METHODS: In this study, a cross-sectional design was employed using the baseline data obtained from the My Body Is Fit and Fabulous at school (MyBFF@school) intervention program involving obese school children. Obesity status was defined using the body mass index (BMI) z-score from the World Health Organization (WHO) growth chart. Cardiometabolic risk factors presented in this study included fasting plasma glucose (FPG), triglycerides (TGs), total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), blood pressure, acanthosis nigricans, insulin resistance (IR), and MetS. MetS was defined using the International Diabetes Federation (IDF) 2007 criteria. Descriptive data were presented accordingly. The association between cardiometabolic risk factors, such as obesity status, and acanthosis nigricans with MetS was measured using multivariate logistic regression, which was adjusted for gender, ethnicity, and strata.

RESULTS: Out of 924 children, 38.4% (n = 355) were overweight, 43.6% (n = 403) were obese, and 18% (n = 166) were severely obese. The overall mean age was 9.9 ± 0.8 years. The prevalence of hypertension, high FPG, hypertriglyceridemia, low HDL-C, and the presence of acanthosis nigricans among severely children affected by obesity was 1.8%, 5.4%, 10.2%, 42.8%, and 83.7%, respectively. The prevalence of children affected by obesity who were at risk of MetS in <10-year-old and MetS >10-year-old was observed to be similar at 4.8%. Severely children affected by obesity had higher odds of high FPG [odds ratio (OR) = 3.27; 95% confdence interval (CI) 1.12, 9.55], hypertriglyceridemia (OR = 3.50; 95%CI 1.61, 7.64), low HDL-C (OR = 2.65; 95%CI 1.77, 3.98), acanthosis nigricans (OR = 13.49; 95%CI 8.26, 22.04), IR (OR = 14.35; 95%CI 8.84, 23.30), and MetS (OR = 14.03; 95%CI 3.97, 49.54) compared to overweight and children affected by obesity. The BMI z-score, waist circumference (WC), and percentage body fat showed a significant correlation with triglycerides, HDL-C, the TG: HDL-C ratio, and the homeostatic model assessment for IR (HOMA-IR) index.

METHODS: Twenty-three out of 1196 government primary schools in central Peninsular Malaysia participated in this cluster-randomized control study. Schoolchildren aged 9-11 years with a body mass index (BMI) z-score greater than + 1 SD (WHO) were eligible for the study. The intervention group participated in the MyBFF@school program while the control followed the existing standard curriculum. The primary outcome was cardiorespiratory fitness using physical fitness score (PFS) measured by the modified Harvard step test. Data were collected at baseline, month-3 and month-6 and were analyzed according to the intention-to-treat principle using mixed linear models.

RESULTS: A total of 954 schoolchildren completed six months follow up, with 439 (n = 439) in the intervention group (n = seven schools), while 515 (n = 515) in the control group (n = 16 schools). In the first three months, there was significant within-group PFS improvement in overall (both), girls (both) and obese (control). Comparing between-groups, the mean differences favored the control in most parameters, but were not significant: overall (-0.15(-0.75, 0.45), p = 0.83), boys (-0.07(-0.98, 0.83), p = 0.83), girls (-0.27(-1.27, 0.73), p = 0.81), overweight (-0.16(-1.28, 0.94), p = 0.97), obese (-0.05(-1.03, 0.92), p = 0.93), morbidly obese (-0.68(-2.43, 1.05), p = 0.26), urban (0.07(-0.79, 0.94), p = 0.45), and rural (-0.35(-1.34, 0.62), p = 0.30). At month-six, the within-group improvements maintained. However, the mean differences now favored the intervention group although they remained not significant: overall (0.05(-0.98, 1.07), p = 0.69), boys (0.06(-1.35, 1.46), p = 0.86), girls (0.10(-1.31, 1.51), p = 0.74), overweight (0.15(-1.07, 1.36), p = 0.93), obese (0.28(-0.98, 1.55), p = 0.75), morbidly obese (-0.79(-2.74, 1.15), p = 0.47), urban (0.61(-0.56, 1.77), p = 0.47), and rural (-0.69(-2.52, 1.14), p = 0.17).

CONCLUSIONS: MyBFF@school program showed positive trend in cardiorespiratory fitness changes especially after six months. MyBFF@school intervention program has the potential to combat obesity in primary schoolchildren and should be at least six months.

METHODS: This is a cluster randomized controlled trial which involved schoolchildren aged 13, 14 and 16 years old from 15 out of 415 government secondary schools in central Peninsular Malaysia which were randomly assigned into six intervention (N = 579 schoolchildren) and nine control (N = 462 schoolchildren). The intervention group was given NEI consisting of a nutrition education module carried out by trained personnel for 24 weeks on top of the existing curriculum while the control group only followed the existing school curriculum by the Ministry of Education. The primary outcomes were the nutrition knowledge and attitude score. The mixed effect model taking into consideration the cluster effect was used to assess the changes of nutrition knowledge and attitude scores from baseline until 6 months.

RESULTS: Overall, there was no significant increase in the adjusted mean difference (AMD) of nutrition knowledge score (AMD = 0.33%, Confident Interval (95 CI): -4.35% to 5.01) between the intervention and control group after 6 months of intervention after controlling for nutrition knowledge score at baseline, gender, location and ethnicity. Similarly, after controlling for the nutrition attitude score at baseline, ethnicity, location and gender as well as taking into account the cluster effects, there was no significant increase on the AMD of nutrition attitude score in the overall (AMD = 0.194, (95 CI): -1.17 to 1.56) and also among girls, location (urban vs rural) and Malays. There was also no significant reduction of AMD in the nutrition attitude score among boys and non-Malays.

CONCLUSION: MyBFF@school with NEI resulted with no significant improvement for nutrition knowledge and attitude among older schoolchildren. Therefore, to effectively impart the nutrition knowledge and change their nutrition attitude requires an in-depth study and multi-pronged and customized approach.

METHODS: A school-based cluster randomized controlled trial of the MyBFF@school obesity intervention program was conducted among overweight and obese schoolchildren aged 9-11. Out of 1,196 eligible government primary schools in central Peninsular Malaysia, 23 were randomly assigned into seven intervention schools (647 children) and 16 control schools (750 children). A standard nutrition education module was delivered for 24 weeks to the intervention group, whereas children in the control group followed only the currently existing school nutrition education program. The main outcome measures were nutrition knowledge and attitude scores. Changes of nutrition knowledge and attitude scores from follow up until end of 6 months was assessed using the mixed effect model taking into account the cluster effect.

RESULTS: A total of 563 children in the intervention group and 482 in the control group completed the six-month program and were included in the analysis. The overall nutrition knowledge score was significantly higher in the intervention group (adjusted mean difference (AMD): 4.75%, p = 0.028 ) after controlling for mean nutrition knowledge score at baseline, gender, location school group (intervention vs control) and ethnicity. There was also a significant improvement in the nutrition knowledge score with AMD among boys (6.02%), urban children (8.07%), and non-Malays (10.4%). In contrast, after controlling for mean nutrition attitude score at baseline, gender, location, school group (intervention vs control) and ethnicity, there was no significant difference in the nutrition attitude scores between the intervention and the control groups in the overall, gender, location and ethnicity.

CONCLUSIONS: The MyBFF@school program with an adjunct NEI improves the overall knowledge on nutrition but has no positive effect on the nutrition attitude of younger schoolchildren, necessitating additional improvements.

METHODS: DIAMOND was a randomised, double-blind, placebo-controlled crossover trial done at six hospitals in Canada, Malaysia, and the Netherlands. Eligible participants were adult patients (aged 18-75 years) with chronic kidney disease, without a diagnosis of diabetes, with a 24-h urinary protein excretion greater than 500 mg and less than or equal to 3500 mg and an estimated glomerular filtration rate (eGFR) of at least 25 mL/min per 1·73 m2, and who were on stable renin-angiotensin system blockade. Participants were randomly assigned (1:1) to receive placebo and then dapagliflozin 10 mg per day or vice versa. Each treatment period lasted 6 weeks with a 6-week washout period in between. Participants, investigators, and study personnel were masked to assignment throughout the trial and analysis. The primary outcome was percentage change from baseline in 24-h proteinuria during dapagliflozin treatment relative to placebo. Secondary outcomes were changes in measured GFR (mGFR; via iohexol clearance), bodyweight, blood pressure, and concentrations of neurohormonal biomarkers. Analyses were done in accordance with the intention-to-treat principle. This study is registered with ClinicalTrials.gov, NCT03190694.

FINDINGS: Between Nov 22, 2017, and April 5, 2019, 58 patients were screened, of whom 53 (mean age 51 years [SD 13]; 32% women) were randomly assigned (27 received dapagliflozin then placebo and 26 received placebo then dapagliflozin). One patient discontinued during the first treatment period. All patients were included in the analysis. Mean baseline mGFR was 58·3 mL/min per 1·73 m2 (SD 23), median proteinuria was 1110 mg per 24 h (IQR 730-1560), and mean HbA1c was 5·6% (SD 0·4). The difference in mean proteinuria change from baseline between dapagliflozin and placebo was 0·9% (95% CI -16·6 to 22·1; p=0·93). Compared with placebo, mGFR was changed with dapagliflozin treatment by -6·6 mL/min per 1·73 m2 (-9·0 to -4·2; p<0·0001) at week 6. This reduction was fully reversible within 6 weeks after dapagliflozin discontinuation. Compared with placebo, bodyweight was reduced by 1·5 kg (0·03-3·0; p=0·046) with dapagliflozin; changes in systolic and diastolic blood pressure and concentrations of neurohormonal biomarkers did not differ significantly between dapagliflozin and placebo treatment. The numbers of patients who had one or more adverse events during dapagliflozin treatment (17 [32%] of 53) and during placebo treatment (13 [25%] of 52) were similar. No hypoglycaemic events were reported and no deaths occurred.

INTERPRETATION: 6-week treatment with dapagliflozin did not affect proteinuria in patients with chronic kidney disease without diabetes, but did induce an acute and reversible decline in mGFR and a reduction in bodyweight. Long-term clinical trials are underway to determine whether SGLT2 inhibitors can safely reduce the rate of major clinical kidney outcomes in patients with chronic kidney disease with and without diabetes.

METHODS: Using 3 d of dietary records, FA intakes of 333 recruited patients were calculated using a food database built from laboratory analyses of commonly consumed Malaysian foods. Plasma triacylglycerol (TG) and erythrocyte FAs were determined by gas chromatography.

RESULTS: High dietary saturated fatty acid (SFA) and monounsaturated fatty acid (MUFA) consumption trends were observed. Patients on HD also reported low dietary ω-3 and ω-6 polyunsaturated fatty acid (PUFA) consumptions and low levels of TG and erythrocyte FAs. TG and dietary FAs were significantly associated respective to total PUFA, total ω-6 PUFA, 18:2 ω-6, total ω-3 PUFA, 18:3 ω-3, 22:6 ω-3, and trans 18:2 isomers (P < 0.05). Contrarily, only dietary total ω-3 PUFA and 22:6 ω-3 were significantly associated with erythrocyte FAs (P < 0.01). The highest tertile of fish and shellfish consumption reflected a significantly higher proportion of TG 22:6 ω-3. Dietary SFAs were directly associated with TG and erythrocyte MUFA, whereas dietary PUFAs were not.

METHODS: Twenty-six patients on HD underwent US and CT scans on the same day, postdialysis session. QMT for rectus femoris (RF) and vastus intermedius (VI) muscles was taken at the midpoint (MID) and two-thirds (2/3) of both thighs and CSA of the RF muscle (RFCSA ), respectively. Correlation between US and CT measurements was determined by intraclass correlation coefficient (ICC) and Bland-Altman plot.

RESULTS: ICC (95% CI) computed between US and CT was 0.94 (0.87-0.97), 0.97 (0.93-0.99), 0.94 (0.87-0.97), 0.94 (0.86-0.97), and 0.92 (0.83-0.97) for RFMID , VIMID, RF2/3, VI2/3 , and RFCSA , respectively (all P < 0.001). Bland-Altman analysis indicated no bias in agreement between both methods.

METHODS: Plasma samples were collected in a randomised, placebo-controlled, double-blind, cross-over trial (DIAMOND, NCT03190694, n = 53) that assessed the effects of 10 mg of dapagliflozin in patients with a glomerular filtration rate ≥ 25 mL/min/1.73 m2 and proteinuria > 500 mg/day. Mixed-effects models were used to develop a pharmacokinetic model and to evaluate the association between plasma exposure and response.

METHODOLOGY: A total of 571 healthcare workers at COVID-19 and non-COVID-19 wards as well as the emergency department and laboratory staff at COVID-19 testing labs were recruited. The presence of novel human coronavirus (SARS-CoV-2) and IgM/IgG antibodies were confirmed in all healthcare workers. The healthcare workers responded to an online Google Forms questionnaire that evaluates demographic information and comorbidities, exposure and adherence to infection prevention and control measures against COVID-19. Descriptive analysis was performed using Statistical Package for the Social Sciences 24.0.

RESULTS: Three healthcare workers (0.5%) tested positive for SARS-CoV-2, while the remaining 568 (99.5%) were negative. All were negative for IgM and IgG antibodies during recruitment (day 1) and follow-up (day 15). More than 90% of the healthcare workers followed infection prevention and control practices recommendations regardless of whether they have been exposed to occupational risk for COVID-19.