human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: INTRODUCTION We aim ed to determine the risk factors associated with abdominal obesity ( AO )  in suburban adolescents . METHODS This cross-sectional study included adolescents aged 15 - 17 years from five r and omly selected secondary schools in the Hulu Langat district of Selangor state , Malaysia .  Waist circumference ( WC ) was measured at the midpoint between the lower margin of the last palpable rib and the top of the iliac crest . Information on sociodemographic data , dietary habits , physical activity levels and duration of sleep was obtained via interviewer-administered question naires . Participants ' habitual food intake was determined using a 73-item Food Frequency Question naire . RESULTS Among 832 participants , 56.0 % were girls ; 48.4 % were Malay , 40.5 % Chinese , 10.2 % Indian and 0.8 % of other ethnic groups . Median age and WC were 16 ( interquartile range [ IQR ] 15 - 16 ) years and 67.9 ( IQR 63.0 - 74.6 ) cm , respectively . Overall prevalence of AO ( > 90th percentile on the WC chart ) was 11.3 % . A higher proportion ( 22.4 % ) of Indian adolescents were found to have AO compared with Malay and Chinese adolescents . Logistic regression analysis showed that female gender ( adjusted odds ratio [ OR ] 7.064 , 95 % confidence interval [ CI ] 2.087 - 23.913 ; p = 0.002 ) , Indian ethnicity ( adjusted OR 10.164 , 95 % CI 2.182 - 47.346 ; p = 0.003 ) , irregular meals ( adjusted OR 3.193 , 95 % CI 1.043 - 9.774 ; p = 0.042 ) and increasing body mass index ( BMI ) ( adjusted OR 2.867 , 95 % CI 2.216 - 3.710 ; p < 0.001 ) were significantly associated with AO . CONCLUSION AO was common among Malaysian adolescents . Female gender , Indian ethnicity , irregular meals and increasing BMI were significant risk factors The relationship between dietary intake and obesity is complex , and dietary pattern analysis may offer new insight . We examined associations between dietary patterns identified in a diverse cohort of adolescents and weight status cross-sectionally and over a 5-year period . Project EAT ( Eating Among Teens ) ( Time 1 ) collected data on 4746 middle ( younger cohort ) and high school ( older cohort ) students in 1998 - 9 . EAT-II ( Time 2 ) resurveyed 2516 of the original cohort in 2003 - 4 . All analyses were run separately by age cohort and sex . The relationship between dietary patterns identified previously ( vegetable , fruit , vegetable & fruit , starchy food , sweet & salty snack food , and fast food ) and weight status was examined using logistic regression . All analyses were adjusted for socioeconomic status , race/ethnicity and activity level ( longitudinal analyses were also adjusted for baseline weight status ) . In cross-sectional analyses , higher adherence to dietary patterns loading heavily on vegetables was associated with lower risk of overweight/obese weight status  in older and younger girls , whereas higher adherence to a ' sweet & salty snack food ' pattern was associated with lower risk in older and younger boys . These associations were found prospect ively in older boys and girls , but were no longer significant in analyses adjusting for baseline weight status . We did not find consistent or intuitive associations between dietary patterns and weight status . Identified patterns may not capture the elements of diet that are truly important in determining adolescent weight , or diet may not be the primary driver in determining weight status at this age . Method ological difficulties in assessing diet must also be taken into consideration Unhealthy dietary pattern increases the risk of obesity and metabolic disorders in growing children and adolescents . However , the way the habitual pattern of breakfast consumption influences body composition and risk of obesity in adolescents is not well defined . Thus , the aim of the present study was to assess any associations between breakfast consumption practice s and body composition profiles in 236 apparently healthy adolescents aged 12 to 19 years . A self-administered question naire on dietary behaviour and lifestyle practice s and a dietary food frequency question naire were used . Body composition and adiposity indices were determined using st and ard anthropometric measurement protocol s and dual energy χ-ray absorptiometry ( DXA ) .  Mean age of the participants was 15.3±1.9 years . The majority of participants ( 71.2 % ) fell in the normal body mass index ( BMI ) ranges . Breakfast consumption patterns showed that only half of the participants ( 50 % ) were consuming breakfast daily . Gender-specific multivariate analyses ( ANCOVA ) showed that in both boys and girls , those eating breakfast at least 5 times a week had significantly lower body weight , body mass index ( BMI ) , BMI z-scores , waist circumference , body fat mass and percent body fat ( % BF ) compared to infrequent breakfast eaters , after adjustment for age , household income , pubertal status , eating-out and snacking practice s , daily energy intakes , and daily physical activity levels . The present findings indicate that infrequent breakfast consumption is associated with higher body adiposity and abdominal obesity . Therefore , daily breakfast consumption with healthy food choices should be encouraged in growing children and adolescents to prevent adiposity during these critical years of growth INTRODUCTION Paediatric obesity is a public health concern worldwide as it can track into adulthood and increase the risk of adult morbidity and mortality . While the aetiology of obesity is multi-factorial , the roles of diet and physical activity are controversial . Thus , the purpose of this study was to report on the differences in  energy intake , diet composition , time spent doing physical activity and energy expenditure  among underweight ( UW ) , normal weight ( NW ) and at-risk of overweight ( OW ) Malaysian adolescents ( 317 females and 301 males ) aged 11 - 15 years . METHODS This was a cross-sectional study with 6,555 adolescents measured for weights and heights for body mass index ( BMI ) categorisation . A total of 618 subjects were r and omly selected from each BMI category according to gender . The subjects '  dietary intake and physical activity  were assessed using self-reported three-day food and activity records , respectively . Dietary intake components included total energy and macronutrient intakes .  Energy expenditure was calculated as a sum of energy expended for basal metabolic rate and physical activity . Time spent ( in minutes ) in low , medium and high intensity activities was also calculated . RESULTS The OW adolescents had the highest crude energy intake and energy expenditure . However , after adjusting for body weight , the OW subjects had the lowest energy intake and energy expenditure ( p-value is less than 0.001 ) . The study groups did not differ significantly in time spent for low , medium and high intensity activities . Macronutrient intakes differed significantly only among the girls where the OW group had the highest intakes compared to UW and NW groups ( p-value is less than 0.05 ) . All study groups had greater than 30 percent and less than 55 percent of energy intake from fat and carbohydrate , respectively . CONCLUSION The data suggested that a combination of low energy expenditure adjusted for body weight and high dietary fat intake may be associated with overweight and obesity among adolescents . To prevent overweight and obesity among children and adolescents , strategies that address eating behaviours and physical activity are required . Various segments of the society must be involved in efforts to promote healthful dietary intakes and active lifestyle in children and adolescents INTRODUCTION A cross-sectional study was conducted to determine physical activity , eating behaviour , body weight management knowledge , perception of body image and their association with  body weight status of adolescents . METHODS Respondents were 360 adolescents , aged between 13 to 14 years , from six r and omly selected secondary schools in Kuantan , Pahang . Physical  activity , eating behaviour , body weight management knowledge and perception of body image were measured by the  Physical Activity Question naire for Older Children ( PAQ-C ) , Eating Attitude Test-26 ( EAT-26 ) , Weight Management Knowledge Inventory ( WMKI ) and Contour Drawing Rating Scale ( CDRS ) , respectively . RESULTS Almost half of the respondents were categorised as having a normal BMI , while 30.3 % were severely thin and thin and 20.3 % were overweight and obese . Mean physical activity score was 2.06 + /- 0.45 with more males ( 35.0 % ) being physically active than females ( 17.3 % ) . Mean eating behaviour score was 15.41 + /- 10.37 , with 27.8 % of the respondents being at-risk for eating disorders . Mean weight management knowledge score was 5.35 + /- 1.80 , with more females ( 77.7 % ) having higher mean scores than males ( 42.3 % ) . Further , mean discrepancy score for body image perception was 1.24 + /- 0.99 , with 78.1 % of the respondents being dissatisfied with their current body size . Positive associations were found between eating behaviour ( r = 0.28 , p < 0.05 ) and body image ( r = 0.35 , p < 0.05 ) with BMI . Respondents with high eating behaviour scores and body image discrepancy scores were more likely to have greater BMI . CONCLUSION This study shows the need for healthy eating and body image intervention programmes to prevent overweight and obesity problems among adolescents 
    Output:
    
agent
The studies showed that obese and overweight adolescents consume significantly more energy and macronutrients .
They are also more likely to skip their daily meals compared to their normal weight peers .
In most studies , the direction of the PA effect on body weight was unclear .
Some studies found that higher PA is associated with a lower risk of overweight and obesity .
Conclusions This review identified a lack of evidence and well-conducted prospect i ve studies on the effect of diet and PA on cardio-metabolic health of Malaysian adolescents
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: INTRODUCTION We aim ed to determine the risk factors associated with abdominal obesity ( AO )  in suburban adolescents . METHODS This cross-sectional study included adolescents aged 15 - 17 years from five r and omly selected secondary schools in the Hulu Langat district of Selangor state , Malaysia .  Waist circumference ( WC ) was measured at the midpoint between the lower margin of the last palpable rib and the top of the iliac crest . Information on sociodemographic data , dietary habits , physical activity levels and duration of sleep was obtained via interviewer-administered question naires . Participants ' habitual food intake was determined using a 73-item Food Frequency Question naire . RESULTS Among 832 participants , 56.0 % were girls ; 48.4 % were Malay , 40.5 % Chinese , 10.2 % Indian and 0.8 % of other ethnic groups . Median age and WC were 16 ( interquartile range [ IQR ] 15 - 16 ) years and 67.9 ( IQR 63.0 - 74.6 ) cm , respectively . Overall prevalence of AO ( > 90th percentile on the WC chart ) was 11.3 % . A higher proportion ( 22.4 % ) of Indian adolescents were found to have AO compared with Malay and Chinese adolescents . Logistic regression analysis showed that female gender ( adjusted odds ratio [ OR ] 7.064 , 95 % confidence interval [ CI ] 2.087 - 23.913 ; p = 0.002 ) , Indian ethnicity ( adjusted OR 10.164 , 95 % CI 2.182 - 47.346 ; p = 0.003 ) , irregular meals ( adjusted OR 3.193 , 95 % CI 1.043 - 9.774 ; p = 0.042 ) and increasing body mass index ( BMI ) ( adjusted OR 2.867 , 95 % CI 2.216 - 3.710 ; p < 0.001 ) were significantly associated with AO . CONCLUSION AO was common among Malaysian adolescents . Female gender , Indian ethnicity , irregular meals and increasing BMI were significant risk factors The relationship between dietary intake and obesity is complex , and dietary pattern analysis may offer new insight . We examined associations between dietary patterns identified in a diverse cohort of adolescents and weight status cross-sectionally and over a 5-year period . Project EAT ( Eating Among Teens ) ( Time 1 ) collected data on 4746 middle ( younger cohort ) and high school ( older cohort ) students in 1998 - 9 . EAT-II ( Time 2 ) resurveyed 2516 of the original cohort in 2003 - 4 . All analyses were run separately by age cohort and sex . The relationship between dietary patterns identified previously ( vegetable , fruit , vegetable & fruit , starchy food , sweet & salty snack food , and fast food ) and weight status was examined using logistic regression . All analyses were adjusted for socioeconomic status , race/ethnicity and activity level ( longitudinal analyses were also adjusted for baseline weight status ) . In cross-sectional analyses , higher adherence to dietary patterns loading heavily on vegetables was associated with lower risk of overweight/obese weight status  in older and younger girls , whereas higher adherence to a ' sweet & salty snack food ' pattern was associated with lower risk in older and younger boys . These associations were found prospect ively in older boys and girls , but were no longer significant in analyses adjusting for baseline weight status . We did not find consistent or intuitive associations between dietary patterns and weight status . Identified patterns may not capture the elements of diet that are truly important in determining adolescent weight , or diet may not be the primary driver in determining weight status at this age . Method ological difficulties in assessing diet must also be taken into consideration Unhealthy dietary pattern increases the risk of obesity and metabolic disorders in growing children and adolescents . However , the way the habitual pattern of breakfast consumption influences body composition and risk of obesity in adolescents is not well defined . Thus , the aim of the present study was to assess any associations between breakfast consumption practice s and body composition profiles in 236 apparently healthy adolescents aged 12 to 19 years . A self-administered question naire on dietary behaviour and lifestyle practice s and a dietary food frequency question naire were used . Body composition and adiposity indices were determined using st and ard anthropometric measurement protocol s and dual energy χ-ray absorptiometry ( DXA ) .  Mean age of the participants was 15.3±1.9 years . The majority of participants ( 71.2 % ) fell in the normal body mass index ( BMI ) ranges . Breakfast consumption patterns showed that only half of the participants ( 50 % ) were consuming breakfast daily . Gender-specific multivariate analyses ( ANCOVA ) showed that in both boys and girls , those eating breakfast at least 5 times a week had significantly lower body weight , body mass index ( BMI ) , BMI z-scores , waist circumference , body fat mass and percent body fat ( % BF ) compared to infrequent breakfast eaters , after adjustment for age , household income , pubertal status , eating-out and snacking practice s , daily energy intakes , and daily physical activity levels . The present findings indicate that infrequent breakfast consumption is associated with higher body adiposity and abdominal obesity . Therefore , daily breakfast consumption with healthy food choices should be encouraged in growing children and adolescents to prevent adiposity during these critical years of growth INTRODUCTION Paediatric obesity is a public health concern worldwide as it can track into adulthood and increase the risk of adult morbidity and mortality . While the aetiology of obesity is multi-factorial , the roles of diet and physical activity are controversial . Thus , the purpose of this study was to report on the differences in  energy intake , diet composition , time spent doing physical activity and energy expenditure  among underweight ( UW ) , normal weight ( NW ) and at-risk of overweight ( OW ) Malaysian adolescents ( 317 females and 301 males ) aged 11 - 15 years . METHODS This was a cross-sectional study with 6,555 adolescents measured for weights and heights for body mass index ( BMI ) categorisation . A total of 618 subjects were r and omly selected from each BMI category according to gender . The subjects '  dietary intake and physical activity  were assessed using self-reported three-day food and activity records , respectively . Dietary intake components included total energy and macronutrient intakes .  Energy expenditure was calculated as a sum of energy expended for basal metabolic rate and physical activity . Time spent ( in minutes ) in low , medium and high intensity activities was also calculated . RESULTS The OW adolescents had the highest crude energy intake and energy expenditure . However , after adjusting for body weight , the OW subjects had the lowest energy intake and energy expenditure ( p-value is less than 0.001 ) . The study groups did not differ significantly in time spent for low , medium and high intensity activities . Macronutrient intakes differed significantly only among the girls where the OW group had the highest intakes compared to UW and NW groups ( p-value is less than 0.05 ) . All study groups had greater than 30 percent and less than 55 percent of energy intake from fat and carbohydrate , respectively . CONCLUSION The data suggested that a combination of low energy expenditure adjusted for body weight and high dietary fat intake may be associated with overweight and obesity among adolescents . To prevent overweight and obesity among children and adolescents , strategies that address eating behaviours and physical activity are required . Various segments of the society must be involved in efforts to promote healthful dietary intakes and active lifestyle in children and adolescents INTRODUCTION A cross-sectional study was conducted to determine physical activity , eating behaviour , body weight management knowledge , perception of body image and their association with  body weight status of adolescents . METHODS Respondents were 360 adolescents , aged between 13 to 14 years , from six r and omly selected secondary schools in Kuantan , Pahang . Physical  activity , eating behaviour , body weight management knowledge and perception of body image were measured by the  Physical Activity Question naire for Older Children ( PAQ-C ) , Eating Attitude Test-26 ( EAT-26 ) , Weight Management Knowledge Inventory ( WMKI ) and Contour Drawing Rating Scale ( CDRS ) , respectively . RESULTS Almost half of the respondents were categorised as having a normal BMI , while 30.3 % were severely thin and thin and 20.3 % were overweight and obese . Mean physical activity score was 2.06 + /- 0.45 with more males ( 35.0 % ) being physically active than females ( 17.3 % ) . Mean eating behaviour score was 15.41 + /- 10.37 , with 27.8 % of the respondents being at-risk for eating disorders . Mean weight management knowledge score was 5.35 + /- 1.80 , with more females ( 77.7 % ) having higher mean scores than males ( 42.3 % ) . Further , mean discrepancy score for body image perception was 1.24 + /- 0.99 , with 78.1 % of the respondents being dissatisfied with their current body size . Positive associations were found between eating behaviour ( r = 0.28 , p < 0.05 ) and body image ( r = 0.35 , p < 0.05 ) with BMI . Respondents with high eating behaviour scores and body image discrepancy scores were more likely to have greater BMI . CONCLUSION This study shows the need for healthy eating and body image intervention programmes to prevent overweight and obesity problems among adolescents 
    Output:
    