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Knowledge, attitude and practice on nutrition, dietary intake and prevalence study on childhood obesity among secondary school students in Kedah state

Marcus Ong Shi Ming, Saw Sun Yang, Evie Tan Wei Wei, Faun Hao YanDr Kyaw Min (PhD),Unit of Community Medicine, Faculty of Medicine, AIMST UniversityAbstractThis descriptive cross-sectional study was done in SMK Aman Jaya in the district of Sungai Lalang of Sungai Petani, Kedah to increase the awareness of the students regarding the severity of childhood, analyzed the reason behind the increasing prevalence rate of childhood obesity by assessing the knowledge, attitude and practice on nutrition of the students and at the same time came up with strategies to overcome childhood obesity . A total of 191 students participated in the study ranging from 13,14,15,17 years old and information on knowledge, attitude, practice and dietary intake were recorded. Of the 191 students, about 46 students were either overweight or obese with the overall prevalence of 24.0%. Of these, 18(39.13%) were males and 28(60.87%) were females. Knowledge, attitude and practice about childhood obesity were assessed and correlated with overweight and obesity. Among the obese and overweight group, majority have knowledge above average (55.8%) but attitude (32.6%) and practice (34.8%) below average. This can be concluded that the obese and overweight groups have knowledge but lack of attitude and practice.MethodThe study design was a descriptive cross sectional study where questionnaires was given in attempt to obtain socio-demographic profile, knowledge about obesity and certain disease known to occur in obese people, attitude and practice towards their daily diet. Following then, the students' weight and height were measured using calibrated SECA weight and height scale and Body Mass Index were calculated. Using SPSS version 22, Chi-square test was used to evaluate the relationship between knowledge, attitude and practice with factors such as race, sex, parent education, residential area, family income and BMI.ResultThere were 191 students participated in the study, among them, 46 students were either overweight or obese with the overall prevalence of 24.0%. Of these, 18(39.13%) were males and 28(60.87%) were females. , the number of overweight or obese students was the least among the Chinese which was about 6, followed by the Indians (7) and the Malays (33). The breakfast of the overweight and obese people consumed is less than 351kcal, comparatively those who are in normal and underweight BMI range consumed higher calorie in their breakfast. Besides that, there is a noticeable trend that as the income of their parents increase, the prevalence of obesity is lower. Which they have better knowledge, attitude and practice. KAP interpretation shows that majority of the students have knowledge above mean, but below mean in attitude and practice. There is only a statistical significant between knowledge score and mothers education (p=0.05). However, there were no statistical significant between knowledge, attitude and practice to BMI, calorie intake in breakfast, parents income, race, gender.ConclusionIntervention should be done in improving the attitude and practice, healthy lifestyle promotion[8] ,adherence to recommended dietary guidelines, increase participation in physical activity, and limiting screen time and reducing sedentary behavior [9]. Besides that, nutritious food should be made available to everyone regardless of their socioeconomic status, which can be achieved by reducing the price. BackgroundThe American Heritage Dictionary formally defined obesity as a condition of increased body weight that was caused by an excessive accumulation of fat [1]. Reports indicate that there was a high and increasing rate of overweight and obesity among preschool children living in developing countries, which common causes were unhealthy eating patterns, lack of physical activity, genetic factors, or a combination of these factors [2]. As 50-80% of obese children continue to be obese in adult, it may increase the incidence of hypertension, type 2 diabetes mellitus, cardiovascular disease, fatty liver disease. It is important to attain the desired behavioral changes related to nutrition, the achievement of adequate and right knowledge, attitudes and practice to prevent the progression of the obesity and its related co morbidities into adulthood.

Discussion From our survey, we found that prevalence of obese and overweight were higher in female. This could be because females generally achieve puberty earlier than males and their growth rate then decline earlier during adolescent compared to males. As growth rate (height) declines, fat accumulation resumes in a rate twice faster in females compared to males.[3] Malays consume more fried food thus higher calorie intake. According to the 2004 National Nutrition Survey, one in two Malays take deep-fried food more than twice a week. Besides, one in five Malays drink at least seven sweetened drinks weekly[4]. Hence, it is not surprised that there are higher number of students who are overweight or obese among the Malays compared to Chinese and Indian. Low-income neighborhoods frequently lack of full-service grocery stores and farmers markets where residents can buy a variety of fruits, vegetables, whole grains, and low-fat dairy products.[5] When a variety of food is available, healthy food is often more expensive, whereas refined grains, added sugars, and fatty foods are generally less expensive and readily available in low-income communities.[6] Students who were obese consumes less calorie in their breakfast. The best range of calories for breakfast is between 350 to 500kcal. Below 350kcal, the body could not fulfill the requirements for morning energy usage while above 500kcal, the body may store unused calories as fat. [7]

Table 1: Mean Score of KAP

References:1. Houghton Mifflin Harcourt. American Heritage Dictionary, 5th Edition. Apple Inc: 20142. DeOnis M. &Blassner M. (2000). Prevalence and trends of overweight among preschool children in developing countries, American Journal of Clinical Nutrition, 72, 1032-1039.3. . Suecoff, S. A., Avner, J. R., Chou, K. J., & Crain, E. F. (1999). A comparison of New York City playground hazards in high- and low-income areas. Archives of Pediatrics and Adolescent Medicine, 153(4), 363-366.4. Chang Ai-Lien. Malays & Obesity: Big Trouble. The Straits Times. Saturday, 2010 March5. Prof. WinneeChee. Weight Issues: Fighting flab from young. The Star 2014 April 14: Health.6. Drewnowski, A. (2010). The cost of US foods as related to their nutritive value. American Journal of Clinical Nutrition, 92(5), 1181-1188.7. Breakfast: The first chance to fill your tank [Internet].Available from http://www.health.columbia.edu/(Assessed on 2September 2014)8. Michaela Vine, Margaret B. Hargreaves, Ronette R. Briefel, and Cara Orfield"Expanding the Role of Primary Care in the Prevention andTreatment of Childhood Obesity: A Review of ClinicandCommunity-Based Recommendations and Interventions" BMC article9. N. F. Krebs and M. S. Jacobson, Prevention of pediatric overweight and obesity, Pediatrics, vol. 112, no. 2, article 424, 2003.

MeanSDKnowledge mean score18.67 2.82Minimum_maximum11 to 16Attitude mean score33.553.74Minimum_maximum22 to 47Practice mean score20.642.26Minimum_maximum13 to 27