The relationship between household income and dietary intakes of 1-10 year old urban Malaysian

Zalilah Mohd Shariff,Khor Geok Lin,Sarina Sariman,Huang Soo Lee,Chin Yit Siew,Barakatun Nisak Mohd Yusof,Chan Yoke Mun,Maznorila Mohamad 한국영양학회 2015 Nutrition Research and Practice Vol.9 No.3

BACKGROUND/OBJECTIVES: Diet plays an important role in growth and development of children. However, dietary intakes of children living in either rural or urban areas can be influenced by household income. This cross-sectional study examined energy, nutrient and food group intakes of 749 urban children (1-10 years old) by household income status. SUBJECTS/METHODS: Children’s dietary intakes were obtained using food recall and record for two days. Diet adequacy was assessed based on recommended intakes of energy and nutrients and food group servings. RESULTS: For toddlers, all nutrients except dietary fiber (5.5 g) exceeded recommended intakes. Among older children (preschoolers and school children), calcium (548 mg, 435 mg) and dietary fiber (7.4 g, 9.4 g) did not meet recommendations while percentage of energy from total fat and saturated fats exceeded 30% and 10%, respectively. The mean sodium intakes of preschoolers (1,684 mg) and school children (2,000 mg) were relatively high. Toddlers in all income groups had similar energy and nutrient intakes and percentages meeting the recommended intakes. However, low income older children had lowest intakes of energy (P < 0.05) and most nutrients (P < 0.05) and highest proportions that did not meet recommended energy and nutrient intakes. For all food groups, except milk and dairy products, all age groups had mean intakes below the recommended servings. Compared to middle and high income groups, low income preschoolers had the lowest mean intake of fruits (0.07 serving), meat/poultry (0.78 serving) and milk/dairy products (1.14 serving) while low income toddlers and school children had the least mean intake of fruits (0.09 serving) and milk/dairy products (0.54 serving), respectively. CONCLUSION: Low socioeconomic status, as indicated by low household income, could limit access to adequate diets, particularly for older children. Parents and caregivers may need dietary guidance to ensure adequate quantity and quality of home food supply and foster healthy eating habits in children.

Household food insecurity and coping strategies in a poor rural community in Malaysia

Zalilah Mohd. Shariff,Geok Lin Khor 한국영양학회 2008 Nutrition Research and Practice Vol.2 No.1

This cross-sectional study assessed household food insecurity among low-income rural communities and examined its association with demographic and socioeconomic factors as well as coping strategies to minimize food insecurity. Demographic, socioeconomic, expenditure and coping strategy data were collected from 200 women of poor households in a rural community in Malaysia. Households were categorized as either food secure (n=84) or food insecure (n=116) using the Radimer/Cornell Hunger and Food Insecurity instrument. T-test, Chi-square and logistic regression were utilized for comparison of factors between food secure and food insecure households and determination of factors associated with household food insecurity, respectively. More of the food insecure households were living below the poverty line, had a larger household size, more children and school-going children and mothers as housewives. As food insecure households had more school-going children, reducing expenditures on the children's education is an important strategy to reduce household expenditures. Borrowing money to buy foods, receiving foods from family members, relatives and neighbors and reducing the number of meals seemed to cushion the food insecure households from experiencing food insufficiency. Most of the food insecure households adopted the strategy on cooking whatever is available at home for their meals. The logistic regression model indicates that food insecure households were likely to have more children (OR=1.71; p<0.05) and non-working mothers (OR=6.15; p<0.05), did not own any land (OR=3.18; p<0.05) and adopted the strategy of food preparation based on whatever is available at their homes (OR=4.33; p<0.05). However, mothers who reported to borrow money to purchase food (OR=0.84; p<0.05) and households with higher incomes of fathers (OR=0.99; p<0.05) were more likely to be food secure. Understanding the factors that contribute to household food insecurity is imperative so that effective strategies could be developed and implemented.

Food Neophobia and Nutritional Outcomes in Primary School-Children

MS Zalilah,GL. Khor,K. Mirnalini,S. Sarina Korean Society of Community Nutrition 2005 Journal of community nutrition Vol.7 No.3

Food neophobia, unwillingness to try novel foods, is a personality trait that can influence children's food preferences and consequently their food acceptance and consumption. The purpose of this study was to determine whether children with food neophobia have poor dietary and growth outcomes compared to non-neophobic children. Subjects were 332 primary school children from 6 randomly selected schools in the district of Hulu Selangor, Selangor. Parents and children were interviewed to obtain demographic, socio-economic, food neophobia and dietary intake information. The children were also measured for weights and heights. One-way ANOVA and Chi-square procedures were utilized for statistical data analysis. Children with food neophobia had higher intakes of energy and most nutrients than average and neophilic children. However, only the mean intakes of protein (p < 0.05) , fat (p < 0.05), vitamin A (p < 0.01) and iron (p < 0.01) were significantly higher in neophobic than average or neophilic children. Compared to neophilic and average groups, a higher percentage of neophobic children met 2/3 of the RNIs for energy $(85.2\%)$, protein $(98.4\%)$ and vitamin A $(72.1\%)$. Mean percentage of carbohydrate energy was lowest$(54.8\pm6.6\%)$ while fat energy $(31.8\pm6.2\%)$ was highest among neophobic children. Neophobic group had the lowest percentage of children $(49.2\%)$ with carbohydrate energy > $55\%$ but highest percentage $(50.8\%)$ with fat energy > $30\%$. For the three study groups, the mean number of servings for all food groups, except grain and cereal, did not meet the Food Pyramid recommendations. Neophobic children consumed significantly more numbers of servings from the meat group than average and neophilic groups (p < 0.01). All study groups had relatively low mean dietary diversity scores but neophobic children had the lowest score $(0.67\pm0.73)$ compared to the average $(0.97\pm0.72)$ and neophilic $(1.98\pm0.81)$ groups. Significant difference in mean dietary diversity scores were only observed between neophobic and neophilic children (p<0.05). Higher percentages of neo-phobic children had low weight-for-height and were at-risk of overweight(p < 0.05). Nutrition practitioners need to understand children's food preferences in their efforts to promote healthful diets for children. To improve children's eating behaviors, parents may need the guidance and support from nutritionists and dietitians that are specific to their needs and their child's situation.

Food Neophobia and Nutritional Outcomes in Primary School-Children

Khor GL,Zalilah MS,Mirnalini K,Sarina S 대한지역사회영양학회 2005 Journal of community nutrition Vol.7 No.3

Stages of change to increase fruit and vegetable intake and its relationships with fruit and vegetable intake and related psychosocial factors

Wong Chee Yen,Zalilah Mohd Shariff,Mirnalini Kandiah,Mohd Nasir Mohd Taib 한국영양학회 2014 Nutrition Research and Practice Vol.8 No.3

BACKGROUND/OBJECTIVES: Understanding individual’s intention, action and maintenance to increase fruit and vegetable intake is an initial step in designing nutrition or health promotion programs. This study aimed to determine stages of change to increase fruit and vegetable intake and its relationships with fruit and vegetable intake, self-efficacy, perceived benefits and perceived barriers. SUBJECTS/METHODS: This cross-sectional study was conducted among 348 public university staff in Universiti Putra Malaysia. A pre-tested self-administered questionnaire and two days 24-hour diet recall were used. RESULTS: Half of the respondents (50%) were in preparation stage, followed by 43% in action/maintenance, 7% in pre-contemplation/contemplation stages. Respondents in action/maintenance stages had significantly higher self-efficacy (F =9.17, P < 0.001) and perceived benefits (F =5.07, P < 0.01) while respondents in pre-contemplation/contemplation and preparation stages had significantly higher perceived barriers (F = 4.83, P < 0.05). Perceived benefits tend to outweigh perceived barriers pre-ceding to taking action. Self-efficacy is important in motivating individuals to increase fruit and vegetable intake as self-efficacy and perceived barriers crossed over between preparation and action/maintenance. Respondents in action/maintenance stages had the highest adjusted mean serving of fruit and vegetable intake (F = 4.52, P < 0.05) but the intake did not meet recommendation. CONCLUSION: Intervention strategies should emphasize on increasing perceived benefits and building self-efficacy by providing knowledge and skills to consume a diet high in fruits and vegetables in order to promote healthy changes in having high fruit and vegetable intake.

Associations between the dietary patterns of pregnant Malaysian women and ethnicity, education, and early pregnancy waist circumference: A prospective cohort study

Heng Yaw Yong,Zalilah Mohd Shariff,Barakatun Nisak Mohd Yusof,Zulida Rejali,Jacques Bindels,Yvonne Yee Siang Tee,Eline M Van der Beek 한국영양학회 2019 Nutrition Research and Practice Vol.13 No.3

BACKGROUND/OBJECTIVES: Little is known about the dietary patterns (DPs) of women during pregnancy. The present study aimed to identify the DPs of pregnant Malaysian women and their associations with socio-demographic, obstetric, and anthropometric characteristics. SUBJECTS AND METHODS: This prospective cohort study included 737 participants enrolled in Seremban Cohort Study between 2013 and 2015. Food consumption was assessed using a validated 126-food item semi-quantitative food frequency questionnaire (SFFQ) at four time-points, namely, pre-pregnancy and at each trimester (first, second, and third). Principal component analysis (PCA) was used to identify DPs. RESULTS: Three DPs were identified at each time point and designated DP 1-3 (pre-pregnancy), DP 4-6 (first trimester), DP 7-9 (second trimester) and DP 10-12 (third trimester). DP 1, 4, and 7 appeared to be more prudent diets, characterized by higher intakes of nuts, seeds & legumes, green leafy vegetables, other vegetables, eggs, fruits, and milk & dairy products. DP 2, 5, 8, and 11 had greater loadings of condiments & spices, sugar, spreads & creamer, though DP 2 had additional sweet foods, DP 5 and 8 had additional oils & fats, and DP 11 had additional tea & coffee, respectively. DP 3 and 6 were characterized by high protein (poultry, meat, processed, dairy, eggs, and fish), sugars (mainly as beverages and sweet foods), and energy (bread, cereal & cereal products, rice, noodles & pasta) intakes. DP 9 had additional fruits. However, DP 12 had greater loadings of energy foods (bread, cereal & cereal products, rice, noodles & pasta), sugars (mainly as beverages, and sweet foods), and good protein sources (eggs, nuts, seeds & legumes). Malays were more likely to have lower adherence (LA) for DP 1 and 10 than non-Malays. DP 2, 8, and 11 were more prevalent among Malays than non-Malays. Women with a higher education were more likely to have LA for DP 10, and women with a greater waist circumference at first prenatal visit were more likely to show LA for DP 11. CONCLUSIONS: DPs observed in the present study were substantially different from those reported in Western populations. Information concerning associations between ethnicity, waist circumference and education with specific DPs before and throughout pregnancy could facilitate efforts to promote healthy dietary behavior and the overall health and well-being of pregnant women.

Colorectal Cancer and its Association with the Metabolic Syndrome: a Malaysian Multi-Centric Case-Control Study

Ulaganathan, V.,Kandiah, M.,Zalilah, M.S.,Faizal, J.A.,Fijeraid, H.,Normayah, K.,Gooi, B.H.,Othman, R. Asian Pacific Journal of Cancer Prevention 2012 Asian Pacific journal of cancer prevention Vol.13 No.8

Objective: Colorectal cancer (CRC) and the metabolic syndrome (MetS) are both on the rise in Malaysia. A multi-centric case-control study was conducted from December 2009 to January 2011 to determine any relationship between the two. Methods: Patients with confirmed CRC based on colonoscopy findings and cancer free controls from five local hospitals were assessed for MetS according to the International Diabetes Federation (IDF) definition. Each index case was matched for age, gender and ethnicity with two controls (140: 280). Results: MetS among cases was highly prevalent (70.7%), especially among women (68.7%). MetS as an entity increased CRC risk by almost three fold independently (OR=2.61, 95%CI=1.53-4.47). In men MetS increased the risk of CRC by two fold (OR=2.01, 95%CI, 1.43-4.56), demonstrating an increasing trend in risk with the number of Mets components observed. Conclusion: This study provides evidence fora positive association between the metabolic syndrome and colorectal cancer. A prospective study on the Malaysian population is a high priority to confirm these findings.

Use of Complementary and Alternative Medicine among Breast Cancer Survivors

Saibul, Nurfaizah,Shariff, Zalilah Mohd,Rahmat, Asmah,Sulaiman, Suhaina,Yaw, Yong Heng Asian Pacific Journal of Cancer Prevention 2012 Asian Pacific journal of cancer prevention Vol.13 No.8

Complementary and alternative medicine (CAM) use is prevalent among individuals with cancer, especially breast cancer survivors. This study was conducted among 394 breast cancer survivors in selected regions of Peninsular Malaysia to identify the pattern and factors associated with CAM use. About 51% of the respondents reported CAM use as complementary treatment. Vitamins (47.2%), spiritual activities (33.2%) and other dietary supplements (30.7%) were the most commonly used CAM therapies. Common reasons for CAM use were to increase the body's ability to perform daily activities (70.9%), enhance immune function (58.3%) and improve emotional well-being (31.7%). Users obtained CAM information mainly from friends and family members (62.5%), physicians (25.0%) and mass media (13.9%). Ethnicity and years of education were significantly associated with CAM use. Although no adverse effects of CAM were reported, breast cancer survivors should discuss their CAM use with health professionals to prevent potential adverse effects of these therapies.

Associations between the dietary patterns of pregnant Malaysian women and ethnicity, education, and early pregnancy waist circumference: A prospective cohort study

Yong, Heng Yaw,Shariff, Zalilah Mohd,Yusof, Barakatun Nisak Mohd,Rejali, Zulida,Bindels, Jacques,Tee, Yvonne Yee Siang,van der Beek, Eline M. The Korean Nutrition Society 2019 Nutrition Research and Practice Vol.13 No.3

BACKGROUND/OBJECTIVES: Little is known about the dietary patterns (DPs) of women during pregnancy. The present study aimed to identify the DPs of pregnant Malaysian women and their associations with socio-demographic, obstetric, and anthropometric characteristics. SUBJECTS AND METHODS: This prospective cohort study included 737 participants enrolled in Seremban Cohort Study between 2013 and 2015. Food consumption was assessed using a validated 126-food item semi-quantitative food frequency questionnaire (SFFQ) at four time-points, namely, pre-pregnancy and at each trimester (first, second, and third). Principal component analysis (PCA) was used to identify DPs. RESULTS: Three DPs were identified at each time point and designated DP 1-3 (pre-pregnancy), DP 4-6 (first trimester), DP 7-9 (second trimester) and DP 10-12 (third trimester). DP 1, 4, and 7 appeared to be more prudent diets, characterized by higher intakes of nuts, seeds & legumes, green leafy vegetables, other vegetables, eggs, fruits, and milk & dairy products. DP 2, 5, 8, and 11 had greater loadings of condiments & spices, sugar, spreads & creamer, though DP 2 had additional sweet foods, DP 5 and 8 had additional oils & fats, and DP 11 had additional tea & coffee, respectively. DP 3 and 6 were characterized by high protein (poultry, meat, processed, dairy, eggs, and fish), sugars (mainly as beverages and sweet foods), and energy (bread, cereal & cereal products, rice, noodles & pasta) intakes. DP 9 had additional fruits. However, DP 12 had greater loadings of energy foods (bread, cereal & cereal products, rice, noodles & pasta), sugars (mainly as beverages, and sweet foods), and good protein sources (eggs, nuts, seeds & legumes). Malays were more likely to have lower adherence (LA) for DP 1 and 10 than non-Malays. DP 2, 8, and 11 were more prevalent among Malays than non-Malays. Women with a higher education were more likely to have LA for DP 10, and women with a greater waist circumference at first prenatal visit were more likely to show LA for DP 11. CONCLUSIONS: DPs observed in the present study were substantially different from those reported in Western populations. Information concerning associations between ethnicity, waist circumference and education with specific DPs before and throughout pregnancy could facilitate efforts to promote healthy dietary behavior and the overall health and well-being of pregnant women.

Diet and Physical Activity in Relation to Weight Change among Breast Cancer Patients

Yaw, Yong Heng,Shariff, Zalilah Mohd,Kandiah, Mirnalini,Weay, Yong Heng,Saibul, Nurfaizah,Sariman, Sarina,Hashim, Zailina Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.1

Background: This study aimed to provide an overview of lifestyle changes after breast cancer diagnosis and to examine the relationship between dietary and physical activity changes with weight changes in breast cancer patients. Women with breast carcinomas (n=368) were recruited from eight hospitals and four breast cancer support groups in peninsular Malaysia. Dietary and physical activity changes were measured from a year preceding breast cancer diagnosis to study entry. Mean duration since diagnosis was $4.86{\pm}3.46$ years. Dietary changes showed that majority of the respondents had decreased their intake of high fat foods (18.8-65.5%), added fat foods (28.3-48.9%), low fat foods (46.8-80.7%), red meat (39.7%), pork and poultry (20.1-39.7%) and high sugar foods (42.1-60.9%) but increased their intake of fish (42.7%), fruits and vegetables (62.8%) and whole grains (28.5%). Intake of other food groups remained unchanged. Only a small percentage of the women (22.6%) had increased their physical activity since diagnosis where most of them (16.0%) had increased recreational activities. Age at diagnosis (${\beta}$= -0.20, p= 0.001), and change in whole grain (${\beta}$= -0.15, p= 0.003) and fish intakes (${\beta}$= 0.13, p= 0.013) were associated with weight changes after breast cancer diagnosis. In summary, the majority of the women with breast cancer had changed their diets to a healthier one. However, many did not increase their physical activity levels which could improve their health and lower risk of breast cancer recurrence.