Diet, physical activity and cardiometabolic health in Malaysian adolescents: from epidemiology to intervention

In Malaysia the prevalence of obesity among adolescents is increasing and non-communicable diseases, like type 2 diabetes and cardiovascular disease, account for two out of three deaths. While research in European and US-based populations has found that particular lifestyle factors might cause adolescents to be fatter and less fit we do not have a complete picture of what causes these problems in Malaysia. In this study we are going to look at how different lifestyle factors, like foods eaten, timing or frequency of eating, physical activity, sedentary behaviours and their timing or location, combine together to create an overall behavioural pattern score that indicates whether adolescents have good health. We've previously found that a combination of factors is more important for health compared with single factors alone. Initial analysis of health outcomes will focus on obesity, blood pressure, and how much LDL cholesterol, fats and glucose are in blood samples. We also plan to use a new, reproducible laboratory technique, known as metabolomics, to measure 233 different components of blood that indicate a range of metabolic processes. This will help us find out in much more detail than ever before how behaviour leads to better cardiovascular health via metabolic pathways. When we know more about the pathway that leads from lifestyle to disease we will be better able to predict who will stay healthy and who will not. In this study, one of our aims is to find the main behaviours related to keeping a healthy metabolism and reducing the risk of cardiovascular disease in the future. We'll then work out how these behaviours can changed by an intervention. This research is possible because of a large study of over 1361 adolescents, called MyHeARTs. The aim of MyHeARTs was to identify which factors best predict health to enable the early detection and prevention of type 2 diabetes and cardiovascular disease. MyHeARTs started in 2012, collecting information on the behaviour and health of 1361 adolescents from 15 urban and rural schools in 3 regions of Malaysia and has just completed a third follow-up in 2016. The participants have provided detailed reports of their diet, activity, and other health behaviours as well as measurements of body composition, physical fitness and blood samples at age 13, 15 and 17, which we will use for this study. We are interested to see whether combinations of lifestyle behaviours can accurately predict changes in the blood chemical profile of participants as they progress through adolescence before they develop clear symptoms of cardiovascular disease or diabetes. Finally, within this project we lay the foundations for improving adolescents' metabolic health. We will talk to adolescents and school staff about how they could adopt the behaviours we found were important for health in MyHeART. We will then use their views paired with known methods of behaviour change to encourage a healthy lifestyle and prevent disease that will work in countries, like Malaysia, where resources are limited.