Chapter 5

Lifestyle habits and healthrest/sleep. Where exercising is concerned, this is a phase when development of the nerve system occurs,
which prompts a child to try a variety of different body movements, such as those that require control ofbody balance (i.e. standing, sitting, or spinning), those that move the body from one place to another (i.e.
walking, running, or climbing), and those that involve the maneuvering of tools (i.e. throwing, kicking,or pedaling)1.
School-age years: The first half of this phase is when a child undergoes relatively stable growth, andLearning objectives

it is important that a child should not only establish habits of healthy diet, exercise, and rest/sleep, but

You will be able to gain proper understanding and explain:also learn and gain an understanding and sense of right and wrong, language and cognitive abilities, and- What makes heathy lifestyle habits.

self-affirmation, as well as developing social skills2. Following infancy and early childhood, school-age- Healthy lifestyle habits at different stages of children’s development.

years will continue to see development of the nerve system; in addition to body movements that require- How malnutrition and overnutrition affect the human body.

control of body balance, moving the body from one place to another, or which involve the maneuvering- How lack of sleep and physical inactivity affect the human body.

of tools, a child during this period will try body movements that test their body strength (for example,- What relationship diet, exercise, and rest/sleep have with health, and then think about healthy

two children carrying another child, tug-of-war) or those that combine more than one basic bodylifestyle behaviors.
- What should be improved in terms of healthy lifestyle behaviors by reviewing your life on a
specific day (from the previous week).
- What should be improved in terms of healthy diet and balanced nutrition by reviewing your dieton a specific day (from the previous week).

movement3. In the latter half of the school-age years, meanwhile, a child will experience significant
growth of their body, and it is essential that they lead a healthy life to promote body growth. This is aperiod when a child’s body will come to change to that of an adult’s, although growth varies significantly
among individual children. In terms of exercising, it is important that a child practice sustained, lowintensity exercise that helps them become better at keeping skilled movements, such as jumping ropeand standing on one foot.

In this chapter, you will learn about the relationships between one’s health and lifestyle habits (lifestyle

Adolescence: A child will undergo dramatic changes to their body such as menarche or spermarche.

behaviors), with a focus on diet, exercise, and rest and sleep. Specifically, we will cover topics that

These are called secondary sex characteristics. During this phase, a child will experience certain

include children’s growth/development and lifestyle habits, lifestyle habits and health, basic lifestylephysical issues associated with body growth and development, including anemia due to deficiencies ofhabits, diet/nutrition and health, exercise and health, rest/sleep and health.

nutrients, especially iron, as a result of muscle growth and menstruation, or dizziness and fatigue due tounstable autonomic function.

1. Children’s lifestyle habits and health1) Growth/development and lifestyle habits

In psychological and behavioral development, a child may develop sexual interest and rebel against
adults. It is therefore necessary to pay attention to any sign of risky sexual activities, smoking, drinking,Learning of body movements

Mental and physical changes in children are known to include growth and development. The former(qualitative) changes. While children’s growth and development vary among individuals, they may be
divided into the following stages according to their nature: neonatal (first four weeks after birth);
infancy (birth to 1 year); early childhood (preschool years); middle childhood (primary school years);
and adolescence (junior high school years to young adulthood, or until one stops gaining height) (seeAnnual gain

includes quantitative changes in factors such as height and weight, and the latter refers to functional

HeightEndurance

Chapter 3 for details on the topic of children’s growth and development). Here we discuss the relationship
Body strength

between lifestyle habits and health in the following phases: infancy and early childhood; school-age
years; and adolescence.
Infancy and early childhood: This is a phase when a child will become able to do things on their

0
5

6

7

8

9

10

11

12

13

14

15

16

17

78

19 (Years of age)
(Miyashita, 1986)

own, such as eating, using the toilet, and dressing and undressing themselves, as well as learn patternsof everyday life. It is therefore important that a child should acquire habits of healthy diet, exercise, and18

Figure 5.1 Child growth/development patterns4
Chapter 5

Lifestyle habits and health79

or drug abuse. Socially, a child will need to acquire control of their social life so that they remain true tothemselves and live their own way while fulfilling their social responsibilities in interactions with friends
and adults in school, the local community, and at home. In terms of exercising, this is a period when the

2. Diet/nutrition and health

6-81) What it means to human health to eat9

load on children increases so that they acquire abilities (endurance) and body strength to performsustained exercise that helps them become better at skilled movements4 (Figure 5.1).

Humans need to take in nutrients from the external world in order to maintain life activities. Humans
fulfill this need by eating. Eating has the following three primary functions:2) Establishment of basic lifestyle habitsi. Supplying nutrients to sustain life and support living activities
ii. Providing a sense of security and satisfaction, bringing about psychological fulfillmentiii. Building a basic unit of social community

Basic lifestyle habits refer to a set of lifestyle habits with well-balanced nutrition, exercise, and rest/

The function of “supplying nutrients to sustain life and support living activities” is an important one

sleep that are important for the promotion of a child’s growth. Sections 3, 4, and 5 below discuss diet/for the purpose of maintaining homeostasis in the body of a living person. The body of a living person

nutrition, exercise, and rest/sleep, respectively. They are not independent of one another, however, but

has biological clocks that regulate the cycle of circadian rhythms. Maintaining one’s circadian rhythm

are mutually interrelated. As Figure 5.2 shows, for instance, reduced quality of sleep affects breakfast

is strongly associated with maintaining their health in a favorable condition. When the body of a living

habits, skipping breakfast affects daytime activities, and physical inactivity during the day reduces

person develops a memory of the timing when nutrients are supplied, regulatory functions such as

quality of sleep, thus creating a vicious cycle.5 Rather than focusing on one element only, it is critical tohormone secretion and enzyme reaction are synchronized properly. While nutrients may be pooledestablish healthy and regular lifestyle habits in which all of the elements are well-balanced, and thus aim

within the body of a living person to a certain degree, they are basically supplied with each meal.

for a virtuous cycle based on good rhythm of everyday life.5

Regular supplies of nutrients are essential for sustaining life and supporting living activities. Eating
regularly everyday therefore forms a foundation of desirable lifestyle habits, which in turn helps prevent

Example of good rhythm of everyday life

lifestyle-related diseases.
The function of “providing a sense of security and satisfaction, bringing about psychologicalMorning- Gets up early- Wakes up feeling refreshed- Eats breakfast- Passes a bowel movement

At school- Can focus on studying- Plays well with friends, fullof energy- Eats lunch

fulfillment” helps one avoid a sense of danger to life and remain emotionally stable. If the body of a

Evening- Enjoys supper- Seldom has late-night snacks- Goes to bed early

At home- Plays outdoors, full of energy- Does household chores- Does schoolwork and reads
books

that they will always obtain food at regular times or when they feel hungry. Eating food that is delicious

Example of poor rhythm of everyday life
Morning- In bed until last moment- Hard to wake up- Skips breakfast- Fails to pass a bowel movement

At school- Cannot focus on studying- Behaves restlessly- Feels ill after physical activity- Skips lunch

living person senses a state of starvation, it will trigger a variety of chemical reactions, including
preferential activation of the system that supplies glucose to the brain and nerve cells. During infancy
and early childhood, in particular, meals have the significance of giving children a sense of security inor which is something they like can also give them a sense of satisfaction or a zest for life.
The function of “forming a basic unit of a social community” is, in other words, a tool forcommunication to form connections between people. This is because people form human relationshipsthat will become basic units of a community through interactions among themselves as they share ameal, giving children an opportunity to acquire social-mindedness from adults such as their food culture,
table manners, and ceremonial rituals. Furthermore, the same group of people sharing the same time andplace regularly will be able to check in on the safety and health of one another. It has been reported thatthose in middle childhood and adolescence who share family meals three or more times per week are
more likely to stay in a normal weight range and have healthy dietary and eating patterns compared tothose who do so less than three times per week10.

Evening- Eats supper at later hours- Has late-night snacks- Stays up late at night

At home- Plays video games indoors- Attends many after-school
programs

Adapted from Ministry of Education, Culture, Sports, Science and Technology,
Learning materials on eating habits (for 5th and 6th graders)

Figure 5.2 Examples of good and poor rhythms of everyday life5802) Characteristics of dietary effect
The body of a living person will not fall out of form immediately after the external supply of foodceases. This is because various mechanisms come into play to maintain the homeostasis of the body. For
Chapter 5

Lifestyle habits and health81

instance, mineral or vitamin deficiencies will not immediately cause pain or other problems; in many

the body; and to coordinate the chemical reactions that occur in the body. Carbohydrates, lipids, andcases, by the time a mental or physical symptom does manifest itself, the problem will already haveproteins serve as the sources of energy, and proteins and minerals (i.e. the 16 essential minerals

fairly progressed. Dietary effects have the following three characteristics:

including calcium, iron, and sodium) form components of the body, while minerals, vitamins, and dietaryi. Diet has gradual effects on the body of a living person

fibers are required to coordinate the chemical reactions in the body.

ii. Adequacy of content of meals does not become clear to them immediately in generaliii. One must take in nutrients repeatedly and indefinitely

Nutrients

The effects a diet has are characterized by their slow and gradual nature. While pharmaceuticalproducts in general produce effects rapidly, food produces effects little by little, which often makes it
impossible to evaluate its effects promptly. Imbalance in diet results in inadequate nutrient intake, leading
to malnutrition. In many cases, people recognize the fact that they have an inappropriate diet only after
a state of malnutrition persists for a while and they themselves or others around them notice their mental

Carbohydrates

at an early stage, it is important to conduct a diet survey and physical examination. If malnutrition is
manifested as mental or physical symptoms, testing must be performed, including biochemical andphysiological tests such as blood tests (e.g. white blood cell count and hemoglobin levels) and urine tests

Primary dietary sources

Energy sources

Starchy food, cereal, fat

Building components ofthe body

Fish, meat, eggs, beans, milk

Coordination of chemical
reactions in the body

Whole small fish, milk, dairy
products, fruits, vegetables

LipidsProteinsor physical changes. Figure 5.3 illustrates what characterizes dietary effects and how they may beevaluated. In order to detect any imbalance in nutrient intakes and a poor nutrition due to improper diet

Major roles

Minerals
Vitamins
Dietary fibers(e.g. urine protein, occult blood, and urine glucose level), and functional and morphological tests (e.g.

Figure 5.4. Nutrients, and their major roles and primary dietary sourcesheight/weight measurements, athletic performance, pulmonary function test, hearing, and eyesight).
Diet

Body

Body

Body

Factors

Nutrients

Nutrition status

Biochemical/
physiological changes

Functional/
morphological changes

Evaluation
methods

Diet survey

Physical examination

Blood/urine testing

Function testing

Subclinical/asymptomatic
Mild

Clinically evident
SevereFigure 5.3 Dietary effects and methods for their evaluation

3) Healthy diet

Whole grain, beans, seeds,
vegetables, seaweeds

With the exception of granulated sugar and refined oils, very few food items contain a single nutrient;food contains a variety of nutrients. In order to minimize imbalance in nutrient intake, it is important totake in as many types of food as possible. In reality, however, it is difficult to have every type of food in
one meal and such an attempt can even result in excessive intake. It is therefore important to focus on
daily total or weekly average intake to keep a well-balanced diet. In the following, we will briefly
discuss the nutritional significance of the nutrients shown in Figure 5.4. It is important that you gain
understanding of where these nutrients exist and what roles they serve in the body of a living person.
Column: Things to consider when using dietary supplements

A large variety of dietary supplements are marketed for use to supplement inadequate intake ofminerals, vitamins, and amino acids. It is important that you should review your diet rather thantaking such dietary supplements without careful consideration. Some dietary supplements may

In order to stay healthy both mentally and physically, one needs to take in energy and nutrients in acontain ingredients that are different from those found in plant- or animal-based food products. It ismanner that is appropriate for their individual physical build, behavioral patterns, state of health, andimportant that you acquire correct knowledge about dietary supplements in order to stay in goodliving environment. When one “keeps a well-balanced diet,” it means that their dietary intake of energy

health.

and nutrients closely match those they need, with very little excess or shortage.
Figure 5.4 shows major nutrients and their roles, as well as their respective primary dietary sources.

Nutrients may be divided roughly into the following: carbohydrates, lipids, proteins, minerals, and

82(1) Nutritional significance of carbohydrates

vitamins. They are called the five essential nutrients. In recent years, it is recommended that dietary

Saccharinity is also called “available carbohydrates,” which are high in polysaccharide starch. Starchfibers (nondigestible saccharides) should also be taken in addition to these five. There are three major

is the main source of carbohydrates in our diet and is composed of hundreds to thousands of basicroles of nutrients: to provide energy required for physical activity; to become building components ofcarbohydrate molecules. This basic molecule is a monosaccharide, of which glucose, fructose, andChapter 5

Lifestyle habits and health83

galactose are important for our body. Our body uses digestive enzymes to decompose many of the“available carbohydrates” in our diet into monosaccharides, absorbs, and then uses them as an energy(4) Nutritional significance of minerals

source. The cells in the brain and nerve tissues, red blood cells, as well as skeletal muscles during

Minerals are divided into macrominerals and microminerals, depending on the amount needed; thedepletion of energy, can only use glucose. Because depletion of glucose can result in a collapse offormer are needed in relatively large amounts, while the latter are needed in trace amounts. There are six

homeostasis and even death, the level in the blood (blood glucose levels) is maintained even during amacrominerals: calcium, phosphorus, sodium, potassium, chloride, and magnesium. They are required

fasting state. The liver and muscles store glucose temporarily in the form of glycogen, which is afor the control of pH and osmotic pressure of body fluids as well as for nerve impulse transmission andpolysaccharide of glucose. Glycogen in the liver is readily used as an energy source to maintain the levelmuscle contraction. Of the six macrominerals, calcium, potassium, and magnesium are essential for theof blood glucose concentration. Excessive amounts of glucose are stored as triglycerides, which may be

development of bones and teeth. Microminerals, meanwhile, include 16 types of minerals, such as iron,used as another source of energy in the future. When energy taken in from food is not entirely consumed

zinc, and iodine. They are involved primarily in metabolism. Some microminerals, including arsenic andand leaves an excess, triglycerides are carried in the bloodstream to become subcutaneous or viscerallead, can cause harm to health and trigger poisoning symptoms when taken in large amounts, so caution

fats, which promote the development of arteriosclerosis.

is required against excessive intake.

(2) Nutritional significance of lipids(5) Nutritional significance of vitamins

As a source of energy that is readily stored in the body of a living person, lipids are stored primarily in

Although not a source of energy for the living body, vitamins are an essential nutrient that serves

the form of triglyceride. They are constituents of hormones, cell membranes, and nuclear membranes.

significant physiological roles even with a trace amount of intake. They can be either water-soluble

In the form of subcutaneous fats, they serve to protect internal organs and tissues against injury and cold.

(such as vitamin C and B vitamins) or fat-soluble (such as vitamin A and vitamin D) (Table 5.1). Water-

They also promote absorption of fat-soluble vitamins.

soluble vitamins are excreted in urine and not readily stored in the body, making them prone to deficiency.

(3) Nutritional significance of proteins

Fat-soluble vitamins, meanwhile, are stored in the liver, and may cause poisoning symptoms in case ofcontinuous excessive intake.

Proteins are an important nutrient that supports cells’ life activities. The muscles, organs, skin, hair, nail,
Table 5.1 Types of vitamin and symptoms of their deficiencies

hormones, enzymes, and antibodies are built with proteins. While proteins are broken down into aminoacids before being absorbed, proteins that are absorbed without having been broken down into amino

Types of vitaminacids can become allergens (which trigger allergic reactions.)

Deficiency symptoms

Vitamin B1 (thiamin)

Beriberi, anorexia, edema

Vitamin B2 (riboflavin)Impaired growth, oral ulcer

Vitamin B3 (niacin)

Dermatitis, diarrhea, brain damage

Vitamin B6 (pyridoxine)

Impaired growth, arteriosclerosis, dementia

Vitamin B7 (biotin)

Hair loss, dermatitis, impaired growth

Vitamin B9 (folic acid)

Anemia, arteriosclerosis, dementia, fetal neural tube closurein which the reaction occurs shortly after the intake of the offending food. They are mediated by aVitamin B12 (cobalamin)

Anemia, neuropathy

protein found in the living body called immunoglobulin E (IgE antibody). Typical symptoms of food

Vitamin C

Gum or skin bleeding

Vitamin A

Night blindness, impaired immunity

Vitamin D

Impaired bone formation, osteomalacia

Vitamin E

Infertility, miscarriage

Vitamin K

Excessive bleeding (intracranial hemorrhage in newborns
and infants), impaired bone formation

Column: Food allergy

The immune system is a biological defense mechanism that protects our body by ridding the bodyof invading pathogens or other substances that are harmful to the body (See Chapter 7). A food

Water-soluble
vitamins

allergy occurs when the immune system mistakenly treats a certain protein in food that entered the
body as an antigen and overreacts to it. Many food allergies produce immediate allergic reactions,allergies include hives, eczema, vomiting/stomachache/diarrhea, coughing/sneezing, and breathingdifficulties. Intense allergic reactions that cause a drop in blood pressure, lowering of consciousness,or fainting are called anaphylactic shock, which can be life-threatening. It is necessary that school
teachers and staff are aware of whether or not their pupils have any food allergies, and they have aform to keep tabs on them (https://schoolsequella.det.nsw.edu.au/file/d6b6621f-7036-4d2a-a84c0cc740cbe946/1/anaphylaxis-appendix-1-khmer.pdf).This form provides a space to check as toFat-soluble
vitamins

whether a child has an EpiPen prescribed. It is preferable that teachers familiarize themselves with
first aid and use of an EpiPen in the event of anaphylactic shock (https://allergy.org.au/images/
stories/anaphylaxis/2018/Khmer_ASCIA_PCC_Anaphylaxis_First_Aid_2018.pdf).

84

Chapter 5

Lifestyle habits and health85

(6) Nutritional significance of dietary fibers (nondigestible saccharides)
Dietary fibers are a type of carbohydrate. They are also called nondigestible saccharides because they
are not broken down by digestive enzymes. They are fermented by intestinal bacteria, and work toregulate the functions of the intestines and maintain gastrointestinal function. One needs to take indietary fibers to maintain and improve health.

(7) Recommended dietary allowances of nutrients

Table 5.2 Definition of 6 food types and standard of serving

Food type

Standard of serving

1 small bowl ore 10 spoons of cooked rice (140 g)
2 changvay (set) of Khmer noodle (165 g)
Cereals and Starchy
1 serving is 40 g of carbohydrate 1/2 of corn (65 g)
foods
1 loaf of baguette (70 g)
2 1/2 pieces of sandwich bread (80 g)
1 serving is 30 g

2 spoons of green vegetable (30 g)
3 pieces of pumpkin (30 g)
1/2 or 4 pieces of cucumber (30 g)

1 serving is 100 g

4 pieces of water melon (100 g)
3 pieces of guava (100 g)
4 pieces of papaya (100 g)
1 1/2 of banana (100 g)
4 pieces of ripe mango (100 g)

1 serving is 6 g of protein

2 spoons of chopped or slice meat (20 g)
4 pieces of fish meat (30 g)
1 chicken egg (50 g)
3 spoons of mungbean (60 g)

Calcium-rich foods

1 serving is 100 mg of calcium

2 spoons of small fish (40 g)
7 small dried fish (10 g)
1 cup of yoghurt (100 g)
1/2 glass of milk (100 ml)
5/9 pieces of tofu (60 g)

Fat and oils

1 teaspoon of butter (5 g)
1 teaspoon of oil/fat (5 g)Try to choose vegetable oil rather than animal fat.
Fat is also contained in other food types.
Limit your fat intake by 2-3 teaspoons (10-15 g) per day only.

Vegetables

In Cambodia, the Government discussed the recommended dietary allowances (RDA) for children aged
between 6 and 17 years in collaboration with FIDR, and established the RDA for different nutrientsusing a reference body weight for each age group of school-aged children11. In addition, the Food-Based
Dietary Guidelines (FBDG) were proposed; the recommended food intakes are visually illustrated for

Fruitssix food types in the Cambodian Food Pyramid (Figure 5.5). The definition of 6 food types and standardof serving (Table 5.2) provides the standard of serving and the portion size of serving for each of the six
food types, while the following seven key messages are proposed for the healthy growth of children(Figure 5.6)11. In school health education, it is necessary to actively teach and disseminate these messages

Protein-rich foodsby using a handbook based on these guidelines.

Salt, Sugar, Fat and Oil

Calcium rich foodPortion size of serving

Protein rich foodi. Eat food from all food types with a well-balanced diet* everyday

Fruitsii. Consume calcium rich-food such as whole small fish, milk, and milk products.
Vegetablesiii. Eat protein-rich food such as fish, meat, eggs, or beans at least 2 or 3 times a day.
iv. Eat plenty of fruits and vegetables regularly.
v. Eat cereal and starchy food such as rice, noodles, breads, and its alternatives in an
adequate amount.

Cereals and Starches

vi. Reduce food high in salt, sugar, and fat.
vii. Measure your body weight and height regularly and track your growth.
11

Figure 5.5 Cambodian food pyramid*Balanced diet is to eat from all types in proper amounts and in line with physical activity.
Figure 5.6 Seven key messages11

86

Chapter 5

Lifestyle habits and health874) Habit of choosing foods with safety and security assured
We take in nutrients required for the maintenance of homeostasis in the living body in the form of food.
For this reason, we need to take in a wide variety of food. The intake of contaminated or spoiled food may
modify the homeostasis of the body and lead to diseases. It is therefore important that we gain knowledgeof food safety and sanitation, and acquire the habit of choosing safe food. Such a habit not only

Prevalence(%)

50.0

maintains and improves our health but also promotes environmental health and safety (see Chapter 4).

Obesity(BMI>2SD)

40.0

Overweight(BMI>1SD)

30.0
20.0

Underweight(BMI<1SD)

10.0

Food safety and sanitation must be evaluated in a careful and wide-reaching manner, from each

0.0

process of food production/harvesting, processing, distribution, preparation, and sales, to the stages

5

6

7

8

9 10 11 12 13 14 15 16 17 18 19

Agewhere consumers purchase, cook, and eat the food. In the agriculture, dairy, forestry, and fisheryindustries, the safety of soil, sea water, and air is important. Using safe seeds and seedlings, fertilizers,

Figure 5.7 Nutrition status by age (Boys, 2016)

and feedstuff helps ensure environmental safety. It is also desirable that consistent views on food safety
are introduced to the processes of food processing, distribution, and sales, as well. It is also important to50

It is important for consumers to acquire knowledge of food safety and sanitation, and choose safe
and sanitarily prepared food on an everyday basis. It is therefore necessary for pupils/students to learn
in school health education about contamination and other risks that may occur anywhere between the
production and consumption of food. It is also important to provide opportunities for them to learn
through first-hand experience, which may include, for instance, growing edible plants from seeds orseedlings, raising animals, observing parasites in fish, and visiting a market or a shop in person. Keeping
school vegetable gardens may also offer an opportunity for pupils/students to learn about and improve
nutrition.

Obesity(BMI>2SD)

40

Overweight(BMI>1SD)30
20

Underweight(BMI<1SD)

10
0

5

6

7

8

9 10 11 12 13 14 15 16 17 18 19

Moderate and severe
underweight(BMI<2SD)

Age
Figure 5.8 Nutrition status by age (Girls, 2016)

Column: Prevalence of underweight, overweight and obesity in Cambodian children andadolescents aged 5–19 years

88

Prevalence(%)

establish regulations and standards concerning the genetic engineering, irradiation, and preservatives,and for consumers to gain correct knowledge of these.

Moderate and severe
underweight(BMI<2SD)

Column: UN WFP (United Nations World Food Programme)

When you look at the nutrition status of boys and girls in Cambodia in their middle childhood andUN WFP (United Nations World Food Programme) won the Nobel Prize for Peace in 2020. This wasadolescence, aged between 5 and 19 years, based on the Global Nutrition Report (https://in recognition of WFP members’ fighting hunger in all corners of the world and helping to improveglobalnutritionreport.org/resources/nutrition-profiles/asia/south-eastern-asia/cambodia/)itsconditions to bring peace to the people, as they go anywhere on the planet if needed, even war zones

data (https://ncdrisc.org/data-downloads-adiposity-ado.html), percentages of boys who are(https://insight.wfp.org/world-food-programme-chief-pays-tribute-to-front-line-staff-and-partners-

underweight are high for all ages, with approximately 40% being underweight between 11 and 17

after-nobel-peace-prize-fc406608d60).

andyears of age (Figure 5.7). This shows that many in this age group have problems in their nutrition

In Cambodia, the WFP Cambodia Country Strategic Programme - 2019-2023 started in February

status. While the percentages of boys who are overweight are relatively large between 5 and 11

2019. At the top of the Executive Summary, the challenges in food security are described as follows:

years of age, they decrease with age.

“Cambodia has achieved sustained economic growth over the past two decades, attaining lower

Compared to boys, girls overall show lower percentages of being underweight, although about

middle-income country status in 2016. Despite substantial progress, socio-economic and gender

40% are underweight at around the age of 10 years, which is comparable to boys (Figure 5.8).

inequalities persist, hampering access to a nutritious diet. Food security and nutrition face challenges

Percentages of girls who are obese are also small, at about one-third of those of boys. Based on

caused by shocks, a rapidly changing food environment, and inefficiencies in the food system.”these findings on excessively low or high body weight, the nutrition status seems to present larger(https://docs.wfp.org/api/documents/WFP-0000112436/download/?_ga=2.261728648.484506432.

problems with boys than with girls.

1604280209-264903587.1595213932)

Chapter 5

Lifestyle habits and health893. Exercise and health

Physical inactivity can cause lifestyle diseases such as obesity, arteriosclerosis, and diabetes. In
Cambodia, while some children were physically active for a total of at least 60 minutes per day on five

Exercising promotes growth and development of children’s organs, and benefits their health. Stimulation

or more days, many were not so physically active (Figures 5.10 and 5.11)12. For instance, nearly 40% of

to epiphysis as a result of exercising promotes bone growth. Moderately loaded exercise that involves

the children said they had not been physically active for a total of at least 60 minutes per day on any ofmuscle contraction, such as strength training, enlarges muscles and improves muscle strength. Aerobic

the preceding seven days, while around 35-43% had been attending zero physical education classes per

exercise that sends oxygen throughout the body, such as walking and swimming, strengthens the heart

week. The fact that physical education class is not common poses a challenge for ensuring that children

and lungs, and helps reduce the risk of lifestyle diseases. Exercise that improves flexibility, such as

acquire exercising habits in Cambodia. Styles of living vary among individual children, and it isstretching, increases the range of motion in joints, which helps reduce the risk of injuries (Figure 5.9).

important that a child should choose what suits them from among different varieties of exercises, andAerobic exercises

enjoy doing it. In doing so, they should incorporate activities that improve muscle strength and postexercise activities that improve flexibility, in order to prevent injury. Care should be taken to avoid

Aerobic exercises

excessive exercise, for it can cause injury, which may hinder a child’s growth and development.
(%)

50

National

40
Rural

30

Do exercises that would make you sweat and huff and puff, for a duration of 30 minutes,
three times a week.

Exercises to improve muscle strength

Urban

20
10
0

0 days1 days2 days3 days4 days

5 days6 days7 days

Source: 2013 Global School – Based Student Health Survey Results -Cambodia Survey
Public Use Codebook (https://extranet.who.int/ncdsmicrodata/index.php/catalog/220)

Figure 5.10 No. of days with a daily total of ≥60 minutes of physical activity during thepreceding seven days

Do exercises such as standing on tiptoes, sit-ups, and push-ups to an extent that does
not put strain on you.

(%)

50

National

Exercises to improve flexibility

40
Rural

30

Urban

20
10
0

Extend body part(s) without recoil, stop where they feel stretched, and take deep breaths.

Figure 5.9 Examples of physical activities to build health90

0 days1 days2 days3 days4 days

5 days ormore days

Source: 2013 Global School – Based Student Health Survey Results -Cambodia Survey
Public Use Codebook (https://extranet.who.int/ncdsmicrodata/index.php/catalog/220)

Figure 5.11 No. of days with a physical education class per week
Chapter 5

Lifestyle habits and health91

4. Rest/sleep and health

The relationship between health habits and health has since been explored in a variety of different
combinations. In a study15 that examined five lifestyle factors, for instance, the authors found that those

Sleep not only helps one recover from fatigue caused by various activities they have performed during

who adhered to more of the following factors: never smoked cigarettes; physical activity of ≥3.5 hours/

the day, but also promotes growth and development in children. The growth hormone produced during

week with moderate to vigorous intensity; high diet quality (e.g. a diet rich in whole grains, nuts,

sleep, in particular, helps repair damaged tissues and promotes child growth.

legumes, and vegetables, and low in red and/or processed meats, refined grains, sugar-sweetened

Sleep is a part of lifestyle habits, and good sleep is a product of a regular sleeping pattern. Humans

beverages, and sodium); moderate alcohol intake of 5–15 g/day for women or 5–30 g/day for men; andhave a body clock, which not only determines the timing of sleep but also regulates hormone secretion

normal weight (body mass index <25) had a longer life expectancy from age 50 free of diabetes,and other physiological activities in advance to prepare one for sleep. Keeping regular hours helps one’s

cardiovascular diseases, and cancer.

body clock work properly and facilitates sleep.

Past studies such as these have shown that life habits related to exercise, diet, smoking, alcohol use,

In modern life, however, use of electronic devices such as smartphones and PCs is on the increase.

and weight control are important factors of health habits. Health habits are influenced by society andExposure to blue light, or intense light from a smartphone or PC, before bedtime is believed to affectculture, however, and it is important that Cambodia should pursue health habits that are rooted in its own

the quality of sleep and sleep rhythm in a negative manner. In order to improve the quality of sleep, one

society and culture. To promote school health education, in particular, it is necessary to clarify how

should aim to get the right amount of exercise during the day, keep a well-balanced diet, and do things

lifestyle habits and living activities are associated with health, growth, and development of young people

that relax the body, such as stretching and avoiding the use of electronic devices that stimulate the brain

in Cambodia.

before bedtime.

Topics for further thought and research

5. Health habits of adults and life expectancy[5-1] List up as many types of play as you can think of that would involve children being physically
active.

We have so far looked at the relationships between lifestyle habits and growth/development and health[5-2] Think of what teachers can do to secure playtime for children to be physically active.

by focusing on exercise, diet/nutrition, and sleep/rest. We will now take a look back at past studies to see

Do research on foods in Cambodia that can cause food allergies (see the column on Food Allergy).

what lifestyle habits or kinds of lifestyles have an influence over our health and life expectancy. The[5-3] Recall and write down what you have eaten in the past few days, and discuss with others as toterm “health habits” here refers to lifestyle habits that are associated with health. In a study initiated inwhether or not you are keeping a well-balanced diet based on a good variety of food, by using the1965, Breslow, L., et al.13,14 surveyed 7,000 residents of Alameda County, California, United States on

Cambodian food pyramid (Figure 5.5) and the Seven key messages (Figure 5.6) as references. If

a variety of health practices and levels of their physical health, and found that seven health practices

your diet lacks certain foods, think of what you should eat to make up for it.

were strongly associated with physical health levels. When a 45-year-old man who was practicing 6-7[5-4] Ask an elderly person (Cambodians have an average life expectancy of approximately 69 years)of the seven health practices was compared with another 45-year-old man who was practicing only 0-3,

who is active and healthy without suffering any major illness about what health habits they keepfor instance, the two had a gap of approximately eleven years in their life expectancy. This was the firstin their everyday life (such as diet, physical activity, smoking, drinking, and stress-relief habits).

study that demonstrated that one’s habits have an influence on their health.

[5-5] Identify unhealthy lifestyle behaviors of people around you, and think of what should be done tohelp them change such behaviors.

The seven health habits identified by Breslow, L., et al. 13,14 are as follows:
1. Getting 7–8 hours of sleep at night regularly[5-6] Check on your lifestyle habits using the checklist in Table 5.3. Based on the results, review yourlifestyle habits by using the examples of good and poor rhythms of everyday life (Figure 5.2).

2. Eating breakfast nearly every day
3. Eating between meals once a day or less frequently
4. Not drinking habitually, or having four drinks or less at one time
5. Not smoking habitually
6. Performing moderate to vigorous physical activities*1 frequently, and
7. Keeping a proper weight*2*1 Vigorous sports activities, long-distance walking, hunting, gymnastic exercises, gardening*2 BMI of around 22 (see Chapter 6)

92

Chapter 5

Lifestyle habits and health93

Table 5.3 Lifestyle habit checklist

Item / Date
What time did you
get up in themorning? (Rest/
sleep)
Did you get up
feeling refreshed?
(Rest/sleep)
How many hours of
sleep did you have?
(Rest/sleep)
Did you havebreakfast? (Diet)
Did you pass abowel movement?
(Diet)For how long did
you do sports orother exercises on
the day in question?
(Exercise)
For how long did
you walk getting toand from school, or
do light exercises?
(Exercise)

/

/

/

/

/

/

/

) (

) (

) (

) (

) (

) (

)

H: 6

H:

H:

H:

H:

H:

H:

H:

Min: 30

Min:

Min:

Min:

Min:

Min:

Min:

Min:

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

No

No

No

No

No

No

No

8 hours

hours

hours

hours

hours

hours

hours

hours

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

No

No

No

No

No

No

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

No

No

No

No

No

No

No
References

90 min

min

min

min

min

min

min

min

Ministry of Education, Culture, Sports, Science and Technology. Why is the use of various body movements important? Childhood
pdf

2

60 min

min

min

min

min

min

min

min

Ministry of Education, Culture, Sports, Science and Technology. Characteristics and important challenges in children for different
developmental stages. https://www.mext.go.jp/b_menu/shingi/chousa/shotou/053/gaiyou/attach/1283165.htm

3Ministry of Education, Culture, Sports, Science and Technology. Exercises that produce a range of body movements (plays). https://www.mext.go.jp/a_menu/sports/jyujitsu/__icsFiles/afieldfile/2009/12/28/1247477_1.pdf

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

No

No

No

No

No

No

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

No

No

No

No

No

No

No

Did you use asmartphone, etc.
before bedtime?
(Rest/sleep)
Did you do things
that improve sleep
like stretching andtaking a bath?
(Sleep/rest)

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

What time did you
go to sleep? (Rest/
sleep)

H: 21

H:

H:

H:

H:

H:

H:

H:

Min: 30

Min:

Min:

Min:

Min:

Min:

Min:

Min:

Did you eat between
meals? (Diet)

1

Exercise Guidelines. 2012. https://www.mext.go.jp/component/a_menu/sports/detail/__icsFiles/afieldfile/2012/05/11/1319748_4_1.

Yes

Did you eat at
regular hours? (Diet)

94

8/23/2021( Mon ) (

No

No

Yes

No

Yes

No

No

Yes

No

No

Yes

No

No

Yes

No

No

Yes

No

Yes

No

No

4

Miyashita M., et al.: Pediatric sports medicine, Nankodo, 1986.

5

Ministry of Education, Culture, Sports, Science and Technology. Learning materials on eating habits (for 5th and 6th graders) Think
about your eating habits: Keeping physically and mentally healthy every day. https://www.mext.go.jp/a_menu/shotou/eiyou/06050810/001.pdf

6

Oku T, Yamada K: Basic learning of biochemistry. Rev. Ver. 2. Nankodo, Tokyo. 2014.

7

Oku T, Yamada K: Basic learning of biochemistry. Rev. Ver. 3. Nankodo, Tokyo. 2019.

8

Oku T, Shibata K. s.b. National Institute of Health and Nutrition, Incorporated Administrative Agency. Basic nutrition. Rev. Ver. 3.
Nankodo, Tokyo. 2010.

9

British Columbia Health LinkBC. The Benefits of Eating Together For Children and Families.https://www.healthlinkbc.ca/healthyeating/eating-together#:~:text=People%20of%20all%20ages%20eat,and%20how%20to%20communicate%20better.

No

10 Hammons AJ., Fiese BH. Is frequency of shared family meals related to the nutritional health of children and adolescents?

Yes

11 Federation for International Development Relief. Development of recommended dietary allowance and food-based dietary guidelines

No

Pediatrics. 127(6), e1565-e1574. 2011. https://pediatrics.aappublications.org/content/127/6/e1565
for school-aged children in Cambodia. 2017. http://www.fao.org/3/I9704EN/i9704en.pdf
12 Preventive Medicine Department Ministry of Health. Global School-based Student Health Survey (GSHS) CAMBODIA, 2013
COUNTRY REPORT 2014. https://extranet.who.int/ncdsmicrodata/index.php/catalog/220/related_materials
13 Belloc NB, Breslow L.: Relationship of physical health status and health practices. Prev Med. 1(3):409-21.1972.
14 Breslow L, Enstrom JE.: Persistence of health habits and their relationship to mortaliy. Prev Med. 9(4):469-483.1980.
15 Li Y, Schoufour J, Wang DD. et al. Healthy lifestyle and life expectancy free of cancer, cardiovascular disease, and type 2 diabetes:
prospective cohort study. British Medical Journal 2020;368:l6669 doi: 10.1136/bmj.l6669.
Chapter 5

Lifestyle habits and health95