Whole Grain Intakes in the Diets Of Malaysian Children and Adolescents – Findings from the MyBreakfast Study

Ak, Norimah; Koo, Hui Chin; Jm, Hamid Jan; Desa, Mohd Nasir Mohd; Tan, Sue Yee; Appukutty, Mahenderan; Ar, Nurliyana; Thielecke, Frank; Hopkins, Sinead; Ong, M. K.; Ning, C.; Tee, E‐Siong

doi:10.1371/journal.pone.0138247

Cited by 26 publications

(32 citation statements)

References 22 publications

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“…Consumption of whole grains was calculated at 21 g/d for adults (19-85 years) [9], indicating inadequate whole grain consumption. However, this was similar to the level of consumption recorded in the United Kingdom [10], the United States [11], Ireland [12] and Singapore [13], while other countries, such as France [14], Italy [15] and Malaysia [16] have far lower intakes. Scandinavian countries have recently increased intakes, in particular Denmark, where successful promotion of whole grains, via a public-private partnership, increased consumption from 33 g/day (from 2000 to 2004) to 55 g/day (in 2011-2014) [17].…”

Section: Introductionsupporting

confidence: 80%

Whole Grains and Consumer Understanding: Investigating Consumers’ Identification, Knowledge and Attitudes to Whole Grains

Foster

Beck

Hughes³

et al. 2020

Nutrients

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Whole grains may assist in reducing risk of non-communicable disease, but consumption is limited in many countries. In Australia, the reasons for poor consumption are not well understood. The aim of this study was to investigate consumers’ knowledge, attitudes and identification of whole grains, incorporating an exploration of factors influencing consumption, promotion and provision. An online semi-structured questionnaire was used to gather responses from 735 participants (61% complete responses). Although 92% of respondents consumed grains, only 8% reported an intake consistent with age and gender recommendations. Refined pasta and rice were the most frequently purchased grain foods followed by wholemeal/whole grain bread. Of whole grain foods, bread and breakfast cereals were consumed more frequently. However, overall, participants did not prioritise consumption of whole grains. Despite this, 93% of participants had seen food packaging information drawing attention to whole grain content, with a high proportion describing whole grain as less processed (72%) or high in dietary fibre (67%). Two-thirds were aware of health benefits but stated that if they had further information, they would be more likely to swap to whole grain. Further education, increasing exposure, accessibility and extensive promotion of whole grain health benefits are required to facilitate whole grain consumption. Furthermore, removing the negative stigma associated with carbohydrate foods, including grains, will be necessary to improve consumption.

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Section: Introductionsupporting

confidence: 80%

Whole Grains and Consumer Understanding: Investigating Consumers’ Identification, Knowledge and Attitudes to Whole Grains

Foster

Beck

Hughes³

et al. 2020

Nutrients

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“…In theory, the combined effect of these components may be beneficial in preventing obesity. The weak association between Prudent diet and odds of overweight and obesity in the current study may be explained by the local dietary habits where whole grains were not commonly consumed among the Malaysian population [ 44 , 45 ]. Additionally, increased consumption of palm oil in the diet may contribute to the high-calorie intake among Malaysians [ 46 ].…”

Section: Discussionmentioning

confidence: 98%

Dose–Response Relationship between Western Diet and Being Overweight among Teachers in Malaysia

et al. 2020

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The rising prevalence of overweight and obesity is partly due to nutrition transition. The reported association between dietary patterns and overweight/obesity has been controversial because of inconsistent results and weak observed associations. Although it has been hypothesized that an unhealthy diet can increase obesity risk, none of the previous studies have examined the dose–response association using nonlinear dose–response analyses. This study aimed to examine the dose–response association between major dietary patterns and overweight/obesity. This was a cross-sectional study involving teachers selected through stratified multistage sampling from public schools in three Malaysian states. Dietary intake was assessed using a food frequency questionnaire, and two major dietary patterns (Western and Prudent diet) were extracted using factor analysis. Logistic regression followed by trend analysis was used to test the difference in odds of overweight and obesity in each quintile of diet score. A further analysis using restricted cubic spline models was performed to examine the dose–response associations of dietary patterns with odds of overweight/obesity. The logistic regression analysis showed that participants with the highest quintile of Western diet score were 1.4 times more likely to be overweight/obese compared to those in the lowest quintile (95% CI: 1.11, 1.83, p-trend < 0.001). The odds of overweight/obesity showed a significant increasing trend across quintiles of Western diet among both men and women (p-trend < 0.001). In the dose–response analysis, a positive linear association (Pnonlinearity = 0.6139) was observed where overweight/obesity was more likely to occur among participants with a Western diet score greater than a mean score of zero. There was an inverse trend of odds of overweight/obesity across quintiles of Prudent diet score, significant only for men (p for trend < 0.001). Linear association was found between Prudent diet score and odds of overweight/obesity among both men (Pnonlinearity = 0.6685) and women (Pnonlinearity = 0.3684) in the dose–response analysis. No threshold at the level of adherence to Prudent diet was linked to odds of overweight/obesity. Dose–response analysis indicated that women with a Western diet score greater than zero were more likely to be overweight or obese among women. In men, higher adherence to Western diet was associated with increased odds of overweight/obesity, while greater adherence to Prudent diet decreased the odds of overweight/obesity. Promoting and enhancing the consumption of Prudent diet and limit in Western diet may be used to guide the development of evidence-based diet interventions to curb overweight and obesity.

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“…Outcomes from the GReat-Child Trial indicated positive improvement in weight management [ 8 ], knowledge, attitudes, and practices toward whole grain [ 21 ], as well as whole grain intake and quality of diet among the children participants. Considering that whole grain intake among Malaysian children has been a mere 2.3 g/d [ 30 ] in the past few years, these positive findings may have significant impact on the long-term dietary habits among Malaysian children. To our knowledge, this is the first reported quasi-experimental trial designed to increase the whole grain consumption, as well as improve the overall quality of diet in Malaysian children who are overweight and obese.…”

Section: Discussionmentioning

confidence: 99%

“…In fact, an earlier intervention aimed at improving the consumption of fruits among schoolchildren showed a result similar to our T1 results not being sustained at T2 [ 41 ]. It should be noted that whole grain foods are not only less available but also more expensive in Malaysia [ 30 ]. Whole grain foods availability and accessibility in the marketplace hinges on consumer demand along with cost, as well as the industry’s ability to produce whole grain foods and to maintain sufficient return on investment.…”

Section: Discussionmentioning

confidence: 99%

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The GReat-Child TrialTM: A Quasi-Experimental Dietary Intervention among Overweight and Obese Children

2020

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Diet composition is a key determinant of childhood obesity. While whole grains and micronutrients are known to decrease the risk of obesity, there are no interventions originating from Southeast Asia that emphasize whole grain as a strategy to improve overall quality of diet in combating childhood obesity. The GReat-Child Trial aimed to improve whole grain intake and quality of diet among overweight and obese children. It is a quasi-experimental intervention based on Social Cognitive Theory. It has a 12-week intervention and 6-month follow-up, consisting of three components that address environmental, personal, and behavioral factors. The intervention consists of: (1) six 30 min lessons on nutrition, using the Malaysian Food Pyramid to emphasize healthy eating, (2) daily deliveries of wholegrain foods to schools so that children can experience and accept wholegrain foods, and (3) diet counseling to parents to increase availability of wholegrain foods at home. Two primary schools with similar demographics in Kuala Lumpur were assigned as control (CG) and intervention (IG) groups. Inclusion criteria were: (1) children aged 9 to 11 years who were overweight/obese; (2) who did not consume whole grain foods; and (3) who had no serious co-morbidity problems. The entire trial was completed by 63 children (31 IG; 32 CG). Study outcomes were measured at baseline and at two time points post intervention (at the 3rd [T1] and 9th [T2] months). IG demonstrated significantly higher intakes of whole grain (mean difference = 9.94, 95%CI: 7.13, 12.75, p < 0.001), fiber (mean difference = 3.07, 95% CI: 1.40, 4.73, p = 0.001), calcium (mean difference = 130.27, 95%CI: 74.15, 186.39, p < 0.001), thiamin (mean difference = 58.71, 95%CI: 26.15, 91.28, p = 0.001), riboflavin (mean difference = 0.84, 95%CI: 0.37, 1.32, p = 0.001), niacin (mean difference = 0.35, 95%CI: 1.91, 5.16, p < 0.001), and vitamin C (mean difference = 58.71, 95%CI: 26.15, 91.28, p = 0.001) compared to CG in T1, after adjusting for covariates. However, T1 results were not sustained in T2 when intervention had been discontinued. The findings indicate that intervention emphasizing whole grains improved overall short-term but not long-term dietary intake among schoolchildren. We hope the present trial will lead to adoption of policies to increase whole grain consumption among Malaysian schoolchildren.

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Whole Grain Intakes in the Diets Of Malaysian Children and Adolescents – Findings from the MyBreakfast Study

Cited by 26 publications

References 22 publications

Whole Grains and Consumer Understanding: Investigating Consumers’ Identification, Knowledge and Attitudes to Whole Grains

Whole Grains and Consumer Understanding: Investigating Consumers’ Identification, Knowledge and Attitudes to Whole Grains

Dose–Response Relationship between Western Diet and Being Overweight among Teachers in Malaysia

The GReat-Child TrialTM: A Quasi-Experimental Dietary Intervention among Overweight and Obese Children

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