ToyBox Study Malaysia: Improving healthy energy balance and obesity-related behaviours among pre-schoolers in Malaysia

S. Reeves*, B. K. Poh†, C. Essau*, C. Summerbell‡, W. L. Cheah§, D. Koh†, J. A. C. Lee§,
A. T. Ruzita† and E. L. Gibson*

* University of Roehampton, London, UK;
Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia;
Department of Sport and Exercise Sciences, University of Durham, Durham, UK;
§ Universiti Malaysia Sarawak, Kota Samarahan, Malaysia


The prevalence of childhood overweight and obesity is increasing in Malaysia and currently nearly 10% of children aged between 6 months and 12 years are overweight and almost 12% are obese. Early interventions to prevent excess weight gain are needed. ToyBox Study Malaysia is a feasibility project, funded by the Medical Research Council Newton-Ungku Omar Fund, to assess the practicalities of adapting the existing European ToyBox Study intervention
programme to the Malaysian kindergarten setting. The main aims of all ToyBox programmes are related to improving four key energy balance-related behaviours, namely drinking water, eating healthy snacks and meals, reducing sedentary behaviour and increasing physical activity. Using stratified sampling, the ToyBox Study Malaysia intervention will be delivered and compared to usual practice by assessing behaviour, physical activity and health-related outcomes as measured by questionnaires, accelerometry and anthropometry. It is hoped that the evidence-based ToyBox Study Malaysia will help to achieve healthier energy balance-related behaviours in the children and their families and provide lifelong benefits to health. This article provides information on the dietary patterns, physical activity levels and prevalence of overweight and obesity in Malaysian children, and the approach of the ToyBox Study Malaysia.

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Validity and Reliability of a Food Frequency Questionnaire (FFQ) to Assess Dietary Intake of Preschool Children

Yatiman Noor Hafizah, Lee Choo Ang, Fendy Yap, Wan Nurul Najwa, Whye Lian Cheah, Talib Ruzita Abd, Farra Aidah Jumuddin, Denise Koh, Julia Ai Cheng Lee, Cecilia Essau, Sue Reeves, Carolyn Summerbell, Edward Leigh Gibson, Bee Koon Poh

Department of PsychologyDepartment of Life Sciences


As there are few food frequency questionnaires (FFQ) to assess the dietary intake of preschool children, this study examined the validity and reliability of an FFQ for this purpose. A total of 210 preschoolers aged 4 to 6 years participated in the validation study, while a subsample of 66 participants joined the reliability study. The FFQ is modified from ToyBox-study and SEANUTS, and comprised 108 food items from 13 food 30 groups. A three-day estimated dietary record (3DR) was used as reference and reliability was assessed through a second administration of the FFQ (FFQ2), four weeks after the first administration (FFQ1). For the validation study, Spearman’s correlation coefficients showed moderate to high correlations (p<0.001) between FFQ and 3DR. Cross-classification of quartile analysis showed moderate agreement between the two methods. As for reliability, Spearman’s correlation coefficients showed moderate to high correlations (p<0.001) between FFQ1 and FFQ2. Cronbach’s alpha values (0.708 to 0.824) and intraclass correlation coefficients (0.710 to 0.826) showed good agreement between repeated FFQs. The results suggest that the FFQ has acceptable validity and good reliability. Hence, the FFQ can be used to assess preschool children’s food intake.