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Fulltext Nutritional status and complementary feeding among Penan infants and young children in rural Sarawak, Malaysia

Bong, M.W., Norimah A. Karim, Ismail Mohd Noor

Malays J Nutr, 2018;24(4):539-550.
MyJurnal

Introduction: The Penan people are largely settled in rural and remote areas of
Sarawak with high rates of undernutrition among the children. The study aimed to
determine the nutritional status and infant and young child feeding (IYCF) practices
of Penan children. Methods: Subjects consisted of 121 children, aged between 0-23
months, from 15 Penan longhouses in Belaga district. Malnutrition was assessed
using anthropometric measurements of children and categorised according to the
World Health Organization (WHO) Growth Standards (2006). Feeding practices were
assessed using questionnaires based on WHO IYCF Indicators (2008). Results:
The prevalence of underweight was 29.8%; stunting 43.0% and wasting 5.8%.
Prevalence of exclusive breastfeeding under 6 months was 44.4%. About 86% of
infants aged 6-8 months were already given solid, semi-solid and soft foods. The
proportion of children aged 6-23 months achieving minimum dietary diversity
(MDD) was 76.6%, while minimum meal frequency (MMF) was 83.0% (breastfed and
non-breastfed). Among the children who achieved MDD, 64.9% of their meals were
derived from 4-5 food groups. More than half (55.3%) of all subjects (breastfed and
non-breastfed) received minimum acceptable diet (MAD). Achievement of iron-rich
foods (IRF) indicator was 77.7%. There was no significant association between the
IYCF indicators of MDD, MMF and MAD and underweight, stunting and wasting.
Conclusion: A high prevalence of poor nutritional status was recorded among
the Penan children. While the IYCF indicators apparently showed satisfactory
complementary feeding practices, future studies should assess quantitatively the
intake of complementary food among Penan infants and young children.
Fulltext Knowledge on body weight management amongst working women in Kuala Lumpur. [Pengetahuan pengurusan berat badan di kalangan wanita bekerja di Kuala Lumpur.]

Poh, B.K., Sia, P.H., Norimah A. Karim, Mohd Ismail Noor

Jurnal Sains Kesihatan Malaysia, 2006;4(1):71-84.
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Obesity prevalence and body image consciousness are on the rise, and women often try to lose weight using a variety of methods. This paper reports the knowledge on body weight management amongst working women aged 30 – 45 years in Kuala Lumpur. Respondents comprised 131 school teachers and 122 civil servants. Anthropometric measurements included body weight and height; while knowledge on weight management was assessed using a questionnaire. The respondents were Malay (64%), Chinese (26%) and Indian women (10%) with mean age of 38.3 ± 4.6 years old. The respondents were grouped into two weight categories based on body mass index (BMI): normal weight (BMI 18.5 to 24.9 kg/m2) and overweight (BMI ≥ 25.0 kg/m2). Mean body weight and BMI were significantly different (p < 0.001) between the two weight categories. Overweight and normal weight groups had mean body weight of 69.0 ± 9.5 kg and 53.5 ± 5.3 kg; while mean BMI were 29.2 ± 3.6 kg/ m2 dan 21.9 ± 1.7 kg/m2; respectively. Mean scores for knowledge on weight management were similar for both weight categories, 62.4 ± 13.7 and 61.8 ± 13.4 for overweight and normal weight, respectively. A majority of overweight (71%) and normal weight (73%) women had moderate level (scores 50–74%) of weight management knowledge. However, it was interesting to note that there were more overweight women (20%) who had high knowledge level (scores ≥ 75%) as compared to normal weight women (15%). Only 9% of overweight and 12% of normal weight women demonstrated low knowledge level (scores <50%). School teachers were significantly (p < 0.001) more knowledgeable than civil servants in weight management matters with mean knowledge scores of 65.5 ± 12.3 and 58.4 ± 13.9, respectively. On the whole, the results indicated that women were fairly knowledgeable in healthy body weight management. Knowledge on body weight management is essential for preventing comorbidity risks related to overweight problem. The study also revealed that there was a need for nutrition education related to body image and effective weight management. Key words: Body weight management, working women, overweight, obesity
Fulltext Food choices and diet quality in the school food environment: a qualitative insight from the perspective of adolescents

Suhaila Abdul Ghaffar, Ruzita Abdul Talib, Norimah A. Karim

Malaysian Journal of Medicine and Health Sciences, 2019;15(201):16-24.
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Introduction: Overweight and obesity among adolescents are not caused by a single factor, and evidence indicates that the food environment is one of the driving forces behind the current escalating obesity epidemic. Therefore, it is imperative to explore any perceived factors related to food choices and quality of food in the school food environ- ment among adolescents. Methods: A qualitative study based on the Socio-Ecological Model (SEM) was conducted on a purposive, multi-ethnic sample of 51 adolescents from different localities. The semi-structured and in-depth in- terviews were fully transcribed and analyzed qualitatively using Atlas.Ti. The transcribed texts were coded into simi- lar and related themes such as food choices, quality of food, social-peers’ influence, cost of food and self-awareness. Results: The findings revealed that there is a clustering of barriers to practising a healthy dietary intake within the school food environment. Accessibility to low cost snacks and fried foods, influence by parents and peers, as well as the autonomous character of informants in making their own purchases are the contributing factors to healthy eating practice among adolescents. Conclusions: The study highlights that the barriers to practicing healthy eating consid- erably outweighs the enabling factors. Therefore, the findings will help facilitate the construction of policy-driven environmental changes as well as strategies in designing effective and multilevel interventions that raise awareness in helping adolescents navigate healthy food in their school’s compound.
Fulltext Effectiveness of a nutrition education intervention for primary school children: the healthy kids programme, Malaysia

Chin Yit Siew, Tee E Siong, Zawiah Hashim, Rasyedah Ahmad Raqi, Norimah A Karim

Malaysian Journal of Medicine and Health Sciences, 2020;16(106):1-10.
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Introduction: This paper discussed the effectiveness of “Healthy Kids Programme (HKP)”, specifically in improving the body weight status as well as knowledge, attitude and practice (KAP) of the children. Methods: In this longi- tudinal intervention study, a total of 12 primary schools in Klang Valley were randomly selected and divided into intervention and control groups. There were 386 standard three children participated at baseline. All children in the intervention group participated in the HKP that was conducted by nutritionists. The evaluations included the pre- and post-Immediate Impact survey (IIS) (every topic), and changes in nutrition KAP survey and anthropometric assess- ment of the children at the beginning and end of every year for three years. Results: School children in intervention group reported with an increased in the IIS score for each topic and achieved a significantly higher mean nutrition knowledge score than those in the control group over time. There were no significant differences in mean attitude and practice scores between two groups after the intervention. Children in the intervention group had lower rates of overweight and obesity (pre-test: 27.3%; post-test: 32.5%) than their counterpart (pre-test: 26.6%; post-test: 44.0%). Conclusions: The HKP is effective in improving nutrition knowledge of the children. A lower rate of overweight and obesity was observed in intervention group than control group. This approach will contribute towards inculcating healthy eating and active lifestyle habits among Malaysian children that bring about long-term health benefits.
Fulltext The effect of low glycemic index bread eaten with different fillings on blood glucose response in healthy individuals

Barakatun Nisak Mohd Yusof, Ruzita Abd. Talib, Norimah A. Karim, Nor Azmi Kamarudin, Fatimah Arshad

Jurnal Sains Kesihatan Malaysia, 2008;6(1):1-10.
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White and whole meal breads have been classified as high glycemic index (GI) foods which in turn produce the greatest rise in blood glucose. One of the commercial bread products in Malaysia known as Brown breads (BB) has been recently marketed as a healthy choice for diabetics due to its low GI value. This study was conducted to examine the effect of BB when eaten with different fillings on blood glucose response among healthy individuals and to describe the influences of these fillings in reducing blood glucose response. Five test meals using BB (BB eaten with baked beans, BB eaten with vegetable, BB eaten with apple, BB eaten with roast chicken and BB eaten with seaweeds) had been prepared for this study. Postprandial blood glucose response was determined for each test meal and reference food (glucose) that contained 50 g carbohydrate respectively. A total of 21 healthy subjects were recruited by advertisement to participate. Only 20 subjects (15 males, 5 females, Mean + SD Age : 24.4 + 3.7 years; BMI 23.4 + 3.0 kgm-2) completed this study. After an overnight fast, subjects consumed BB eaten with fillings according to the assigned group given and three repeated tests of reference food (glucose). Fasting capillary blood glucose samples were taken at time 0 and at 15, 30, 45, 60, 90 and 120 min respectively after the meal began. The blood glucose response was obtained by calculating the incremental area under the curve (AUC). Blood glucose response after consuming reference food (251.8 + 12.1 mmol.min/L) was significantly higher than all the test meals (p < 0.05). Among the test meals, BB eaten with baked beans produced the highest rise in blood glucose (97.0 + 16.9 mmol.min/L) whereas BB eaten with seaweeds demonstrated the lowest response in blood glucose (33.3 + 6.5 mmol.min/L) and the difference was statistically significant (p < 0.05). The postprandial blood glucose response after ingestion of BB when eaten with vegetable was 73.3 + 19.1 mmol.min/L followed by BB eaten with apple (58.9 + 12.2 mmol.min/L) and BB eaten with roast chicken (56.5 + 10.1 mmol.min/L). Generally, BB when eaten with fillings produced a slow rise in blood glucose response than the reference food. Combining this BB with fillings had the effect of reducing the postprandial blood glucose further.
Fulltext Weight loss practice using physical activity among working women in Klang Valley, Malaysia

Sena Abdullah Abdul Jabbar Al-Qalah, Hasanain Faisal Ghazi, Zaleha Md.Isa, Norimah A. Karim

Malaysian Journal of Public Health Medicine, 2014;14(3):0-0.
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An increase in physical activity is a key component for effective weight loss. It helps to control weight loss by using excess calories as well as boosting metabolism and lowering insulin levels. Physical activity also helps prevent many chronic diseases and improve the overall human health. The objective of this study was to assess weight loss practice using physical activity strategies among working women in Kuala Lumpur, Malaysia. A total of 639 adult Malaysian working women were screened and 120 respondents were identified based on their experience of losing at least 10% of their highest lifetime body weight, which is a criterion for successful weight-loss. Self-administered questionnaire was used to collect information from 120 successful weight loss respondents. Physical activity was measured by using International Physical Activity Questionnaire (IPAQ) short version. Results showed that 35.8% of women had low physical activity level; slightly above than one third of women (38.3%) had moderate activity level, while 25.8% women had high physical activity level.The most common physical activity monitoring strategies implemented were exercise at least 30 minutes per day (22.5%) and incorporate physical activity into daily life (21.7%). A total of 70.8% women regained weight after significant weight loss. A total of 40.0% who regained weight as compared to 25.7% of those who did not regain weight were physically inactive (p=0.138). There was no statistically significant different in daily sitting time between the two groups (p=0.627). As a conclusion, government working women in Kuala Lumpur have low to moderate physical activity levels. Majority women regained weight after significant weight loss. Common strategies to lose weight are exercise at least 30 minutes per day and incorporate physical activity into daily life. More education and promotion regarding the importance of physical activity should be done to all community members especially to the government working women.
Differences in Body Build in Children of Different Ethnic Groups and their Impact on the Prevalence of Stunting, Thinness, Overweight, and Obesity

Poh BK, Wong JE, Norimah AK, Deurenberg P

Food Nutr Bull, 2016 Mar;37(1):3-13.
PMID: 26769039 DOI: 10.1177/0379572115626025

The prevalence of stunting, thinness, overweight, and obesity among children differs by ethnicity. It is not known whether differences in body build across the ethnic groups influence the interpretation of nutritional parameters.
Improvement of dietary quality with the aid of a low glycemic index diet in Asian patients with type 2 diabetes mellitus

Barakatun Nisak MY, Ruzita AT, Norimah AK, Gilbertson H, Nor Azmi K

J Am Coll Nutr, 2010 Jun;29(3):161-70.
PMID: 20833988 DOI: 10.1080/07315724.2010.10719830

OBJECTIVES: This randomized controlled study was conducted to determine the effect of low glycemic index (GI) dietary advice on eating patterns and dietary quality in Asian patients with type 2 diabetes (T2DM).

METHODS: Asian patients with T2DM (N = 104) were randomized into 2 groups that received either low GI or conventional carbohydrate exchange (CCE) dietary advice for 12 weeks. Nutritional prescriptions were based on the medical nutrition therapy for T2DM, with the difference being in the GI component of the carbohydrates. Dietary intake and food choices were assessed with the use of a 3-day food record.

RESULTS: At week 12, both groups achieved the recommendations for carbohydrate (52 ± 4% and 54 ± 4% of energy) and fat (30 ± 4% and 28 ± 5% of energy) intake. There were no significant differences in the reported macronutrient intake in both groups. With the low GI diet, crude fiber and dietary calcium intake increased, while the dietary GI reduced. Subjects in the lowest dietary glycemic index/glycemic load (GI/GL) quartile consumed more parboiled/basmati rice, pasta, milk/dairy products, fruits, and dough, which are foods from the low GI category. There was a significant reduction in the hemoglobin A(1c) level at week 12 for patients in the lowest GI/GL quartile (Δ = -0.7 ± 0.1%) compared with those in the highest GI/GL quartile (Δ = -0.1 ± 0.2%).

CONCLUSIONS: These results demonstrate the ability of low GI dietary advice to improve the dietary quality of Asian patients with T2DM.
Effects of a probiotic fermented milk on functional constipation: a randomized, double-blind, placebo-controlled study

Mazlyn MM, Nagarajah LH, Fatimah A, Norimah AK, Goh KL

J Gastroenterol Hepatol, 2013 Jul;28(7):1141-7.
PMID: 23432408 DOI: 10.1111/jgh.12168

Evidence suggests that probiotics reduce certain constipation-related symptoms. Lactobacillus casei strain Shirota has never been tested as treatment for functional constipation in otherwise-healthy subjects. To evaluate the efficacy of this probiotic among adults with functional constipation was aimed.
Fulltext Development and validation of a food frequency questionnaire for dietary intake assessment among multi-ethnic primary school-aged children

Fatihah F, Ng BK, Hazwanie H, Norimah AK, Shanita SN, Ruzita AT, et al.

Singapore Med J, 2015 Dec;56(12):687-94.
PMID: 26702165 DOI: 10.11622/smedj.2015190

This study aimed to develop and validate a food frequency questionnaire (FFQ) to assess habitual diets of multi-ethnic Malaysian children aged 7-12 years.
Nutritional status and dietary intakes of children aged 6 months to 12 years: findings of the Nutrition Survey of Malaysian Children (SEANUTS Malaysia)

Poh BK, Ng BK, Siti Haslinda MD, Nik Shanita S, Wong JE, Budin SB, et al.

Br J Nutr, 2013 Sep;110 Suppl 3:S21-35.
PMID: 24016764 DOI: 10.1017/S0007114513002092

The dual burden of malnutrition reportedly coexists in Malaysia; however, existing data are scarce and do not adequately represent the nutritional status of Malaysian children. The Nutrition Survey of Malaysian Children was carried out with the aim of assessing the nutritional status in a sample of nationally representative population of children aged 6 months to 12 years. A total of 3542 children were recruited using a stratified random sampling method. Anthropometric measurements included weight, height, mid-upper arm circumference, and waist and hip circumferences. Blood biochemical assessment involved analyses of Hb, serum ferritin, and vitamins A and D. Dietary intake was assessed using semi-quantitative FFQ, and nutrient intakes were compared with the Malaysian Recommended Nutrient Intakes (RNI). The prevalence of overweight (9·8%) and obesity (11·8%) was higher than that of thinness (5·4%) and stunting (8·4%). Only a small proportion of children had low levels of Hb (6·6%), serum ferritin (4·4%) and vitamin A (4·4%), but almost half the children (47·5%) had vitamin D insufficiency. Dietary intake of the children was not compatible with the recommendations, where more than one-third did not achieve the Malaysian RNI for energy, Ca and vitamin D. The present study revealed that overnutrition was more prevalent than undernutrition. The presence of high prevalence of vitamin D insufficiency and the inadequate intake of Ca and vitamin D are of concern. Hence, strategies for improving the nutritional status of Malaysian children need to consider both sides of malnutrition and also put emphasis on approaches for the prevention of overweight and obesity as well as vitamin D insufficiency.
Fulltext Consumption of ready-to-eat cereals (RTEC) among Malaysian children and association with socio-demographics and nutrient intakes - findings from the MyBreakfast study

Mohd Nasir MT, Nurliyana AR, Norimah AK, Jan Mohamed HJB, Tan SY, Appukutty M, et al.

Food Nutr Res, 2017;61(1):1304692.
PMID: 28469545 DOI: 10.1080/16546628.2017.1304692

Background: The association between different types of breakfast meals and nutrient intakes has been studied to a lesser extent. Objective: This study compared nutrient intakes at breakfast and throughout the day between Malaysian children who consumed ready-to-eat cereals (RTEC) and those who did not. Methods: Anthropometric and dietary data for 1955 children aged 6-12 years from the MyBreakfast study were used in the analysis. Results: Overall, 18% of the children consumed RTEC at breakfast on at least one of the recall days. RTEC consumption was associated with younger age, urban areas, higher income and education level of parents. Among consumers, RTEC contributed 10% and 15% to daily intakes of calcium and iron respectively and ≥20% to daily intakes of vitamin C, thiamin, riboflavin and niacin. RTEC consumers had significantly higher mean intakes of vitamin C, thiamin, riboflavin, niacin, calcium, iron and sugar but lower intakes of fat and sodium than non-RTEC consumers at breakfast and for the total day. Conclusion: Consumption of fortified RTEC at breakfast was associated with lower fat and sodium intakes and higher intakes of several micronutrients both at breakfast and for the total day. However, total sugar intakes appeared to be higher.
Fulltext Prevalence of Anaemia and Iron Deficiency among Primary Schoolchildren in Malaysia

Nik Shanita S, Siti Hanisa A, Noor Afifah AR, Lee ST, Chong KH, George P, et al.

Int J Environ Res Public Health, 2018 10 23;15(11).
PMID: 30360488 DOI: 10.3390/ijerph15112332

The present study aimed to report the prevalence of anaemia and iron deficiency (ID) and to explore the associations among socio-demographic characteristics, nutritional status and inflammation status in the occurrence of anaemia and ID in a nationally representative sample of Malaysian primary schoolchildren. Using data from the South East Asian Nutrition Surveys (SEANUTS), 544 Malaysian children aged 7 to 12 years were included in this secondary analysis. Blood samples were drawn for haemoglobin and serum ferritin analysis while C-reactive protein (CRP) and α-1-acid glycoprotein (AGP) were measured to detect inflammation. Prevalence of anaemia and ID were 4.0% and 5.2%, respectively. There were significantly more anaemic indigenous bumiputra children (9.9%) than Chinese children (0.6%). Correction for inflammation did not change the prevalence of ID. More overweight/obese children than thin/normal weight children were found to have elevated acute phase protein (APP). Children with elevated inflammatory markers had significantly higher ferritin level than children without inflammation. Periodic health assessments of anaemia and ID at the population level to monitor and clarify the epidemiology of health problems are required to inform public health policies and strategies.
Fulltext Breakfast consumption among Malaysian primary and secondary school children and relationship with body weight status - Findings from the MyBreakfast Study

Tee ES, Nurliyana AR, Norimah AK, Mohamed HJBJ, Tan SY, Appukutty M, et al.

Asia Pac J Clin Nutr, 2018 2 1;27(2):421-432.
PMID: 29384332 DOI: 10.6133/apjcn.062017.12

BACKGROUND AND OBJECTIVES: This study aimed to determine the relationship between breakfast consumption and body weight status among primary and secondary school children in Malaysia.
METHODS AND STUDY DESIGN: This nationwide cross-sectional study involved 5,332 primary school children aged 6 to 12 years and 3,000 secondary school children aged 13 to 17 years. Height and weight were measured and BMI-for-age was determined. Socio-demographic backgrounds, breakfast habits and physical activity levels were assessed using questionnaires. Breakfast frequency was defined as follows: breakfast skippers (ate breakfast 0-2 days/week), irregular breakfast eaters (ate breakfast 3-4 days/week) and regular breakfast eaters (ate breakfast ≥5 days/week).
RESULTS: The overall prevalence of breakfast skippers and irregular breakfast eaters was 11.7% and 12.7% respectively. Breakfast skipping was related to age, sex, ethnicity, income and physical activity level. Among primary school boys and secondary school girls, the proportion of overweight/obesity was higher among breakfast skippers (boys: 43.9%, girls: 30.5%) than regular breakfast eaters (boys: 31.2%, girls: 22.7%). Among primary school children, only boys who skipped breakfast had a higher mean BMI-for-age z-score than regular breakfast eaters. Among secondary school boys and girls, BMI-for-age z-score was higher among breakfast skippers than regular breakfast eaters. Compared to regular breakfast eaters, primary school boys who skipped breakfast were 1.71 times (95% CI=1.26-2.32, p=0.001) more likely to be overweight/obese, while the risk was lower in primary school girls (OR=1.36, 95% CI=1.02-1.81, p=0.039) and secondary school girls (OR=1.38, 95% CI=1.01-1.90, p=0.044).
CONCLUSION: Regular breakfast consumption was associated with a healthier body weight status and is a dietary behaviour which should be encouraged.
Triple burden of malnutrition among Malaysian children aged 6 months to 12 years: Current findings from SEANUTS II Malaysia

Poh BK, Wong JE, Lee ST, Chia JSM, Yeo GS, Sharif R, et al.

Public Health Nutr, 2023 Nov 07.
PMID: 37932916 DOI: 10.1017/S1368980023002239

OBJECTIVE: This paper aims to report South East Asian Nutrition Surveys (SEANUTS) II Malaysia data on nutritional status, dietary intake, and nutritional biomarkers of children aged 6 months to 12 years.
DESIGN: Cross-sectional survey conducted in 2019-2020.
SETTING: Multistage cluster sampling conducted in Central, Northern, Southern, and East Coast regions of Peninsular Malaysia.
PARTICIPANTS: 2989 children aged 0.5-12.9 years.
RESULTS: Prevalences of stunting, thinness, overweight, and obesity among children aged 0.5-12.9 years were 8.9%, 6.7%, 9.2%, and 8.8%, respectively. Among children below 5 years old, 11.4% were underweight, 13.8% had stunting, and 6.2% wasting. Data on nutritional biomarkers showed a small proportion of children aged 4-12 years had iron (2.9%) and vitamin A deficiencies (3.1%). Prevalence of anaemia was distinctly different between children below 4 years old (40.3%) and those aged 4 years and above (3.0%). One-fourth of children (25.1%) had vitamin D insufficiency, which was twice as prevalent in girls (35.2% vs. boys: 15.6%). The majority of children did not meet the recommended dietary intake for calcium (79.4%) and vitamin D (94.8%).
CONCLUSIONS: Data from SEANUTS II Malaysia confirmed that triple burden of malnutrition co-exists among children in Peninsular Malaysia, with higher prevalence of overnutrition than undernutrition. Anaemia is highly prevalent among children below 4 years old, while vitamin D insufficiency is more prevalent among girls. Low intakes of dietary calcium and vitamin D are also of concern. These findings provide policymakers with useful and evidence-based data to formulate strategies that address the nutritional issues of Malaysian children.

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