Obesity-related behaviors of Malaysian adolescents: a sample from Kajang district of Selangor state

This study aims to determine the association between obesity-related behaviors (dietary practices, physical activity and body image) and body weight status among adolescents. A total of 382 adolescents (187 males and 195 females) aged 13 to 15 years in Kajang, Selangor participated in this study. Majority of the respondents were Malays (56.0%), followed by Chinese (30.1%) and Indians (13.9%). Dietary practices, physical activity and body image of the adolescents were assessed through the eating behaviors questionnaire, two-day dietary record, two-day physical activity record and multi-dimensional body image scale (MBIS), respectively. Body weight and height were measured by trained researchers. The prevalence of overweight and obesity (19.5%) was about twice the prevalence of underweight (10.5%). About two-thirds of the respondents (72.3%) skipped at least one meal and half of them (56.2%) snacked between meals with a mean energy intake of 1,641 ± 452 kcal/day. More than half of the respondents (56.8%) were practicing sedentary lifestyle with a mean energy expenditure of 1,631 ± 573 kcal per day. Energy intake (r = 0.153, P < 0.05), physical activity (r = 0.463, P < 0.01) and body image (r = 0.424, P < 0.01) were correlated with BMI. However, meal skipping, snacking and energy expenditure per kg body weight were not associated with body weight status. Multiple linear regression analysis showed that body image, physical activity and energy intake contributed significantly in explaining body weight status of the adolescents. In short, overweight and obesity were likely to be associated not only with energy intake and physical activity, but also body image. Hence, promoting healthy eating, active lifestyle and positive body image should be incorporated in future obesity prevention programmes in adolescents

Associations between home environment, dietary practice, and physical activity among primary school children in Selangor, Malaysia

Introduction: The home environment plays an influential role in affecting dietary and physical activity practices of children. This study aimed to determine the association between the home environment, dietary practice and physical activity among primary school children in Selangor. Methods: This cross-sectional study was conducted in five primary schools selected using multistage stratified sampling. A total of 293 children (32.8% males and 67.2% females) (mean age of 11.0±0.9 years) and their parents (10.7% fathers and 89.3% mothers) completed the study. Dietary practice of the children was assessed using a two-day dietary recall. Energy expenditure and physical activity of the children were-assessed using a two-day physical activity recall. Parents of the children completed the Home Environment Survey (HES). Results: The mean energy intake of the children was 1765±416 kcal/day with 75.0% not achieving the Malaysian Recommended Nutrient Intake (RNI) for energy. Almost all children (96.5%) . . were physically inactive, with a mean energy expenditure of 1269±342 kcal/day. High availability of fruit/vegetable at home was associated with high vegetable intake (r=0.128, p<0.05) and low fat intake (r=-0.115, p<0.05). High availability of fats/sweets at home (r=0.125, p<0.05) and parental role modelling of healthy eating (r=0.117, p<0.05) were associated with high fruit intake. High availability of physical activity equipment at home was associated with high energy expenditure (r=0.123, p<0.05). Parental role modelling of physical activity was associated with high energy expenditure (r=0.123, p<0.05) and high physical activity (r=0.123, p<0.05). Conclusion: The results indicate the important roles of parents in promoting healthy eating and active lifestyles among children

Association between disordered eating and body weight status among adolescents in Kuala Lumpur, Malaysia

Overweight and disordered eating are major public health problems among adolescents due to the high prevalence and potential physical and psychological health consequences. This study aimed to determine the association between disordered eating behaviors and body weight status among adolescents in Kuala Lumpur, Malaysia. A cross-sectional multistage study was conducted in four selected schools in Kuala Lumpur. A total of 501 Malaysian adolescents (male: 42.0%; female: 58.0%) aged between 13–17 years completed the Eating Attitude Test-26 (EAT-26) which was used to screen adolescents who are at-risk of eating disorders and Three Factor Eating Questionnaire (TFEQ-R) was used to measure restrained eating, uncontrolled eating, and emotional eating. Body weight and height of the adolescents were measured. The prevalence of overweight and obesity (21.2%) was three times higher than the prevalence of thinness (7.2%) among adolescents. About one in five (24.4%) of the adolescents were at-risk of eating disorders, with the highest prevalence among obese adolescents (39.3%) followed by overweight (29.8%), normal weight (21.8%) and thin (20.0%) adolescents (X2 = 12.4, p < 0.05). Multiple linear regression analysis showed that adolescents with poor cognitive restraint on eating (R2 changed = 0.18, B = −0.154, p < 0.01) and greater tendency of emotional eating (R2 changed = 0.11, B = 0.075, p < 0.01) explained 29.0% of variances in the BMI-for-age model. In conclusion, disordered eating was prevalent in adolescents, particularly among overweight and obese adolescents. Intervening disordered eating problem should be included as one of the crucial components of overweight and obesity prevention program in adolescents

Evaluation of diet quality and its associated factors among adolescents in Kuala Lumpur, Malaysia

BACKGROUND/OBJECTIVES: This study aims to determine contribution of meal frequency, self-efficacy for healthy eating, and availability of healthy foods towards diet quality of adolescents in Kuala Lumpur, Malaysia. SUBJECTS/METHODS: This study was conducted among 373 adolescents aged from 13 to 16 years old. Diet quality of the respondents was assessed using the Healthy Eating Index for Malaysians. Meal frequency, self-efficacy for healthy eating, and availability of healthy foods were assessed through the Eating Behaviours Questionnaire (EBQ), self-efficacy for healthy eating scale, and availability of healthy foods scale, respectively. RESULTS: The majority of the respondents (80.7%) were at risk of poor diet quality. Males (mean = 34.2 ± 8.2%) had poorer diet quality than females (mean = 39.9 ± 9.0%) (t = -5.941, P < 0.05). Malay respondents (mean = 36.9 ± 8.7%) had poorer diet quality than Indian respondents (mean = 41.3 ± 10.0%) (F = 2.762, P < 0.05). Age (r = 0.123, P < 0.05), self-efficacy for healthy eating (r = 0.129, P < 0.05), and availability of healthy foods (r = 0.159, P < 0.05) were positively correlated with the diet quality of the respondents. However, meal frequency was not correlated with the diet quality of the respondents. Multiple linear regression analysis showed that being a male, being a Malay, low self-efficacy for healthy eating, and low availability of healthy foods contributed significantly towards poor diet quality among respondents. CONCLUSIONS: In short, sex, ethnicity, self-efficacy for healthy eating, and availability of healthy foods were associated with diet quality among adolescents. Health practitioners should take into consideration of differences in sex and ethnicity during implementation of nutrition-related intervention programs. Self-efficacy for healthy eating and availability of healthy foods should be included as important components in improving diet quality of adolescents

Personal, behavioral and socio-environmental factors associated with diet quality among in-school adolescents in Kuala Lumpur

This study aimed to determine the contribution of personal, behavioral, and socio-environmental factors towards the diet quality among in-school adolescents in Kuala Lumpur. This study was conducted in three selected secondary schools in Kuala Lumpur. This study is a cross-sectional study design in which multi-stage sampling was used for the selection of respondents. The diet quality of respondents was assessed using the Healthy Eating Index for Malaysians (HEI for Malaysians). The personal factors, particularly body image, self-efficacy for healthy eating, and nutrition knowledge of the respondents were assessed using Multi-dimensional Body Image Scale (MBIS), self-efficacy for healthy eating scale from the Project EAT Survey, and nutrition knowledge questionnaire adapted from the Dietary Questionnaire on Food Habits, Eating Behavior, and Nutritional Knowledge, respectively. The behavioral factors, particularly eating behaviors, dietary intake, and physical activity of the respondents were assessed using the Eating Behaviors Questionnaire (EBQ), 2-day Dietary Recall, and 2-day Physical Activity Recall, respectively. The socio-environmental factors, particularly parental role modelling of healthy eating, availability of healthy foods, and family meal frequency were assessed using the Parental Role Modelling of Healthy Eating Scale, availability of healthy foods scale from the Project EAT Survey, and EBQ, respectively. Pearson Product-Moment Correlation was used to determine the correlations between continuous variables. Independent Samples T-test, Mann-Whitney U Test, and One-Way ANOVA were used to compare the differences between the means and medians of the variables. Multiple linear regression analysis was used to determine the contribution of the independent variables on a dependent variable. A total of 373 respondents (35.1% males, 64.9% females), with a mean age of 14.3±1.2 years old participated in this study. The majority of the respondents were Malays (54.4%), followed by Chinese (34.3%), Indians (8.8%), and other ethnic groups (2.5%). The majority of the respondents (80.7%) had a high risk of poor diet quality, with a mean HEI for Malaysians composite score of 37.9±9.1%. About one in five of the respondents (23.8%) were overweight and obese, with a mean BMI z-score of 0.02±1.44. The mean composite score of MBIS among the respondents was 56.52±9.84%. The mean score of self-efficacy for healthy eating and nutrition knowledge among the respondents were 15.5±3.8 and 6.7±1.7, respectively. The mean frequencies for breakfast, lunch, and dinner consumption were 4.9±2.4 days/week, 5.8±1.9 days/week, and 5.9±2.0 days/week, respectively. The mean frequencies for morning tea, afternoon tea, and supper among the respondents were 4.2±2.6 days/week, 3.9±2.4 days/week, and 2.1±2.2 days/week, respectively. The mean frequency for eating away from home among the respondents was 2.3±1.8 days/week. The mean frequency for fast food consumption at any fast food restaurant among the respondents was 1.3±1.3 days/week, while the median frequency for take away at any fast food place was 0.0 day/week. The mean energy intake, percentages of energy from meals and snacking among the respondents were 1699±549 kcal, 61.5±22.9%, and 38.3±22.7%, respectively. The mean physical activity level value of the respondents was 1.41±0.38, indicating that the respondents were practicing a low active lifestyle. The mean score of parental role modelling of healthy eating among the respondents was 33.49±6.23. The mean score of availability of healthy foods and the mean family meal frequency among the respondents were 9.42±2.95 and 5.6±2.0 days/week, respectively. Males (34.2±8.2%) had a significantly poorer diet quality than the females (39.9±9.0%) (t=-5.941,p<0.05). Malays (36.9±8.7%) had significantly poorer diet quality than Indians (41.3±10.0%) (F=2.762,p<0.05). Diet quality of respondents decreased as age decreased (r=0.123,p<0.05). The self-efficacy for healthy eating (r=0.129,p<0.05) and availability of healthy foods (r=0.159,p<0.05) were positively correlated with the diet quality among the respondents. Being a male (t=-6.296,p<0.05), being a Malay (t=-2.716,p<0.05), and low availability of healthy foods (t=2.007,p<0.05) contributed 14.5% of the variance in poor diet quality among the respondents (F=12.486,p<0.05). Thus, programme planners should consider the differences in sex and ethnicity in implementing intervention to improve the diet quality of adolescents. The components of the availability of healthy foods should be incorporated in the future nutrition and health-related intervention programme to improve the diet quality of adolescents

Adolescent self-report and parent proxy-report of health-related quality of life: an analysis of validity and reliability of PedsQLTM 4.0 among a sample of Malaysian adolescents and their parents

Background The Pediatric Quality of Life Inventory™ Generic Core Scales (PedsQL™) 4.0 is a generalized assessment of health-related quality of life (HRQoL) based on adolescent self-report and parent proxy-report. This study aims to determine the construct validity and reliability of PedsQL™ 4.0 among a sample of Malaysian adolescents and parents. Methods A cross-sectional study was carried out at three selected public schools in the state of Selangor. A total of 379 Malaysian adolescents completed the PedsQL™ 4.0 adolescent self-report and 218 (55.9%) parents completed the PedsQL™ 4.0 parent proxy-report. Weight and height of adolescents were measured and BMI-for-age by sex was used to determine their body weight status. Results There were 50.8% male and 49.2% female adolescents who participated in this study (14.25 ± 1.23 years). The prevalence of overweight and obesity (25.8%) was four times higher than the prevalence of severe thinness and thinness (6.1%). Construct validity was analyzed using Confirmatory Factor Analysis (CFA). Based on CFA, adolescent self-report and parent proxy-report met the criteria of convergent validity (factor loading > 0.5, Average Variance Extracted (AVE) > 0.5, Construct Reliability > 0.7) and showed good fit to the data. The adolescent self-report and parent proxy-report exhibited discriminant validity as the AVE values were larger than the R2 values. Cronbach’s alpha coefficients of the adolescent self-report (α = 0.862) and parent proxy-report (α = 0.922) showed these instruments are reliable. Parents perceived the HRQoL of adolescents was poorer compared to the perception of the adolescent themselves (t = 5.92, p 0.05). Parent proxy-report was negatively associated with the adolescents’ BMI-for-age (r = -0.152, p 0.05). Conclusion Adolescent self-report and parent proxy-report of the PedsQL™ 4.0 are valid and reliable to assess HRQoL of Malaysian adolescents. Future studies are recommended to use both adolescent self-report and parent-proxy report of HRQoL as adolescents and parents can provide different perspectives on HRQoL of adolescents