- Title
- The family diet study: dietary and lifestyle factors associated with weight status of Malay primary school children and their main carers in urban areas of Klang Valley, Malaysia
- Creator
- Yang, Wai Yew
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2016
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Childhood obesity is becoming more prevalent as Malaysia, a developing Asian country experiences a rapid nutrition and lifestyle transition. Given the detrimental short-term and long-term consequences of childhood obesity, effective and well-targeted obesity treatment interventions are the priorities for implementation. Yet, current evidence related to major environmental determinants of childhood obesity in Malaysia is limited and warrants an observational study as the most appropriate first step to inform a weight management intervention programme. The primary aim of this thesis is to evaluate and describe the dietary intakes and body weight status within Malay families, and the secondary aim is to examine association within Malay families for parent-child dyads related to body weight status and dietary intake. Two systematic reviews, one pilot study, and one cross-sectional studies were undertaken to meet the aims of the research. Two systematic reviews assembled the available literature from developing countries in Asia to provide a clear background and justification for this thesis. The first review summarised the prevalence of childhood overweight and obesity, and synthesised the associations between children’s dietary patterns and their body weight status. Results indicated that there was a wide range of prevalence rates of overweight and obesity with no specific trend in age or gender. As meta-analysis was not possible due to heterogeneity of the studies, several significant yet inconsistent statistical associations between dietary patterns and childhood overweight/ obesity were found. The second review appraised the quality of dietary assessment methodology and reporting in studies included in the first systematic review. The analyses provided evidence that the majority of the included studies had ‘poor’ ratings and the quality rating was influenced by the dietary assessment method chosen. A pilot study tested the study protocol in terms of flow, timeline, recruitment and feasibility of the main cross-sectional study (known as the Family Diet Study) in the Malaysian setting. Eleven families completed pilot data collection by answering study questionnaires (inclusive of socio-demographic, food habits, parental child feeding practices and physical activity), diet intakes were reported using 24-hour dietary recalls and participant anthropometric measures (body weight, height, body fat and waist circumference) were measured. Results showed overall feasibility of the study protocol and directed some modifications in recruitment and measurements. The pilot sample also allowed the investigation of the prevalence of energy intake mis-reporting amongst the children. A high prevalence of energy mis-reporting was found and varied according to the cut-points used (Goldberg equations, Torun cut-point and Black & Cole method). A cross-sectional study, the Family Diet Study (n=236) evaluated the body weight status and dietary intakes of Malay families (child aged 8-12 years and their parents), in comparison to current obesity standards and food and nutrient recommendations. Body mass index was calculated and categorised using World Health Organisation BMI-forage growth reference (5 to 19 years old) and using BMI Asian classification for ≥ 18 years for the adults. Approximately a third of the children and three-quarter of the parents were classified as overweight or obese. The children’s BMI was positively associated with parental BMI. Mean nutrient intakes and food group servings were compared to the Malaysian Recommended Nutrient Intakes and the national dietary guidelines for adults and children. The majority of participants had sub-optimal intakes of nutrients and food groups were below the recommended targets. The obese children had the lowest energy intakes adjusted for body weight compared to children of other weight status categories. Moderate-to-strong and weak-to-moderate correlations were found between mother-father and child-parent dyads, respectively, with child-mother dietary intakes more closely related than that of child-father intakes. Multiple regression analyses demonstrated that maternal percentage energy from fat largely explained the variation in child fat intakes. Using the Black & Cole method, a large proportion of energy intake mis-reporters were identified within all family members. Amongst children reporting plausible energy intake (n=141), results suggested that higher energy intake was associated with higher BMI z-score. In conclusion, the study findings presented in this thesis support the evidence that developing Asian countries undergoing nutrition transition are at risk of childhood obesity epidemic. High quality dietary studies are limited in this region due to usage of non-validated tools and a lack of standardised reporting. Despite a significant proportion of Malay families being overweight or obese, the majority reported dietary intakes below national recommended levels which was distorted by energy intake mis-reporting. Children’s body weight status may be modifiable through optimising total energy intake and by conducting nutritional interventions that target the mother. The results have important implications for obesity-related research targeting Malaysian families, emphasizing the need for higher quality research and specific nutrition programmes to improve overall family dietary patterns.
- Subject
- child; family; Malaysia; diet; lifestyle; feeding practices; thesis by publication; developing country; nutrition; food habits; parent; body weight; weight status; childhood obesity; Asia
- Identifier
- http://hdl.handle.net/1959.13/1314636
- Identifier
- uon:22792
- Rights
- Copyright 2016 Wai Yew Yang
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
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| View Details Download | ATTACHMENT01 | Abstract | 371 KB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Thesis | 2 MB | Adobe Acrobat PDF | View Details Download |