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  1. Woon Fui Chee, Yu Min Si, Chin Yit Siew
    MyJurnal
    Introduction: This cross-sectional study determines factors associated with the rates of gestational weight gain (GWG) among women in the second and third trimester of pregnancy. Methods: A total of 180 pregnant women (29.2 ± 4.3 years old) attending the maternal and child health clinics in Batu Pahat district were enrolled in the present study be- tween January and February, 2015. Information regarding demographic characteristics, obstetrical history, physical activity, and calorie intake was assessed through direct interview. Anthropometric data were collected from medical records. GWG rates were determined based on 2009 IOM recommendations. Results: Of the 180 pregnant women, 37.2% were at their second trimester and 62.8% were at the third trimester of pregnancy. While 53.3% of them had excessive GWG rate, 28.9% have inadequate GWG rate. More than half of the women (56.7%) were normal weight, 21.1% overweight, 14.4% underweight, and 7.8% obese before pregnant. The total mean activity and energy intake of the pregnant women were 195.9±94.2 MET-hour/week and 2365±709 kcal/day, respectively. The multinomial logistic model indicates that women who were overweight or obese at pre-pregnancy were seven times more likely to have excessive GWG rate (OR = 7.44, 95% CI = 2.07-26.66) as compared to women who were pre-pregnancy normal weight. Conclusions: About four in every five of the pregnant women had their GWG rates outside the IOM recommendations. Women who were overweight/obese at pre-pregnancy were at-risk of having excessive GWG rate, which underlines the importance of targeting these women for pre-conception counselling on GWG.
  2. Chin YS, Woon FC, Chan YM
    PLoS One, 2022;17(1):e0262332.
    PMID: 35041712 DOI: 10.1371/journal.pone.0262332
    BACKGROUND: The COVID-19 pandemic lockdowns have affected daily lives of the communities worldwide. This study aims to determine the lifestyle behaviours and their associations with body weight changes among Malaysian adults during the Movement Control Order (MCO) due to COVID-19 pandemic.

    METHODS: A total of 1319 Malaysian adults participated in this cross-sectional online survey. Information on anthropometric data including body weight and height, and lifestyle behaviours including eating pattern, physical activity, and sleep pattern were self-reported by the respondents. A multivariable generalised linear mixed model was used to assess the associations between lifestyle behaviours and body weight changes with adjustment of confounding factors; namely, age, sex, ethnicity, and body weight status before MCO.

    RESULTS: During MCO, 41.2% of the respondents perceived that their eating patterns were healthier, but 36.3% reduced their physical activities, and 25.7% had a poorer sleep quality. Further, the proportion of adults who reported having lose weight (32.2%) was almost similar to those who reported having gained weight (30.7%). Lifestyle behaviours including less frequent practice of healthy cooking methods and lunch skipping were associated with weight gain, while less frequent consumption of high fat foods, more frequent physical activity, and good sleep latency were associated with lower risk of weight gain. In contrast, practicing healthy eating concept, skipped lunch, and more frequent physical activity were significantly associated with weight loss.

    CONCLUSION: Lifestyle behaviours were associated with body weight changes during MCO. While the COVID-19 pandemic lockdown is necessary to prevent further spread of the disease, promoting healthy lifestyle practices during lockdown should be implemented for a healthy weight and better health.

  3. Woon FC, Chin YS, Mohd Nasir MT
    Obes Res Clin Pract, 2015 Jul-Aug;9(4):346-56.
    PMID: 25476772 DOI: 10.1016/j.orcp.2014.10.218
    This paper investigates the association between behavioural factors and BMI-for-age among early adolescents (10-11 years old) in Hulu Langat district, Selangor.
  4. Woon FC, Chin YS, Ismail IH, Abdul Latiff AH, Batterham M, Chan YM, et al.
    Nutrients, 2020 Aug 12;12(8).
    PMID: 32806653 DOI: 10.3390/nu12082418
    Allergic diseases are the most common chronic illness in childhood. Findings from developed countries have reported associations between Vitamin D levels during pregnancy and offspring allergy risk. This prospective cohort study aimed to determine the associations between maternal Vitamin D levels during late pregnancy and allergic diseases in Malaysian infants during the first year of life. Serum 25(OH)D concentrations of 380 pregnant women in the third trimester were measured using a chemiluminescent immunoassay. Children's allergic outcomes were assessed at 3, 6, and 12 months based on parental reports. Specific IgE antibodies against food and inhalant allergens were measured in infants at 12 months of age. A total of 43.2% pregnant women were Vitamin D deficient (<30 nmol/L) and 56.8% were nondeficient (≥30 nmol/L). A total of 27.6% of the infants had eczema, 6.1% had wheeze, 27.4% had food sensitization, 10.8% had inhalant allergen sensitization, and 3.8% had IgE-mediated food allergy during the first year of life. Compared with the nondeficient group, maternal Vitamin D deficiency in late pregnancy was not associated with any allergic outcomes after adjustment for potential confounding factors. In conclusion, the present study does not support an association between maternal Vitamin D levels in late pregnancy and allergic outcomes during the first year of life.
  5. Rezali FW, Chin YS, Mohd Shariff Z, Mohd Yusof BN, Sanker K, Woon FC
    Nutr Res Pract, 2015 Oct;9(5):511-6.
    PMID: 26425281 DOI: 10.4162/nrp.2015.9.5.511
    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.
  6. Edi M, Chin YS, Woon FC, Appannah G, Lim PY, On Behalf Of The Micos Research Group
    PMID: 33530307 DOI: 10.3390/ijerph18031068
    Despite the advancement of the healthcare system, low birth weight (LBW) remains as one of the leading causes of under-five mortality. This cross-sectional study aimed to determine the prevalence of LBW and its associated factors among 483 third trimester pregnant women recruited from six selected public health clinics in the Federal Territory of Kuala Lumpur and the state of Selangor, Malaysia. Pregnant women were interviewed for information on socio-demographic characteristics, smoking behaviour, and second-hand smoke (SHS) exposure at home and in the workplace. Information on the obstetrical history and prenatal care visits history were retrieved from the maternal medical records, while infant's birth outcomes were retrieved from infant medical records. The prevalence of LBW (<2.5 kg) in infants was 10.4%, with a mean birth weight of 3.0 [standard deviation (SD) 0.4] kg. Results from the multivariable logistic regression model showed that inadequate weight gained during pregnancy [odds ratio (OR) = 2.41, 95% confidence interval (CI) = 1.18-4.90] and exposure to SHS at home (OR = 1.92, 95% CI = 1.03-3.55) were significantly associated with LBW. In conclusion, pregnant women should monitor their rate of weight gain throughout pregnancy and avoid SHS exposure at home to reduce the risk of delivering LBW infants.
  7. Woon FC, Chin YS, Ismail IH, Chan YM, Batterham M, Abdul Latiff AH, et al.
    BMC Pediatr, 2018 Jul 18;18(1):233.
    PMID: 30021541 DOI: 10.1186/s12887-018-1219-3
    BACKGROUND: Nutrition and environmental factors are essential for the education of the neonatal immune system. Epidemiological evidence has shown that malnutrition and allergic diseases that occur during early childhood share similar protective and risk factors. This paper describes the protocol of the Mother and Infant Cohort Study (MICOS), which aims to determine the contribution of early nutrition to the development of malnutrition and allergic diseases in infants' first year of life.

    METHODS: MICOS is a prospective cohort study conducted at selected government health clinics in two states, namely Selangor and Wilayah Persekutuan Kuala Lumpur, Malaysia. Women in their third trimester of pregnancy are recruited into the study and their infants will be followed-up at 3, 6, and 12 months of age. Information on prenatal factors including socio-demographic characteristics, obstetric history, pre-pregnancy body mass index, gestational weight gain, smoking, family history of allergic diseases, maternal dietary intake and sunlight exposure during pregnancy are obtained through face-to-face interviews. Postnatal factors including dietary intake, sun exposure, and anthropometric measurements of the mothers, as well as feeding practices, dietary intake, anthropometric measurements, and development of allergic diseases of the infants are assessed at each follow-up. Blood samples are collected from the mothers in the third trimester to determine 25-hydroxyvitamin D levels as well as from the infants at age 12 months to determine atopic sensitisation.

    DISCUSSION: The concept of developmental origins of health and disease (DOHaD) which emphasises on the role of early life environments in shaping future health and disease susceptibility in adulthood has gained a huge interest in recent years. The DOHaD paradigm has influenced many fields of research including malnutrition and allergic diseases. While findings from the developed countries remain controversial, such studies are scarce in developing countries including Malaysia. The present study will determine the cause and effect relationship between early nutrition and the development of malnutrition and allergic diseases in infants' first year of life.

  8. Kaartina S, Chin YS, Fara Wahida R, Woon FC, Hiew CC, Zalilah MS, et al.
    Health Qual Life Outcomes, 2015 Apr 08;13:44.
    PMID: 25889663 DOI: 10.1186/s12955-015-0234-4
    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 R(2) 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 < 0.01). There was no significant difference in total HRQoL score between male and female adolescents (t = 0.858, p > 0.05). Parent proxy-report was negatively associated with the adolescents' BMI-for-age (r = -0.152, p < 0.05) whereas no significant association was found between adolescent self-report and BMI-for-age (r = 0.001, 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.

  9. Woon FC, Chin YS, Ismail IH, Batterham M, Abdul Latiff AH, Gan WY, et al.
    PLoS One, 2019;14(6):e0216439.
    PMID: 31233513 DOI: 10.1371/journal.pone.0216439
    BACKGROUND: Despite perennial sunshine, vitamin D deficiency is prevalent among Malaysians especially pregnant women. This study determines the vitamin D status and its associated factors among third trimester pregnant women attending government health clinics in Selangor and Kuala Lumpur, Malaysia.

    METHODS: Information on socio-demographic characteristics, obstetrical history, and sun exposure were obtained through face-to-face interviews. Vitamin D intake was assessed using a semi-quantitative food frequency questionnaire (FFQ). Serum 25-hydroxyvitamin D concentration was measured and classified as deficient (< 30 nmol/L), insufficient (30-50 nmol/L), and sufficient (≥ 50 nmol/L).

    RESULTS: Of the 535 pregnant women recruited, 42.6% were vitamin D deficient. They consumed an average of 8.7 ± 6.7 μg of vitamin D daily. A total of 80.4% of the vitamin D were obtained from the food sources, while 19.6% were from dietary supplements. Fish and fish products showed the highest contribution to vitamin D intake (35.8%). The multivariable generalized linear mixed models, with clinic as a random effect, indicates that higher intake of vitamin D is associated with lower odds of vitamin D deficiency among pregnant women (OR = 0.96; 95% CI = 0.93-0.99). The odds of having vitamin D deficiency was reduced by 87% in non-Malays (OR = 0.14; 95% CI = 0.05-0.41) compared to Malays. No associations were found between age, educational level, monthly household income, work status, gravidity, parity, pre-pregnancy body mass index, total hours of sun exposure, total percentage of body surface area, and sun exposure index per day with vitamin D deficiency.

    CONCLUSION: Vitamin D deficiency is prevalent among Malaysian pregnant women. Considering the possible adverse obstetric and fetal outcomes of vitamin D deficiency during pregnancy, future nutrition education should emphasise on vitamin D-fortified foods consumption among pregnant women by taking into consideration ethnic differences.
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