programmes may improve outcomes for this vulnerable group in Southeast Asia.

Introduction: Cafeteria environments within universities have a significant influence over sustainable and healthy dietary behaviours. Hence, this study aimed to understand the nutritional landscape of food options in university cafeterias and to identify the factors contributing to unhealthy food options from the perspective of food service vendors. Methods: Using a mixed-methods approach, 122 food options from all 12 residential campus cafeterias in Universiti Malaya (UM) were collected between October and December 2024. All food options were grouped into (i) bread, (ii) meat dishes, (iii) drinks, (iv) Western dishes, and (v) rice- or noodle-based fried food group; they were further analysed for calories, fat, saturated fat, dietary fibre, and salt using the Malaysian Food Composition Database (MyFCD) and the Singapore Food Composition Database (SFCD). Nutrient classification (high vs. low) was based on the criteria outlined in the Labelling Guidelines 2023. Additionally, food service vendors were interviewed to explore operational challenges, with data collection ceasing upon reaching thematic saturation. The interviews were then transcribed and analysed using thematic analysis. Results: Quantitative findings showed that there were 36 bread-based meals, 16 meat-based dishes, 18 beverages, 30 Westernstyle meals, and 22 rice- or noodle-based fried foods. The study also revealed an over-reliance on high-calorie, high-fat, and low-fibre foods, with limited availability of sustainable and nutritious options. Qualitative findings highlighted the influence of affordability, vendor practices, and student preferences on campus food choices. Conclusion: The study underscored the need for internal policy intervention, improved vendor education and sustainability practices, and increased accessibility to healthier meals on campus.

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.