Introduction: The benefits of breastfeeding for both mothers and infants are
widely recognised. Breastfeeding confirms a woman’s unique ability to care for her
infant in the best way possible and promotes optimum infant and maternal health.
Methods: A qualitative research method involving five focus group discussions
(n=33) was chosen in this study to compare and contrast the breastfeeding practice
in two different locations: the communities of Pos Pulat and the regroupment
scheme settlement at Rancangan Pengumpulan Semula (RPS) Kuala Betis in
Kelantan, Malaysia which represents different lifestyle experiences of indigenous
Temiar population. Results: The benefits of breastfeeding to the infants reported
by some Temiar women (42.4%) were for the infant’s health and growth. Responses
from urban RPS Kuala Betis women include breast milk contains antibodies (3.0%),
delays in the return of regular ovulation (6.1%), thus lengthening birth intervals
and bonding between maternal-baby (6.1%). In general, respondents from Pos
Pulat seemed to have little knowledge regarding this issue, except for a woman who
mentioned that maternal milk contains vitamins. Based on the narrative analysis,
knowledge gap was observed between these two communities. Conclusion: Although
all the women interviewed had the experience of breastfeeding their infants, most
of them lacked the knowledge regarding the benefits of the breastfeeding either
to the infants or to the mothers. The findings from this study are crucial for the
preservation of breastfeeding culture among the Temiar women and can be used to
improve promotion of breastfeeding to other Orang Asli groups in Malaysia.
Introduction: The primary reason that compels working mothers to decrease their
ability to continue to breastfeeding successfully is their return to work. Attempts
to continue breastfeeding at work encounters several difficulties. This study
aims to provide an overview of the workplace environment and how facilities at
the workplace affect breastfeeding in Indonesia. Methods: We used a qualitative
approach to provide a detailed picture of the influence of workplace support for
working mothers to perform breastfeeding. We enrolled working mothers (n=18)
in Jakarta, as participants and obtained the following information from them:
parity, type of family and type of work. Results: The findings provided the general
overview of the workplace environment and identified three factors that affected
breastfeeding: seeking information during pregnancy, expression of breast milk at
office facilities and the problem faced by working mothers. Conclusion: Although
the breastfeeding performance of most working mothers in this study comprised
exclusive breastfeeding, some fed their infants with formula milk. This study
suggests that working mothers who continue to breastfeed after returning to work
need the support of their employers, co-workers and others in the workplace to
ensure the provision of health facilities and the protection and dissemination the
rights of breastfeeding working mothers that might lead them to discontinue their
breastfeeding practice.
Introduction: The consumption of processed food is increasing in developing
countries. Nutrition labels on food packaging are important for the education of
consumers, particularly adolescents, to help them make healthier food choices.
However, there is evidence to suggest that adolescents generally do not use nutrition
labels. This study aims to explore the personal factors that influence the practice of
Malaysian adolescents in reading nutrition labels. Methods: The participants were
adolescents, aged 13-16 years, from five public schools in Negeri Sembilan. Five
semi-structured focus group discussions (FGDs) were conducted. The participants
discussed their personal views, knowledge and perceptions regarding the use of
nutrition labels and food selection. Data gathered from the FGDs were coded through
thematic analysis using the NVivo software. Results: While the participants were
familiar with nutrition labels, their usage was relatively low during food selection
due to the lack of interest in nutrition information, past experiences, hunger and
cravings, time constraints and the taste of the food. The main reasons for using
nutrition labels were health consciousness and their curiosity about specific
nutrition information provided on the labels. The majority of participants believed
that information provided on the labels was accurate because it was provided by
reliable institutions. There was also misperception among some participants, mixing
up nutrition labels with list of ingredients and the expiry dates. A few participants
were unconvinced by the labels and stated that the labels provided misleading
information. Conclusion: Personal factors such as knowledge, misperception,
awareness and trust significantly impact how adolescents read nutrition labels.
Introduction: Obesity and excess weight gain in adults are linked to an increased
risk of cardiometabolic abnormalities. The changing lifestyle experienced by the
Orang Asli predisposes the population to the risk of obesity and non-communicable
diseases. This study aimed to describe the prevalence of overweight and obesity as
well as body-weight change over a period of four years among Orang Asli adults.
Methods: Data were collected from Orang Asli adults aged ≥18 years, who were
enrolled in the 2011-2012 and 2015-2016 surveys, and who were residing within
the Krau Wildlife Reserve. Weight and height of the adults (N2011-2012=828; N2015-
2016=662) were measured at both time points. Follow-up data were available for 378
adults (male:113; female:265). Results: The prevalence of overweight and obesity
were 18.8% and 7.4% in 2011-2012 and 26.1% and 9.5% in 2015-2016. In the
follow-up group, significant differences in body weight and body mass index (BMI)
were observed in men and women, respectively. More than one-third (35.5%) of the
adults had weight gain of more than 5.0%. The increasing percentage of body weight
change was associated with being female, younger age, more years of schooling and
reduced household income. Conclusion: Obesity is a growing health problem in
the Orang Asli adult population. Weight gain was associated with socioeconomic
indicators and it was more prominent in women. Effective strategies are needed to
address the increasing prevalence of overweight and obesity in this population to
further reduce adverse health outcomes.
Introduction: In Indonesia, most training modules for health paraprofessionals
have been adapted from existing foreign modules without assessment. In addition,
there have been few studies on training development for this group. We aimed to
develop, using a systematic tool, implement and evaluate a training module to
improve the competencies of voluntary health workers (cadres) in communicating
safe complementary feeding practice to caregivers of young children in Indonesia.
Methods: A mixed methods approach was used. A qualitative study employing
in-depth interviews, focus group discussions, mini-workshops, documentary
reviews and expert validation was used to develop the training module, following a
systematic approach. The module’s effectiveness for improving the health workers’
competencies was evaluated using a quantitative study with a non-equivalent
pre-test and post-test control group design that included 70 (intervention group)
and 68 (comparison group) voluntary health workers from a peri-urban district.
Changes in the workers’ cognitive, affective and psychomotor competencies were
tested before and after attending a 3-day training module (intervention group) or
a half-day event (comparison group). Results: A 24-hour learning session module
on communicating safe complementary feeding was developed and used to train
voluntary health workers. After the training, a significantly higher proportion of
workers in the intervention group than in the comparison group were assessed as
competent in the psychomotor and composite domains (psychomotor: 67.1% vs.
20.6%; composite: 74.3% vs. 36.8%; p
Introduction: Monitoring changes in energy and nutrient intakes of the population
over the course of time is essential to help healthcare providers develop effective
dietary policies. The aim of this study was to assess the changes in the nutrient
intake and Recommended Nutrient Intake (RNI) achievements by using the data
obtained from the Malaysian Adult Nutrition Surveys (MANS) that were carried out
in 2003 and 2014. Mis-reporting of energy intake was taken into account. Methods:
Dietary data were obtained from MANS 2003 and MANS 2014, which involved a
combined total of 4,044 randomly selected respondents, aged 18-59 years, using
a single 24-hour diet recall. Energy and nutrients calculations were based on the
Malaysian Food Composition database using the Nutritionist Pro software. The
results were compared against the RNI for Malaysia to assess dietary adequacy.
Results: The proportions of calories derived from macronutrients were within the
recommendations for a healthy diet. The consumption of protein, fat, calcium, iron
and vitamin A was significantly higher in 2014 than in 2003. The consumption
of protein, iron, vitamin C, and vitamin A was found to exceed the RNIs in 2014.
However, carbohydrate and sodium intakes had significantly decreased. Despite the
decrease, sodium intake still exceeded RNI recommendations. Conclusion: Signs
of changing energy and nutrient intakes were found, including increases in protein
and fat intakes since 2003, and decreased carbohydrates. This could be an alarming
indicator of the tendency to eat energy dense food among the population.
Introduction: Data on water and sugar sweetened beverages (SSB) intake
among young adults in Malaysia is sparse. This study aimed at measuring the
intake of plain water and SSB among undergraduate students in a Malaysian
university and examine its association with body mass index (BMI). Methods:
A total of 376 undergraduate students aged 18-30 years were recruited. A selfadministered questionnaire was used to determine the SSB consumption pattern.
The questionnaire consisted of five sections that included the background of the
participants, knowledge about SSB, SSB preferences, frequency and portion size.
Results: 23.9% of subjects in this study were overweight. Almost all of the subjects
took outside food (93.1%) and drink (74.2%). The highest daily consumption was
plain water (92.3%), with a majority drinking more than two cups at each intake.
Caffeinated drinks (coffee or tea) were the most popular SSB among the students
(18.4%). Most students (79.7%) did not consume SSB on a daily basis. A significant
association was found between the proportion of plain water consumption and BMI
(p
Introduction: The aging population is a matter of global concern. Age-related
physiological, pathological, psychosocial, economic, cultural and environmental
changes are common and may greatly influence the quality of life of the elderly.
The aim of this review was to explore the determinants and motivations that drive
the elderly in making food choices. Methods: The search strategy of this literature
review used the PRISMA protocol. Potential literature that was related to food
choices was identified using two different combinations of keywords and two major
electronic search engines, namely Pubmed and Science Direct. The articles that
were selected for this review had to be in the English language, open-accessed and
published between January 2007 and December 2017. Results: From a search of
1398 articles, 15 articles (seven quantitative and eight qualitative) were identified
that were related to food choices among the elderly. The key factor that determined
food choices among the elderly population was identified to be health. Others
included convenience, sensory appeal, price, early food experience and more. The
limitations of these studies that were reported were the small sample size and the
reliance on self-reporting. The conclusions that were drawn were for specific groups
that were studied in this review should be extrapolated or generalised with caution.
Conclusion: Strategies for intervention programmes should be undertaken in
collaboration with health professionals, researchers, policymakers, and the food
industry. Future research is needed in the elderly who have chronic diseases, are
dependent or who have disabilities.
Introduction: Under-reporting of energy intake is a common cause of bias
in nutritional studies. This study was aimed at examining the extent of underreporting of energy intake and its related characteristics among respondents in
the Malaysian Adult Nutrition Survey (MANS) 2003 and MANS 2014. Methods:
The present study analysed energy intakes of 9,624 adults aged 18-59 years from
the MANS in year 2014 (2,890 respondents) and 2003 (6,734 respondents) using
a single 24-hour diet recall. Basal metabolic rates (BMR) were calculated from the
age- and gender-specific equations of Schofield. Under-reporting was defined as an
energy intake:BMR ratio of
Introduction: The ability to perform daily living activities among the elderly is
important, as physical disability may lead to dependency and various public
health implications. This study aimed to determine the prevalence of instrumental
activities of daily living (IADL) disability and its association with socio-demographic
characteristics, dietary intake, social participation, perceived-health-status and risk
of falls. Methods: This cross-sectional study was conducted among communitybased elderly in the Gombak District of Selangor. 258 respondents aged 60-88
years old (mean age 66±6.5 years) were recruited through multi-stage proportional
sampling. Most of the respondents (88.4%) aged 60-74 years and 11.6% were ≥75
years. IADL disability was determined using an eight-item IADL scale. The presence
of IADL disability was defined as needing help in at least one or more of eight-IADL
activities. Dietary intake and fall risk were assessed using diet history questionnaire
(DHQ) and 21-item fall risk index (FRI-21), respectively. Results: The prevalence
of IADL disability among the respondents was 58.1%. A binary logistic regression
analyses showed that the following factors predicted IADL disability: advanced age
(≥75 years, OR=6.4; 95% CI: 1.3, 30.8), being unmarried (OR=2.5; 95% CI: 1.1, 5.9),
unemployed/retired (OR=2.3; 95% CI: 1.2, 4.3), and at risk of falls (OR=2.5; 95%
CI: 1.3, 6.1). Conclusion: Predictors such as marriage and employment highlight
the importance of social support among elderly. In practical terms, this means that it
is incumbent upon caregivers, family members, and the community to provide both
physical and emotional support if the functional status of the elderly is to be improved.
Introduction: Cariogenic food intake and oral health knowledge, attitude and
practices (KAP) of parents are contributing factors that influence the oral health
status of children. As there is lack of a validated questionnaire in Bahasa Melayu
(the Malay language) to measure the factors, this cross-sectional study was
carried out to establish a linguistically valid and reliable cariogenic food frequency
questionnaire (M-CFFQ) and oral health kap questionnaire (M-OHKAPQ) in Bahasa
Melayu, for parents of children aged 6-11 years in Kota Bharu, Kelantan. Methods:
Relevant questionnaires in English were selected and translated to Malay language.
This process included forward translation, synthesis, backward translation and
consolidation to produce the preliminary drafts of M-CFFQ and M-OHKAPQ. Pretesting
was conducted on ten parents of children from a primary school in Kota
Bharu by face-to-face interview. The findings were reviewed to produce the final
versions of M-CFFQ and M-OHKAPQ. A test-retest reliability study was undertaken
involving 49 parents. The participants were asked to answer the final M-CFFQ and
M-OHKAPQ versions twice, within a 7-14 days interval. Data collected were entered
into IBM SPPS version 22 software and analysed using the Intraclass Correlation
Coefficient (ICC) test. Results: Semantic, idiomatic, experiential, conceptual as well
as content and face validity issues were successfully resolved. Fifteen categories
of food/drinks for M-CFFQ and 26 items/questions M-OHKAPQ were produced.
The total ICC values achieved for M-CFFQ and M-OHKAPQ were 0.887 and 0.807,
respectively. Conclusion: The M-CFFQ and M-OHKAPQ appeared to be linguistically
valid and reliable with excellent test-retest reliability (ICC>0.80).
Introduction: This study aimed to identify dietary patterns (DPs) and their
association with successful aging (SA). Methods: A comparative cross-sectional
study was conducted among 579 elderly subjects recruited from four states in
Malaysia through a multistage random sampling method. SA was defined as having
no chronic illnesses, no functional limitation, normal global function, no depression,
a good quality of life and good self-perceived health. Information on dietary intake was
obtained using a diet history questionnaire. Cognitive functions were assessed using
the Mini Mental State Examination (MMSE), depressive symptoms using Geriatric
Depression Score-15 items (GDS-15) and a question regarding their perceived health
and quality of life. Activities of Daily Living (ADL) and Instrumental Activities of Daily
Living (IADL) questionnaires were used to determine functional status. DPs were
obtained using the principal component analysis (PCA) approach. An ordinal logistic
regression model was used to examine associations between DP scores and SA.
Results: Five DPs were identified namely ‘sweet foods-beverages’, ‘meat-vegetablesrice and noodles’, ‘local snacks-fish and seafood-high salt foods’, ‘fruits-legumes’, and
‘tropical fruits-oats’. A higher score for ‘tropical fruits-oats’ DP was associated with
SA [Adjusted OR=1.59 (95% CI: 1.08-2.32)]. However, the association diminished
when the model was adjusted for education level. Further analysis indicated that
this DP increased the chance of SA among those with secondary education and above
[Adjusted OR=2.43 (95% CI: 1.09–5.42)]. Conclusion: ‘Tropical fruits-oats’ DP is
associated with SA among elderly with secondary education and above. There is a
need to investigate DPs among those with lower education.
Introduction: A compromised quality of life (QOL) as a result of haemodialysis
(HD) is a rising global issue. Elderly HD patients face more challenges than
younger counterparts. This study determined the association of socio-demographic
characteristics, nutritional status, risk of malnutrition and depression with QOL,
among elderly HD patients. Methods: A cross-sectional study was conducted
among 112 HD elderly patients in selected dialysis centres in Selangor, Malaysia.
The patients completed interview-based questionnaires on socio-demographic
characteristics, risk of malnutrition (Dialysis Malnutrition Score, DMS), depression
(Patient Health Questionaire-9, PHQ-9) and QOL (KDQOL-36). Anthropometric
measurements, 24-hour dietary recall and food intake information were obtained
from them and biochemical data from their medical records. Results: Just over half
(50.9%) of the patients had a normal body mass index while 85.7% had optimal
albumin levels. The proportion of patients who met the recommended energy and
protein intakes were 19.0% and 3.4%, respectively. Patients were at moderate risk
of malnutrition, had minimal depression level and perceived better QOL in terms of
effects and symptoms of kidney disease. There was a significant positive correlation
between protein intake and the physical domain of QOL (p=0.02) and negative
correlation between risk of malnutrition with physical and mental composites of
QOL (p
Introduction: The prevalence of child undernutrition and micronutrient deficiencies
are higher in the Orang Asli (OA) than the general Malaysian population. The World
Health Organization recommends the use of multiple micronutrient supplement
(MMS) that is a blend of micronutrients in powder form that can be sprinkled onto
foods for home fortification to prevent undernutrition among children. This pilot
study aimed to assess the feasibility of using MMS among OA children. Methods: A
total of 25 OA children (14 boys and 11 girls) aged 6-31 months (mean±SD = 15.7±7.2
months) in Negeri Sembilan were given three sachets of MMS weekly for 5 weeks.
Caregivers were instructed to add MMS to three types of food from the same food
group per week varying with a different food group weekly. Written instruction for
using MMS in simple language was given prior to the supplementation. Caregivers
were interviewed for information on socio-demographics, compliance, acceptance,
preference and adverse effect of MMS. Results: A high level of compliance was
observed (85%). All caregivers reported that the instructions for use were easy to read.
No noticeable changes to the foods mixed with MMS were observed and no adverse
effects were reported. Conclusion: This study demonstrated feasibility of the use of
MMS for future trials among OA children. The easy to read information that comes
with the MMS, frequent monitoring of MMS use and support to caregivers were
required to ensure compliance. Cultural feeding practices and financial constraints
may limit the types of food that can be mixed with MMS.
Introduction: It is widely recognised that health-related quality of life (HRQOL) is
impaired in chronic obstructive pulmonary disease (COPD) patients. Most previous
studies were conducted among the younger adult population and there is limited
information on the elderly population. This study aimed to determine the COPD
assessment test (CAT) score in the elderly with COPD. Methods: This was a crosssectional study involving 140 elderly patients who had been diagnosed with COPD
at two selected government institutions. Data on socio-demographic and health
status were collected by interviewing patients and reviewing their medical records.
The HRQOL was measured using CAT. The independence sample t-test and one-way
ANOVA were conducted to compare the CAT scores with socio-demographic and
health status. Results: The socio-demographic and health characteristics of the
patients were as follows: majority (54%) were aged 60-70 years, male (97%), Malay
(59%), married (75%), ex-smokers (72%), had attained primary education (48%),
had co-morbidities (54%), no history of hospitalisation or visits to the emergency
department due to COPD (57%), and were in moderate stage of airflow obstruction
(53%). The mean of CAT score was 21.87±6.85 and the majority of the patients were
classified as having worst symptoms of COPD (93%) as they had high CAT score
which was ≥ 10. Conclusion: Majority of the patients in this study had high scores
of CAT, which indicated poor HRQOL. Ex-smokers had higher scores compared
to non-smokers. More attention need to be given to these subgroups in order to
increase their quality of life.
Introduction: Food insecurity exists whenever people are unable to access sufficient
food at all times for an active and healthy life. University students are a potentially
vulnerable group of people to face food insecurity. This study aimed to identify the
prevalence and determinants of food insecurity among a population of university
students in Kuantan, in the state of Pahang. Methods: Food security status was
identified using the United States Adult Food Security Survey Module (USAFSSM).
Factors, which include demographic background, spending expenditure pattern
and time constraints, were assessed. A total of 316 students were selected through
stratified random sampling throughout six faculties of the International Islamic
University Malaysia, of whom 307 successfully completed the survey. Results:
The result shows that 54.4% of the students were experiencing food insecurity,
from which 32.9% were sub-categorised as low food security and 21.5% as very low
food security. Food insecurity was found to be significantly associated with time
constraints (p
Introduction: This study aimed to determine the relationship of maternal dietary
intake with human milk nutritional composition, among Malay mothers during the
postpartum period of exclusive breastfeeding. Methods: Human milk samples (20-
30ml) were collected from mothers (n=32) at least once monthly for six months
postpartum. Macronutrients and fatty acids contents were determined using
proximate analysis and gas chromatography methods, respectively. Maternal
dietary intakes were recorded using the multiple-pass diet recall method prior
to each milk sampling and were analysed using the Nutritionist ProTM software.
Associations between the milk composition and maternal diet were tested using
Spearman correlation. Results: The energy content ranged between 49.6-59.2
kcal/100ml, protein 1.3-1.4 g/100ml, carbohydrate 6.5-9.7 g/100ml and total
fat 6.5-9.7 g/100ml. The polyunsaturated, monounsaturated, and saturated fatty
acids concentrations were 10.5-19.1 %, 40.6-43.5 %, and 38.0-49.7 %, respectively.
During confinement (first month postpartum), total energy and total fat content of
human milk were the highest whereas total carbohydrate was the lowest, compared
to the rest of the exclusive breastfeeding period. In contrast, intakes of total calorie
and total fat were the lowest, whereas protein was the highest during this period.
However, no associations were detected between human milk nutritional contents
and maternal dietary intake. Conclusion: In our study population, the composition
of maternal diet and nutritional content of human milk differed between confinement
and post-confinement periods. However, the association between maternal diet and
human milk composition itself warrants further investigation.
Introduction: The refeeding programme in government hospitals is aimed at
improving the nutritional status of malnourished children with weight-for-height
z-score (WHZ) below -2.0, using special therapeutic food. However, there is a lack of
data on the nutritional status of indigenous (Orang Asli) children when they return
to the community after hospital discharge. Case presentation: A 3-year-old Temiar
boy residing in a tribal village in Hulu Perak was visited to determine his nutritional
status following discharge from a refeeding programme in a government hospital.
He was admitted to the hospital with a weight of 10.0 kg, height of 85.5 cm and
WHZ of -2.09. The boy was later discharged weighing 11.0 kg, and with height
unchanged at 85.5 cm and WHZ of -0.87. During our visit to the child’s home
three months after discharge, his weight was 9.5 kg, height 86.0 cm, and WHZ
–2.91. Discussion: The management of the case in the hospital was based on
the Malnourished Orang Asli Protocols of the hospital. Household food insecurity,
feeding and care practices, unhealthy household environment and the lack of
communication between hospital and community health services were all identified
as risk factors for malnutrition. Conclusion: The recurrence of malnutrition in this
child, after successful improvement during hospital stay, highlights the importance
of identifying factors that may affect nutritional status after hospital discharge. This
knowledge will be beneficial in planning specific interventions, especially for Orang
Asli children, living in remote villages.
Introduction: Adequate, nutritive and safe foods are crucial for growth and healthy
living. Adolescents are vulnerable to food insecurity. This study was aimed at
determining the demographic factors, food security status, health-related quality of
life (HRQOL) and body weight status of adolescents in Mentakab, Pahang, Malaysia.
Methods: This study involved 160 households that comprised pairs of mothers and
children aged 13-17 years. Face-to-face interviews were conducted with the mothers
to assess their demographic and food security status (Radimer/Cornell Hunger and
Food Insecurity Instrument). Meanwhile, the children answered a self-administered
HRQOL questionnaire (Pediatric Quality of Life Inventory, PedsQL). Body weight
and height were measured to obtain the body mass index (BMI). Results: About
48.8% of the adolescents were from households with food insecurity. The number
of school-going siblings, occupation status of mother, occupation status of father,
household income and house ownership status were predictors of food security
status (p
Introduction: The implementation of front-of-pack (FOP) energy icon labelling helps
consumers in making good food choices. This is the first study in Malaysia focusing
on such labelling since it was launched in 2012. It was aimed at determining the
awareness and understanding of the FOP energy icon on food labels in Malaysia.
Methods: A total of 366 consumers aged 18-60 years old in the state of Negeri
Sembilan participated in the study. A guided, self-administered survey was
conducted using a convenient sampling method. Results: The results showed
that 85% of consumers surveyed were aware of FOP energy icon. Among those
who were aware of the icon, 50% (n=155) were categorised as ‘excellent’ and 41%
(n=128) categorised as ‘good’, for understanding the FOP. Conclusion: This study
indicated that the icon could be viewed as a potential tool to be used in conjunction
with the nutrition information panel (NIP). Most of the respondents could extract
nutrition information from the FOP (energy) icon. The study showed that those who
had understood the icon were in the group categories of high education, youth
and female. There was also no significant association between those who received
nutrition labelling education and level of understanding nutrition information from
the icon. Therefore, it is important to further explore the possibility the beneficial
impact of FOP labelling system, including consumer education aspects.