Introduction: Dietitians play an essential role in the management of childhood obesity and consistency in dietetic practices is required to ensure the effectiveness of treatment. This study assessed dietitians’ current practices in the management of childhood obesity, compared the practices with nutrition practice guidelines used by dietitians in other countries and identified practice components for the development of nutrition practice guidelines for the management of childhood obesity in Malaysia. Methods: A cross-sectional study was conducted among 40 dietitians in 16 Ministry of Health hospitals and three teaching hospitals. Information on current dietetic practices in the management of childhood obesity was obtained through a mailed survey questionnaire. The practices included nutritional assessment, determination of energy requirement, dietary prescription and physical activity modification. Emails were sent to 31 dietetic associations in other countries to obtain information on practice guidelines used by dietitians. Results: Frequently used dietary intervention and physical activity modification approaches were high fibre diet (65%), low fat diet (40%), reduction of sedentary pursuits and screen times (67.5%) and an increase in duration of current physical activities (60%). In comparison to other dietetic practice guidelines, the current dietetic practices in Malaysia do not usually include waist circumference, biochemical and blood pressure data. However, similar to other guidelines, the current dietetic practices included low dietary fat, high fibre diet, decreased sedentary activity and increased physical activity level. Conclusions: The dietetic practices in the management of childhood obesity in Malaysia are diverse. A comprehensive nutrition practice guideline for management of childhood obesity is urgently needed for standardisation of dietetic practices in Malaysia.
Dietetics ; Child ; Obesity ; Prevalence

Introduction: The use of email and website as channels for workplace health information delivery is not fully explored. This study aims to describe the rationale, design, and baseline findings of an email-linked website intervention to improve modifiable cancer risk factors. Methods: Employees of a Malaysian public university were recruited by systematic random sampling and randomised into an intervention (n=174) or control group (n=165). A website was developed for the intervention and educational modules were uploaded onto the website. The intervention group received ten consecutive weekly emails with hypertext links to the website for downloading the modules and two individual phone calls as motivational support whilst the control group received none. Diet, lifestyle, anthropometric measurements, psychosocial factors and stages of change related to dietary fat, fruit and vegetable intake, and physical activity were assessed. Results: Participants were predominantly female and in non-academic positions. Obesity was prevalent in 15% and 37% were at risk of co-morbidities. Mean intake of fats was 31%, fruit was ~1 serving/day and vegetable was <1 serving/day. Less than 20% smoked and drank alcohol and about 40% were physically inactive. The majority of the participants fell into the Preparation stage for decreasing fat intake, eating more fruit and vegetables, and increasing physical activity. Self-efficacy and perceived benefits were lowest among participants in the Precontemplation/Contemplation stage compared to the Preparation and Action/Maintenance stages. Conclusion: Baseline data show that dietary and lifestyle practices among the employees did not meet the international guidelines for cancer prevention. Hence the findings warrant the intervention planned.

Introduction: It is known that dietary diversity improves diet quality and nutritional status of young children. This study aimed to determine the relationship between dietary diversity and nutritional status of Orang Asli children in Krau Wildlife Reserve. Methods: A total of 216 children from three Orang Asli sub-tribes (Jah Hut, Temuan and Che Wong) aged 1 to 6 years from 162 households in 16 villages participated in this cross-sectional study. Children and mothers were measured for body weight and height. Mothers were interviewed for household socio-demographic information and diet diversity of children in the last 7 days. Diet diversity score (DDS) was calculated based on 15 food groups. Results: There was a high prevalence of underweight (50.9%) and stunting (61.6%) in Orang Asli children. For mothers, 11.1%, 27.8% and 7.4% were underweight, overweight and obese, respectively. Mean DDS of children was 6.38 [95% CI-6.10, 6.65] of the possible 15. Higher DDS of children was significantly related to older age (p<0.05), the non Jahut sub-tribe (p<0.01) and longer maternal years of schooling (p<0.05). DDS was also positively related to weight-for-age z-scores (p<0.001) and height-for-age z-scores (p<0.05). Conclusion: Undernutrition remains a major nutrition problem among Orang Asli children living within the forest reserve. Efforts to promote dietary diversity should emphasise traditional and nutritious foods that could improve health and nutritional status of the Orang Asli children.

Introduction: Meal patterns have received little attention in nutrition studies. The aim of this study is to present the findings on general meal patterns of Malaysian adults. Methods: The Malaysian Adults Nutrition Survey (MANS), carried out in 2002 and 2003, involved 6,928 adults selected by stratified random sampling from all households by zone in Peninsular Malaysia, Sabah and Sarawak. Results: In general, the results showed that most respondents (74.16%) ate three meals per day; 89.20% of the respondents consumed breakfast, while 88.57% consumed lunch and 91.97% consumed dinner with no significant difference in terms of sex. In Peninsular Malaysia, the Northern Zone had the highest number of people consuming breakfast compared to other zones. Meanwhile, the population in Sarawak had the largest proportion of people consuming lunch and dinner, but the smallest proportion of people consuming breakfast. A significantly higher number of the rural population consumed breakfast and lunch than urbanites; however there was no significant difference in dinner consumption. Generally, breakfast consumption increased with age whereby significant difference existed between the 18 to 19 years age group and the age group of 30 years and older. Lunch intake among the age groups showed no significant difference. In contrast, dinner consumption was significantly lower among the 18 to 19 years age group compared to all other age groups. Comparison among the ethnic groups showed that the Indian population had the lowest percentage of having breakfast and lunch while the Orang Asli had the lowest percentage of consuming dinner. However, the Orang Asli recorded the highest percentage for taking breakfast and lunch while the Chinese had the highest percentage of taking dinner. Conclusion: Considering that Malaysian adults consumed their conventional breakfast, lunch and dinner, these findings indicatethat Malaysians are maintaining their traditional meal patterns.

Introduction: This study aimed to evaluate the validity and reliability of the Multidimensional Body Image Scale (MBIS), a seven-factor, 62-item scale developed for Malaysian female adolescents. This scale was evaluated among male and female Malaysian university students. Methods: A total of 671 university students (52.2% women and 47.8% men) completed a self-administered questionnaire on MBIS, Eating Attitude Test-26, and Rosenberg Self-Esteem Scale. Their height and weight were measured. Results: Results in confirmatory factor analysis showed that the 62-item MBIS reported poor fit to the data, ²/df = 4.126, p < 0.001, CFI = 0.808, SRMR = 0.070, RMSEA = 0.068 (90% CI = 0.067, 0.070). After re-specification of the model, the model fit was improved with 46 items remaining, ²/df = 3.346, p < 0.001, CFI = 0.903, SRMR = 0.053, RMSEA = 0.059 (90% CI = 0.057, 0.061), and the model showed good fit to the data for men and women separately. This 46-item MBIS had good internal consistency in both men (Cronbach’s alpha = 0.88) and women (Cronbach’s alpha = 0.92). In terms of construct validity, it showed positive correlations with disordered eating and body weight status, but negative correlation with self-esteem. Also, this scale discriminated well between participants with and without disordered eating. Conclusion: The MBIS-46 demonstrated good reliability and validity for the evaluation of body image among university students. Further studies need to be conducted to confirm the validation results of the 46-item MBIS.

Introduction: University students are potentially important targets for the promotion of healthy lifestyles as this may reduce the risks of lifestyle-related disorders later in life. This cross-sectional study examined differences in eating behaviours, dietary intake, weight status, and body composition between male and female university students. Methodology: A total of 584 students (59.4% females and 40.6% males) aged 20.6±1.4 years from four Malaysian universities in the Klang Valley participated in this study. Participants completed the Eating Behaviours Questionnaire and two-day 24-hour dietary recall. Body weight, height, waist circumference and percentage of body fat were measured. Results: About 14.3% of males and 22.4% of females were underweight, while 14.0% of males and 12.3% of females were overweight and obese. A majority of the participants (73.8% males and 74.6% females) skipped at least one meal daily in the past seven days. Breakfast was the most frequently skipped meal. Both males and females frequently snacked during morning tea time. Fruits and biscuits were the most frequently consumed snack items. More than half of the participants did not meet the Malaysian Recommended Nutrient Intake (RNI) for energy, vitamin C, thiamine, riboflavin, niacin, iron (females only), and calcium. Significantly more males than females achieved the RNI levels for energy, protein and iron intakes. Conclusion: This study highlights the presence of unhealthy eating behaviours, inadequate nutrient intake, and a high prevalence of underweight among university students. Energy and nutrient intakes differed between the sexes. Therefore, promoting healthy eating among young adults is crucial to achieve a healthy nutritional status.

The Rohingya is a group of refugees from Myanmar who have been residing in Malaysia since the 1980s. At present, there is no published information on health and nutritional status of refugee children in Malaysia. This study was conducted to assess nutritional status of the Rohingya children aged 6 months to 12 years old (N=87) and to determine the associations between nutritional status with socio-demographic, dietary diversity and health (birth weight, immunization and childhood illness) variables. Children were measured for weight and height while their guardians were interviewed for socio-demographic, dietary diversity and health information. About 27.5% of the Rohingya children were underweight, 11.5% stunted, 16.1% thin and 12.6% at risk of overweight and overweight. The percentage of children with low birth weight (< 2.5 kg) and no immunization was 17.8% and 11.5%, respectively. Fever (67.8%) and flu (62.1%) were the most common childhood illnesses reported in previous month with 44-75% of the children with these illnesses did not receive any medical treatment. The mean dietary diversity score was 8.9+3.2 out of a possible 14, with a higher score indicating a more diverse diet. There were significant correlations between frequency of immunization received by the children with weight-for-age-z score (rs=0.27, p<0.05), height-for-age-z score (rs=0.25, p<0.05) and BMI-for-age-Z score (rs=0.24, p<0.05). Height-for-age-z score was also positively correlated with childhood illness score (rp=0.24, p<0.05) and dietary diversity score (rp=0.23, p<0.05) in that children with less common childhood illnesses and variety of foods in the diets had better linear growth. As refugees have limited access to health care services, they are at greater risk of health and nutritional problems.

Introduction: Findings from the National Health and Morbidity Survey III (MOH, 2008) indicate a 43.7% prevalence of physical inactivity among Malaysian adults. This sedentary lifestyle can also be observed among children and adolescents. Methodology: A cross-sectional study was conducted to determine factors associated with physical activity levels of four hundred, 13 year-old adolescents in Kuantan, Pahang. Data on socio-demographic, health-related, and psychosocial factors were collected using a self-administered questionnaire while physical activity level was assessed using the Physical Activity Questionnaire for Older Children (PAQ-C). Results: About one-third of the respondents were in the low physical activity level category, 61.5% were in the moderate category and only 3.0% of the adolescents were in the high physical activity level category. Males were more physically active than females (χ2=23.667, p=0.0001) with female adolescents (45.1%) twice as likely as male adolescents (22.1%) to be in the low physical activity level category. The associations between physical activity level with socio-demographic and health-related factors, perception of weight status and body parts satisfaction were not significant. However, physical activity was found to be positively correlated with physical activity self-efficacy (r=0.496, p=0.0001), peer influence (r=0.468, p=0.0001), family influence (r=0.298, p=0.0001) and beliefs in physical activity outcomes (r=0.207, p=0.0001). Negative relationships were found between physical activity with depression (r=-0.116, p=0.021) and body size discrepancy (r=-0.143, p<0.01). Respondents who had a better perception of their current health status were more physically active (χ2=21.062, p=0.0001). Multivariate analyses for the prediction of physical activity showed that physical activity self-efficacy, sex and peer influence were the most significant contributors in explaining physical activity among adolescents. Conclusion: Physical activity interventions should include psychosocial components as mediator variables in interventions designed to promote regular physical activity in adolescence.

This paper aims to report the physical activity pattern and energy expenditure of adults aged 18 – 59 years in the Malaysian Adults Nutrition Survey (MANS) carried out between October 2002 and December 2003. The survey included 7349 adults representative of Peninsular Malaysia (Northern, Southern, Central and East Coast), as well as Sabah and Sarawak. A total of 6926 adults, comprising 3343 men and 3583 women, completed the physical activity section of the survey. Physical activity data was obtained using a physical activity questionnaire and 24-hour physical activity recall. Basal metabolic rate (BMR) was calculated from Ismail et al. (1998) predictive equations; total energy expenditure (TEE) was then estimated through factorial calculations based on time allocated and energy cost of various activities. Physical activity level (PAL) was calculated as the ratio of TEE to BMR. It was found that almost three-quarters of Malaysian adults travelled by passive modes of transportation. Only a third reported having ever-exercised, and an even smaller proportion of the population (14%) had adequate exercise. The population also spent the majority of their time (74% of the day) in sedentary activities, such as sleeping or lying down; doing light intensity activities (15% of the day), and doing moderate to vigorous intensity activities (10% of the day). Mean BMR and TEE was significantly higher amongst men than women, while mean PAL values were similar for men [1.6 (1.6 – 1.7)] and women [1.6 (1.6 – 1.6)]. More men (16%) were categorised as having active PAL compared to women (10%), while more women (43%) were categorised as having sedentary PAL compared to their male counterparts (37%). The present study provides the first in-depth report of the physical activity pattern, and national estimates of energy expenditure and physical activity levels of Malaysian adults, and concluded that Malaysian adults are generally sedentary. It is thus important that physical activity be further promoted and integrated into the lives of the population, preferably through various health promotion efforts as well as through the commitment of the authorities in providing a suitable environment for an active lifestyle.

The Malaysian Adults Nutrition Survey (MANS) was carried out between October 2002 and July 2003, involving 6,775 men and 3,441 women aged 18 – 59 years. Anthropometric assessment showed that the overall mean body weight and BMI were 62.65 kg (CI: 62.20, 63.09) and 24.37 kg/m2 (CI: 24.21, 24.53) respectively. Based on the WHO (1998) classification of BMI, 12.15% (CI: 11.26, 13.10) were obese (BMI > 30 kg/m2), and 26.71% (CI: 25.50, 27.96) overweight (BMI > 25 - 29.9 kg/m2). Significantly, more women were obese [14.66% (CI: 13.37, 16.04)] while significantly more men were overweight [28.55% (CI: 26.77, 30.40)]. Ethnicitywise, prevalence of obesity was highest among the Malays [15.28% (CI: 13.91, 16.77)] while overweight was highest for the Indians [31.01% (CI: 26.64, 35.76)]. Both obesity and overweight were highest among those aged 40 - 49 years. Obesity was highest for those whose household income was between RM1,500 - 3,500 while overweight was more prevalent for those whose household income exceeded RM3,500. The prevalence of overweight was highest for those with primary education [31.90% (CI: 29.21, 34.72)]. There was no significant urbanrural differential in both obesity and overweight. The study found 9.02% (CI: 8.82, 10.61) with chronic energy deficiency (CED) (BMI < 18.5 kg/m2). The prevalence of CED was relatively higher in the indigenous population (Orang Asli) [14.53% (CI: 5.14, 34.77)], subjects aged 18-19 years [26.24% (CI: 21.12, 32.09)], and with monthly household income of < RM1,500 [10.85% (CI: 9.63, 12.20)]. The prevalence of CED was not significantly different among the geographical zones and educational levels, and between urban/rural areas and sexes. The results call for priority action to address the serious problem of overweight and obesity among Malaysian adults as it poses a grave burden to the country’s resources and development.