snacking habit among adolescent school students
TRANSCRIPT
SNACKING HABIT AMONG ADOLESCENT SCHOOL ,
STUDENTS (AGED 13-14) OF SEKOLAH MENENGAH SWASTA SERI INSAN
AND KlAN KOK MIDDLE SCHOOL
ENG JUI YEE
PERPUSTAKAAN UNIVERSIT/ MAlP.YSIA SABA4
SEKOLAH SAINS MAKANAN DAN PEMAKANAN UNIVERSm MALAYSIA SABAH
2006
PUMS 9' UNNERSITI MALAYSIA SABAH
BORANG PENGESAHAN STATUS TESIS
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SESI PENGAJIAN: J'TJfHr . J).(J02. / ;J (J 03
ENd .1L{1 'Itt (HURUF BESAR)
gaku membenarkan tesis (LPSI Sarjanal Doktor Falsafah) ini di simpan di Perpustakaan Universiti Malay~ ;an syarat-syarat kegunaan seperti berikut:
I. Tesis adalah hakmilik Universiti Malaysia Sabah. ) Perpustakaan Universiti Malaysia Sabah dibenarkan membuat salinan untuk tujuan pengajian sahaja. I. Perpustakaan dibenarkan membuat salinan tesis ini sebagai bahan pertukaran an tara institusi pengajial L ** Sila tandakan ( / )
SULIT
TERHAD
TIDAK TERHAD
(t&i~~ PENULlS)
.at Tetap: 43 . JLN PUTR" -0/11/
;f N pu Tk.A _ .f r()o /
h: _ _ I':t+t-+5/ __ 0 __ b' __ _
TAN: * Potong yang tidak berkenaan.
(Mengandungi maklumat yang berdarjah keselamatan atau kepentingan Malaysia seperti yang termaktub di dalam AKT A RAHSIA RASMI 1972)
(Mengandungi maklumat TERHAD yang telah ditentukak oleh organisasiibadan di mana penyelidikan dijalankan)
Disahkan oleh
(T.rliAL, n.. GAN PUST AKA WAN)
Nama Penyelia
Tarikh: ___ ''f--'.1_1....L..-°_6_· ------
* Jika tesis ini SULIT atau TERHAD, sila lampiran surat daripada pihak berkuasalorgansasi berkenaan dengan menyatakan sekali sebab dan tempoh tesis ini perlu dikelaskan sebagai SULIT danTERHAD.
* Tesis dimaksudkan sebagai tesis bagi Ijazah Doktor Falsafah dan Sarjana secara penyelid disertasi bagi pengajian secara kerja kursus dan penyeJidikan, atau Laporan Projek Sarjana Muda
DECLARA liON
The materials in this thesis are original except for quotations, excerpts,
summaries and references which have been duly acknowledged .
15 MAY 2006 /,,:( t '-l (J /: l
I] ./ ENG JUI YEE
HN2003-2387
11
CERTIFIED BY
Puan Ramlah George @ Mohd. Rosli
Supervisor
Datin Rugayah Issa
Examiner 1
Dr. Muhammad Iqbal Hashmi
Examiner 2
Prof. Madya Dr. Mohd. Ismail Bin Abdullah
Dekan
III
ACKNOWLEDGEMENT
First and foremost, my appreciation goes to my family especially
my parents and friends for their encouragement and valuable support,
which gives me the strength to attain the success and completion of this
thesis . I would also like to express my sincere gratitude and appreciation
to my research supervisor Puan Ramlah for all her wise guidance,
support, dedication and motivation throughout this project. lowed a
million thanks for the inspirational advices and criticisms that she offered
all along the whole research . I would also like to take this opportunity to
express my grateful thanks to other lecturers for their helpful advices and
support. A token of appreciation also goes to numerous important
personnel for their useful assistance during my survey. Firstly a million
thanks to the principal of Sekolah Menengah Swasta Seri Insan and Kian
Kok Middle School for their kind permissions to conduct this study. Last
but not least, I would like to express my appreciative to all the
respondents who participated in this study.
IV
ABSTRAK
T ABIAT PENGAMBILAN SNEK 01 KALANGAN PELAJAR SEKOLAH REMAJA (BERUMUR 13-14) DAR 1 SEKOLAH MENENGAH
SWASTA SERIINSAN DAN KlAN KOK MIDDLE SCHOOL
Responden yang terlibat dalam kajian ini terdiri daripada 227 orang remaja yang berumur antara 13 dan 14 tahun yang dipilih secara rawak dari dua sekolah menengah swasta di Kota Kinabalu .Kajian ini adalah mengenai tabiat pengambilan snek di kalangan remaja sekolah menengah yang berumur antara 13-14 tahun di Kota Kinabalu, Sabah, Matlamat utama tesis ini ialah untuk menentukan tabiat pengambilan snek di kalangan pelajar sekolah remaja yang berumur 13 hingga 14 tahun, jumlah pengambilan kalori harian (kkal) serta jumlah kalori yang disumbang oleh snek, faktor yang berpotensi yang boleh mempengaruhi tabiat pengambilan snek seperti umur, jantina , kelas sosial-ekonomi serta tontonan televisyen serta hubungan antara Index Jisim Badan (BMI) and jumlah pengambilan kalori harian dan tenaga yang disumbangkan oleh pengambilan snek. Tiga set borang penilaian iaitu borang demografik, borang ingatan semula 24-jam dan jadual kekerapan makanan (FFQ) digunakan dalam kajian ini. Data yang diperolehi dianalisa dengan menggunakan Ujian Khi dan Pearson korelasi pada aras keertian, p <0.05. Jumlah tenaga yang diambil telah dibanding dengan Saranan Pengambilan Nutrient (RNI) Malaysia 2005 untuk remaja yang berumur 13 hingga 14 tahun. Carta pertumbuhan CDC yang dihasilkan oleh National Center for Health Statistics digunakan sebagai piawai membandingkan nilai 8MI para responden. Hasil kajian menunjukkan kebanyakan responden (55.94%) mempunyai 8MI yang normal iaitu di antara 5 persentil dan 85 persentil. Akan tetapi , terdapat 100 orang responden yang mempunyai 8MI luar daripada julat piawai. Sejumlah 12 (5.29%) daripada responden mempunyai berat badan yang kurang; di mana 69 (30.40%) mempunyai berat badan yang berlebihan dan 19 (8.37%) merupakan responden yang obes. Kesemua responden yang terlibat mengambilan snek sekurang-kurangnya satu kali dalam sehan. Kebanyakan responden iaitu 116 (36. 14%) daripada mereka mengambil snek pada waktu petang. Snek yang paling digemari oleh para responden ialah jus buah-buahan segar, susu lemak rendah , gulagula, minuman coklat bermalt dan minuman berkarbonat. Hasil menunjukkan tiada hubungan yang linear antara jumlah pengambi/an kalori harian dengan jumlah tenaga yang disumbangkan oleh pengambilan snek.
ABSTRACT
SNACKING HABIT AMONG ADOLESCENT SCHOOL STUDENTS (AGED 13-14) OF SEKOLAH MENENGAH SWASTA SERI
INSAN AND KlAN KOK MIDDLE SCHOOL
v
This is a study on snacking habit among adolescent school students in Kota Kinabalu, Sabah. Respondents of this study consisted of 227 adolescents (55.95% of male and 44.05% of female) aged between 13 and 14 who were randomly selected from two private secondary schools in Kota Kinabalu. The primary goal of this study was to determine snacking habit among adolescent school students aged 13-14 years old, respondents ' total daily energy intake (kcal) and the proportion of energy contributed by snacks, potential factors (such as age, gender, socia/economic class and television viewing) that affect snacking habit and the relationship between 8MI and total daily energy intake as well as energy intake contributed by snacks. This study used questionnaires which include demographic form, 24-hour recall dietary assessment form and Food Frequency Questionnaire (FFQ). Data obtained were analyzed using Chi-Square and Pearson Correlation with a p-value <0.05 (onetailed). Total energy was compared to the Recommended Nutrient Intake (RNI) for Malaysia 2005 for adolescents aged 13 and 14 years old. The other standard used for comparison included CDC growth chart by the National Center for Health Statistics for comparison of the 8MI value of respondents. Result indicated that more than half of the respondents 127 subjects (55.94%) were within normal 8MI range which is between 5th
perr;entile to less than 85th percentile. However, most of the respondents (44.05%) were out of this normal 8MI range. There were 12 (5.29%) of the respondents were categorized as underweight); while 69 (30.40%) of them were classified as overweight; only 19 (8.37%) of the respondents were obese. All respondents consumed snacks at least once a day. A total of 116 (36.14%) of the respondents categorized themselves as afternoon snacker. The most popular snack foods among adolescents were fresh fruit juice, low-fat milk, carbonated drinks, chocolate malt drinks and candy. There is a no linear relationship between total daily calories intake and the proportion of energy contribute by snacks
Title
DECLARATION VERIFICATION ACKNOWLEDGEMENT ABSTRAK ABSTRACT TABLE OF CONTENT LIST OF TABLES LIST OF FIGURES ABBREVATIONS SYMBOLS
CHAPTER 1 INTRODUCTION 1.1 Introduction 1.2 Objectives
CHAPTER 2 LITERATURE REVIEW 2.1 Snacks
2.1.1 Definition of Snack 2.1.2 Role of Snacks in Diet
TABLE OF CONTENT
2.1.3 Consumer Perception about Snacks 2.1.4 Determinants of Snacking Habit
2.1.4.1 Taste 2.1.4.2 Parents Income and Education Level 2.1.4.3 Individual, Society and Cultural Factors 2.1.4.4 Stress 2.1.4.5 Television Viewing 2.1.4.6 Marketing and Adolescents 2.1.4.7 Food Availability
2.2 Adolescents 2.2 .1 Nutritional Requirements of Adolescents
2.2.1.1 Calorie 2.2.1.2 Food Guide Pyramid 2.2.1.3 Energy 2.2.1.4 Protein 2.2.1.5 Vitamin 2.2.1.6 Mineral
2.2.2 Dietary Pattem among Adolescents 2.2.3 Types of Snacks Usually Consumed by Adolescents
2.3 Obesity and Overweight 2.3 .1 Definition of Obesity and Overweight 2 .3.2 Factors That Affect Obesity and Overweight
2.3.2.1 Size of Package 2.3.2.2 Soft Drinks Consumption 2.3.2.3 Physiological Stress 2.3.2.4 Genetic Factor
VI
Page Number
ii iii iv v vi ix x xi xii
1
1 4
5
5 5 6 7 8 9 10 10 11 11 12 13 13 14 15 15 17 18 19 20 22 23 24 27 27 28 28 29 29
2.3.2.5 Television Viewing 2.3.2.6 Fast Food Consumption 2.3.2.7 Parental Influence
2.3.3 Methods Used to Measure Obesity and Overweight 2.3.4 Health Risk of Excess Body Fat
2.4 Snacking Habit and Obesity 2.5 Dietary Assessment
2.5.1 Twenty-four Hour Recall 2.5.2 Food Frequency Questionnaire
CHAPTER 3 MATERIALS AND METHODS 3.1 Location of Study 3.2 Application to Conduct Study 3.3 Sa mpli ngls ubjects/R espondents 3.4 Pre-Survey Study/Pilot Study 3.5 Survey 3.6 Anthropometry 3.7 Data Analysis
CHAPTER 4 RESULTS AND DISCUSSION 4.1 Demographic
4.1 .1 Gender 4.1.2 Age 4.1.3 Ethnics 4.1.4 Body Mass Index 4.1.5 Total Family Income 4.1 .6 Total Pocket Money 4.1.7 Television Viewing 4.1.8 Occasions of Snacking Events 4.1.9 Snacking Frequency
4.2 The Average Intake of Snack Foods Intake 4.2.1 Fruits and Fruit Products 4.2 .2 Vegetables 4.2 .3 Milk and Milk Products 4.2.4 High Sugar, Salt and Fat Foods 4.2.5 Cereal, Flour and Their Products 4.2.6 Carbonated Drinks 4.2.7 Meat and Meat Products 4.2 .8 Local Delights 4.2.9 Nuts
4.3 Total Daily Calorie Intake 4.4 Total Energy Contributed from Snacks 4.5 The Relationship between Total Daily Calorie Intake and the Proportion of
Energy Contributed from Snacks 4.6 The Relationship between Snacking Habit and Gender
4.6.1 Types of Snacks Frequently Consumed 4.6.2 Occasion of Snacking 4.6.3 Snacking Frequency 4.6.4 Total Energy Contributed from Snacks
4.7 The Relationship between Snacking Habit and Age
Vll
30 30 31 31 34 37 38 40 40
42 42 42 42 43 43 44 46
47 47 47 47 47 48 48 50 51 52 53 56 56 57 59 61 62 64 66 67 69 70 72 73
74 74 76 77 78 78
4.7.1 Types of Snacks Frequently Consumed 4.7.2 Occasion of Snacking 4.7.3 Snacking Frequency 4.7.4 Total Energy Contributed from Snacks
4.8 The Relationship between Snacking Habit and Socio-economic Class 4.8.1 Types of Snacks Frequently Consumed 4.8.2 Occasion of Snacking 4.8.3 Snacking Frequency 4.8.4 Total Energy Contributed from Snacks
4.9 The Relationship between Snacking Habit and Total Time Spent for Television Viewing
4.9.1 Types of Snacks Frequently Consumed 4.9.2 Occasion of Snacking 4.9.3 Snacking Frequency 4.9.4 Total Energy Contributed from Snacks
CHAPTER 5 CONCLUCION AND SUGGESTIONS
CHAPTER 6 REFERENCES APPENDIX
Vl ll
78 79 80 80 81 81 82 83 83
84 84 85 86 86
87
90
IX
LIST OF TABLES
Table Title Page number
Table 2.1 Factors Adolescents View as Influencing 9
Their Food Choices
Table 2.2 Iron Requirement for Adolescents 22
Table 2.3 Body Mass Index Formula 33
Table 2.4 Potential medical complications of overweight 35
during adolescence
Table 2.5 Possible Psychosocial Consequences of 36
Adolescent Overweight
Table 3.1 Body Mass Index Formula 45
Table 4.1 Data Demographic of the Subjects 55
Table 4.2 The Average Frequency of Milk and Milk 60
Products Intake
Table 4.3 The Average Frequency of Cereal, Flour and 62
Its Products Intake
Table 4.4 The Average Frequency of Meat and Meat 66
Products Intake
Table 4.5 The Average Frequency of Nuts Intake 69
Table 4.6 Total Daily calorie Intake of Male Adolescents 70
Table 4.7 Total Daily calorie Intake of female 71
Adolescents
Table 4.8 Daily Calorie Intake from Snacks
x
LIST OF FIGURES
Figure Title Page number
Figure 4.1 The "Food Pyramid Guide Shows 13
Recommended Proportions for Food Groups for
Healthy Diet
Figure 4.2 The Pattern of Children 's TV Advertising 13
Distorts the Food Pyramid into Unhealthy
Proportions
Figure 4.3 Malaysian Food Guide Pyramid 16
Figure 4.4 Obesity of Malaysian Males and Females Aged 27
15+,2002
Figure 4.5 Obesity of Malaysian Males and Females Aged 27
15+,2005
Figure 4.6 The Average Frequency of Fruits and Fruits 56
Products Intake
Figure 4.7 The Average Frequency of Vegetables Intake 58
Figure 4.8 The Average Frequency of High Sugar, Salt 62
and Fat Foods Intake
Figure 4.9 The Average Frequency of Carbonated Drinks 64
Intake
Figure 4.10 The Average Frequency of Local Delights 68
Intake
Xl
ABBREVIATIONS
BMI Body Mass Index
BMR Basal Metabolic Rate
CDC Center for Disease Control
FFQ Food Frequency Questionnaire
g Gram
kcal kilocalorie
kg kilogram
m2 Meter square
mg Milligram
RE Retinol equivalents
WHO World Health Organization
I-Ig Microgram
%
>
<
Percentage
More than
Less than
SYMBOLS
More than or equals to
Less than or equals to
XII
1 Introduction
CHAPTER 1
INTRODUCTION
Malaysia is experiencing rapid industrialization and urbanization in recent decades .
New technology as well as socioeconomic development have been taken place and
changed the eating pattern. The economic transition has led to 'westernization' of
lifestyle leading to a rapid increase in prevalence and incidence of obesity in our
country (Sherina & Rozali, 2004). The associated obeSity-related morbidity and other
chronic conditions result in a heavy burden on health care systems and lower the
quality of life among obese subjects in our country (Pon , Mimalini & Mohd Nasir,
2004).
Sabah is the second largest state in Malaysia and is also known as ''The Land
Below The Wind" and covering an area of 73 ,600 square kilometers. According to the
Department of Statistics Malaysia, it is estimated that the Malaysian population is
1,420, 000 based on years 2000 Population Census. Population between ages 10 to
14 was the highest number among others which was 347 ,600 of them. The largest
indigenous ethnic group is the Kadazan-Dusun, roughly 62% of the total population
(Department of Statistics Malaysia , 2005). One fifth of the wor1d's population is
adolescents; that's around 1.2 billion people and 85% of them living in the developing
country (WHO, 2003a).
The foods of a country are generally shaped by the nation; Malaysian foods
reflect the multi racial aspects of Malaysia. Tradition or culture has a closed relation to
foods. Food habits and tradition are due to the pressure on a person towards the
2
social and religious norms in choosing and using the available source of foods as well
as cooking methods (Anon, 2005). Each ethnic groups in Malaysia have their own
unique dishes. As a result, many dishes in Malaysia derived from multiple ethnic
influences available in our country.
Today, Malaysia is one of the most dynamic higher processed food and
beverage market and industry. Besides that, most of Malaysia's households are
economically active and independent. Malaysia is Southeast Asia 's leading biscuit and
chocolate confectionery exporter and one of the region's largest exporters of noodles,
beer, soft drinks and sugar confectionery which usually consume as snack foods. In
addition, Malaysians adopt many Westem food ideas and eating habits , they also
retain many of the Asian characteristics and cultures inherent in their upbringing.
These income groups already form a significant consumer market for a broad range of
processed food and beverages. They are very important in shaping the market
development of the future , based on their relatively high purchasing power when
compared to that seen in the other ASEAN nations. The rapid development of food
industries have been signifICant change the dietary patterns of Malaysians (Abdullah,
1999).
Malaysia is at the crossroads of nutrition and lifestyle transition (Pan, Mimalini
& Mohd Nasir, 2004). In Singapore , eating out is easily assessable as the economical
hawker's centers, coffee shops fast food restaurants and others are spread all over
(Ang & Foo, 2002). This modem lifestyles and food availability situation also happens
in our country. As a result, people tend to making unhealthy food choice. Malaysians
are increasingly consuming diets that are high in fat and calories and generally
leading sedentary lives (Tee, 1999).
3
Both energy intake from snacks and the proportion of total energy consumed
as snacks have increased among adolescents (Zizza, Seiga-Riz & Popkin, 2001).
Diet and lifestyle are ostensibly major contributors to weight problems. Poor diet and
physical activity are increasingly becoming part of the lifestyles of many individuals,
resulting in increased risks of several chronic diseases (Driskell, Kim & Goebel,
2005). The rapid rise in the incidence of obesity and overweight has lead to
suggestions that the eating environment promotes excessive energy intake (Rolls et
al. , 2004). Irregular food intake particularly breakfast skipping, snacking (Lee et aI.,
2002) and others tend to be more common among overweight and obese adolescents
than among nonnal-weight adolescents (Elgar et al. , 2004). Adolescents are
generally adopting new eating habits that they will carry to adulthood (WHO, 2003a).
Overweight and obesity have become a global epidemic and is increasing
rapidly in both childhood and adolescence (Will & Baune, 2005). According to
Goodman & Whitaker, 2002, adolescent obesity is a strong predictor of adult obesity.
Obesity is a condition of abnormal or excessive fat accumulation in adipose tissue to
the extent that health may be impaired (WHO, 2000). Several reports showed high
and increasing rates of overweight and obesity in developing countries (World Health
Organization, 1997; De Onis & Blassner, 2000; Martorefl, Hugher & Grummer-Strawn,
1998). Malaysians become overweight for a variety of reasons. The most common
causes are unhealthy eating pattems, lack of physical activity, genetic factors, or a
combination of these factors (Tee, 1999).
The importance of this study is to determine the relationship between the total
calorie intake from snacks and Body Mass Index (BMI). Currently, economic transition
has led to unhealthy snacking trend that leads to a rapid increase in prevalence and
4
incidence of obesity in Malaysia (Tee, 1999). The calorie intakes from snacks affected
by the frequency as well as type of snacks consumed. In addition , a few factors can
affect snacking patterns among teenagers such as gender, age and social-economic
class. Adolescence is a transitional period that involves physiological, psychological
and social changes that may contribute towards the development of overweight or
obesity (Stang & Story, 2004). Therefore, it is important to study on the contribution of
total daily calories intake and the proportions of energy contribute by snacks to their
Body Mass Index. Besides that, adolescent population was the highest in Sabah
population , therefore , it is important to carry out a study on adolescents.
1.2 Objectives
1. To determine snacking habit among teenage school students aged 13-14 years
old.
2. To determine respondents ' total daily energy intake (kcal) and the proportion of
energy contributed by snacks.
3. To determine the relationship between
a. Snacking habit and potential factors that may affect it such as age,
gender, social-economic class and total time spend for television viewing.
b. Total daily energy intake and energy intake contributed by snacks
respectively with BM!.
CHAPTER 2
LITERATURE REVIEW
2.1 Snacks
Nowadays, snacking habit have become a common eating behavior. Snacks are not
only consumed by children but also adults as well as the elderly. Since the tendency
to consume snacks is on the increase, it is important that people understand the type
of snack foods that build a well balanced diet and lifestyle. Nearly all children one to
19 years of age reported eating at least one snack per day (Nicklas et al., 2001) .
Snacks can be divided into morning snack, afternoon snack, evening or late-night
snack (Driskell , Kim & Goebel, 2005) . Eating habits include consumption frequency,
types of food items and temporal distribution of eating events across the day (Yao ef
al., 2003). Therefore, snacking habit can be define as snacking frequency, types of
snack items consumed and distribution of snacking events across the day.
2.1.1 Definition of Snack
A problem arises in defining or categorizing "snacks". People have different ideas as
to exactly what constitutes a snack. A snack may be a light meal at a conventional
eating time (Chamontin , Pretzer & Booth, 2003). Snacks are also defined as a food or
drink not taken at a recognized mealtime (Ruxton , Kirk & Belton, 1996). An eating
occasion as defined is a "snackn if it occurs outside of usual mealtime (Waller, Du &
Popkin , 2003) . Others say that snacks are a selection of small items which are eaten
to replace traditional meals (Waller, Du & Popkin , 2003). Some people have a
negative connotation on snacks they classify snacks as "junk food". Snacking habit
6
can be define as snacking frequency, types of snack items consumed and distribution
of snacking events across the day (Yao eta!. , 2003).
2.1.2 Role of Snacks in Diet
Snacks playa major role in our daily life . Snacks can give energy boost to help fuel
human body between meals. The human body uses up the carbohydrate stores in
liver in 4 to 6 hours in that case human body need food to replace energy. National
survey, such as USDA's Continuing Survey of Food Intakes by Individuals (CFSII),
shows that snacks provide 10% to 20% oftotal energy intake in the general population
(Ziegler et a/., 2002). People who snacked frequently are able to control their weight
better than people who do not consume snack between meals (Ambrose, 2000).
Growing children with tiny appetite may not be able to fulfill their energy needs
with only three meals a day. Snacks can provide what may be missing from their
meals. Kids need to refuel their bodies many times during the day because they need
a ton of energy for their activities. Healthy snacks playa major role in contributing to
mean daily intake; healthy snacks contribute to energy intake and a large proportion of
nutrient intakes. Kids and teenagers may not obtain enough energy intakes from three
meals a day to satisfy their hunger moreover provides nutrient they need for their daily
activity. Therefore , snacks can help to promote calorie and portion control during
regular meals because snacks play an important role in provide additional energy
intake. Snacks can also give little fuel to keep our body from getting too tired and
hungry. Snacks can make important contribution to the overall nutrient intake of
adolescents (Anding, Kubena & Mcintosh, 1995) and 20% of the total energy intake of
adolescents (Ruxton, Kirk & Belton, 1996).
CHAPTER 6
REFERENCES
Abdullah A. Salleh. 1999. Malaysia Market Development Reports Food Processing Sector Report. USDA. 6 November 1999.
ADA Division of Communications. 2002. Diet and Tooth Decay. The American Dental Association. 133(4): 527 .
Ainhoa, C., Gabriele, P. & David, A. B. 2003. Ambiguity of 'Snack' in British Usage. Appetite. 41 : 21-29.
Aldinger, C. E. & Jones, J. T. 1998. Healthy Nutrition: An Essential Element of a Health Promoting School. World Health Organization.
Alton, I. 2005. The Overweight Adolescent. Stang, J. & Story, M. (ed.) . Guidelines for Adolescents Nutrition Services. University of Minnesota. 77-92.
Ambrose , J .. 2000. No-Guilt Snacking - Healthy Snack Food Suggestion . Better Home & Garden. Meredith Corporation .
Anderson , P. M, Butcher, K. F. & Levine, P. B. 2003. Economic Perspective on Childhood Obesity. Economic Perspective, 3: 30-32.
Anderson , R. E., Crespo , C. J., Bartlett, S. J ., Cheskin, L. & Pratt, M. 1998. Relationship of Physical Activity and Television Watching with Body Weight and Level of Fatness among Children . The Journal of American Medical Association. 279: 938-942.
Anding, J .D., Kebena , K.S. & MCintosh, AM. 1995. Snacking, Obesity, Cardiovascular Fitness and Television Viewing Among Adolescents . Journal of the American Dietetic Association. 95(9): A98 .
Ang Kai Ling & Foo Schuhert. 2002 . An Exploratory Study of Eating Pattern of Singapore. Health Management. 102(5): 239-248.
Anon. 2005. What is Malaysian Food. www.MalaysianFood.net. 10 December 2005.
91
Berkey, C. S., Rockett, H. R. , Willet, W . C. & Colditz, G. A. 2005. Milk, Dairy Fat, Dietary Calcium and Weight Gain. Pediatrics. 159(6): 543-550.
Brewer, E. A. , Kolotkin , R. L. & Baird, D. D. 2003. The Relationship Between Eating Behaviors and Obesity in African American and Caucasian Women. Eating Behaviors. 4(2): 159-171.
Bruijn , Gert-An de, Kremers Stef, P.J., Schaalma, H., Mechelen, W. van & Brug, J. 2004. Determinants of Adolescent Bicycle Use for Transportation and Snacking Behavior. Preventive Medicine. 40: 658-667.
Buller, D. B., Morril, C. , Taren, D., Aickin, M., Sennott-Miller, L., Buller, M. K., Larkey, L., Alatorre , C. & Wentzel, T. M. 1999. Randomized trial Testing the Effect of Peer Education at Increasing Fruits and Vegetable Intake. Journal of the National Cancer Instffute. 91 (17) : 1491-1500.
Cataldo , C. B., Debruyne , L. K. & Whitney, E. N. 2003a. Overweight, Underweight and Weight Control. Howe Elizabeth (ed.). Nutrition and Diet Therapy. (6th edition). USA WasworthlThomson Learning. 139-168.
Cataldo , C. B., Debruyne, L. K. & VVhitney, E. N. 2003b. Nutrition Through the Life Span: Childhood and Adolescence. Howe Elizabeth (ed.). Nutrition and Dirt Therapy. (6th
edition). USA WasworthlThomson Learning. 333-362.
Cavadini , C., Siega-Riz, A. M. & Popkin, B. M. 2000 . US Adolescents Food Intake Trends from 1965-1996. Archives of Disease in Childhood. 83: 18-24.
CDC. 2003. Standard CDC charts of children Body Mass index (BMI) . http://www.halis .md/body-mass-indexlhtm. August 2005.
Committee on School Health . 2004. Soft Drinks in Schools . Pediatrics. 113(1): 152-154.
Conway, J . M., Ingwersen, L. A. , Vinyard , B. T. & Moshfegh, A. J . 2003. Effectiveness of the US Department of Agriculture 5-step Multiple-Pass Method in Assessing Food Intake in Obese and Nonbese Women. American Journal of Clinical Nutrition. 77(5): 1171-1178.
Coon, K. A. , Goldberg, J ., Rogers , B. L. & Tucker, K. L. 2001. Relationship between Use of Television during Meals and Children's Food Consumption Patterns. Pediatrics. 107(1): 7-21 .
92
Cullen , K. W., Baranowski , T ., Baranowski , J., Hebert, D. & Moor Carl de. 1999. Pilot Study of the Validity and Reliability of Brief Fruit, juice and Vegetable Screeners among Inner City African-American Boys and 17 to 20 year old Adults. Journal of the American Col/edge of Nutrition . 18(5): 442-450.
Dalmeny, K, H. E. & Lobstein, T. 2003. Broadcasting Bad Health : Why Food Marketing to Children Needs to be Controlled. International Association of Consumer Food Organizations. WHO.
Demory-Luce, D., Morales , M., Nicklas, T ., Baranowski, T ., Zakeri Issa & Berenson , G. Changes in Food Group Consumption Patterns from Childhood to Young Adluthood : The Bogalusa Heart Study. Journal of the American Dietetic Association. 10(11): 1684-1691 .
Dennison, B. A. , Rockwell , H. L. & Baker, S. L. 1998. Fruits and vegetable Intake in Young Children. Journal of the American Col/edge of butrition. 17(4): 371-378.
De Onis, M. & Blassner, M. 2000. Prevalence and Trends of Overweight among Pre-school Children in Developing Countries. American Journal of Clinical Nutrition. 72:1032-1039.
Department of Statistic Malaysia . 2005. http://www.statistics.gov.my/
Driskell , J. A. , Kim Young-Nam & Goebel, K. J . 2005. Few Differences Found in the Typical Eating and Physical Activity Habits of Lower-Level and Upper-Level University Students. Journal of the American Dietetic Associaation. 105: 798-801.
Ear1 , R.& Borra, S. T. 2000. Guidelines for Dietary Planning. Mahan L.K. & Escott-Stump S. (ed.). Food, Nutrition, & Diet Theraphy. United State of America : W.B. Saunders Company. (1 Olh edition). 332-352.
Elgar, F.J ., Roberts , C., Moore, L. & Tudor-Smith, C. 2004. Sedentary Behaviour, Physical Activity and Weight Problems in Adolescents in Wales. Journal of the Royal Institute of Public Health . 119: 518-524.
Fisher, J. O. & Brich , L. L. 1999. Restricting Access to Palatable Foods Affects Children Behavioral Response, Food Selection and Intake. American Journal of Clinical Nutrition. 69(6): 1264-1272.
Fisher, J. 0 ., Mitchell , C. D .. Smiciklas-Wright, H. & Birch, L. L. 2001 . Milk and Soft Drinks in Young Gir1s' Diet. JoumalofNutrition.131: 246-250.
93
Forslund , B. H., Torgerson , J. S., Sjostrom, L. & Lindroos , A. K. 2005. Snacking Frequency in Relation to Energy Intake and Food Choices in Obese Men and Women Compared to A References Population . International Journal of Obesity. 29(6): 711-719.
Ganji , Vijay & Kafa i, M. R. 2004. Frequent Consumption of Milk, Yogurt, Cold Breakfast Cereals, Peppers , and Cruciferous Vegetables and Intakes of Dietary Folate and Riboflavin but not Vitamin B-12 and B-6 are Inversely Associated with Serum Total Homocysteine Concentrations in the US Population . American Journal of Clinical Nutrition. 80(6): 1500-1507.
Gibson, R. S., Sazawal, S. & Peerson , J . M. 2003. Design and Quality Control Issues Related to Dietary Assessment, Randomized Clinical Trials and Meta-Analysis of Field-Based Studies in Developing Countries . The American Society for Nutrition Sciences. 133: 1569S-1573S.
Goodman, E. & Whitaker, R. C. 2002 . Development and Persistence of Adolescent Obesity. Pediatrics. 11 (3): 497-504.
Gore , S., Foster, J . A , DiLillo , V. G., Krik , K. & West, D. S. 2003. Television Viewing and Snacking. Eating Behaviors. 4: 399-405.
Grosvenor, M. B. & Smolin , L. A. (ed.). 2002a. Applying the Science of Nutrition. Nutrition: From Science to Life. United States: Harcourt Inc. 28-61.
Grosvenor, M. B. & Smolin , L. A (ed.). 2002b. Defining Nutrition. Nutrition: From Science to Ufe . United States: Harcourt Inc. 1-27.
Grosvenor, M. B. & Smolin , L. A. (ed.). 2002c. Nutrition from Infancy to Adolescence. Nutrition: Frorn Science to Life. United States : Harcourt Inc. 556-595.
Grosvenor, M. B. & Smolin , L. A (ed.). 2002d. Energy Balance and Regulation of Body Weight. Nutrition: From Science to Life. United States: Harcou rt Inc. 218-251 .
Hampl, J. S., Taylor, C. A. & Johnston, C. S. 1999. Intakes of Vitamin C, Vegetables and Fruits: Which Schoolchildren are at Risk? Journal of the American College of Nutrition . 18(6): 582-590.
Hellmich, N. 2004. School Vending Rated as Junk. http://\w.w.usatoday.com/news/health/2004-05-11 -vending-machines x.htm. May 2005 .
94
Hergreen, W. P., Van , B. S., Van Wiebringen , J . C., Reerink, J. D. , Verloove-Vanhorick, S. P. & Ruys , J . H. 1994. Growth in Length and Weight from Birth 2 to Years of Representat ive Sampling of Netherlands Children Related to Socio-economic Status and Other Background Characteristic. Annals of Human Biology. 21 : 449-493.
Huang , Terry T -I<, Howarth, N. C., Lin Biing-Hwan, Roberts, S. B. & McCrory, M. A. 2004. Energy Intake and Meal Portions: Associations with BMI Percentile in U.S. Children. Obesity Research. 12: 1875-1885.
Kalkwarf, H. J., Khoury, J . C. & Lanphear, B. P. 2003. Milk Intake during Childhood and Adolescence , Adult Bone Density, and Osteoporotic Fractures in US Women. American Jouma! of Clinic a! Nutrition. 77(!) : 257-265.
Kam Sharon. 2005. A Balancing Act. Welcome to Sun2Surf. http://vvww.sun2surf.comlarticle.cfm?id=8909. May 2005
Kasmini K, Idris MN, Fatimah A, Hanafiah S, Iran H & Asmah Bee MN. 1997. Prevalence of overweight and obese school children aged between 7 to 16 years amongst the major 3 ethnic groups in Kuala Lumpur, Malaysia. Asia Pacific Joumal of Clinical Nutrition. 6 (3) : 172-174.
Khor Geok Lin , Cobiac, L. & Skrzypiec. 2002. Gender Differences in Eating Behavior and Social Self Concept among Malaysian University Students. Malaysian Joumal of Nutrition. 8(1): 75-79.
Kiess , W., B6ttner, A. , Bluher, S., Raile, K., Galler, A. & Kapellen, T. M. 2004. Types 2 Diabetes Mellitus in Children and Adolescents - The Beginning of A Renal Catatrophe? Oxford University Press. 19(11): 2693-2696.
Laquatra Ida. 2000. Nutrition for Weight Management. Mahan L.K. & Escott-Stump S. (ed.) . Food, Nutrition, & Diet Theraphy. United State of America : W.B. Saunders Company. (10 edition). 485-515.
Lazzer, S., Boirie , Y., Bitar, M., Vemet, J ., Meyer. M. & Vermorel. M. 2003. Assessment of Energy Expenditure Associated with Physical Activities in Free-living Obese and Nonobese Adolescents . American Joumal of Clinical Nutrition. 78(3): 471-479.
Lee S. Kem, Kelli , E. F., Simona, K. R., Philip, R. C. & Gerard, J. M. 2002. A Preliminary study to Consider Broader Measures of Weight Control Treatment Success. Eating Behaviors. 3(2): 113-121 .
95
Marmonier, S. J., Chappelot, D. & Loius-Sylvestre, J. 1999. Metabolic and Behavioral Consequences of a Snack Consumed in a Satiety State. American Journal of Clinical Nutrition . 70: 854-866.
Martorell, R, Khan L. K, Hugher, M. L. & Grummer-Strawn, L. M. 1998. Obesity in Latin American women and Children . Journal of Nutrition. 128:1464-1473.
Mattes , R. D. 2000. Ready-to eat Cereal Used as a Meal Replacement Promotes Weight Loss in Humans. Journal of the American College of Nutrition. 21 (6): 570-577.
Monteiro , C. A., Conde , W. L. & Popkin , B. M. 2001 . Independent Effects of Income and Education on the Risk of Obesity in Brazilian Adult Population. Adviser. 81: 38-43.
Munoz, K. A ., Krebs-Smith , S. M., Ballard-Barbash , R.I & Cleveland, L. E. 1997. Food Intakes of US Children and Adolescents Compared with recommendations. Pediatrics. 100(3): 323-329 .
National Coordinating Committee on Food and Nutrition Ministry of Health Malaysia, 2005. Recommended Nutrient Intakes for Malaysia. A Report of the Technical Working Group on Nutritional Guideline. National Coordinating Committee on Food and Nutrition . Putrajaya.
Nicklas, T . A. , Baranowski, T. , Cullen, K. W. & Berenson, G. 2001. Eating Pattem, Dietary Quality and Obesity. Journal of the American Colledge of Nutrition . 20(6): 599-608.
Nutrition Society of Malaysia. 2005. Enjoy a Variety of Food. http://www.nutriweb.org.mv/modules.php?op=modload&name=foodpyramid&file=inde ~. 6 October 2005.
Phillips , S. M, Bandini , L. G. Naumova, E. N, Cyr, H., Colclough. S., Dietz, W. H. & Must. A. 2004. Energy-dense Snack Food Intake in Adolescence: Longitudinal Relationship to Weight and Fatness. The North American Assiociation for the Study of Obesity. 12: 461-472 .
Poh Bee Koh. 2001 . Nutririon for Growing up. http://www.nutriweb.org .my/article.php?sid=55. 19 February 2006.
Pon Lai Wan , Mimalini Kandiah & Mohd Nasir Mohd Taib. 2004. Body Image Perception, Dietary Practices and Physical Activity of Overweight and normal Weight Malaysian Female Adolescents . Malaysian Journal of Nutrition. 10(2).
96
Popkin , B. M. & Udry, J. R. 1998. Adolescent Obesity Increased Significantly in Second and Third Generation U.S. Immigrants: The National Longitudinal Study of Adolescent Health . American Joumal of Nutrition. 128: 701-706.
Prichard, M. E., King, S. L. & Czaika-Narins, D. M. 1997. Adolescent Body Mass Indices and Self-Perception . Adolescence. Winter 1997.
Rinderknecht, K. & Smith, C .. 2002. Body-Image Perceptions among Urban Native American Youth. Obesffy Research. 10; 315-327.
Roemmich , J . N., Wright , S. M. & Epstein, L. H. 2002 . Dietary Restraint and Stress-Induced Snacking in Youth. The North American Association for The Study of Obesity. 10: 1120-1126.
Rolls , B. J ., Roe . L. S., Kral, T. V. E, Meengs, J . S. & Wall, D. E. 2004. Increasing the Portion Size of a Packaged Snack Increases Energy Intake in Men and Women. Appetite. 42: 63-69.
Ruxton , C. H. S, Kirk , T. R. & Belton, N. R. 1996. The Contribution of Specific Dietary Patterns to Energy and Nutrient Intakes in 7-8-Years Old Scottish Schoolchildren. III. Snacking Habits. Journal of Human Nutrition and Dietetics. 9 (1) : 23-31.
Shanthy, A. B., Steven, L. G., Cara, B. E., Mark, A . P. & David, S. L.. Effects of Fast-Food Consumption on Energy Intake and Diet Quality among Children in a National Household Survey. Pediatrics. 113(1): 112-118.
Satterwhite, S. S. 2003. Better Snacking. Southern Living. www.findarticles .com. 10 December 2005 .
Sherina Mohd Sidik & Rozali Ahmad. 2004. Childhood Obesity: Contributing Factors, Consequences and Intervention. Malaysian Journal of Nutrition. 10(1): 13-22.
Spear, B. A. 2000. Nutrition in Adolescence. Mahan LK. & Escott-Stump S. (ed.) . Food, Nutrition, & Diet Theraphy. (10th edition). USA: W.B. Saunders Company. 257-270.
Stang, J . & Story, M. (ed.). 2004. Nutrition Screening, Assessment and Intervention. Guidelines for Adolescents Nutrition Services. University of Minnesota. 35-55.
Stang, J . & Story, M. (ed .).2005 . Understanding Adolescent Eating Behaviors. Guidelines for Adolescents Nutrition Services. University of Minnesota. 9-20.
97
Stella Ainun bt. Abdullah. 2002. Nutritional Status (As Determined by Anthropometric Data) of Children Aged 6 to 8 Years in Kota Kinabalu and Ranau. Nutrition Program School of Food Science and Nutrition, University Sabah Malaysia.
Stockman, N. K. A , Schenkel, T. C. , Brown, J . N. & Duncan, A M. 2005. Comparison of Energy and Nutrient Intakes among Meals and Snacks and Adolescent Males. Preventive Medicine. 41 : 203-210.
St-Onge, M., Keller, K L & Heymsfield, S. B. 2003. Changes in childhood food consumption patterns: a cause for concem in light of increasing body weights . American Society for Clinical Nutrition. 78(6) :1068-1073 .
Summerfield, L. M. (ed.). 2001a. Overweight, Underweight and Obesity. Nutrition, Exercise and Behavior. USA: WasworthlThomson Learning. 1-40.
Summerfield, L. M. (ed.). 2001b. Behavioral Approaches to Weight Management. Nutrition, Exercise and Behavior. USA: WasworthlThomson Learning. 344-395.
Summerfield, L. M. (ed.). 2001c. Assessment Approach in Weight Management. Nutrition, Exercise and Behavior. USA: WasworthlThomson Learning. 344-395.
Tanasescu , M. , Ferris , AM., Himmelgreen, 0 , A , Rodriguez, N. & Perez-Escamilla, R. 2000. Biobehavioral Factors are Associated with Obesity in Puerto Rican Children. Journal of Nutrition. 130: 1734-1742.
Tee E Siong. 1999. Nutrition of Malaysians: Where are We Heading? Malaysian Journal of Nutrition . 5: 87-109.
Tee E Siang. 2000. Malaysians Dietary Guidelines . Nutriweb Malaysia . Nutrition Society of Malaysia. http://WIIVW.nutriweb.org.my/downloads/dietary english. pdf. 19 February 2006.
Thomquist mark, D., Kristal, A. R. , Patterson , R. E., Neuhauser, M. L., Rock, C. L., NeumarkSztainer, D. & Cheskin, L. J . 2000. Olestra Consumption Dose Not Predict Serum Concentrations of Carotenoids and Fat-Soluble Vitamins in Free-Living Humans: Early Results from the Sentinel Site of the Olestra post-marketing Surveillance Study. Journal of Nutrition. 130: 1711-1718.
98
Tran Thi Minh Hanh , Komatsu Tatsushi, Nguyen Thi Kim Hung, Nguyen Van Chuyen , Yoshimura Yukio, Pham Gia Tien & Yamamoto Shigeru . 2001 . Nutriotional Status of Middle-Aged Vietnamese in Ho Chi Minh City. Joumal of the American College of Nutrition . 20(6): 616-622.
Waller , C. E., Du Shufa & Popkin , B. M. 2003. Pattem of Overweight, inactivity and Snacking in Chinese Children . Obesity Research. 11 : 957-961 .
Wang Youfa . 2001 . Cross-national Comparison of Childhood Obesity: the Epidemic and the Relationship between Obesity and Soioeconomic Status. International Joumal of Epidemiology. 30: 1129-1136
Wang Youfa, Bentley, M. E., Zhai Fengying & Popkin , B. M. 2002. Tracking of Dietary Intake Patterns of Chinese From Childhood to Adolescence Over a Six-Year Follow-Up Period . The Joumal of Nutrition. 132: 430-438.
Wikipedia the Free Encyclopaedia. 2005. Sabah. Wikipedia the Free Encyclopaedia. htlp:llen.wikipedia.orglwikiJSabah#Population and ethnic composition. 12 December 2005.
World Health Organization . 1990. Prevention in Children and Youth of Adult Cardiovascular Disease. Geneva: World Health Organization .
World Health Organization . 1995. Physical status: the use and interpretation of anthropometry. Geneva: World Health Organization.
World Health Organization . 1997. Obesity: Preventing and managing the global epidemic. Report on a World Health Organization Consultation on Obesity. Geneva: World Health Organization . 3-5 June.
World Health Organization . 2000a. Obesity in the Pacific: Too Big to Ignore. Workshop on Obesity Prevention and Control Strategies in the Pacific. Samoa: World Health Organization .
World Health Organization . 2000a. The Asia-Pacific Perspective: Redefining Obesity and its Treatment. Westem Pacific Regional Office. World Health Organization .
World Health Organization . 2001 . Water Related Diseases. Geneva . World Health Organization .
99
World Health Organ ization. 2002. Globalization, Diets and Noncommunicable Diseases. Geneva. World Health Organization.
World Health Organization. 2003a. Value, Adolescents, Invest in the Future. Regional Office for the Westem Pacific Manila, Philippines. Wor1d Health Organization.
World Health Organization. 2003b. Obesity and Overweight. Global Strategy on Diet, Physical Activity and Health. World Health Organization .
World Health Organization . 2005a. WHO Global InfoBase Online: Quick Compare. www.who.intlncd surveillance/infobaselweb/lnfoBasePolicyMaker/CountryProfiles/Qui ckCom are.as x? 10 December 2005
World Health Organization. 2005b. Obesity and Overweight. Global Strategy on Diet, Physical Activity and Health. World Health Organ ization.
Yao Manjiang, McCrory, M. A, Ma Guansheng, Tucker, K. L, Gao Shujun, Fuss, P. & Roberts, S. B. 2003. Relative influence of diet and physical activity on body composition in urban Chinese adults. American Society for Clinical Nutrition. 77(6):1409-1416.
Zalilah Mohd Shariff, Bond, J. T ., & Johson, N. E. 2000. Nutritional Status of Primary School Children from Low Income Households in Kuala Lumpur. Malaysians Journal of Nutrition. 6: 17-32.
Ziegler, P. J., Jonnalagadda, S. S., Nelson, J. A. , Lawrence, C.& Baciak, B. 2002. Contribution of Meal and Snacks Intake of Male and Female Elite Figure Skaters during Peak Competition Season. Journal of the American Col/ege of Nutrition. 21 (2): 114-119.
Zizza , C., Seiga-Riz, A. M., Popkin, B. M. 2001 . Significant Increase in Young Adults' Snacking Between 1977-1978 and 1994-1996 Represent a Cause and Concern . Prevent;ve Medicine. 32: 303-310.