title: Eating behaviour among multi-ethnic adolescents in a middle-income country as measured by the self-reported Children's Eating Behaviour Questionnaire.
abstract: BACKGROUND
  Escalating weight gain among the Malaysian paediatric population necessitates identifying modifiable behaviours in the obesity pathway.
  
  
  OBJECTIVE
  This study describes the adaptation and validation of the Children's Eating Behaviour Questionnaire (CEBQ) as a self-report for adolescents, investigates gender and ethnic differences in eating behaviour and examines associations between eating behaviour and body mass index (BMI) z-scores among multi-ethnic Malaysian adolescents.
  
  
  METHODS
  This two-phase study involved validation of the Malay self-reported CEBQ in Phase 1 (n = 362). Principal Axis Factoring with Promax rotation, confirmatory factor analysis and reliability tests were performed. In Phase 2, adolescents completed the questionnaire (n = 646). Weight and height were measured. Gender and ethnic differences in eating behaviour were investigated. Associations between eating behaviour and BMI z-scores were examined with complex samples general linear model (GLM) analyses, adjusted for gender, ethnicity and maternal educational level.
  
  
  RESULTS
  Exploratory factor analysis revealed a 35-item, 9-factor structure with 'food fussiness' scale split into two. In confirmatory factor analysis, a 30-item, 8-factor structure yielded an improved model fit. Reliability estimates of the eight factors were acceptable. Eating behaviours did not differ between genders. Malay adolescents reported higher Food Responsiveness, Enjoyment of Food, Emotional Overeating, Slowness in Eating, Emotional Undereating and Food Fussiness 1 scores (p<0.05) compared to Chinese and Indians. A significant negative association was observed between BMI z-scores and Food Fussiness 1 ('dislike towards food') when adjusted for confounders.
  
  
  CONCLUSIONS
  Although CEBQ is a valuable psychometric instrument, adjustments were required due to age and cultural differences in our sample. With the self-report, our findings present that gender, ethnic and weight status influenced eating behaviours. Obese adolescents were found to display a lack of dislike towards food. Future longitudinal and qualitative studies are warranted to further understand behavioural phenotypes of obesity to guide prevention and intervention strategies.
authors.affiliation: Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Debbie Ann
authors.initials: DA
authors.lastname: Loh
authors.affiliation: Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Foong Ming
authors.initials: FM
authors.lastname: Moy
authors.affiliation: Department of Pharmacology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Nur Lisa
authors.initials: NL
authors.lastname: Zaharan
authors.affiliation: Department of Pharmacology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Zahurin
authors.initials: Z
authors.lastname: Mohamed
mesh_terms: D000293:Adolescent; D001835:Body Weight; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D008297:Male; D008954:Models, Biological; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires