What’s Happening in Malaysia?
Malaysia mirrors this global trend. The country currently faces a triple burden of malnutrition - undernutrition, micronutrient deficiencies, and a high prevalence of overweight and obesity (Poh et al. 2023). Our earlier research showed that children with higher body weight or abdominal fat were significantly more likely to exhibit early signs of hypertension - a concerning health risk, even in childhood stage (Poh et al. 2022).
Urban living in Malaysia is reshaping children’s routines. Schoolchildren are growing up in fast-paced environments filled with processed food, increasing screen time, and intense school pressure - all of which affect how they eat, move, and sleep. In addition, 41.5% of Malaysian children (aged 6-12 years) did not get enough sleep (Firouzi et al. 2013) and 24.0% of secondary school children had poor sleep quality (Kesintha et al. 2018). To support children’s growth and development, we need to understand how these lifestyle factors are interconnected.
Why It Matters: Diet, Activity, and Sleep are Interconnected
Our latest study of 296 schoolchildren in Kuala Lumpur reveals just how closely diet, physical activity, and sleep are linked—sometimes in surprising ways:
- Over two-thirds of children did not get enough sleep for their age, whereby the recommendation is 9–11 h/day for children aged 5–13 years, and 8–10 h/day for adolescents aged 14–18 years (Loo et al. 2022).
- Lower energy intake was linked to sleep disruptions, while lower protein intake was unexpectedly associated with longer sleep duration.
- Children who were less physically active had more sleep problems, including bedtime resistance, daytime sleepiness, and overall poor sleep behaviours.
Together, these findings point to a clear message:
Healthy sleep doesn’t exist in a vacuum. It’s closely tied to what children eat and how active they are. To be truly effective, health strategies must address diet, physical activity, and sleep as interconnected elements, rather than separate factors.
Taking It Beyond the Data: Building Trust with Communities
This research was not just about numbers. It was about connection. We:
- Partnered with school administrators, teachers, parents, and the children to both collect data and raise awareness about their healthy habits along the way.
- Shared personalised health reports with the parents, highlighting their child’s nutritional status and key health indicators.
- Delivered engaging nutrition talks that encouraged children to build healthy routines on nutritious food, sleep, and physical activity.
Through these efforts, we aimed not only to inform but to empower families and schools to take small, practical steps toward healthier daily routines that support children’s sleep and overall well-being.
Research Isn’t Always Easy: The Challenges on the Ground
Behind every data point is a long day in a bustling school.
Key challenges included:
- Coordinating with busy school administrators and working around tight school schedules, demanding ongoing flexibility and negotiation.
- Obtaining informed consent was tough, especially in communities with different levels of health literacy, called for clear, respectful, and culturally sensitivity communication.
- Managing logistics - from setting up equipment to keeping enthusiastic children engaged - often turned simple tasks into complex ones.
- A shortage of trained manpower to ensure smooth data collection added another layer of complexity.
But these challenges underscored the value of working on the ground. They pushed us to be adaptable, patient, and creative – skills that are essential for conducting meaningful and impactful public health research.
Advancing Child Health: The Next Chapter
Research should go beyond publications - it should drive real change. Our study aimed to do just that by building trust and working closely with schools, parents, and children to understand and improve daily health habits in urban settings.
While the research findings provided valuable insights, they also raised key questions:
- How do school policies and urban environments influence children’s health and well-being?
- What makes a school-based interventions truly effective in promoting child’s health and well-being?
Turning Insights into Action: Collaborating for Healthier Futures
To make a lasting impact, we are moving from research to real-world solutions. Our next steps:
- Partnering with schools and local health professionals to design and implement practical, school-based health interventions.
- Expand our research to rural and underserved communities to ensure inclusive, context-sensitive strategies.
- Advocate for supportive policies and environments that foster healthier lifestyles for all children in Malaysia.
We believe true progress happens not just in journals, but in homes, classrooms, and communities – the places where change truly begins.
Building Healthy Habits: A Guide for Parents
Based on our findings, here are simple ways parents can support their child’s well-being, particularly by following the 24-hour activity guidelines (Loo et al. 2022):
- Encourage daily physical activity – Aim for at least 60 minutes of moderate to vigorous movement each day.
- Maintain a consistent sleep schedule – Set regular bedtimes and wake-up times to enhance sleep patterns.
- Limit recreational screen time – Keep it to 2 hours or less per day, and avoid screens before bedtime to support melatonin production and sleep quality.
- Promote healthy eating – Provide balanced, nutritious meals and drinks to support growth and overall health.
Bottom Line:
Urbanisation in Malaysia is reshaping children’s lifestyles, contributing to unhealthy diets, reduced physical activity, and poor sleep - all of which are interconnected and impact children’s health. Our research highlights the need for holistic strategies that tackle these issues together, not in isolation. Real change begins in the everyday spaces where children live, learn, and play.
Our work is just at the beginning. Together with communities, schools, and families, we hope to build a future where every child – urban or rural – has the support they need to grow, thrive, and rest well.
Relevant Studies
Poh BK, Wong JE, Lee ST, et al. Triple burden of malnutrition among Malaysian children aged 6 months to 12 years: current findings from SEANUTS II Malaysia. Public Health Nutrition. 2023;27(1): e151. https://doi.org/10.1017/S1368980023002239
Poh BK, Ang YN, Yeo GS, et al. Anthropometric indices, but not birth weight, are associated with high blood pressure risk among Malay adolescents in Kuala Lumpur. Dialogues in Health. 2022;1:100006. https://doi.org/10.1016/j.dialog.2022.100006
Firouzi S, Poh BK, Noor MI, et al. Sleep pattern and sleep disorders among a sample of Malaysian children. Sleep and Biological Rhythms. 2013;11:185–93. https://doi.org/10.1111/sbr.12020
Kesintha A, Rampal L, Sidik SM, et al. Prevalence and predictors of poor sleep quality among secondary school students in Gombak district, Selangor. Medical Journal of Malaysia. 2018;73:31–40.
Loo BKG, Okely AD, Pulungan A, et al. Asia-pacific consensus statement on integrated 24-h activity guidelines for children and adolescents. British Journal of Sports Medicine. 2022;56:539–45. https://doi.org/10.1136/bjsports-2021-104527