Influence of physical activity, sedentary lifestyle and bone biomarkers on bone health among adolescents in Kota Bharu, Kelantan

Pencapaian jisim tulang puncak pada masa pertumbuhan adalah sangat penting untuk mengurangkan risiko keretakan osteoporosis pada kemudian hari. Pemahaman dan pengenalan faktor-faktor gaya hidup seperti aktiviti fizikal dan gaya hidup yang berkaitan dengan pertumbuhan dan pemeliharaan jisim tulang yang tinggi dalam kalangan kanak-kanak dan remaja adalah amat penting bagi memaksimakan jisim tulang puncak sewaktu tempoh pertumbuhan yang kritikal. Oleh itu, objektif utama kajian ini adalah untuk mengkaji pengaruh aktiviti fizikal, gaya hidup sedentari dan petunjuk biokimia darah tulang terhadap status kesihatan tulang yang ditentukan dengan pengukuran tenaga dwi sinar-X absorptiometri (DXA) dalam kalangan 455 orang remaja lelaki dan perempuan berbangsa Melayu dan Cina yang berumur lingkungan di antara 12 hingga 19 tahun di Kota Bharu, Kelantan. Maximum attainment of peak bone mass (PBM) during the growing years is ultimately important to reduce the risk of osteoporotic fracture later in life. Understanding and identification of lifestyle factors such as physical activity (PA) and other lifestyle practices that are associated with higher bone mass accruals in children and adolescents is important in order to optimize the PBM during these critical years of growth. Therefore, the main objective of the study was to determine the influence of PA, sedentary behavioural practice and blood biomarkers of bone remodeling on bone health status, as assessed by a dual energy X-ray absorptiometry (DXA) in 455 adolescent boys and girls of Malay and Chinese-origins aged 12 to 19 years of age in Kota Bharu, Kelantan

Ethnic Differences in the Food Intake Patterns and Its Associated Factors of Adolescents in Kelantan, Malaysia

Objective: The aim of the study was to identify the ethnic differences in dietary patterns and its association with socio-economic, dietary and lifestyle practices among adolescents in Kelantan, Malaysia. Methods: A population-based study of 454 adolescents aged 12 to 19 years was included. A validated food frequency questionnaire was used to assess dietary patterns and three dietary patterns were identified based on the principal component analysis method. Results: Malay adolescents had significantly higher scores for the Western-based food pattern and local-based food pattern, whereas Chinese adolescents showed higher scores for the healthy-based food pattern. Multivariate analyses show that age and physical activity (PA) levels were positively associated with healthy-based food pattern in Malay (All, p < 0.001), whereas higher consumption of eating-out from home (EatOut) (p = 0.014) and fast food (p = 0.041) were negatively associated. High weekly breakfast skipping (p < 0.001) and EatOut (p = 0.003) were positively associated with aWestern-based pattern, whereas age (p < 0.001) and household income (p = 0.005) were negatively associated. Higher frequency of daily snacking (p = 0.013) was positively associated with local-based food pattern. For Chinese adolescents, age (p < 0.001), PA levels (p < 0.001) and maternal education level (p = 0.035) showed positive associations with the healthy-based pattern, whereas high EatOut (p = 0.001) and fast food intakes (p = 0.001) were negatively associated. Higher weekly consumption of EatOut (p = 0.007), fast food (p = 0.023) and carbonated beverages (p = 0.023), and daily snacking practice (p = 0.004) were positively associated with higher Western-based food pattern, whereas age (p = 0.004) was inversely associated. Conclusion: This study showed that there were significant differences in dietary patterns and its association factors between Malay and Chinese adolescents. More importantly, these findings suggest that unhealthy dietary and lifestyle practices could increase the risk of adherence to unhealthy Western-based food pattern that is high in fat, sugar and salt contents, and, consequently, increase the risk of developing obesity and metabolic-related disorders during these critical years of growth

Infrequent Breakfast Consumption Is Associated with Higher Body Adiposity and Abdominal Obesity in Malaysian School-Aged Adolescents

Unhealthy dietary pattern increases the risk of obesity and metabolic disorders in growing children and adolescents. However, the way the habitual pattern of breakfast consumption influences body composition and risk of obesity in adolescents is not well defined. Thus, the aim of the present study was to assess any associations between breakfast consumption practices and body composition profiles in 236 apparently healthy adolescents aged 12 to 19 years. A selfadministered questionnaire on dietary behaviour and lifestyle practices and a dietary food frequency questionnaire were used. Body composition and adiposity indices were determined using standard anthropometric measurement protocols and dual energy x-ray absorptiometry (DXA). Mean age of the participants was 15.361.9 years. The majority of participants (71.2%) fell in the normal body mass index (BMI) ranges. Breakfast consumption patterns showed that only half of the participants (50%) were consuming breakfast daily. Gender-specific multivariate analyses (ANCOVA) showed that in both boys and girls, those eating breakfast at least 5 times a week had significantly lower body weight, body mass index (BMI), BMI z-scores, waist circumference, body fat mass and percent body fat (%BF) compared to infrequent breakfast eaters, after adjustment for age, household income, pubertal status, eating-out and snacking practices, daily energy intakes, and daily physical activity levels. The present findings indicate that infrequent breakfast consumption is associated with higher body adiposity and abdominal obesity. Therefore, daily breakfast consumption with healthy food choices should be encouraged in growing children and adolescents to prevent adiposity during these critical years of growth

Lifestyle Practices and Obesity in Malaysian Adolescents

Aim: To determine the influence of physical activity (PA) and sedentary behavior (SB) on obesity profiles of 454 Malaysian adolescents aged 12 to 19. Methods: Validated PA and SB questionnaires were used and body composition assessed using anthropometry and dual-energy X-ray absorptiometry (DXA). Results: Gender-specific multivariate analyses showed boys with high levels of total PA and moderate-to-vigorous physical activity (MVPA) exhibited significantly lower levels of total body fat, percent body fat and android fat mass compared with low PA and MVPA groups, after adjusting for potential confounders. Girls with high SB levels showed significantly higher BMI, waist circumference and DXA-derived body fat indices than those at lower SB level. Multiple logistic analyses indicated that boys with low levels of total PA and MVPA had significantly greater obesity risk, 3.0 (OR 3.0; 95% CI, 1.1–8.1; p < 0.05) and 3.8-fold (OR 3.8; 95% CI, 1.4–10.1; p < 0.01), respectively, than more active boys. Only in girls with high SB level was there a significantly increased risk of obesity, 2.9 times higher than girls at low SP levels (OR 2.8; 95% CI, 1.0–7.5; p < 0.05). Conclusions: The present findings indicate that higher PA duration and intensity reduced body fat and obesity risk while high screen-based sedentary behaviors significantly adversely influenced body fat mass, particularly amongst girls when the PA level was low

Similar taste-nutrient relationships in commonly consumed Dutch and Malaysian foods

Three recent studies showed that taste intensity signals nutrient content. However, current data reflects only the food patterns in Western societies. No study has yet been performed in Asian culture. The Malaysian cuisine represents a mixture of Malay, Chinese and Indian foods. This study aimed to investigate the associations between taste intensity and nutrient content in commonly consumed Dutch (NL) and Malaysian (MY) foods. Perceived intensities of sweetness, sourness, bitterness, umami, saltiness and fat sensation were assessed for 469 Dutch and 423 Malaysian commonly consumed foods representing about 83% and 88% of an individual's average daily energy intake in each respective country. We used a trained Dutch (n = 15) and Malaysian panel (n = 20) with quantitative sensory Spectrum™ 100-point rating scales and reference solutions, R1 (13-point), R2 (33-point) and R3 (67-point). Dutch and Malaysian foods had relatively low mean sourness and bitterness (<R1), but higher mean sweetness, saltiness and fat sensation (between R1 and R2). Mean umami taste intensity of Malaysian foods (15-point) was higher than that of Dutch foods (8-point). Positive associations were found between sweetness and mono- and disaccharides (R2 = 0.67 (NL), 0.38 (MY)), between umami and protein (R2 = 0.29 (NL), 0.26 (MY)), between saltiness and sodium (R2 = 0.48 (NL), 0.27 (MY)), and between fat sensation and fat content (R2 = 0.56 (NL), 0.17(MY)) in Dutch and Malaysian foods (all, p < 0.001). The associations between taste intensity and nutrient content are not different between different countries, except for fat sensation-fat content. The two dimensional basic taste-nutrient space, representing the variance and associations between tastes and nutrients, is similar between Dutch and Malaysian commonly consumed foods

When “Stamppot” meets “Nasi lemak” : Dietary taste patterns in the Netherlands and Malaysia

In recent years, dietary changes appear to be shifting universally towards a diet with high intakes of caloric sweeteners, foods from animal origin and edible oils. There is an enormous societal pressure in both middle and high income countries in the world to reduce salt, sugar and fat levels in foods. However, attempts to reduce these levels face the challenge of keeping sensory perceptions of tastes at optimal levels. From this perspective it is important to have insight in the relationships between the physical, chemical or nutrient composition of commonly consumed foods and the sensory perception of taste. In addition, the taste characteristics in current diet-within and across cultures- are highly relevant for nutritional research. Nevertheless, this demands for accurately described food-taste databases, which are supported with data on the reliability and performance of the sensory panel that determined the taste values. The present thesis has two main objectives. First, to quantify taste of commonly consumed foods by means of a trained sensory panel that acquired a common frame of references throughout training. Followed by to describe and compare the dietary patterns of two target populations, i.e. Dutch and Malaysian in terms of the quantified taste food database. In order to quantify the taste profiles of commonly consumed foods, we set-up and trained a Dutch and Malaysian taste panel, based on taste modalities of sweetness, sourness, bitterness, umami, saltiness and fat sensation, with the aid of inspired SpectrumTM scales (Chapter 2). Performance of both panels was described by discrimination, repeatability (RMSE), and agreement. Our descriptive training procedure yielded two panels from different cultures that were similar in panel performance. More importantly, they obtained similar taste profiles for 19 different foods. This implies that food-taste databases obtained with valid and standardized training procedures may be used to quantify the sensory profiles of dietary patterns of populations. In Chapter 3, we first compiled and translated the obtained taste profiles of a total of 892 commonly consumed foods (i.e. representing 83% and 88% of daily Dutch and Malaysian individual’s average daily energy intake) into Dutch and Malaysian taste databases. We then further combined with compositional data to investigate whether taste could function as a nutrient sensor in the context of the current diet, within and across populations. Results showed that sweetness was associated with mono- and disaccharides, umami was associated protein content, saltiness was associated with sodium content, and fat sensation was associated with fat content, in both commonly consumed Dutch and Malaysian foods. This suggests that sweetness, umami, saltiness and fat sensation can signal the presence of nutrients, and that associations of taste intensity and nutrient content are not culture-specific. Combined with food consumption data, the taste databases can be used to describe the taste exposures in the whole diet, i.e. dietary taste patterns. In Chapter 4, we first described the dietary taste patterns in Malaysia, and compared to these to the dietary taste patterns in The Netherlands, a country with Western eating patterns. Next to this, we further compared dietary taste patterns of specific demographic subgroups in Dutch and Malaysians, that is men and women, younger and older individuals, and overweight and normal-weight individuals. Our findings indicated that the overall dietary taste patterns were different between two populations, in which Malaysians consumed a larger percentage of energy from ‘savory fatty’ tasting foods but a smaller percentage of energy from ‘neutral’ tasting foods than Dutch. Despite these differences, men consume more savory fatty foods than women in both populations. No consistent differences were seen according to age and weight status. In Chapter 5, we described and compared the taste dietary patterns in the Netherlands and Malaysia, based on different eating occasions at both the level of energy contribution as well as the frequency of consumption. In total eating occasions, Malaysian individuals heightened energy intakes from ‘savory fatty’ tasting foods than ‘sweet fatty’ tasting foods compared to their Dutch counterparts. We also observed that the dietary taste patterns of main meals and snacking behaviors in the Dutch population were more varied and distinct over a day, compared to the Malaysian population. This suggests that cultural context plays an important role in determining food choice and intake patterns, even when the available foods have similar taste profiles. Summarizing, the research described in this thesis provides new insights by putting sensory science (i.e. perception of taste) into nutrition and public health domain. The findings showed the standardized training procedure yields similar panel performance of two cross-cultural trained taste panels, and whereby this serves as the ground work to obtain food taste profiles that can be further translated into populations’ taste databases. The information richness of the quantified food taste databases allows it to cross-correlate with compositional and consumption data, within and across cultures. The results demonstrate that taste can signal the presence of nutrients, and that associations of taste intensity and nutrient content are not culture-specific. Whilst, the overall dietary taste patterns are different across cultures, in which Malaysians heightened energy intakes from ‘savory fatty’ tasting foods than ‘sweet fatty’ tasting foods compared to Dutch. Interestingly, men consume more ‘savory fatty’ foods than women in both populations. Across eating occasions, dietary taste intake patterns of the Dutch population are more varied and distinct over a day, compared to the Malaysian population. In conclusion, assessing the role of taste in diet faces numerous challenges that extend beyond the rigorous measures to quantify taste and appropriateness to describe the dietary behavior as a whole diet. This thesis highlights the use of objective panel, taste databases and dietary patterns to describe and compare the taste characteristics of a diet within and across cultures. By focusing on the role of taste in diet, we learned that cultural context plays an important role in determining food choice and intake, even when the available foods have similar taste characteristics. Much more needs to be done not only in expanding and updating food taste databases; there is also a need to further assess the dietary taste patterns in other population groups, i.e. children, elderly, patients and ethnic-specific groups. Future prospective studies should be carried-out to relate the dietary taste patterns with chronic diseases. Studying dietary patterns from a taste perspective - and not only a nutritional perspective – can provide us with a deeper understanding of the role of taste in dietary intake.</p

Validity and reproducibility of a food frequency questionnaire (FFQ) for dietary assessment in Malay adolescents in Malaysia

Background: Food frequency questionnaire (FFQ) must be tailored to the target populations because dietary habits vary within the populations due to differences in cultural and lifestyles practices. Limited information is available to assess the validity of FFQ used among Malaysian adolescents. Objective: To construct the validity and reproducibility of a newly developed FFQ in assessing habitual nutrients intake over the past year of 170 Malay adolescent boys and girls in Kelantan, Malaysia. Methods: The FFQ that consisted of 124 food items was assessed, whereas three days of 24-hours dietary recalls (DR) was administered as the standard criteria method. Results: Estimated mean intake for most nutrients assessed by the FFQ were higher as compared to the three DRs (p<0.05). Pearson correlation coefficients for energy-adjusted nutrients intake between both methods were ranged from 0.22 (zinc) to 0.68 (calcium) with a median r-value of 0.43. The cross classification of quartile analysis showed that most nutrients were classified into the same or adjacent quartiles (median=52.7%). For the reproducibility of FFQ, the correlation of nutrients ranged from 0.43 for carotene to 0.86 for total fat intake (median= 0.67), after adjusting for total energy intake. Conclusion: The newly developed dietary FFQ is a relatively good and valid tool in assessing habitual nutrients intake for the past year among Malay adolescents in Malaysia

Development of a new computer-based physical activity questionnaire to estimate habitual physical activity level in Malaysian adolescents

Objectives: To assess the validity and reproducibility of a new computer-based physical activity questionnaire (cPAQ) to estimate the habitual physical activity levels in Malaysian adolescents. Design: Cross-sectional study. Methods: About 425 adolescent boys and girls participated in the study. A heart rate monitor and a 7-days physical activity logbook were used as objective and subjective method criteria, respectively. Results: The mean estimated weekly total physical activity levels measured by the cPAQ were 16.5±17.5h and 13.1 ± 16.9h for boys and girls, respectively. Analyses of the gender-specific Spearman’s correlation coefficient between cPAQ and both objective and subjective method criteria showed that r values ranged from 0.54 to 0.76 (p < 0.001). Method comparisons assessed by the Bland–Altman plot analysis found that the total physical activity levels, calculated from the cPAQ, fell within the mean ± 2 standard deviation. Reproducibility of the cPAQ was re-examined after two-weeks, showing that intra-class correlations for most PA intensity levels in boys and girls were high with a mean r value of 0.72. The effectiveness of the cPAQ showed a significantly shorter assessment time compared to the manual paper-administered questionnaire in adolescents (p < 0.001) and the majority of participants (93%) accepted the overall appearance of this new cPAQ. Conclusions: The cPAQ provides a valid and reliable method for assessing the habitual physical activity levels for the past year in Malaysian adolescents. It was also proven to be highly effective, based on duration time and its overall appearance for the adolescent participants

Infrequent breakfast consumption is associated with higher body adiposity and abdominal obesity in Malaysian school-aged adolescents.

Unhealthy dietary pattern increases the risk of obesity and metabolic disorders in growing children and adolescents. However, the way the habitual pattern of breakfast consumption influences body composition and risk of obesity in adolescents is not well defined. Thus, the aim of the present study was to assess any associations between breakfast consumption practices and body composition profiles in 236 apparently healthy adolescents aged 12 to 19 years. A self-administered questionnaire on dietary behaviour and lifestyle practices and a dietary food frequency questionnaire were used. Body composition and adiposity indices were determined using standard anthropometric measurement protocols and dual energy χ-ray absorptiometry (DXA). Mean age of the participants was 15.3±1.9 years. The majority of participants (71.2%) fell in the normal body mass index (BMI) ranges. Breakfast consumption patterns showed that only half of the participants (50%) were consuming breakfast daily. Gender-specific multivariate analyses (ANCOVA) showed that in both boys and girls, those eating breakfast at least 5 times a week had significantly lower body weight, body mass index (BMI), BMI z-scores, waist circumference, body fat mass and percent body fat (%BF) compared to infrequent breakfast eaters, after adjustment for age, household income, pubertal status, eating-out and snacking practices, daily energy intakes, and daily physical activity levels. The present findings indicate that infrequent breakfast consumption is associated with higher body adiposity and abdominal obesity. Therefore, daily breakfast consumption with healthy food choices should be encouraged in growing children and adolescents to prevent adiposity during these critical years of growth