Prevalence and Predictors of Overweight and Obesity Among Adolescents in Seremban, Negeri Sembilan, Malaysia

Breakfast Habits, Anthropometry, and Nutrition-Related Outcomes in Adolescents From Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

Breakfast skipping is a commonly reported dietary habit among adolescents despite this life stage marked by critical growth and development. Limited comparable evidence exists from low- and middle-income countries (LMICs), where the detrimental effect of inadequate diets remains a major public health challenge. We conducted a systematic review to assess the scientific evidence available from LMICs regarding the association of breakfast skipping and consumption habits and anthropometry- and nutrition-related outcomes in adolescents 10-19 years old. Electronic searches for relevant studies were conducted on MEDLINE, EMBASE, CINAHL, CENTRAL and Web of Science from the date of database inception until June 28, 2023. Additionally, reference lists of included studies and gray literature were searched. We included studies of all designs that compared breakfast skipping and consumption habits among adolescents aged 10-19 years in LMICs. Exclusion criteria included the following: review articles, if the target population age was outside the WHO definition of adolescents, assessed only lunch or dinner consumption, skipped any other meal besides breakfast, only collected point prevalence data, did not include a breakfast consumer control group, or co-interventions were inconsistent across breakfast habit groups. The primary outcomes were body mass index (BMI in kg/m2), also defined categorically as underweight, normal weight, overweight and obese or as BMI-for-age (z-score) and anemia (defined according to Hemoglobin (Hb) levels in different age groups for boys and girls). Secondary outcomes included other adiposity measures and nutrient concentrations or deficiencies. Title screening, data extraction, and risk of bias assessment were conducted in duplicate. The risk of bias was evaluated using the NHLBI Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Random-effects meta-analysis models were used to pool data for each outcome measure from the included studies. Standardized mean differences with 95% confidence intervals (95% CI) were calculated for continuous outcomes, while odds ratios (OR) with 95% CIs were computed for dichotomous outcomes. The certainty of the evidence for each outcome was appraised using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Our search yielded 3604 records, and 41 studies met our inclusion criteria. Among these, 39 cross-sectional studies and two prospective cohort studies were eligible, with 36 providing data for meta-analysis. Overall, there was very low certainty of evidence regarding the association between breakfast consumption habits and the risk of being overweight/obese, mainly due to the risk of bias and inconsistency. Adolescents who infrequently ate breakfast (0-2 days/week) were twice as likely to be overweight/obese (OR: 2.05, 95% CI: 1.61-2.61; I 2 = 85%; n = 15 studies) compared to regular breakfast consumers (5-7 days/week), while irregular breakfast consumers (3-4 days/week) had 32% higher likelihood of being overweight/obese (OR: 1.32, 95% CI: 1.16-1.50; I 2 = 59%; n = 9 studies). The odds of non-daily breakfast consumers being overweight/obese were 38% higher than daily breakfast consumers (OR: 1.38, 95% CI: 1.19-1.59; I 2 = 54%; n = 10 studies). The odds of developing anemia were significantly higher for adolescents irregularly consuming breakfast compared to regular breakfast consumers (OR: 2.85, 95% CI: 1.71, 4.76; I 2 = 0%), with very low certainty of the evidence from two studies, limited by a very small sample size. Few studies reported on the association of breakfast skipping with other secondary adiposity outcomes (e.g., waist circumferences, waist-to-height ratio). We found very low certainty of evidence that breakfast skipping increases the risk of overweight/obesity and anemia, primarily derived from cross-sectional studies. There is a paucity of evidence regarding breakfast habits and nutritional outcomes among adolescents in LMICs. Further cohort or intervention studies are warranted to elucidate the relationship between breakfast skipping and the risk of overweight/obesity, as well as other anthropometric and adiposity measurements within this demographic. Emphasis should also be placed on evaluating nutritional outcomes as a part of these assessments to better inform public health policy and programming best practices for adolescents to ensure the health and well-being of the next generation. Breakfast integrated within school feeding programs may be well positioned as a double-duty solution to tackle malnutrition in all its forms among adolescents.

Knowledge, attitude, and practice toward cervical spondylosis among the healthy general population

BACKGROUND

This study aimed to investigate the knowledge, attitude and practice (KAP) of the healthy general population toward cervical spondylosis.

METHODS

A cross-sectional study was conducted among healthy individuals at Peking University Third Hospital between May and December 2023, utilizing a self-designed questionnaire.

RESULTS

A total of 506 valid questionnaires were collected, of which 276 (64.94%) were completed by females. The mean scores for knowledge, attitudes, and practices were 4.07 ± 1.24 (range: 0-8), 35.69 ± 3.67 (range: 9-45), and 27.01 ± 4.38 (range: 9-36), respectively. Structural equation modeling (SEM) revealed that knowledge had a direct influence on both attitudes (β = 0.589, P = 0.002) and practices (β = 0.353, P = 0.020). Furthermore, attitudes had a direct effect on practices (β = 0.442, P < 0.001).

CONCLUSION

The healthy general population demonstrated inadequate knowledge, a positive attitude, and suboptimal practices regarding cervical spondylosis. These findings highlight the need for targeted educational interventions to improve public awareness and foster healthier practices in managing cervical spondylosis.

Double burden of malnutrition and its socio-demographic determinants among children and adolescents in Malaysia: National Health And Morbidity Survey 2019

INTRODUCTION

Malaysia faces the threat of a double burden of malnutrition where undernutrition and overweight (including obesity) coexist in the same population. This study aimed to determine the anthropometric assessment among children and adolescents aged 5 to 17 years and its association with socio-demographic factors.

METHODS

Data were extracted from the National Health and Morbidity Survey conducted in 2019. This cross-sectional survey applied a two-stage stratified sampling design. Socio-demographic characteristics were obtained. Weight and height were measured, age- and sex-specific standard scores for height and BMI were calculated to establish individual's anthropometric assessment. Having either stunting or thinness was considered undernutrition, while being overweight (including obesity) was considered overnutrition. If someone had undernutrition and/or overnutrition, they were classified as having malnutrition. The prevalence was determined using complex sampling analysis, while the association was assessed through logistic regression. The analysis included a total of 3,185 respondents.

RESULTS

The prevalence of stunting, thinness, overweight and obesity among the respondents aged 5 to 17 years was 12.7%, 10.0%, 15.0% and 14.8%, respectively. The overall prevalence of malnutrition was 48.3%. Respondents residing in rural had 1.35 times more likelihood of experiencing undernutrition [AOR = 1.35, 95% CI (1.04, 1.77)] compared to their urban counterparts. Boys exhibited a greater likelihood of being overweight and obese than girls [AOR = 1.40, 95% CI (1.13, 1.73)]. Respondents aged 10 to 14 years were 1.37 times more likely to be overnutrition than those aged 5 to 9 years old [AOR = 1.37, 95% CI (1.09, 1.73)].

CONCLUSION

There is growing evidence of the increasing prevalence of coexistence of undernutrition along with overweight and obesity among children and adolescents in Malaysia. Moving forward, greater initiatives and efforts are required to formulate strategies for planning and implementing programs and policies to expedite progress in improving nutrition.

Seasonality, food security, diet quality and nutritional status in urban poor adolescents in Malaysia

Seasonality was shown to have an effect on food availability and accessibility, increasing the risk of food insecurity and causing poor diet quality and malnutrition. Therefore, this study aimed to determine seasonal effects on household food security status, diet quality, and nutritional status of urban poor adolescents in Malaysia. A cohort study was conducted among 164 adolescents aged 10-17 from 12 People Housing Programme in Kuala Lumpur, Malaysia during the Northeast (November 2021 till March 2022) and Southwest (June 2022 till September 2022) monsoon. Household food security status was measured using the 18-item USDA Household Food Security Survey Module. Dietary intake was determined using a two-days 24-h dietary recall and translated into Standardized Malaysian Healthy Eating Index (S-MHEI). Anthropometric and haemoglobin level measurements were performed to determine nutritional status. Seasonality was found to have a significant effect on overall diet quality (p = 0.021), food groups such as fish (p < 0.001), meat/poultry/eggs (p = 0.003), and legumes/nuts (p < 0.001), and fat nutrient (p = 0.037) as well as anaemia status (p = 0.020) after controlling the confounders. Although food security did not vary with seasons, seasonality affected the consumption of certain food groups as well as anaemia status for urban poor adolescents. Seasonally sensitive nutrition initiatives should be developed to ensure diet adherence to recommendations, ultimately enhancing the diet quality of urban poor adolescents.

Lifestyle indices of body composition and obesity risk and prevalence among multi-ethnic adolescents in Malaysia

The prevalence of childhood obesity in Malaysia has doubled in less than a decade. Moreover, being overweight and obese have been associated with immediate and later comorbidities, thus emphasizing the need to prevent obesity from an early age. This cross-sectional study involved 923 multi-ethnic Malaysian adolescents aged between 15 and 17 years old. Body composition was estimated using bioelectrical impedance analysis. Body mass index (BMI) classification was based on the World Health Organization (WHO) growth reference and the International Obesity Task Force (IOTF) cut-off. Meanwhile, the Child Growth Foundation (CGF) body fat reference was used to classify adolescents' adiposity. Lifestyle indices including physical activity, sedentary behavior, supplement intake, smoking and alcohol status were assessed via questionnaires. A high prevalence of overweight/obesity among the adolescents was observed according to the CGF (26%), followed by that of the WHO (24%) and then the IOTF (23%) cut-off, with high concordance values between each pair. After adjustment, a significant association was found between physical activity (PAQ score) and lean mass (p = 0.027). No lifestyle determinant was found to be a significant predictor of fat percentage. A high sedentary level increased the likelihood of obesity (OR 3.0, p < 0.01), while antioxidant-rich supplements were found to protect against obesity (OR 0.4, p < 0.05). The lifestyle predictors identified in this study may be considered when designing interventions that integrate lifestyle modifications targeting adolescents.

Physical Activity and Body Image Perception in Adolescents: A Systematic Review

Adolescence represents a vulnerable phase of life for psychological health. The practice of physical activity (PA) appears to have a positive influence on adolescents, increasing self-esteem and producing a more positive body image. A systematic review of published articles over the past 10 years until June 2022 was conducted according to the PRISMA statement employing the electronic databases MEDLINE and Web of Science (639 records) to summarize the literature on the relationship between body image dissatisfaction (BID) and assessed by figural scales and practice of structured and unstructured PA in adolescents (10-18 years), taking into account BMI and/or weight status. All articles were independently reviewed using inclusion/exclusion criteria, retrieved data, and assessed quality with the adapted Newcastle-Ottawa Scale for observational studies. The main finding of interest that emerged from most of the 28 included studies is the negative association between BID and PA during adolescence: as PA increases, BID decreases. However, this updated systematic review also identified some flaws in the existing literature, highlighting the need for high-quality adolescent research using validated figural scales and objective PA assessments. In conclusion, the reviewed studies showed that PA involvement can be efficacious in protecting from body image perception concerns and enhancing body satisfaction. Future interventions should promote structured and unstructured PA during adolescence to improve self-esteem and body image.