Development and evaluation of a questionnaire for feeding problems and gastrointestinal symptoms in children with Autism Spectrum Disorders and the impact of these problems on family life

PhD ThesisManaging feeding problems and gastrointestinal (GI) symptoms in children with Autism Spectrum Disorders (ASD) is a challenging process for professionals and parents especially if they become persistent and longstanding. These problems may have psychosocial and financial impacts on family life. To date, there is no structured questionnaire available to assist community professionals to identify these problems in a systematic manner. The primary aim of this research was to develop an interviewer-based questionnaire for community professionals (the ‘Brief structured questionnaire for the Early identification of Feeding problems and GI symptoms in primary school children with ASD (BEFGASD)). The secondary aim was to evaluate the psychometric properties of the BEFGASD. The development process of the BEFG-ASD included a comprehensive literature review, items and scales construction, specialist review, a modified Delphi technique and a pre-testing with professionals and parents. 42 items within 15 sub-domains of feeding problems, GI symptoms and the impact were selected. The panel experts in the Delphi technique (n=20) rated the items as either ‘important’ or ‘very important’ (Mean score: 1.0-2.0). The final draft of the BEFG-ASD was field-tested with 48 professionals and 74 parents of primary schoolchildren with ASD (aged 4-11) in North East England. Responses from the field-testing were used to evaluate the psychometric properties of the BEFGASD. Face validity and content validity was established. Internal consistency of the 42 items was good (Cronbach’s alpha: 0.85) but varied across domains. Test-retest reliability and inter-rater reliability of domains and items was satisfactory. Criterion validity and construct validity of the BEFG-ASD also varied across domains and sub domains. The BEFG-ASD is the first questionnaire developed for use by community professionals. Further research and clinical practice will increase our understanding of its properties and utility in different population and settings.Ministry of Health Malaysia and The Mental Health Foundation North East Branc

Sociodemographic factors associated with consumption of confectionery among obese and non-obese adults: a secondary analysis

The objective of the present study is to examine sociodemographic factors associated with consumption of confectionery among obese and non-obese adults in Malaysia. Secondary analysis of the Malaysian Adult Nutrition Survey (MANS) 2014 was performed. The survey was conducted in urban and rural areas in the 14 states of Malaysia, including the Federal Territory of Kuala Lumpur. Adults aged 18 years and above (n = 2696) were interviewed. The dependent variable was the total servings of confectionery consumed per week. An ordered logistic regression model was used to examine the associated sociodemographic factors in the decision of people to consume 0, 1−2, 3−5 and ≥6 servings of confectionery. Marginal effects of sociodemographic variables on confectionery consumption were calculated. Analyses stratified by bodyweight group were conducted. The results showed that income, education, gender, ethnicity, and employment status were significantly associated with consumption of confectionery. In particular, income, education, gender, ethnicity and employment status affected confectionery consumption, but not the other way around. However, no relationship was evidenced between age, marital status, household location and confectionery consumption. In conclusion, sociodemographic factors were related to consumption of confectionery. Policies aimed at discouraging consumption of confectionery should focus primarily on high income earners, well-educated individuals and Bumiputr

The relationship between health risk and consumption of confectioneries: an instrumental variable approach

Introduction: Consumption of confectioneries is a determinant of health risk. However, how health risk determines the intake of confectioneries remains unclear. The objective is to examine how waist circumference (WC) as a measurement of health risk influences the consumption of confectioneries among adults. The research question is that do high-risk people consume more confectioneries than low-risk people? Methods: A quantitative research design with a focus on establishing a correlation between the measurement of health risk and consumption of confectioneries was adopted. Secondary analysis of a nationally representative cross-sectional data was used. The population of interest was the Malaysian population, regardless of being obese or non-obese. Analyses stratified by body mass index (BMI) or WC were not conducted. An instrumental variable (IV) approach was used to estimate the regression of consumption of confectioneries. BMI was used as an IV for WC. In the first stage, we regressed WC on all exogenous variables, including BMI. Then, we replaced the original values of WC with the fitted values of WC. Results: BMI was an appropriate IV for WC. An additional cm of WC was associated with a 0.022 unit of reduction in the serving of confectioneries per week. The negative relationship between WC and consumption of confectioneries indicated that adults who had high health risk consumed lesser confectioneries than adults who had low health risk. Conclusion: Drawing from the IV regression results, the present study highlighted that people with high health risk, rather than people with low health risk, were less likely to consume confectioneries

Sociodemographic factors associated with waist circumference among male and female adults: findings of the Malaysian adult nutrition survey 2014

Introduction: This study examined how waist circumference (WC) varied across sociodemographic characteristics of Malaysian adults using a nationally representative data. Methods: Data from the Malaysian Adult Nutrition Survey 2014 (n = 2696) was used. In the sample, 46.55% were males and 53.45% were females. The outcome variable was WC. Waist circumference was categorised into four ordinal outcomes: Very low, low, high and very high. The explanatory variables were age, monthly individual income, education, gender, marital status, ethnicity, employment status and household location. Ordered probit models were utilised. Results: The majority of males had a low WC (54.66%), and only a small proportion had a very high WC (0.96%). Similarly, a high proportion of females had a low WC (55.59%), and only 1.94% had a very high WC. Younger males were more likely to have a high WC than their older counterparts. Males who had monthly income of RM2000-2999 or RM3000-3999 were more likely to have a high WC compared with those who had monthly income of ≤RM999. Chinese and Indian males were more likely to have a high WC than Bumiputera males. For females, those who were married, widowed/divorced and Bumiputera were likely to have a high WC. Conclusion: WC was associated with various sociodemographic profiles of males and females. In particular, there were positive associations between the likelihoods of having a high WC and younger age group, higher income, Chinese, Indian, and being married. Our findings provided policy makers with better information on formulating intervention measure

Prediction of body fat loss in relation to change in nutrient intake among housewives participating in the MyBFF@ home study

Background: Diet compositions are likely to be one of the influential factors for body fat deposition. The aim of this paper was to determine the nutrient changes and its association to body fat loss among the overweight and obese housewives in the MyBFF@home study. Methods: Data of participants in the MyBFF@home study (intervention and control groups) were analysed. Participants in the intervention group received personalised dietary counselling consisted of reduced calorie diet 1200–1500 kcal/day, while the control group was assigned to receive women’s health seminars. The dietary assessment was done during the intervention phase at baseline, 1 month (m), 2 m, 3 m and 6 m using a 3-day food diary. Body fat was measured using a bioelectrical impedance analyser (In-body 720) at baseline and at the end of the intervention phase. The mean differences of nutrient intake and body compositions during the intervention phase were measured with paired t-test. The changes in body fat and nutrients intake were calculated by subtracting baseline measurements from those taken at 6 months. Multiple linear regression analysis was conducted to determine the extent to which the changes in each gram of nutrients per 1000 kcal were predictive of changes in body fat mass. Results: There were significant reductions in energy, all macronutrients, dietary fibre, calcium and iron intake in both study groups after the intervention phase (p <  0.05). In the intervention group, body fat loss increased with the reduction of each gram of carbohydrate, protein and fat per 1000 kcal, (p <  0.05), and decreased with the reduction of each gram of calcium and fibre intake per 1000 kcal (p <  0.05). In the control group, body fat loss increased with the reduction of each gram fat per 1000 kcal (p <  0.05) and decreased with the reduction of each gram iron per 1000 kcal. Conclusion: Changes in the intake of various nutrients have different effects on body fat loss between the intervention and control group

The Third National Health and Morbidity Survey: Prevalence of obesity, and abdominal obesity among the Malaysian elderly population

Obesity is an emerging public health threat in the elderly population in developing countries. Hence, the Third National Health and Morbidity Survey has assessed 4746 individuals aged 60 years and older recruited through a household survey to determine the prevalence of adiposity using body mass index and waist circumference. The national's prevalence of overweight and obesity in men was 29.2% (95% confidence interval [CI] = 27.2-31.3) and 7.4% (95% CI = 6.4-8.6), respectively. However, the prevalence decreased with age. The figures in women were 30.3% (95% CI = 28.5-32.1) and 13.8% (95% CI = 12.5-15.2), respectively. The prevalence of abdominal obesity was 21.4% (95%CI = 20.2-22.6), with 7.7% (95% CI = 6.7-9.0) in men and 33.4% (95% CI = 31.4-35.3) in women. Predictors of adiposity include the following: Malay and Indian ethnicity, higher education level, higher household income, from urban area, and being married. In conclusion, adiposity affects about one third of the Malaysian elderly population, especially those of the younger age group, women, and those with higher socioeconomic status

Sensitivity and specificity of waist circumference as a single screening tool for identification of overweight and obesity among Malaysian adults

Generalised obesity and central obesity are risk factors for Type II diabetes mellitus and cardiovascular diseases. Waist circumference (WC) has been suggested as a single screening tool for identification of overweight or obese subjects in lieu of the body mass index (BMI) for weight management in public health program. Currently, the recommended waist circumference cut-off points of ≥ 94cm for men and ≥80cm for women (waist action level 1) and ≥ 102cm for men and ≥ 88cm for women (waist action level 2) used for identification of overweight and obesity are based on studies in Caucasian populations. The objective of this study was to assess the sensitivity and specificity of the recommended waist action levels, and to determine optimal WC cut-off points for identification of overweight or obesity with central fat distribution based on BMI for Malaysian adults. Data from 32,773 subjects (14,982 men and 17,791 women) aged 18 and above who participated in the Third National Health Morbidity Survey in 2006 were analysed. Sensitivity and specificity of WC at waist action level 1 were 48.3% and 97.5% for men; and 84.2% and 80.6% for women when compared to the cut-off points based on BMI ≥25kg/m 2. At waist action level 2, sensitivity and specificity were 52.4% and 98.0% for men, and 79.2% and 85.4% for women when compared with the cut-off points based on BMI (≥30 kg/m 2). Receiver operating characteristic analyses showed that the appropriate screening cut-off points for WC to identify subjects with overweight (≥25kg/m 2) was 86.0cm (sensitivity=83.6%, specificity=82.5%) for men, and 79.1cm (sensitivity=85.0%, specificity=79.5%) for women. Waist circumference cut-off points to identify obese subjects (BMI≥30 kg/m 2) was 93.2cm (sensitivity=86.5%, specificity=85.7%) for men and 85.2cm (sensitivity=77.9%, specificity=78.0%) for women. Our findings demonstrated that the current recommended waist circumference cut-off points have low sensitivity for identification of overweight and obesity in men. We suggest that these newly identified cut-off points be considered

Nutritional status of children below five years in Malaysia: anthropometric analyses from the third National Health and Morbidity survey III (NHMS, 2006)

The Third National Health and Morbidity Survey (NHMS III) was conducted in 2006 on a nationally representative sample of population in Malaysia. Over 21,000 children aged 0-17.9 years were measured for body weight and stature according to the protocol of the World Health Organization. This article describes the nutritional status of children aged 0-59.9 months. Mean z score for weight-for-age (WAZ), height-for-age (HAZ) and BMI-for-age were compared with the z-scores tables of the WHO standards. The overall prevalence of underweight and stunting of the children were 12.9% and 17.2% respectively. These levels included 2.4% severe underweight and 6.0% severe stunting. In terms of z scores, the age group of 0-5.9 months showed the best nutritional status with mean WAZ of-0.33 (95%CI:-0.52, 0.15) and-0.40 (-0.57, 0.24) for boys and girls respectively, while mean HAZ was 0.64 (0.38, 0.89) for boys and 0.76 (0.54, 0.98) for girls. Mean HAZ and WAZ status was least satisfactory after about 6 months, suggesting a faltering in growth rate at an age that coincides with dependence on complementary feeding. Prevalence of overweight based on BMI-for-age for the sexes combined was 6.4%, while that based on WAZ was 3.4%. The NHMS III results indicate that Malaysian children have better nutritional status compared to children under 5 years in neighbouring countries. In order to meet the targets set in the National Plan of Nutrition (2006-2015), more effective intervention programmes are needed to accelerate the reduction of underweight and stunting, and to arrest the rise of overweight in young children

Sociodemographic factors associated with consumption of confectionery among obese and non-obese adults: A secondary analysis

The objective of the present study is to examine sociodemographic factors associated with consumption of confectionery among obese and non-obese adults in Malaysia. Secondary analysis of the Malaysian Adult Nutrition Survey (MANS) 2014 was performed. The survey was conducted in urban and rural areas in the 14 states of Malaysia, including the Federal Territory of Kuala Lumpur. Adults aged 18 years and above (n = 2696) were interviewed. The dependent variable was the total servings of confectionery consumed per week. An ordered logistic regression model was used to examine the associated sociodemographic factors in the decision of people to consume 0, 1−2, 3−5 and 6 servings of confectionery. Marginal effects of sociodemographic variables on confectionery consumption were calculated. Analyses stratified by bodyweight group were conducted. The results showed that income, education, gender, ethnicity, and employment status were significantly associated with consumption of confectionery. In particular, income, education, gender, ethnicity and employment status affected confectionery consumption, but not the other way around. However, no relationship was evidenced between age, marital status, household location and confectionery consumption. In conclusion, sociodemographic factors were related to consumption of confectionery. Policies aimed at discouraging consumption of confectionery should focus primarily on high income earners, well-educated individuals and Bumiputera

Improvement of health literacy and intervention measurements among low socio-economic status women: findings from the MyBFF@home study

Abstract Background Health literacy (HL) consists of different components and associates with several health outcomes, including obesity. It is linked to an individual’s knowledge, motivation, competencies, behavior, and application to everyday life. The present study aimed to determine the change of HL scores and to investigate the difference of intervention outcomes at the weight loss (WL) intervention and WL maintenance phase between the HL groups. Methods A total of 322 participants from the MyBFF@home study completed the Newest Vital Sign (NVS) test at baseline. However, only data from 209 participants who completed the NVS test from baseline to WL intervention were used to determine the HL groups. Change of the NVS scores from baseline to WL intervention phase was categorized into two groups: those with HL improvement (increased 0.1 score and above) and those without HL improvement (no change or decreased 0.1 score and more). Independent variables in this study were change of energy intake, nutrient intake, physical activity, anthropometry measurements, and body composition measurements between baseline and WL intervention as well as between WL intervention and WL maintenance. An Independent sample t-test was used in the statistical analysis. Results In general, both intervention and control participants have low HL. The study revealed that the intervention group increased the NVS mean score from baseline (1.19 scores) to the end of the WL maintenance phase (1.51 scores) compared to the control group. There was no significant difference in sociodemographic characteristics between the group with HL improvement and the group without HL improvement at baseline. Most of the dietary intake measurements at WL intervention were significantly different between the two HL groups among intervention participants. Physical activity and body composition did not differ significantly between the two HL groups among both intervention and control groups. Conclusion There was an improvement of HL during the WL intervention and WL maintenance phase in intervention participants compared to control participants. HL shows positive impacts on dietary intake behavior among intervention participants. New research is suggested to explore the relationship between HL and weight loss behaviors in future obesity intervention studies