Association between adherence to 24-h movement guidelines and sociodemographic factors among Malaysian preschoolers: Findings from SEANUTS II Malaysia.

BACKGROUND: Adhering to 24-h movement guidelines (24-hMG) have health benefits for young children; yet research on Malaysian preschoolers' movement behaviors is limited. This study investigates the association between adherence to 24-hMG and sociodemographic factors of Malaysian preschoolers. METHODS: Data from 939 preschoolers aged 3-6 years (mean age = 4.83 ± 0.04 years, 53.7% boys) from the Second South East Asian Nutrition Surveys (SEANUTS II) Malaysia study was analyzed. Socio-demography, physical activity, sedentary behaviors, and sleep were parent-reported via questionnaire. Associations between adherence of 24-hMG and sociodemographic factors were analyzed using complex samples logistic regression. RESULTS: Only 12.1% of preschoolers adhered to the overall 24-hMG, and 67.1%, 54.7%, and 42.7% of preschoolers adhered to physical activity, sleep, and sedentary behavior guidelines, respectively; while 6.8% did not meet any guidelines. Compared to 3-4-year olds, preschoolers aged 5-6 years had higher odds of adhering to physical activity guidelines, sedentary behavior guidelines, and overall 24-hMG, but lower odds of adhering to sleep guidelines. Chinese and Indian preschoolers were more likely to adhere to sedentary behavior guidelines than Malay preschoolers; however, Chinese preschoolers had lower odds of adhering to physical activity guidelines. Paternal tertiary education was associated with a higher likelihood of adherence to sleep guidelines. CONCLUSION: Our findings suggest that adherence to 24-hMG among Malaysian preschoolers is associated with age, ethnicity, and paternal education level. This underscores the importance of targeted interventions and health awareness program to promote healthy movement behaviors, particularly among children under 5, ethnic minorities, and educationally disadvantaged families.

South East Asian Nutrition Surveys II (SEANUTS II) Thailand: Triple burden of malnutrition among Thai children aged 6 months to 12 years.

OBJECTIVE: This study assessed nutritional status among Thai children using anthropometry, dietary intakes, and micronutrient status. DESIGN: Cross-sectional survey with multi-stage cluster sampling. Body weight and height were measured in all children. Dietary intakes were assessed using 24-hour dietary recall. Biochemical assessment was performed in one-third of the children. SETTING: The study was conducted in Thailand's four geographical regions and Bangkok. PARTICIPANTS: 3478 Thai children aged 0.5-12.9 years. RESULTS: Stunting showed a downward trend by age group and was most prevalent among infants and toddlers. Overweight and obesity showed a significant upward trend by age group, location, and sex, and was highest among children aged 7-12.9 years. Risks of inadequate micronutrient intakes (calcium, iron, zinc, vitamins A, C, and D) were high (53.2-93.6%). Prevalence of zinc and mild vitamin A deficiencies were low; vitamin D and B12 deficiencies were nil. Vitamin D insufficiency was significantly higher in the urban area and among girls aged 7-12.9 years. Anemia was very high in infants and toddlers (56.6 and 35.2%), but showed a significant downward trend by age group. There was an overall high prevalence of iron deficiency without anemia (25%) versus iron deficiency anemia (4.2%) among children aged 4-12.9 years old. CONCLUSIONS: The high prevalence of stunting and anemia among children aged 1-3.9 years and overweight and obesity among children aged 7-12.9 years requires continued attention. While prevalence of biochemical micronutrient deficiencies was not high (except for iron), high prevalence of dietary inadequacies for several micronutrients warrants further in-depth investigations.

Triple burden of malnutrition among Vietnamese 0·5-11-year-old children in 2020-2021: results of SEANUTS II Vietnam.

OBJECTIVE: SEANUTS II Vietnam aims to obtain an in-depth understanding of the nutritional status and nutrient intake of children between 0.5-11.9 years old. DESIGN: Cross-sectional survey. SETTING: A multistage cluster systematic random sampling method was implemented in different regions in Vietnam: North Mountainous, Central Highlands, Red River Delta, North Central and Coastal Area, Southeast and Mekong River Delta. PARTICIPANTS: 4001 children between 6 months and 11.9 years of age. RESULTS: Prevalence of stunting and underweight was higher in rural than in urban children, whereas overweight and obese rates were higher in urban areas. 12.0% of the children had anemia and especially children 0.5-1-year-old were affected (38.6%). Low serum retinol was found in 6.2% of children ≥ 4 years old. Prevalence of vitamin D insufficiency was 31.1% while 60.8% had low serum zinc. For nutrient intake, overall, 80.1% of the children did not meet the estimated energy requirements. For calcium intake, ∼60% of the younger children did not meet the RNI while it was 92.6% in children >7 years old. For vitamin D intake, 95.0% of the children did not meet RNI. CONCLUSIONS: SEANUTS II Vietnam indicated that overnutrition was more prevalent than undernutrition in urban areas, while undernutrition was found more in rural areas. The high prevalence of low serum zinc, vitamin D insufficiency and the inadequate intakes of calcium and vitamin D are of concern. Nutrition strategies for Vietnamese children should consider three sides of malnutrition and focus on approaches for the prevention malnutrition.

South East Asian Nutrition Surveys (SEANUTS) II - a multi-country evaluation of nutrition and lifestyle indicators in children aged 12 years and below: Rationale and Design.

OBJECTIVE: To assess the nutritional status, growth parameters and lifestyle behaviours of children between 0.5-12 years in nationally representative samples in Malaysia, Indonesia, Thailand, and Vietnam. DESIGN: A cross-sectional study was conducted in the four countries, between May 2019 and April 2021. Data collected can be categorized into four categories: (1) Growth - anthropometry, body composition, development disorder, (2) Nutrient intake and dietary habits - 24-hour dietary recall, child food habits, breast feeding and complementary feeding, (3) Socio-economic status - food insecurity and child health status/environmental, and (4) Lifestyle behaviours - physical activity patterns, fitness, sunlight exposure, sleep patterns, body image and behavioural problems. Blood samples were also collected for biochemical and metabolomic analyses. With the pandemic emerging during the study, a COVID-19 questionnaire was developed and implemented. SETTING: Both rural and urban areas in Malaysia, Indonesia, Thailand, and Vietnam. PARTICIPANTS: Children who were well, with no physical disability or serious infections/injuries and between the age of 0.5-12 years old were recruited. RESULTS: The South East Asian Nutrition Surveys II recruited 13,933 children. Depending on the country, data collection from children were conducted in schools and commune health centres, or temples, or sub-district administrative organizations. CONCLUSIONS: The results will provide up-to-date insights into nutritional status and lifestyle behaviours of children in the four countries. Subsequently, these data will facilitate exploration of potential gaps in dietary intake among Southeast Asian children and enable local authorities to plan future nutrition and lifestyle intervention strategies.

Association of breakfast skipping on nutrient intake and adiposity in Malaysian children: Findings from SEANUTS II.

Malaysian children often skip breakfast, an important meal providing essential nutrients for optimal growth and maintaining proper nutritional status. Therefore, this study aims to investigate the associations between breakfast skipping with dietary intake, diet quality, and adiposity indicators among primary schoolchildren aged 6.0-12.9 years. This study involved 1383 children from the South East Asian Nutrition Surveys (SEANUTS II) Malaysia. Information collected through questionnaires included sociodemography and breakfast consumption, defined as the first meal before noon. Breakfast skipping was identified as skipping breakfast at least once a week. Anthropometric measures, including height, body weight, and waist circumference, as well as percentage of body fat, were collected. Body mass index (BMI) and waist-to-height ratio were calculated, and BMI-for-age-z-scores was determined using WHO (2007) growth reference. A one-day 24-hour dietary recall was employed to assess dietary intake, and diet quality was analyzed using Malaysian Healthy Eating Index. Binary logistic regression was applied to examine relationship between breakfast skipping on diet quality and adiposity indicators. Over one-third (36.0%) of children skipped breakfast at least once a week, resulting in lower intakes of energy, nutrients, cereals/grains, vegetables, and milk/dairy products, though not affecting total diet quality score. Breakfast skipping was associated with higher odds of overweight/obesity (aOR 2.04, 95%CI: 1.52-2.76) and central obesity (aOR 1.87, 95%CI 1.34-2.61). In conclusion, primary schoolchildren in Peninsular Malaysia who skipped breakfast tended to have lower consumption of nutrients and specific basic food groups, as well as increased body fat. This study highlights the importance of continuing to educate parents and children about healthy eating habits, especially the need to adhere to dietary recommendations, with an emphasis on breakfast consumption.

Triple burden of malnutrition among Malaysian children aged 6 months to 12 years: Current findings from SEANUTS II Malaysia.

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.

A randomized controlled trial of different young child formulas on upper respiratory and gastrointestinal tract infections in Chinese toddlers.

BACKGROUND: Bioactive proteins and human milk oligosaccharides (HMOs), important ingredients in breast milk, that protect against infections are lacking in young child formula (YCF). This study investigated the effects of new YCFs on respiratory and gastrointestinal infections in toddlers. METHODS: Four hundred and sixty one healthy Chinese children aged 1-2.5 years were recruited in this randomized, controlled, double-blind, parallel-group clinical trial of different YCFs. They were randomly assigned to either standard milk formula (YCF-Ref) or one of three new YCFs containing bioactive proteins and/or the HMO 2'-fucosyllactose (2'-FL) and/or milk fat for six months. Primary outcomes were incidence of upper respiratory tract infection (URTI) and duration of gastrointestinal tract infections (GITI). RESULTS: There were no significant between-group differences in primary outcomes. For secondary outcomes, subjects receiving 2'-FL-supplemented YCF had longer URTI. Subjects receiving YCF supplemented with milk fat and intact bioactive proteins, and 2'-FL at levels found in breast milk, had more GITI episodes and shorter time to first GITI but similar effects on URTI duration than YCF-Ref recipients. No effects on URTI and GITI were observed in toddlers receiving YCF with bioactive proteins at lower levels than breast milk. Occurrence of adverse events and anthropometry were similar in all groups. CONCLUSIONS: All three YCFs supplemented with different combinations of intact bioactive proteins, 2'-FL, and milk fat are safe in toddlers. No difference is detected among YCFs on URTI incidence and GITI duration. Further studies are needed to verify these findings especially in infants who may benefit most from the immune-boosting effects of bioactive proteins and HMOs.

Attitudes & beliefs that influence healthy eating behaviours among mothers of young children in Singapore: A cross-sectional study.

BACKGROUND: Many countries recommend parental involvement to enhance the effectiveness of healthy lifestyle interventions focusing on behavioural modifications that encourage weight management in children. Our study investigates to what extent the different constructs of the Theory of Planned Behaviour (TPB) are influencing healthy eating behaviour among mothers of pre-school and primary school children in Singapore. METHODS: A total of 716 mothers of pre-schoolers, 3-6 years old (N = 358) and primary school students, 7-12 years old (N = 358) were administered a survey to assess healthy eating behaviour using the TPB constructs. Bivariate correlations among TPB constructs were calculated and tested using Pearson's correlation. Multivariate generalized regression was performed to examine the associations between TPB constructs and healthy eating behaviour. RESULTS: More than 80% of children consumed less than the daily recommended servings of at least 1 glass of dairy,2 servings of fruit and 2 servings of vegetables per day advised by the Singapore Health Board. More primary school children consumed less dairy per day compared to pre-school children (48.9% vs 26.3%; p < 0.001). Primary school children's healthy eating behaviours were correlated with mother's perceived behavioural control (PBC) such as adequate discipline (ß = 0.40; p = 0.001), self-efficacy (ß = 0.35; p = 0.01) and a lower barrier that healthy food does not satisfy hunger (ß = -1.16; p < 0.001). Barriers that significantly reduced pre-school children's healthy food intake were lack of motivation among mothers (ß = -1.13; p < 0.001) and children (ß = -0.49; p = 0.02), lack of satiety (ß = -1.06; p = 0.02), difficulty in changing child's eating habits (ß = -0.58; p = 0.03), lack of family support (ß = -0.62; p = 0.03). CONCLUSIONS: Findings from this study provides a formative foundation for future research and exploration of plausible interventions around improving mother's PBC, self-efficacy and reducing barriers, which could increase mother's engagement in improving their children's healthy eating behaviours in Singapore.

FACTORS ASSOCIATED WITH VITAMIN D STATUS AMONG THAI CHILDREN AGED 3-13 YEARS.

The impact of vitamin D status on bone health and other health conditions is receiving increasingly attention. We aimed to determine the association between environmental factors and vitamin D intake by examining serum 25-hydroxy vitamin D [25(OH)D] levels in Thai children. We conducted a cross sectional study among 477 Thai children from 4 regions in Thailand. Vitamin D intake was assessed using a self-administered questionnaire completed by the older children or by the parents for younger children. Dietary vitamin D intake was assessed using a semi-quantitative food frequency questionnaire. A serum 25(OH)D level was examined for each subject using a chemiluminescence immunoassay. We used structural equation modeling (SEM) to assess the association between studied factors and the serum 25(OH)D level. The final model showed a significant association between sunlight exposure and the serum 25(OH)D level (ß = 0.65, p < 0.01), but not between dietary vitamin D intake and the serum 25(OH)D level (p = 0.01, p = 0.77), suggesting sunlight exposure is more important for the vitamin D status than dietary vitamin D intake.

Low Sleeping Time, High TV Viewing Time, and Physical Inactivity in School Are Risk Factors for Obesity in Pre-Adolescent Thai Children.

OBJECTIVE: Explore the association between physically active behavior and obesity in 7- to 12-years-old Thai children. MATERIAL AND METHOD: As part of SEANUTS Thailand, information on anthropometry, physical activity, and sociodemographic variables were collected in 7- to 12-years-old urban and rural Thai children. Multi-stage sampling technique was used and 1,345 children (32% urban, and 50.3% boys) participated in the study. Anthropometric measurements included weight, height, and BMI-for-age Z-scores (BAZ) using World Health Organization Growth Reference. Obesity was defined as BAZ > 2SD. Physical activity was assessed using a validated physical activity questionnaire (PAQ). The PAQ provided an activity score, activity time in school, sleeping hours, and TV watching time as categorical variable, low, moderate, and high. Chi-square by likelihood ratio test and logistic regression were used to compare obese and non-obese groups. RESULTS: The overall prevalence of overweight and obesity was 10.2 and 10.8% respectively, whereas 8.2% was classified as thin. Maternal education and religion did not differ between obese and non-obese children. However, obese children's family income was higher. After controlling for family income, maternal education, and religion, obese children were significantly less active during break times in school, slept less, and watched more TV than non-obese. However, there was no difference in the activity score of obese and non-obese children. CONCLUSION: The study showed that physical activity during break time in school, sleep duration, and hours of TV viewing were associated with obesity in pre-adolescent Thai children. It is important to note that activity score was not associated with obesity. One of the most important benefits to be physically active in childhood is the potential to maintain this behavior into adulthood. Therefore, programs that encourage healthy behaviors and address these modifiable risk factors should be incorporated in the school curriculum.

A cross-sectional study on the dietary patterns of multiethnic Malaysian preschoolers and their sociodemographic determinants.

Early childhood is a critical developmental stage where established dietary patterns can impact lifelong health outcomes. This study investigates dietary patterns and their relationships with sociodemographic factors among Malaysian preschoolers. A total of 643 preschoolers of Malay, Indian, Chinese and other ethnicities participating in South East Asian Nutrition Surveys (SEANUTS II) were included. Dietary intake was assessed using a single triple-pass 24-h dietary recall method. Dietary patterns were derived using principal component analysis and their association with sociodemographic factors was determined using complex sampling logistic regressions. Five dietary patterns were identified: "healthy eating," "wholegrains and starchy vegetables," "high salt and sugar," "Western food," and "sugary drinks and legumes". Having older siblings was inversely associated with a "healthy eating" pattern (adjusted OR: 0.54, 95% CI: 0.33-0.87). Malay ethnicity was associated with higher odds of adhering to the "high salt and sugar" pattern (adjusted OR: 4.12, 95% CI: 2.20-7.75). Meanwhile, children living in urban areas (adjusted OR: 1.76, 95% CI: 1.03-3.01), those from middle-income families (adjusted OR: 3.20, 95% CI: 1.38-7.40) and whose fathers were overweight (adjusted OR: 2.79, 95% CI: 1.58-4.94) showed a higher association with "Western food" pattern. Conversely, children whose mothers had overweight were less likely to adhere to the "Western food" pattern (adjusted OR: 0.50, 95% CI: 0.30-0.83). Older age was significantly associated with a greater likelihood of the "sugary drinks and legumes" pattern (adjusted OR: 3.99, 95% CI: 1.75-9.06). There was no significant association between "wholegrains and starchy vegetables" pattern with sociodemographic characteristics (all p > 0.05). These findings suggest that ethnicity, age, residence area, having older siblings, parental weight status and household income level are associated with dietary patterns among multiethnic preschoolers in Malaysia. Thus, these sociodemographic characteristics should be considered when designing targeted dietary strategies and interventions for preschoolers.

Food consumption and nutritional and biochemical status of 0·5-12-year-old Indonesian children: the SEANUTS study.

Indonesia is currently facing the double burden of malnutrition. While undernutrition is still a major public health problem, the prevalence of overnutrition is increasing. The objective of the South East Asian Nutrition Survey (SEANUTS) was to provide up-to-date data on nutritional status, food consumption and biochemical parameters related to nutrition for children aged 0·5-12 years. The SEANUTS study in Indonesia was conducted in a nationwide representative sample of 7·211 children using multistage cluster sampling based on probability proportional to size, stratified for geographical location, in forty-eight out of 440 districts/cities. The results show that the growth (weight for age, height for age, weight for height and BMI for age) of Indonesian pre-school- and school-aged children is below the WHO standards. The older the children, the more the deviation from the WHO standard curves. Underweight was more prevalent in rural areas (28·9 v. 19·2%) and overweight/obesity was observed to be more widespread in urban areas (5·6 v. 3·2%). The prevalence varied with age groups and sexes. The overall prevalence of stunting was 25·2 and 39·2% in urban and rural areas, respectively. The prevalence of anaemia was nearly 55% in children aged 0·5-1·9 years and ranged from 10·6 to 15·5% in children aged 2-12 years. Fe deficiency was observed in 4·1-8·8% of the children. The percentage of children with dietary intakes of energy, protein, and vitamins A and C below the Indonesian RDA was high and differed across urban and rural areas and age groups.

SEANUTS: the nutritional status and dietary intakes of 0.5-12-year-old Thai children.

In the present study, we investigated nutritional status and health-related factors in a multistage cluster sample of 3119 Thai urban and rural children aged 0·5-12·9 years. In a subsample, blood samples were collected for the measurement of Hb, transferrin receptor, vitamin A and vitamin D concentrations. The prevalence of stunting and underweight was higher in rural children than in urban children, whereas the wasting rate was similar in both rural and urban areas. Among children aged 3·0-5·9 years, the prevalence of overweight was significantly higher in urban areas than in rural areas and so was the obesity rate in children aged 6·0-12·9 years. Protein intakes of all age groups were relatively high in both the areas. Intakes of Ca, Fe, Zn and vitamin C were significantly higher in urban areas than in rural areas. The prevalence of anaemia in rural areas was twice as high as that in urban areas, particularly in infants and young children. However, the prevalence of Fe-deficiency anaemia was similar in both urban and rural areas. While the prevalence of vitamin A deficiency (by serum retinol cut-off < 0·7 µmol/l) seemed to be very low, vitamin A insufficiency (by serum retinol cut-off < 1·05 µmol/l) was more prevalent (29·4-31·7%) in both the areas. The prevalence of vitamin D insufficiency ranged between 27·7 and 45·6% among the children. The present study indicates that the double burden of malnutrition is still a major public health problem in Thailand. Further studies need to explore the associated risk factors for these nutrient deficiencies. Effective strategies and actions are needed to tackle the nutritional problems in Thai children.

Double burden of undernutrition and overnutrition in Vietnam in 2011: results of the SEANUTS study in 0·5-11-year-old children.

The Vietnamese South East Asian Nutrition Survey (SEANUTS), a cross-sectional study, was undertaken to assess the nutritional status in a nationally representative sample of children aged 0·5-11·9 years. A multi-stage cluster-randomised sampling method was used to recruit 2872 children. Anthropometric measurements included weight, height, mid-upper arm circumference, and waist and hip circumferences. Blood biochemistry involved analyses of Hb, serum ferritin, and vitamins A and D. Dietary intake was assessed using a 24 h recall questionnaire, and nutrient intakes were compared with the Vietnamese RDA. In children aged < 5 years, approximately 14% were stunted, 8·6% underweight and 4·4% thin. A higher prevalence of stunting (15·6%) and underweight (22·2%) was observed in school-aged children. Undernutrition was more prevalent in rural areas than in urban areas. In contrast, almost 29% of the urban children were either overweight or obese when compared with 4% of the overweight children and 1·6% of the obese children in rural areas. A higher percentage of children in the age group 0·5-1·9 years and residing in rural areas had low Hb levels than those in the age group 2·0-5·9 years and residing in urban areas. In children aged 6-11 years, a small percentage had low Hb (11-14%) and vitamin A (5-10%) levels, but almost half the children (48-53%) had vitamin D insufficiency. Food consumption data indicated that the children did not meet the RDA for energy, protein, Fe, vitamin A, vitamin B1 and vitamin C. Results from the SEANUTS highlight the double burden of malnutrition in Vietnam. Information from the SEANUTS can serve as an input for targeted policy development, planning and development of nutrition programmes.

Design of the South East Asian Nutrition Survey (SEANUTS): a four-country multistage cluster design study.

Nutrition is a well-known factor in the growth, health and development of children. It is also acknowledged that worldwide many people have dietary imbalances resulting in over- or undernutrition. In 2009, the multinational food company FrieslandCampina initiated the South East Asian Nutrition Survey (SEANUTS), a combination of surveys carried out in Indonesia, Malaysia, Thailand and Vietnam, to get a better insight into these imbalances. The present study describes the general study design and methodology, as well as some problems and pitfalls encountered. In each of these countries, participants in the age range of 0·5-12 years were recruited according to a multistage cluster randomised or stratified random sampling methodology. Field teams took care of recruitment and data collection. For the health status of children, growth and body composition, physical activity, bone density, and development and cognition were measured. For nutrition, food intake and food habits were assessed by questionnaires, whereas in subpopulations blood and urine samples were collected to measure the biochemical status parameters of Fe, vitamins A and D, and DHA. In Thailand, the researchers additionally studied the lipid profile in blood, whereas in Indonesia iodine excretion in urine was analysed. Biochemical data were analysed in certified laboratories. Study protocols and methodology were aligned where practically possible. In December 2011, data collection was finalised. In total, 16,744 children participated in the present study. Information that will be very relevant for formulating nutritional health policies, as well as for designing innovative food and nutrition research and development programmes, has become available.

Nutritional status and dietary intakes of children aged 6 months to 12 years: findings of the Nutrition Survey of Malaysian Children (SEANUTS Malaysia).

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.

Temporal Changes in Breast Milk Fatty Acids Contents: A Case Study of Malay Breastfeeding Women.

The composition of human breast milk changes in the first two months of life, adapting itself to the evolving needs of the growing new-born. Lipids in milk are a source of energy, essential fatty acids (FA), fat-soluble vitamins, and vital bioactive components. Information on breast milk FA of Malaysian lactating women is scarce. Based on convenience sampling, a total of 20 Malay breastfeeding women who fulfilled the inclusion criteria were recruited. Breast milk was collected three times from each subject at consecutive intervals of 2-3 weeks apart. A total of 60 breast milk samples were collected and classified into "transitional milk" (n = 8), "early milk" (n = 26) and "mature milk" (n = 26). All milk samples were air freighted to University of Groningen, Netherlands for analysis. The dominant breast milk FA were oleic acid, constituting 33% of total fatty acids, followed by palmitic acid (26%). Both these FA and the essential FA, linoleic acid (10%) and alpha-linolenic acid (0.4%), showed no significant changes from transitional to mature milk. Breast milk ratio of n-6:n-3 polyunsaturated fatty acids (PUFA) was comparatively high, exceeding 10 throughout the lactation period, suggesting a healthier balance of PUFA intake is needed in pregnancy and at postpartum.

Association of energy intake and physical activity with overweight among Indonesian children 6-12 years of age.

BACKGROUND AND OBJECTIVES: Indonesia is currently facing double burden malnutrition in children. As overweight and obesity are due to a disturbed energy balance, this study aimed to assess the association of total energy intake and physical activity with the prevalence of overweight among Indonesian children. METHODS AND STUDY DESIGN: The data used for this analysis were from 1143 children, 6-12 years old, that participated in the South East Asian Nutrition Survey (SEANUTS). Physical activity (PA) was measured using pedometers for 2 consecutive days and was categorized low, moderate and high. Child nutritional status was categorized based on body mass index for age z-scores (BAZ) into normal weight (-2 SD ≤BAZ≤1 SD) or overweight (BAZ >1 SD). Energy intake was calculated from a one day 24 hour recall and compared to the Indonesian recommended dietary allowance (RDA) for energy. RESULTS: Children with low PA had higher risk (ODDs 3.4, 95% CI: 2.0, 6.0) of being overweight compared to children who had high PA. Children with moderate PA and energy take >100% RDA had higher risk (ODDs 4.2, 95% CI 1.9, 9.3) of being overweight than children with high PA and energy intakes ≤100% RDA. CONCLUSIONS: Low physical activity independently or moderate physical activity and high energy intake are risk factors for Indonesian children to get overweight. Program intervention such as increasing physical activity at school and home is needed to reduce overweight among children.

The Consumption of Dairy and Its Association with Nutritional Status in the South East Asian Nutrition Surveys (SEANUTS).

Despite a major decrease in undernutrition worldwide over the last 25 years, underweight and stunting in children still persist as public health issues especially in Africa and Asia. Adequate nutrition is one of the key factors for healthy growth and development of children. In this study, the associations between dairy consumption and nutritional status in the South East Asian Nutrition Survey (SEANUTS) were investigated. National representative data of 12,376 children in Indonesia, Malaysia, Thailand, and Vietnam aged between 1 and 12 years were pooled, representing nearly 88 million children in this age category. It was found that the prevalence of stunting and underweight was lower in children who consumed dairy on a daily basis (10.0% and 12.0%, respectively) compared to children who did not use dairy (21.4% and 18.0%, respectively) (p < 0.05). The prevalence of vitamin A deficiency and vitamin D insufficiency was lower in the group of dairy users (3.9% and 39.4%, respectively) compared to non-dairy consumers (7.5% and 53.8%, respectively) (p < 0.05). This study suggests that dairy as part of a daily diet plays an important role in growth and supports a healthy vitamin A and vitamin D status.

Prevalence of Anaemia and Iron Deficiency among Primary Schoolchildren in Malaysia.

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.