Dietary patterns and their association with obesity and cardiometabolic risk factors among adolescents in the southern region of Peninsular Malaysia

While the importance of high intake of energy dense foods for the development of cardiovascular disease (CVD) has been emphasised recently in the Western countries, this was not fully elucidated among Malaysian adolescents. Diet is a modifiable risk factor for CVD in adulthood and is therefore, likely to also be an important early CVD risk factor in adolescence. This cross-sectional study aimed to examine the associations between adolescents’ dietary pattern (DP) and cardiometabolic risk factors (CRF) and obesity. DP offers a new approach in nutritional epidemiology as compared to single nutrient or food groups which is more practical to be translated into recommended advice for use among adolescents. Reduced Rank Regression (RRR) used to derive DP in this study is a hybrid method which combines both exploratory and hypothesis-oriented approach simultaneously. CRF is referred to any risk factor which may increased the odds of developing CVD and diabetes mellitus. CRF assessed in this study are abnormal biochemical levels including fasting blood glucose, serum insulin and lipid profile as well as the presence of dyslipideamia. Obesity which is one of the major CRF is catagorised separately from CRF in this study in order to examine its independent association with identified DP. A total of 933 adolescents aged 13 years old from three southern states in peninsular Malaysia, namely Negeri Sembilan, Melaka and Johor agreed to participate in this study. Anthropometric measurements including weight (kg), height (m) and WC (cm) of adolescents were measured, and BMI z-score was calculated according to the 2006 World Health Organisation (WHO) BMI-for-age growth standards. Biochemical data of 507 adolescents were measured. Self-reported physical activity and socio demographic information were collected from the study adolescents and their parents. Five hundrends and eighty three adolescents provided valid dietary information assessed using a validated food frequency questionnaire (FFQ). The RRR was used to identify a DP that explained the most variation in four chosen response variables, namely dietary energy density, fibre density, percentage of energy from total fat and percentage of energy from sugar. The response variables chosen in this study are hypothesized to be associated with CRF and obesity based on prior scientific evidence from previous studies in Western countries. The identified ‘high sugar, high fibre, high energy density and low fat’ DP, which explained 35% of the variation in all response variables was characterised by high intakes of sugar-sweetened beverages, fruits, sweets and low intakes of meat and meat-based dishes, and cereal and cereal-based dishes. The associations were examined using regression models between DP and cardiometabolic risk factors adjusted for sex, school location, mother’s educational level, dietary misreporting, physical activity and BMI. There was a 0.124 mmol/L (95%CI: 0.002, 0.086) increase in the adolescent’s triglycerides level for every 1 unit SD increase in the identified DP z-score. Adolescents with higher adherence to the identified DP had three times higher odds of having dyslipidaemia (OR=2.68; 95%CI: 1.290, 5.565), elevated total cholesterol (OR=2.68; 95%CI: 1.290, 5.565) and abnormal LDL-C level (OR=3.01; 95%CI: 1.553, 5.189) compared to adolescents with lower adherence to this DP. Female and male adolescents in the third tertile of the DP had significantly three times higher odds of having elevated LDL-C (OR=2.48; 95%CI: 1.16, 5.31) and 28 times higher odds of having elevated serum insulin (OR=27.55; 95%CI: 1.171, 648.263) compared to their counterparts in the first tertile of the DP, respectively. There was no significant association reported between identified DP and obesity among this study adolescents. A DP high in free sugar but not fat was associated with increased risk of having dyslipidaemia, and abnormal levels of triglycerides, total cholesterol and LDL-C among study adolescents. Further longitudinal study are recommended to investigate the association between Malaysian adolescents’ diet and cardiometabolic risk factors, to prevent reverse causality. Identification of early dietary behaviours among adolescents might offer valuable information for prevention strategies of cardiometabolic risk development in later life

The Relationships between a Dietary Pattern Linked to Cardiometabolic Risk Factors and Life Satisfaction in Early Adolescence

Little is known about the contribution of dietary patterns of poor quality on life satisfaction among Malaysian children. We evaluated associations between an empirically derived ”high sugar, high fibre, high dietary energy dense (DED) and low fat” dietary pattern and life satisfaction score in adolescents. A total of 548 adolescents aged 13 years were recruited from randomly selected public schools located in three southern states of Peninsular Malaysia. Dietary intake was assessed using a validated food frequency questionnaire (FFQ) while life satisfaction was measured using a Multidimensional Students’ Life Satisfaction Scale (MSLSS). Z-score for a ”high sugar, high fibre, high DED and low fat” dietary pattern was estimated by applying reduced rank regression analysis. Relationships between the dietary pattern and life satisfaction scores were assessed using regression models. Mean and SD of life satisfaction score was higher in girls (70.5 (12.8)) compared to boys (67.6 (15.4)), p < 0.05. The overall life satisfaction score (β = −0.119; 95% CI: −0.125, −0.004) was inversely associated with dietary pattern z-score as well as scores for self (β = −0.13; 95% CI: −0.170, −0.015) and living environment (β = −0.12; 95% CI: −0.163, −0.007) domains in girls. An opposite trend was observed for school domain in boys whereby an increasing dietary pattern score was positively associated with increasing life satisfaction score (β = 0.216; 95% CI: 0.054, 0.36). The finding of this study highlights the role of free sugar and DED particularly, within the framework of whole diet, and target population at risk to improve life satisfaction among adolescents

Associations of an empirical dietary pattern with cardiometabolic risk factors in Malaysian adolescents

Background: This study aimed to identify a dietary pattern (DP) characterised mainly by high intakes of free sugar and other nutrients hypothesised to be associated with obesity such as dietary energy density (DED), percentage of energy from total fat and fibre density in adolescents from three southern states of Peninsular Malaysia, and its associations with cardiometabolic risk factors. Methods: This is a cross-sectional study among 335 adolescents who provided both dietary information assessed using a validated food frequency questionnaire (FFQ) and biochemical parameters including lipid profile, blood glucose, serum insulin and homeostatic model assessment-insulin resistance (HOMA-IR). Anthropometric measurements included weight (kg), height (cm) and waist circumference (cm), while body mass index (BMI) in kg/m2 was estimated, respectively. Reduced rank regression (RRR) identified a DP with percentage of energy from sugar and total fat, DED and fibre density intake as response variables. Results: The identified ‘high sugar, high fibre, high DED and low fat’ DP was characterised by high intakes of sugar-sweetened beverages, fruits, sweets and low intakes of meat and cereal. Adolescents in the highest tertile of the identified DP had about 3.0 (OR = 2.7; 95%CI: 1.3, 5.6) and 2.0 (OR = 1.9; 95%CI: 1.0, 3.5) times higher odds of having dyslipideamia or elevated total cholesterol and LDL-cholesterol level, respectively compared to adolescents in the lowest tertile DP after adjusting for sex, school location, maternal education, physical activity, dietary misreporting and BMI z-score. This DP was not significantly associated with overweight and obesity. Conclusions: Higher adherence to a DP characterised mainly by free sugars and DED was associated with greater odds of having dyslipideamia, elevated total cholesterol and LDL-cholesterol levels in Malaysian adolescents

Evaluation of dietary quality using Malaysian Healthy Eating Index and its relationships with cardiometabolic risk factors in Malaysian adolescents

Introduction: This cross-sectional study aimed to investigate relationships between diet quality assessed by Malaysian Healthy Eating Index (HEI) and cardiometabolic risk factors in adolescents aged 13 years. Methods: 336 adolescents from various public secondary schools provided information on sociodemography and their anthropometric measurements including height (cm), weight (kg) and waist circumference (cm) were measured. Body mass index (BMI) was estimated thereafter. Dietary intakes assessed using a validated adolescent food frequency questionnaire (FFQ) was used to estimate Malaysian HEI. Biomarker parameters including lipid profile, fasting glucose, insulin and insulin resistance were also assessed. Associations of diet quality indicators to cardiometabolic risk factors were examined using regression models. Results: The overall diet quality of the adolescents was rather poor (49%), with a greater percentage of males were found to have low dietary quality score compared to females (56% vs. 39%; p <0.05). While males were more obese, a higher number of females (46.7%) were found to have at least one risk factors for cardiometabolic health compared to males (37.7%). After adjusting for covariates, no significant associations were observed among adolescents in the lowest quartile compared to those in the highest quartile of HEI score for obesity and abdominal obesity, as well as other cardiometabolic risk factors, in both males and females. Conclusion: Despite of poor dietary quality, no significant associations were observed between dietary quality assessed by Malaysia HEI and cardiometabolic risk factors in adolescents. Prospective studies are needed to establish a causal link between dietary patterns and cardiometabolic risk factors during adolescence