Displaying publications 1 - 20 of 57 in total

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  1. Leong JY, Wong JE
    J Sports Sci, 2016 Mar 7.
    PMID: 26950687
    This study examines the accuracy of three popular, free Android-based pedometer applications (apps), namely, Runtastic (RT), Pacer Works (PW), and Tayutau (TY) in laboratory and free-living settings. Forty-eight adults (22.5 ± 1.4 years) completed 3-min bouts of treadmill walking at five incremental speeds while carrying a test smartphone installed with the three apps. Experiment was repeated thrice, with the smartphone placed either in the pants pockets, at waist level, or secured to the left arm by an armband. The actual step count was manually counted by a tally counter. In the free-living setting, each of the 44 participants (21.9 ± 1.6 years) carried a smartphone with installed apps and a reference pedometer (Yamax Digi-Walker CW700) for 7 consecutive days. Results showed that TY produced the lowest mean absolute percent error (APE 6.7%) and was the only app with acceptable accuracy in counting steps in a laboratory setting. RT consistently underestimated steps with APE of 16.8% in the laboratory. PW significantly underestimated steps when the smartphone was secured to the arm, but overestimated under other conditions (APE 19.7%). TY was the most accurate app in counting steps in a laboratory setting with the lowest APE of 6.7%. In the free-living setting, the APE relative to the reference pedometer was 16.6%, 18.0%, and 16.8% for RT, PW, and TY, respectively. None of the three apps counted steps accurately in the free-living setting.
  2. Wong LS, Wong JE
    J Nutr Sci Vitaminol (Tokyo), 2020;66(Supplement):S184-S189.
    PMID: 33612592 DOI: 10.3177/jnsv.66.S184
    A photographic food atlas is a series of photographs showing different quantities of different foods. It serves as a portion size estimation aid (PSEA). In Malaysia, the existing food atlases, which display foods in exchanges and standard portion sizes, may not be representative of the actual sizes of the portions of food consumed by the local population. This paper aims to describe the development of a food atlas, namely the 'MY Food Album', and assess its usability as a PSEA. Thirty four participants (aged 31.6±20.9 y) served themselves, in a laboratory setting, what they considered to be typical, small, medium, and large portions of 23 amorphus food items. All food portions were weighed to obtain the mean and standard deviation of the range of food portion sizes to be displayed in the food atlas. Using standard camera and lighting settings, various local foods were photographed at an angle of 45º. A total of 393 food items were categorized into 14 food groups and presented as serial (n=101), guide (n=213) and range (n=79) photographs. The usability of MY Food Album was evaluated by six nutritionists and dietitians using an adapted questionnaire. The food atlas was perceived to be useful to aid in the quantification of food during dietary assessment. It was suggested that the function, dimension and application of fiducial markers be introduced in the food atlas to facilitate its use in size estimation. While MY Food Album was well-accepted as a PSEA, futher validation is required to evaluate the effectiveness of this newly developed food atlas in portion size estimation.
  3. Lai LY, Wong JE
    J Nutr, 2023 Jan;153(1):393-399.
    PMID: 36913476 DOI: 10.1016/j.tjnut.2022.11.014
    BACKGROUND: Accurate measurement of dietary intake throughout childhood is important to monitor children's growth and development and for their long-term health. However, measuring dietary intake in children is challenging because of misreporting, difficulties in establishing portion size, and heavy reliance on proxy reporters.

    OBJECTIVES: This study aimed to determine the accuracy of self-reported food intake by primary school children aged 7-9 y.

    METHODS: A total of 105 children (51% boys), aged 8.0 ± 0.8 y, were recruited from three primary schools in Selangor, Malaysia. Individual meal intakes during a school break time were determined using a food photography method as the reference method. The children were then interviewed the following day to assess their recall of their meal intakes the previous day. ANOVA and Kruskal-Wallis tests were used to determine mean differences in the accuracy of reporting food items and amount by age and weight status, respectively.

    RESULTS: On average, the children achieved 85.8% match rate, 14.2% omission rate, and 3.2% intrusion rate for accuracy in reporting food items. The children also achieved 85.9% correspondence rate and 6.8% inflation ratio for accuracy in reporting food amounts. Children living with obesity had notably higher intrusion rates compared with normal weight children (10.6% vs. 1.9%) (P < 0.05). Children aged >9 y had notably higher correspondence rates, compared with children aged 7 y (93.3% vs. 78.8%) (P < 0.05).

    CONCLUSIONS: The low omission and intrusion rates and the high correspondence rate indicate that primary school children aged 7-9 y are capable of self-reporting food intake accurately for a lunch meal without proxy assistance. However, to confirm children's abilities to report their daily food intakes, further studies should be conducted to assess the accuracy of children in reporting their food intakes for more than one meal in a day.

  4. Wu SK, Wong JE, Poh BK
    Malays J Med Sci, 2023 Dec;30(6):108-119.
    PMID: 38239253 DOI: 10.21315/mjms2023.30.6.11
    BACKGROUND: Understanding of psychosocial factors of physical activity (PA) in children is crucial in encouraging sustained PA, which in turn is associated with important health outcomes. This study aimed to examine how children's attraction to physical activity (CAPA) is associated with PA.

    METHODS: This cross-sectional study was conducted among 219 primary school children (105 boys; 114 girls) aged 7 years old-10 years old in Kuala Lumpur, Malaysia in 2016-2017. Children from three main ethnicities, namely Malay, Chinese and Indian, were recruited. Weight, height and waist circumference were measured; body composition was assessed by deuterium dilution technique. CAPA and level of PA were obtained through self-administered questionnaires and reported as CAPA and PA scores.

    RESULTS: Median CAPA and PA scores were 3.40 (Q1 = 3.00, Q3 = 3.80) and 2.31 (Q1 = 1.95, Q3 = 2.74), respectively. Significant gender differences were found in CAPA and PA scores, with boys being more attracted to PA (3.16 [Q1 = 2.90, Q3 = 3.44]; P = 0.001) and more physically active compared with girls (2.47 [Q1 = 2.07, Q3 = 3.07]; P = 0.001). CAPA and PA scores correlated positively in both sexes. Boys scored higher than girls in 'liking of games and sports' (ρ = 0.301, P = 0.002) and 'liking of vigorous PA' (ρ = 0.227, P = 0.02) CAPA subscales, which also correlated positively with PA scores. Girls' PA scores correlated with 'peer acceptance in games and sports' (ρ = 0.329, P < 0.001).

    CONCLUSION: Boys are more physically active and have higher attraction to PA compared with girls. Differences in PA scores between the sexes were related to gender differences in CAPA scores. Thus, attention should be given to gender differences in CAPA related psychosocial factors when planning interventions to promote PA among children.

  5. Saeedi P, Skeaff SA, Wong JE, Skidmore PM
    Nutrients, 2016;8(5).
    PMID: 27164137 DOI: 10.3390/nu8050271
    The aim of this study was to assess the reproducibility and validity of a non-quantitative 28-item food frequency questionnaire (FFQ). Children aged 9-10 years (n = 50) from three schools in Dunedin, New Zealand, completed the FFQ twice and a four-day estimated food diary (4DEFD) over a two-week period. Intraclass correlation coefficients (ICC) and Spearman's correlation coefficients (SCC) were used to determine reproducibility and validity of the FFQ, respectively. Weekly intakes were estimated for each food item and aggregated into 23 food items/groups. More than half of the food items/groups (52.2%) had an ICC ≥0.5. The median SCC between FFQ administrations was 0.66 (ranging from 0.40 for processed meat to 0.82 for sweets and non-dairy drinks). Cross-classification analysis between the first FFQ and 4DEFD for ranking participants into thirds showed that breakfast cereals had the highest agreement (54.0%) and pasta the lowest (34.0%). In validity analyses, 70% of food items/groups had a SCC ≥0.3. Results indicate that the FFQ is a useful tool for ranking children according to food items/groups intake. The low respondent burden and relative simplicity of the FFQ makes it suitable for use in large cohort studies of 9-10 year-old children in New Zealand.
  6. Wong JE, Parikh P, Poh BK, Deurenberg P, SEANUTS Malaysia Study Group
    Asia Pac J Public Health, 2016 Jul;28(5 Suppl):35S-46S.
    PMID: 27257293 DOI: 10.1177/1010539516650726
    This study describes the physical activity of primary school children according to sociodemographic characteristics and activity domains. Using the Malaysian South East Asian Nutrition Surveys data, 1702 children aged 7 to 12 years were included in the analysis. Physical activity was reported as a total score and categorized into low, medium, and high levels based on Physical Activity Questionnaire for Older Children. Higher overall activity scores were found in boys, younger age, non-Chinese ethnicity, and normal body mass index category. Sex, age, and ethnicity differences were found in structured or organized, physical education, and outside-of-school domain scores. Transport-related scores differed by age group, ethnicity, household income, and residential areas but not among the three physical activity levels. Participation of girls, Chinese, and older children were low in overall and almost all activity domains. Sociodemographic characteristics are important factors to consider in increasing the different domains of physical activity among Malaysian children.
  7. 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.
  8. Lee ST, Wong JE, Chan GKL, Poh BK
    PMID: 33925298 DOI: 10.3390/ijerph18094611
    A daily balance of physical activities, sedentary behaviors and sleep are important for maintaining the health of young children. The aim of this study is to explore the association between 24-h movement behavior of Malaysian children aged 4 to 6 years with weight status. A total of 230 preschoolers were recruited from 22 kindergartens in Kuala Lumpur. Physical activity was assessed by Actical accelerometer while screen time and sleep duration were proxy-reported by parents. Children spent on average 5.5 ± 1.3 h on total physical activity (including 1.0 ± 0.4 h of moderate- vigorous physical activity), 3.0 ± 1.6 h on screen activities and 9.5 ± 1.3 h sleeping daily. The proportion of children who complied with physical activity and sleep guidelines were 48.7% and 55.2%, respectively. About 25.2% of children met screen time recommendation. Only 6.5% of children met all three age-specific physical activity, screen time and sleep guidelines. Children who met any two guidelines were less likely to be overweight or obesity compared to those who did not meet any of the guidelines (OR: 0.276; 95% CI: 0.080-0.950). In conclusion, Malaysian preschoolers have low compliance to movement behavior guidelines, especially in meeting screen time recommendations. Compliance to movement behavior guidelines was associated with lower odds of overweight and obesity.
  9. Wong JE, Yamaguchi M, Nishi N, Araki M, Wee LH
    JMIR Form Res, 2022 Dec 07;6(12):e40404.
    PMID: 36476813 DOI: 10.2196/40404
    BACKGROUND: Overweight or obesity is a primary health concern that leads to a significant burden of noncommunicable disease and threatens national productivity and economic growth. Given the complexity of the etiology of overweight or obesity, machine learning (ML) algorithms offer a promising alternative approach in disentangling interdependent factors for predicting overweight or obesity status.

    OBJECTIVE: This study examined the performance of 3 ML algorithms in comparison with logistic regression (LR) to predict overweight or obesity status among working adults in Malaysia.

    METHODS: Using data from 16,860 participants (mean age 34.2, SD 9.0 years; n=6904, 41% male; n=7048, 41.8% with overweight or obesity) in the Malaysia's Healthiest Workplace by AIA Vitality 2019 survey, predictor variables, including sociodemographic characteristics, job characteristics, health and weight perceptions, and lifestyle-related factors, were modeled using the extreme gradient boosting (XGBoost), random forest (RF), and support vector machine (SVM) algorithms, as well as LR, to predict overweight or obesity status based on a BMI cutoff of 25 kg/m2.

    RESULTS: The area under the receiver operating characteristic curve was 0.81 (95% CI 0.79-0.82), 0.80 (95% CI 0.79-0.81), 0.80 (95% CI 0.78-0.81), and 0.78 (95% CI 0.77-0.80) for the XGBoost, RF, SVM, and LR models, respectively. Weight satisfaction was the top predictor, and ethnicity, age, and gender were also consistent predictor variables of overweight or obesity status in all models.

    CONCLUSIONS: Based on multi-domain online workplace survey data, this study produced predictive models that identified overweight or obesity status with moderate to high accuracy. The performance of both ML-based and logistic regression models were comparable when predicting obesity among working adults in Malaysia.

  10. Wong JE, Skidmore PM, Williams SM, Parnell WR
    J Nutr, 2014 Jun;144(6):937-42.
    PMID: 24744308 DOI: 10.3945/jn.113.188375
    Adoption of optimal dietary habits during adolescence is associated with better health outcomes later in life. However, the associations between a pattern of healthy dietary habits encapsulated in an index and sociodemographic and nutrient intake have not been examined among adolescents. This study aimed to develop a behavior-based diet index and examine its validity in relation to sociodemographic factors, nutrient intakes, and biomarkers in a representative sample of New Zealand (NZ) adolescents aged 15-18 y (n = 694). A 17-item Healthy Dietary Habits Score for Adolescents (HDHS-A) was developed based on dietary habits information from the 2008/2009 NZ Adult Nutrition Survey. Post hoc trend analyses were used to identify the associations between HDHS-A score and nutrient intakes estimated by single 24-h diet recalls and selected nutritional biomarkers. Being female, not of Maori or Pacific ethnicity, and living in the least-deprived socioeconomic quintile were associated with a higher HDHS-A score (all P < 0.001). HDHS-A tertile was associated positively with intake of protein, dietary fiber, polyunsaturated fatty acid, and lactose and negatively with sucrose. Associations in the expected directions were also found with most micronutrients (P < 0.05), urinary sodium (P < 0.001), whole blood (P < 0.05), serum (P < 0.01), and RBC folate (P < 0.05) concentrations. This suggests that the HDHS-A is a valid indicator of diet quality among NZ adolescents.
  11. Tan JY, Wong JE, Zainal N, AbuBakar S, Tan KK
    J Vis Exp, 2023 Apr 07.
    PMID: 37092849 DOI: 10.3791/64578
    Zika virus (ZIKV) is a mosquito-borne virus belonging to the genus Flavivirus. ZIKV infection has been associated with congenital brain abnormalities and potentially Guillain-Barré syndrome in adults. Research on ZIKV to understand the disease mechanisms is important to facilitate vaccine and treatment development. The method of quantifying viruses is crucial and fundamental in the field of virology. The focus forming assay (FFA) is a virus quantification assay that detects the viral antigen with antibodies and identifies the infection foci of cells using the peroxidase immunostaining technique. The current study describes the virus propagation and quantification protocol using both 24-well and 96-well (high throughput) formats. Compared with other similar studies, this protocol has further described foci size optimization, which can serve as a guide to expand the use of this assay for other viruses. Firstly, ZIKV propagation is performed in Vero cells for 3 days. The culture supernatant containing ZIKV is harvested and quantitated using the FFA. Briefly, the virus culture is inoculated onto Vero cells and incubated for 2-3 days. Foci formation is then determined after optimized staining processes, including cell fixation, permeabilization, blocking, antibody binding, and incubation with peroxidase substrate. The stained virus foci are visualized using a stereo microscope (manual counting in 24-well format) or software analyzer (automated counting in 96-well format). The FFA provides reproducible, relatively fast results (3-4 days) and is suitable to be used for different viruses, including non-plaque-forming viruses. Subsequently, this protocol is useful for the study of ZIKV infection and could be used to detect other clinically important viruses.
  12. Wong JE, Zainal N, AbuBakar S, Tan KK
    J Vis Exp, 2023 May 05.
    PMID: 37212555 DOI: 10.3791/64887
    Endothelial cells line the inner surface of all blood and lymphatic vessels, creating a semi-permeable barrier regulating fluid and solute exchange between blood or lymph and their surrounding tissues. The ability of a virus to cross the endothelial barrier is an important mechanism that facilitates virus dissemination in the human body. Many viruses are reported to alter endothelial permeability and/or cause endothelial cell barrier disruption during infection, which is able to cause vascular leakage. The current study describes a real-time cell analysis (RTCA) protocol, using a commercial real-time cell analyzer to monitor endothelial integrity and permeability changes during Zika virus (ZIKV) infection of the human umbilical vein endothelial cells (HUVECs). The impedance signals recorded before and after ZIKV infection were translated to cell index (CI) values and analyzed. The RTCA protocol allows the detection of transient effects in the form of cell morphological changes during a viral infection. This assay could also be useful for studying changes in the vascular integrity of HUVECs in other experimental setups.
  13. Lee ST, Wong JE, Shanita SN, Ismail MN, Deurenberg P, Poh BK
    Int J Environ Res Public Health, 2015 Jan;12(1):146-61.
    PMID: 25546277 DOI: 10.3390/ijerph120100146
    Childhood obesity is related to low physical activity level and a sedentary lifestyle. The aim of this study was to assess the physical activity level and sedentary behaviour of Malaysian children aged 7 to 12 years and to examine their association with body mass index (BMI), BMI-for-age Z-score (BAZ), body fatness (%BF) and waist circumference (WC). A total of 1736 children, representing all ethnic groups were recruited from six regions of Malaysia. Anthropometric measurements included body weight, height and waist circumference. Body fat percentage (%BF) was assessed using bioelectrical impedance. Physical activity was assessed by a physical activity questionnaire (PAQ) in all children and by pedometers in a subsample (n = 514). PAQ score and pedometer step counts were negatively associated with BMI, BAZ, %BF and WC after adjusting for covariates. Screen time was positively associated with BAZ and WC. However, other sedentary activities were not significantly related with any anthropometric indicators. Strategies to promote active living among children in Malaysia should focus not only on increasing physical activity but also emphasise reduction in sedentary behaviours.
    MESH: screen time
  14. Clark EM, Quigg R, Wong JE, Richards R, Black KE, Skidmore PM
    Health Place, 2014 Nov;30:78-85.
    PMID: 25218636 DOI: 10.1016/j.healthplace.2014.08.008
    Using a sample of adolescents from schools in Otago, New Zealand, associations between food outlets around schools and dietary quality were investigated. Food outlet environment data were derived using GIS data. Multivariate regression analysis results showed that outlet density, in an 800m buffer around schools, of cafes and restaurants, supermarkets and takeaways was associated with higher Diet Quality Index scores in boys, and distance to nearest outlet for convenience stores, cafes and restaurants and supermarkets with lower scores for girls. Effect sizes were small, suggesting that the food environment around schools plays a minor role in adolescent diet quality.
  15. Tsiountsioura M, Wong JE, Upton J, McIntyre K, Dimakou D, Buchanan E, et al.
    Eur J Clin Nutr, 2014 Jun;68(6):700-6.
    PMID: 24424079 DOI: 10.1038/ejcn.2013.286
    BACKGROUND/OBJECTIVES: In the era of modern multidisciplinary clinical management, very little is known about the prevalence and presentation of malnutrition in children with gastrointestinal disorders (GastroD) particularly employing composite, global measures of nutritional status.
    SUBJECTS/METHODS: Anthropometry, body composition, dietary intake, eating habits and grip strength were assessed with bedside methods in 168 patients from outpatient gastroenterology clinics (n, median (IQR) years; Crohn's disease (CD): n=53, 14.2 (11.6:15.4); ulcerative colitis (UC): n=27, 12.2 (10.7:14.2); coeliac disease: n=31, 9.3 (7.5:13.6); other GastroD: n=57, 9.8 (7.2:13.8)) and compared with 62 contemporary healthy controls (n, median (IQR): 9.8 (6.9:13.8)) and the results of the recent UK, National Diet and Nutritional Survey (NDNS).
    RESULTS: Children with CD had lower BMI z-scores than controls (median (IQR): -0.3 (-0.9:0.4) vs 0.3 (-0.6:1.4); P=0.02) but only 2% were classified as thin (BMI z-score
  16. Lee ST, Wong JE, Ong WW, Ismail MN, Deurenberg P, Poh BK
    Asia Pac J Public Health, 2016 07;28(5 Suppl):21S-34S.
    PMID: 27026634 DOI: 10.1177/1010539516638155
    Children's physical activity has been correlated with child characteristics and social or physical environment. This study aimed to compare preschoolers' physical activity among various sociodemographic characteristics and to determine barriers, motivators, and environmental factors for active play. A total of 835 preschoolers were included in this analysis. Time spent on active play, quiet play, and screen time was reported by parents. Boys spent significantly more time on active play and screen time than girls. Time spent on quiet play was highest in East Coast Peninsular Malaysia and lowest in Sarawak. Some 40% of children achieved active play recommendation while 27% exceeded daily screen time recommendation. Most parents reported that their child played actively in the house area; and that the main barrier and motivator to active play were safety and child's enjoyment, respectively. These findings demonstrate that sociodemographic characteristics and environment should be considered in designing physical activity intervention programs.
    MESH: screen time
  17. Higgins S, Stoner L, Lubransky A, Howe AS, Wong JE, Black K, et al.
    Sleep Med, 2020 11;75:163-170.
    PMID: 32858356 DOI: 10.1016/j.sleep.2020.07.030
    INTRODUCTION: Cardiorespiratory fitness (CRF) is a vital sign that can improve risk classification for adverse health outcomes. While lifestyle-related factors are associated with CRF, few have examined the influence of sleep characteristics, especially in youths. Social jetlag, a mismatch between one's biological clock and sleep schedule, is prevalent in adolescents and associated with increased adiposity, though its relationship with CRF is unclear.

    OBJECTIVE: To quantify the relationship between social jetlag and CRF, independent of other sleep characteristics.

    METHODS: This cross-sectional sample includes 276 New Zealand adolescents (14-18 years, 52.5% female). CRF (VO2max) was estimated from a 20-m multi-stage shuttle run. Average sleep duration, sleep disturbances, social jetlag, physical activity, and the number of bedroom screens were estimated from validated self-report surveys. Social jetlag is the difference in hours between the midpoint of sleep during weekdays (school) and weekend days (free). Combined and sex-stratified linear regression assessed the association between sleep outcomes and CRF, controlling for relevant covariates.

    RESULTS: Males slept 17.6 min less, had less sleep disturbances, and a 25.1-min greater social jetlag than their female peers (all p 

  18. Chan CMH, Wong JE, Wee LH, Jamil NA, Yeap LLL, Swarna Nantha Y, et al.
    Occup Med (Lond), 2020 Sep 09;70(6):400-406.
    PMID: 32537649 DOI: 10.1093/occmed/kqaa107
    BACKGROUND: Past research on work engagement has focused almost exclusively on either psychological or work-related factors in almost wholly separate literature. There is therefore a need to examine how these factors collectively influence work engagement.

    AIMS: To determine levels of work engagement and to identify psychological and work-related characteristics predicting work engagement in employees in Malaysia.

    METHODS: We recruited 5235 employees from 47 public and private organizations in Malaysia who responded to an online health survey. We assessed work engagement with the 9-item Utrecht Work Engagement Scale (UWES-9) and psychological distress using the 6-item Kessler scale. We performed multiple linear regression to determine predictors of work engagement.

    RESULTS: Employee mean age was 33.8 years (standard deviation [SD] ± 8.8). The mean work engagement score on the UWES-9 was 3.53 (SD ± 0.94). Eleven of 18 variables on multiple regression predicted work engagement, F(18, 4925) = 69.02, P < 0.001, R2 = 0.201. Factors that predicted higher work engagement were age, marital status, education level, job type, job permanency, longer sleep duration, lower psychological distress and no history of workplace bullying.

    CONCLUSIONS: Key factors associated with poorer work engagement in Malaysian employees include inadequate sleep, psychological distress and a history of workplace bullying. These are modifiable factors that individuals and employers can target to improve work engagement, ideally tailored according to occupational type.

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