Presentation:

MyBreakfast Study – Key Findings and Implications for Intervention Mahenderan Appukutty, PhD Senior Lecturer Universiti Teknologi MARA

31 May 2016 Hotel Istana, Kuala Lumpur

31st NSM Scientific Conference

About MyBreakfast Study

3

Researchers

• MyBreakfast Study is first comprehensive nationwide study on breakfast

habits in the country

– covering the whole range of primary and secondary school

children

– carried out by the Nutrition Society of Malaysia in 2013

• The study aimed to determine breakfast habits

– including the types of food and beverages that are most commonly

consumed at breakfast among these school children

• Bodyweight status, physical activity level and daily dietary intakes of

the children were also measured

– and associations with breakfast habits examined

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Objectives

• MyBreakfast Study is first comprehensive nationwide study on breakfast

habits in the country

– covering the whole range of primary and secondary school

children

– carried out by the Nutrition Society of Malaysia in 2013

• The study aimed to determine breakfast habits

– including the types of food and beverages that are most commonly

consumed at breakfast among these school children

• Bodyweight status, physical activity level and daily dietary intakes of

the children were also measured

– and associations with breakfast habits examined

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Objectives

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Methodology

A multi-stage sampling method carried out based on 5 geographical zones, rural/urban areas, ethic group and sex distribution • utilising the

Population and Housing Census 2010

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Methodology (2)

Tools included: • Socio-demographic

form • Breakfast habits

questionnaire • Food frequency

questionnaire • Current dietary intake • Physical Activity

Questionnnaire (PAQ) for children and older children

Key Findings

Overweight and Obesity

Key Findings #1

10

of the primary & secondary school

children were either overweight

or obese

A high prevalence of

28.4%

Key Findings #1a

were overweight +

obese

More boys

than girls

Key Findings #1b

Combined primary and secondary school children

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Higher

prevalence of both

overweight and obesity among boys 7.1 5.8

60 69.5

14.4 13.7

18.5 11

Boys Girls

Distribution of BMI Status between boys (n=4017) and girls (n=4644)

Severe thinness/thinness Normal Overweight Obese

>

>

Key Findings #1c

Combined primary and secondary school children 12

13

The combined prevalence of

overweight & obesity was similar

among primary school children and secondary

school children

Key Findings #1d

Key Findings #2

Breakfast skippers among school children

15

High proportion:

24.3% of school children skipped breakfast > 3 days a week

Key Findings #2a

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skipped breakfast

More girls

than boys

Key Findings #2b

among both primary and secondary school

children

17

Breakfast skippers were

1.34 X more likely to be

overweight/ obese*

*adjusted for potential confounders including age, sex, ethnicity, father’s education level, income and physical activity

Key Findings #2c

Key Findings #3

Physical activity level among school children

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school children had

LOW physical activity level

1 in 3 (34.8%)

Key Findings #3a

20

46.7% 28.3%

Prevalence of low physical activity level

was higher than primary school children

among secondary

Key Findings #3b

Highest prevalence was among secondary school girls (59.5%)

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Higher prevalence of overweight/obesity

among children with low physical activity level compared to children with medium and high physical activity level

Physical Activity Level and

Bodyweight Status

Key Findings #3c

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Low physical activity level

was higher among breakfast skippers

than breakfast eaters

Physical Activity

Level between Breakfast

Eaters and

Skippers

Key Findings #3d

32.5 42

58.9 51.7

8.6 6.3

0

20

40

60

80

100

120

Breakfast eaters Breakfast skippers

Pe

rce

nta

ge

Low Medium High

Key Findings #4

Contribution of breakfast to daily nutrient intake

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26.8% of the total daily energy, 21.4% of protein and 29.1% of fat intake of the school children.

Breakfast contributed: about 25% of total daily energy, protein & fat intake

about 25% of the daily micronutrient intake (except vit A)

Key Findings #3d

22.6 33.4

35 32.4

35.8 39.2

26.7 23.5

26.8

% from breakfast

Contribution of breakfast to daily energy and micronutrient intakes (n=2680)

Energy Vitamin A Vitamin C Thiamin Riboflavin Niacin Calcium Iron Phosphorus

Key Findings #5

Most commonly consumed breakfast foods and beverages

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Top 5 most commonly consumed breakfast foods:

1. Bread 2. Eggs 3. Chicken/ meat 4. Nasi lemak 5. Fried rice

Key Findings #5a

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1. Malted beverage 2. Tea/ coffee 3. Ultra-heat treated (UHT)

milk 4. Powdered milk 5. fruit drink/ cordial

Top 5 most commonly consumed breakfast beverages:

Key Findings #5b

Key Findings #6

Ready-to-eat-cereals (RTEC) consumption

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18.0% of the children consumed ready-to-eat-cereal (RTEC)

Consumption of RTEC at breakfast contributed to higher intakes of several micronutrients

compared with non-consumers

Key Findings #6a

% contribution of breakfast to total micronutrient intake

Key Findings #7

Consumption of malted beverage and its contribution to total energy intake and micronutrient intakes

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Consumption of malted beverage contribute to

5.7%

19.4-26.4%

Daily energy intake

Calcium & several B vitamins

Contribution of malted drink to total daily energy and micronutrient intake

Key Findings #6a

Malted beverage consumers had similar total energy intake but higher micronutrient

intakes than non-consumers

Key Findings #8 Wholegrain consumption

among school children

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Only 25% primary school children & 19% secondary school children

consumed whole grain

Key Findings #6a

Wholegrain consumption among school children was very low

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Almost all the children (over 99%) did not meet the recommended intake

of 48g/day

Even among wholegrain consumers, the mean intake was about 9g/day,

well below the recommendation intake

Key Findings #6a

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was the main source of whole grain intake

Wheat

Key Findings #6a

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RTEC was the main source of wholegrain food among both primary & secondary school children

Key Findings #6a

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Recommendations

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Findings from this study should be utilised by relevant ministries, agencies and other stakeholders to develop and implement appropriate intervention programs to

• alleviate the high prevalence of overweight and obesity observed among primary to secondary school

• not neglecting the significant presence of undernutrition 1. Urgent intervention programmes should be systematically

implemented throughout the country, • directed at both dietary habits and physical activity level

2. Nutrition education should be systematically conducted in all schools, utilizing educational modules that have been proven effective.

Recommendations (1)

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3. Interventions to promote regular breakfast consumption should be one of the approaches undertaken

4. Future revisions of Malaysian dietary guidelines should include recommendations on breakfast consumption • suitable types of foods and beverages and • recommended serving size

5. Greater efforts must be undertaken to increase nutrition education in schools on the health benefits of whole grain and how to identify wholegrain foods

6. The regulatory authority in Malaysia should consider measures to encourage manufacturers to add or increase whole grain in products

Recommendations (2)

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7. Participation in physical education should be compulsory

for every child • classes intended for physical activity education should be

strictly utilised for this purpose

8. Nutritionists must be assigned to effectively implement nutrition related activities in schools • carry out nutrition education and promotion activities • monitor and refer under-and over-nourished children • ensure implementation and continuous improvement of

school canteen guidelines

Recommendations (3)

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9. Parents should be role models and be actively involved in all efforts to promote healthy eating and active living among children

Investing in the nutritional wellbeing of children today is the only way to ensure a healthier generation of adult Malaysians tomorrow

Recommendations (4)

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Publications from MyBreakfast Study

Manuscript under preparation:

1. E Siong Tee1*, Abdul Razak Nurliyana2, Mohd Taib Mohd Nasir2, A.

Karim Norimah3, Hamid Jan Jan Mohamed4, Sue Yee Tan5, Mahenderan Appukutty6, Sinead Hopkins7, Frank Thielecke7, Moi Kim Ong8, Celia Ning8 Breakfast Consumption among Malaysian Primary and Secondary School Children and Association with Body Weight Status – Findings from the MyBreakfast Study

2. Mohd Taib Mohd Nasir, E Siong Tee1*, Abdul Razak Nurliyana2,, A. Karim Norimah3, Hamid Jan Jan Mohamed4, Sue Yee Tan5, Mahenderan Appukutty6, Sinead Hopkins7, Frank Thielecke7, Moi Kim Ong8, Celia Ning8 Consumption of ready-to-eat cereals (RTEC) among Malaysian children and association with nutrient intakes – Findings from the MyBreakfast study

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Publications from MyBreakfast Study

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Acknowledgements

End & Thank You