This study was conducted to determine the effects of increased edible palm oil consumption on community health status in the aboriginal communities in Tual Post (treatment group) and Sinderut Post (control group), Kuala Lipis, Pahang. Nutritional status, blood pressure, lipid profiles, fasting blood glucose (FBG), vitamin E (alpha-tocopherol) levels and lipid peroxidation product (malonaldehyde) levels were taken as indicators of health status. This is a pre-and post-controlled community trial in which similar variables were measured in each group. Every family of 2–6 household members was given 2–5 kg cooking palm oil per month for a period of 18 months. All subjects were measured for height (cm), weight (kg) and waist-hip ratio (WHR). For calorie intake measurement, house-to-house interviews were conducted using 24-hour dietary recall method. Blood pressure, percent body fat, lipid profiles, namely total cholesterol, high density lipoprotein cholesterol, triglyceride and fasting blood glucose (FBG) were also measured. Vitamin E (alpha-tocopherol) levels and lipid peroxidation products (MDA) were also determined. There was a significant increase (p
This paper sheds light on infectious diseases and the status of malnutrition in Nepal, a Himalayan country located in South Asia. In spite of efforts by both Government and non-government sectors, infectious diseases are rampant in the countries constituting a major cause of morbidity and mortality, which in turn, impose a socio-economic and public health burden for the country. Intestinal parasitic infection has been implicated in the causation of malnutrition. Malnutrition associated with child mortality is more common among children aged less than five years. Nepalese women suffer from chronic malnutrition. People in rural areas are more affected by malnutrition than those in urban areas. This has been attributed to poverty, lack of education, and rampant infectious diseases.
Introduction: Child malnutrition continues to be a major public health problem in developing countries. This study aims to determine the current nutritional status of Malaysian school children using the anthropometric indicators of weight for age (WAZ), height for age (HAZ), and body mass index for age (BAZ). Methods: A nationwide school-based survey was undertaken in all Malaysian
states and territories, which included 18,078 children aged 8-10 years attending 445 primary schools. The software WHO AnthroPlus was used to calculate zscores for the nutritional status (WAZ, HAZ and BAZ) of the target population relative to the World Health Organization (WHO) 2007 reference. Results: The national prevalence of underweight among school children was 13.6% and in
rural areas, this rate was nearly double that of urban areas. The national prevalence rate for stunting was 10.9%, double among rural school children compared to their urban counterparts. As for thinness, the national prevalence was 6.5%. Using the WAZ indicator, we found that the national prevalence of overweight children was 7.6%. Additionally, we found that urban areas showed a higher
prevalence of overweight children (8.8%) than rural areas (5.9%). Conclusion: The findings of this study indicate that Malaysian school children face the burden of malnutrition, suffering from both undernourishment and overweight. Malaysia must make a concerted effort to overcome the problems of malnutrition among children.
Introduction: Feeding difficulty and functional disability are common problems among patients with dementia but their influence on caregivers' burden has not been addressed comprehensively. Thus, this study aimed to determine the association between feeding problems, functional status and caregiver burden among patients with dementia who receive outpatient treatment at Universiti Kebangsaan Malaysia Medical Centre (UKMMC) in Kuala Lumpur, Malaysia, as compared to their non-demented counterparts. Methods: A cross-sectional comparative study was conducted among 30 patients with dementia (12 men, 18 women, mean age 75 ± 7 years old) and 60 subjects without dementia (25 men, 35 women, mean age 69 ± 7 years), as well as their caregivers. Subjects' functional status, feeding problems and also caregiver burden were assessed using Activities of Daily Livings (ADLs) and Instrumental Activities of Daily Living (IADL) questionnaire, The Edinburgh Feeding Evaluation in Dementia Questionnaire (EdFED-Q) and Zarit Burden Interview (ZBI), respectively. Subjects were also measured for height and weight. Results: Patients with dementia needed supervision (50%) and physical help during mealtime (40%). The mean functional status score of these patients was higher than the patients without dementia (p<0.05). Caregiver burden score was positively correlated with the EdFED-Q score (r=0.405, p<0.05) but negatively correlated with functional status score (r=0.475, p<0.01). Further, multiple regression analysis showed that after adjustment for age, EdFED-Q score and functional status remained correlated with caregiver burden at R2 of 0.210. Conclusion: Caregiver burden is associated with feeding problems and functional disability among patients with dementia. There is a need to educate the caregivers in order to improve the quality of life of both carers and the demented patients.
Key words: Caregiver burden, dementia, feeding problems, functional status, outpatient
Study site: Psychiatric and medical clinics, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
Introduction: The high prevalence of underweight among children is a serious health concern in Bangladesh. Nutritional status influences students' academic performance directly or indirectly. This study aimed to determine factors that affect the academic performance of students in primary schools. Methods: Data were collected from several schools and madrasahs in Chapainawabganj district, Bangladesh using multistage stratified sampling with proportional allocation technique. Results: The prevalence of underweight children was 32.3%, with 43.0% of them being girls and 21.4% boys. Multiple logistic regression analysis demonstrated that normal weight children were more likely (p
Introduction: Scientific evidence indicates that higher dietary fibre consumption protects against various chronic diseases and leads to recovery enhancement. Young corn ear is very rich in total dietary fibre (TDF). The study objective was to evaluate the effects of young corn ear addition on the nutritional composition, textural properties and sensory attributes of conventional cake. Methods: Wheat flour used in the preparation of conventional cake was substituted with different percentages (0%, 5%, 10% and 15%) of young corn ear powder (YCP). Moisture, total ash, fat, protein and TDF content of conventional cake samples were investigated. Textural properties including firmness, cohesiveness, springiness, gumminess and chewiness were examined. The aroma, colour, chewiness, tenderness, flavour and overall acceptance of conventional cake were evaluated via sensory evaluation. Results: The conventional cake with addition of 15% YCP recorded the highest moisture content. There was no predictable trend observed in the ash and fat content following the incorporation of YCP. Addition of 15% of YCP increased the protein content significantly while TDF content of conventional cake increased proportionally (1.42%-2.88%) with the level of YCP added. The incorporation of YCP did not produce any trend on all the textural properties of conventional cake. Conventional cake with 10% of YCP was the most preferred manifested by the highest scores in chewiness, tenderness and flavour attributes. Conclusion: In conclusion, 10% of YCP could be recommended as the ideal formulation in order to produce a healthier conventional cake without jeopardising acceptability.
Introduction: The home environment plays an influential role in affecting dietary and physical activity practices of children. This study aimed to determine the association between the home environment, dietary practice and physical activity among primary school children in Selangor. Methods: This cross-sectional study was conducted in five primary schools selected using multistage stratified sampling. A total of 293 children (32.8% males and 67.2% females) (mean age of 11.0±0.9 years) and their parents (10.7% fathers and 89.3% mothers) completed the study. Dietary practice of the children was assessed using a two-day dietary recall. Energy expenditure and physical activity of the children were assessed using a two-day physical activity recall. Parents of the children completed the Home Environment Survey (HES). Results: The mean energy intake of the children was 1765±416 kcal/day with 75.0% not achieving the Malaysian Recommended Nutrient Intake (RNI) for energy. Almost all children (96.5%) were physically inactive, with a mean energy expenditure of 1269±342 kcal/day. High availability of fruit/vegetable at home was associated with high vegetable intake (r=0.128, p
An assessment of the daily intake of major nutrients among 409 adults (males and females aged between 18-60 years, normal body mass index) residing in four regions in Malaysia was carried out as part of a major study on energy requirement. Subjects from both urban and rural areas completed a 3-day food record during the study. Mean energy intake among the men and women were 9.05 ± 2.21 MJ/day (2163 kcal/day) and 7.19 ± 1.60 MJ/day (1718 kcal/day) respectively, corresponding to 90% of the Malaysian RDA. A mean of 14% of the total energy was derived from protein, 23% from fat and 63% from carbohydrate. Energy intake amongst male subjects in the rural area (8.47 MJ/day, 2024 kcal) was significantly lower than their urban counterparts (9.52 MJ/day, 2275 kcal). There was no difference in mean energy intake in both the urban (7. 19 MJ/day, 1718 kcal) as well as rural women (7.16 MJ/day, 1711 kcal) corresponding to 86% of the RDA. The distribution of nutrients to the total energy intake amongst rural subjects were 13% for protein in both males and females, 65% for carbohydrate in males and 66% in females and 19% for fat in males and 21% for females. In the urban male and female subjects, the distribution of protein, carbohydrate and fat to the total energy intake were 14%, 55% and 29% and 30% respectively. The rural subjects showed a poorer mean intake of vitamins and minerals compared to the urban subjects. The diets of the male subjects in the rural area were deficient, less than two-third RDA in calcium, riboflavin and niacin. Calcium and iron intakes were less than two-third RDA in both the rural as well as the urban women. The rural women also had a poor intake of vitamin A and niacin. Overall, only protein and vitamin C intake met the RDA in most subjects from rural and urban areas.
The objective of this study was to determine the levels of knowledge, attitudes and practices with regards to coronary heart disease (CHD) and its risk factors among CHD patients in the Institut Jantung Negara (National Heart Institute), Kuala Lumpur. All patients admitted for CHD during the study period between 5th May 1997 and 24th May 1997 were included in the study. A total of 105 patients were interviewed by using a pretested questionnaire. Four CHD risk factors were included in the study, namely dietary intake, smoking habit, alcohol intake and physical activity. The majority of the patients (92.4%) were above 45 years old. Most of them (85.7%) had at least one chronic health problem such as diabetes mellitus and hypertension before admission into IJN. Their average total blood cholesterol was 6.1 ± 1.3 mmol/L and 75.2% were hypercholesteromic (≥ 5.2 mmol/L). Mean systolic blood pressure was 151.2 ± 27.5 mmHg. The mean body mass index of the patients was 25.9 ± 3.9 kg/m2 and 58.1% were overweight (BMI ≥ 25.0). Almost half of the patients (49.6%) had smoked before but only 8.6% still smoke. Out of the 56 non-Muslim patients, 9 of them (16.1%) consumed alcoholic drinks on a regular basis. Most of the patients reported walking as the only form of exercise that they do. Most of the patients consume rice, vegetables and fruits almost daily. This study indicated significant relationships between (i) knowledge level and attitude towards CHD risk factors (r = 0.624, p < 0.001), (ii) knowledge level and modifying practices related to CHD risk factors (r = 0.316, p < 0.01) and (iii) attitude and modifying practices (r = 0.234, p
Coronary Heart Disease (CHD) is recognised as an important public health problem in Malaysia. Hyperlipidaemia is one of the main risk factors related to CHD. The mainstay of treatment is diet therapy which should be maintained even if drug treatment is indicated. Since dietitians are the primary providers of dietary treatment to hyperlipidaemic patients, this retrospective study attempts to report the dietary approaches and methodologies adopted by Malaysian dietitians in managing their patients. A postal questionnaire covering various aspects of dietary management of hyperlipidaemia were sent to 47 dietitians practicing in private and government hospitals. A response rate of 53 % was elicited. The survey found that there was a disparity amongst the respondents in the approach to the dietary management of hyperlipidaemia in Malaysia. This was largely due to the absence of a standardised dietary protocol for general lipid lowering in patients with hyperlipidaemia.
Study site: Private and public hospitals in Malaysia
Introduction: Tocotrienol exerts neuroprotective effects resulting in an improved circulating oxidative status. However, accumulation of tocotrienol due to longterm intake may exert pro-oxidant effects. Thus the effects of short- and longterm supplementation of vitamin E tocotrienol rich fraction (TRF) on the parameters of oxidative status in rat brains were determined. Methods: Wistar rats aged 3 months were supplemented with TRF for 3 or 8 months. Control groups received equivolume of distilled water. Rats were sacrificed and brains
harvested, weighed and homogenised. Supernatants were analysed for catalase (CAT), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) activities, vitamin E and protein carbonyl. Results: A significant decline in the level of total vitamin E and its isomers with increasing age were found. TRF supplementation increased the level of total vitamin E with alpha-tocotrienol (ATT) being the major isomer raised. Glutathione peroxidase activity was also
significantly increased in the long-term supplemented group compared to the short-term supplemented and control groups. The results also showed significantly higher superoxide dismutase activity (p
Introduction: This study aimed to determine the prevalence of malnutrition and factors influencing malnutrition among children aged five years and below in Serian District of Sarawak, a district where the majority of people are indigenous. Methods: Using a cross-sectional method, a total of 177 children were randomly selected and assessed, and their mothers or caregivers were interviewed. Data were collected using a pretested questionnaire; anthropometric measurements were also taken. Data were analysed using SPSS version 17.0. Results: The prevalence of underweight, stunting and wasting in children aged five years and below was 20.9%, 11.9% and 10.2% respectively. The results suggest that the significant factors contributing to underweight are birth weight, frequency of child visit to the clinic, and individual insecurity. Only age, when complementary diet was introduced, was found to be significantly associated with stunting. For wasting, individual insecurity, duration of family planning and met recommended protein intake per day were found to be significant factors. Conclusion: The prevalence of malnutrition in children 5 years and below in Serian District of Sarawak is high compared to state figures. The major contributing factors were found to be manifested at the individual and family level. There is a need for appropriate public health promotion and socio- economic improvement interventions towards improving the nutritional status and health of children in Serian District.
Tocotrienols and tocopherols are isoforms of vitamin E. Vitamin E may exhibit antioxidant, prooxidant and non-antioxidant activities depending upon circumstances. In this study, the effect of tocotrienols and α-tocopherol on the activities of HMG CoA reductase and cholesterol 7 α-hydroxylase was investigated. Pure tocotrienols were isolated from palm fatty acid distillate and pure α-tocopherol was obtained commercially. Guinea pigs were treated with different dosages of tocotrienols and α-tocopherol. After the treatment period, animals were sacrificed and liver microsomes were prepared. HMG CoA reductase and cholesterol 7α-hydroxylase were assayed using tracer techniques. Our results showed that the effects of tocotrienols and α-tocopherol on the activities of both the enzymes were dose-dependent. At low dosages, both tocotrienols and α-tocopherol exhibited an inhibitory effect on both the enzymes. Moreover, tocotrienols were a much stronger inhibitors than α-tocopherol. At high dosages, on the other hand, tocotrienols and α-tocopherol showed opposite effects on the enzymes. While tocotrienols continued to exhibit an inhibitory effect, α-tocopherol actually exhibited a stimulatory effect on both the enzymes. A possible explanation for this observation is suggested.
This article examines the fat and fibre intakes of Malaysian adults and highlights discrepancies and practical limitations if these intakes are to match the levels for these nutrients advocated in the World Health Organisation (WHO) and American Heart Association (AHA) ‘diet models’. Local data on food consumption showed that the total fat intakes amongst Malaysian adults, contrary to common perception, were not high and the mean values obtained fell within the range of 40-66g or 22-26% kcal. As such, the dietary target of 30% kcal total fat or its intermediate target of 30-35% kcal, advocated by WHO and AHA mainly to address the problem of a high consumption of dietary fats in western populations, should not be adopted indiscriminately by Malaysians. Dietary fatty acid (FA) analysis by high performance liquid chromatography (HPLC) coupled with the use of food composition tables, showed that the typical Malaysian diet prepared with palm olein or palm olein-groundnut oil blends as cooking oil contained 3.2-4.0% kcal polyunsaturated fatty acids (PUFA), mainly as the w-6 linoleic acid, which is also the predominant essential fatty acid (EFA) in humans. This level of linoleic acid, with an ω-6/ ω--3 FA ratio approximating 10, is adequate for basal PUPA and EFA needs but fell short of the 4-10% kcal linoleic acid recommended by WHO (1993) to counter the effects of the cholesterol-raising saturated fatty acids (SFA). This raised upper limit of 10% kcal linoleic acid (previously 7% kcal), which equals the level of PUFA implied in the AHA diet model, appears unnecessarily high considering that the cholesterol-lowering potential of linoleic acid is maximum at about 6% kcal, while the health hazards associated with long-term high intakes of PUPA have never been completely dismissed. The new WHO lower limit for dietary linoleic acid (4% kcal) would have a controversial impact of raising the previous minimal 3% kcal EFA to above 4% kcal (linoleic + alpha-linolenic acids). Similarly, the WHO recommendation for total dietary fibre of 27-40g (equivalent to a daily combined intake of 400g of vegetables and fruits, 30g of which should come from pulses) appears at present, too high a dietary target for the average Malaysian adult whose habitual daily diet was estimated to contain about 180g of vegetables plus fruits, providing only about 13-16g total dietary fibre. Appropriately, an expert panel on Malaysian Dietary Guidelines has recommended instead, 20-30% kcal total fat containing 3-7% kcal PUFA, and 20-30g total dietary fibre for the local population.
Introduction: This study was conducted to determine immunological and metabolic effects of different concentrations of ginger rhizome (Zingiber officinale Roscoe) in streptozotocin (STZ)-nicotinamide (NA) induced diabetic rats.
Methods: Forty-eight fasted male Sprague-Dawley rats were induced diabetes using a single intraperitoneal injection of NA(110 mg/kg b.w.) and STZ (65 mg/kg b.w, 15 min after NA). Diabetic rats orally received either different concentrations (250, 500 and 750 mg/kg body weight) of ginger rhizome suspension or glibenclamide (10 mg/kg body weight) for 6 weeks. Two control diabetic and normal groups were gavaged with only distilled water as a vehicle.
Results: The results indicated that the lower concentrations of ginger modulated body weight, fasting blood glucose, level of triglyceride and tumor necrosis factor-a (TNF-a) (p
Introduction: By the end of 2015, about 72,152 children with learning disabilities were registered under the Malaysian Welfare Service Department (JKM). Malnutrition has been found to be a common setback among children with learning disability (LD). This study presents available evidence on the prevalence and risk factors associated with malnutrition in children with LD.
Methods: A framework suggested by Arksey & O`Male (2005) was used to carry out this scoping review. Published articles, reviews and reports were identified through a complete search. Inclusion criteria for the search were English articles related to LD, published from 2005 to 2016.
Results: Seventeen international studies published from 2005 until 2015 with a total of 318,596 participants and one study involving 281 participants from Malaysia, were identified and included in this review (n=18). The target age range of the sample in these 18 studies was 2 - 20 years, with a mean age of 3.2 - 14.2 years. The prevalence of underweight among children with LD was 3.4 - 36%, overweight 7.6 - 37% and obesity 5.7 - 52%. Several studies reveal that malnutrition risk among children with LD is significantly associated with gender, age, genetic syndrome, type of disability, medication used, and country economic status.
Conclusion: A number of studies show that children with LD have a higher prevalence of being overweight and obese than typically developing children and the risk associated with obesity significantly increases with age.
Introduction: Malnutrition in cancer patients affects the quality of life (QoL) of the patients and brings about adverse outcomes including morbidity and mortality. This study aims to determine the prevalence of malnutrition among cancer patients at the National Cancer Institute (NCI), Putrajaya.
Methods: A cross-sectional study was conducted among 97 respondents who were admitted to the NCI between August 2014 and January 2015. Information on socio-demographic characteristics, clinical characteristics, anthropometric measurements, dietary intake and biochemical data were obtained. The Malnutrition Screening Tool (MST) was used to identify malnutrition risk, while the Subjective Global Assessment (SGA) determined patients’ nutritional status.
Results: Approximately 61.9% and 43.5% of the patients were malnourished upon admission based on the MST and SGA scores, respectively. Four most common types of cancer among the malnourished patients were nasopharyngeal (NPC), lung, breast and colorectal cancer. About 56.9% and 21.6% of the malnourished patients, according to MST, were at Stage 4 and Stage 3 cancer, respectively. Meanwhile 69.7% of the malnourished respondents, based on SGA, were at Stage 4 cancer. Mean energy intake was 1463±577 kcal and protein intake was 54±22 g proteins.
Conclusion: Prevalence of malnutrition in hospitalised cancer patients in the NCI was high, depending on age, body mass index (BMI), tumour location and cancer stage. Early identification of malnutrition status is required for proper nutritional intervention.
Study site: National Cancer Institute (NCI) in Putrajaya, Malaysia
Introduction: Breakfast skipping is an unhealthy eating behaviour reportedly common among adolescents. A cross-sectional study was carried out to determine the differences in body weight status, socio-demographic, behavioural, and psychological characteristics between daily breakfast takers and breakfast skippers.
Methods: Data were collected from form four students of four randomly selected secondary schools in Sibu, Sarawak using a self-administered questionnaire. Body weight and height were measured using standard procedures and BMI-for-age z-scores were determined.
Results: A total of 375 students were recruited (male: 32.0%, female: 68.0%; Chinese: 39.5%, Than: 26.4%, Malay: 17.1% and Melanau: 17.1 %; mean age = 16.45 ± 0.53 years). The prevalence rate of breakfast skippers at 40.3% was higher compared to the national prevalence of 32.7%. About 19.7% of the students were found to be at risk of eating disorders. In addition, the prevalence rates of overweight and obesity were 10.9% and 7.7%, respectively. Significant associations were found between breakfast skipping with sex, lunch skipping, dinner skipping, eating attitudes, and body weight status. Binary logistic regression analysis showed that female students and those who skipped lunch or dinner were more likely to skip breakfast.
Conclusion: Breakfast skipping was quite common in this sample of adolescents in Sarawak. As frequent breakfast skipping has negative health and academic performance implications, increased nutrition education and health awareness campaigns on the importance of breakfast taking among school students should be undertaken.
Introduction: Malnutrition is a serious unresolved nutritional problem amongst dialysis patients associated with increased mortality and morbidity and prevalence differs according to dialysis modalities. This study compared proteinenergy malnutrition (PEM) prevalence in haemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients. Methods: A total of 155 HD and 90 CAPD patients were enrolled. PEM prevalence was determined using body mass index (BMI), serum albumin, Dialysis Malnutrition Score (DMS) and dietary intake. Results: CAPD patients had significantly higher BMI (24.1 ± 4.8 kg/m2 vs. 22.7 ± 4.8 kg/m2; p=0.024) and mid-arm muscle area (32.1±12.4 cm2 vs. 29.5 ± 15.9 cm2; p=0.044) than HD patients. They also had significantly lower serum albumin (31 ± 5 g/L vs. 35 ± 6 g/L; p
Introduction: There is a lack of information on bone health status of premenopausal women in Malaysia. This study investigated the bone health status of premenopausal women and its associations with anthropometric, dietary and physical activity. Methods: Bone mineral density (BMD) was measured using dual X-ray absorptiometry (DEXA) at the lumbar spine, femoral neck, total hip and total body. Serum osteocalcin, parathyroid hormone (PTH), beta-crosslaps were also determined. Results: A total of 73 Chinese premenopausal women were recruited in the study with a mean age of 39.3 ± 5.0 years. Average BMI, body fat percentage and lean body mass were 22.2 ± 3.4 kg/m2, 33.9 ± 4.6% and 34.5 ± 4.4 kg, respectively. Mean BMD at the spine, total hip, femoral neck, and total body were 1.025 ± 0.118 g/cm2, 0.876 ± 0.109 g/cm2, 0.739 ± 0.110 g/cm2, and 1.061 ± 0.755 g/cm2, respectively. Their serum beta-crosslaps and PTH were within normal range, but serum osteocalcin (8.5 ± 4.2 ng/ ml) was low. On average, calorie intake (1506 ± 427 kcal/ day) was below the Malaysian Recommended Nutrient Intake (RNI) while their calcium intake achieved only 67% of RNI. Their mean metabolic equivalent score (MET) was 771.4 ± 926.1 min/week. Body weight and related indices (BMI, lean mass, fat mass) were significantly positively correlated with BMD at all skeletal sites. Conclusion: The study revealed that Chinese premenopausal women in the Klang Valley have low calcium intake and low level of physical activity.