Chocolate is a popular food and its consumption has long been associated with enjoyment and pleasure. The effect of chocolate on mood too has long been recognised. Chocolate is thought to have interactions with neurotransmitters which contribute to mood modulation and appetite regulation. However, the evidence in chocolate and mood studies remains highly controversial. As more is known about the influence of chocolate on mood, the reasons for these effects appear increasingly complex and inter-related.
There is mounting evidence demonstrating the importance of adequate physical activity to promote better well-being among hemodialysis patients. Available data pertaining to the levels of physical activity and its determinants among hemodialysis patients is, however, scarce in Malaysia. The objectives of this study are hence to determine the levels of physical activity and it associated factors among hemodialysis patients.
Introduction: Childhood stunting is recognised as one of the most significant
barriers to human development. This cross-sectional study aimed to determine the
factors associated with stunting among Orang Asli (OA) preschool children in Negeri
Sembilan, Malaysia.
Methods: A total of 264 children (50.9% boys and 49.1%
girls) aged 2-6 years (M=4.04, SD=1.21 years) including their mothers from 14 OA
villages in Negeri Sembilan participated in this study. Mothers were interviewed to
obtain information regarding socioeconomic status, sanitation facility and personal
hygiene. The height of the children and their mothers were measured. Venous
blood samples were drawn from the children to estimate haemoglobin level, and
stool samples were collected to screen for intestinal parasitic infections.
Results:
Approximately one third of the children (35.6%) and 7.8% of the mothers were
stunted. One in five of the children were anaemic (21.6%), while one- third had
intestinal parasitic infections (35.0%). Low birth weight (AOR=2.526, 95% CI: 1.310-
4.872; p=0.006), anaemia (AOR=2.742, 95% CI: 1.265-5.945; p=0.011), presence
of intestinal parasitic infections (AOR=2.235, 95% CI: 1.310-3.813, p=0.003), not
wearing shoes (AOR=2.602, 95% CI: 1.453-4.660; p=0.001), absence of piped water
at home (AOR=2.395, 95% CI: 1.047-5.476; p=0.039), dirty nails (AOR=1.956, 95%
CI: 1.163-3.289, p=0.011), and stunted mothers (AOR=3.443, 95% CI: 1.334-8.890;
p=0.011) were identified as significant factors for childhood stunting.
Conclusion:
It is suggested that the factors identified associated with childhood stunting be
included in future intervention programmes that address stunting among OA
children.
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: This randomised school-based controlled study aimed to evaluate the baseline results of nutrition knowledge, attitude, and practice (NKAP), health-related quality of life (HRQoL), and parents’ report of parenting skills (PRPS) among overweight and obese children.
Methods: This study was performed on three intervention groups and one control group. It was conducted among Year Five students from primary schools who had overweight or obese status and were generally healthy without any chronic diseases. The children completed NKAP and child self-report of Pediatric Quality of Life (PedsQoL) questionnaires, while parents completed parent proxy report of PedsQoL and PRPS questionnaires. Descriptive statistics and parametric test in SPSS were utilised.
Results: Out of 139 participants involved in the baseline study, 18.7% and 81.3% were overweight and obese respectively. This study revealed a significantly higher knowledge score among boys (p = 0.016) and among those who lived in urban areas (p = 0.019). The children’s selfreport PedsQoL recorded highest score for Social Functioning domain and lowest score for Emotional Functioning domain. A contradictory finding was obtained from the parent proxy report, where the Physical Functioning domain scored the lowest and the Emotional Functioning domain had the highest score. Notably, some of the findings from PRPS questionnaires completed by their parents were unfavourable.
Conclusions: This study provided prospective evidence of the current status of NKAP, HRQoL among overweight and obese children as well as findings from PRPS among their parents.
A cross-sectional comparative study was conducted to determine the nutritional status among physically active groups in Kota Bharu. The study population comprised 83 adult male athletes from 8 different types of sports (athlete group), 80 active men who exercised a minimum of 30 min per day for at least 3 times per week (exercise group), and 80 inactive men (sedentary group). All the respondents were aged between 18 to 44 years. Measurements taken from the respondents were anthropometric measurements, systolic (SBP) and diastolic (DBP) blood pressure, and serum total cholesterol (TC). The results showed that the combined prevalence of pre-obese (BMI 25.0-29.9) and obese (BMI ≥30.0) was 21.7% in athletes, 29.9% in exercise group, and 47.5% in sedentary group. The mean (± SD) percentage of body fat in athletes was 15.7 ± 5.4%, which was lower compared to the exercise (18.9 ± 5.5%) and sedentary (20.6 ± 5.8%) groups. The incidence of waist-to-hip ratio above 0.9 in athlete, exercise and sedentary groups was 9.6%, 18.7% and 31.3%, respectively. The incidence of hypertension (SBP ≥140 and/or DBP ≥90 mmHg) was 13.2% in athletes, 17.5% in exercise group and 42.5% in the sedentary group. The TC values showed that the prevalence of "high risk" individuals (TC ≥6.20 mmol/l) was also lower in athletes (20.5%), compared to the exercise (36.2%) and sedentary (47.5%) groups. The study revealed that individuals who are actively involved in physical activity, particularly in sport activities have better nutritional status compared to sedentary people. However, the nutritional status in the athlete and exercise groups was still unsatisfactory. The incidence of poor health status related to over nutrition in the active groups was rather high and needs attention from health professionals. Further studies are needed to determine nutritional practices among physically active groups.
Introduction: The mNUTRIC score is a nutritional assessment tool to identify critically
ill patients with high nutritional risk who could benefit from nutritional interventions.
This study was conducted to validate the 28-day mortality prognostic performance
of the mNUTRIC score in a Malaysian intensive care unit (ICU). Methods: This was
a retrospective cohort study of adult patients who were consecutively admitted to
the ICU from January 2017 to December 2018 for >24 hours. Data were collected on
variables required to calculate the mNUTRIC score. Patients with mNUTRIC score
≥5 points were considered to be at high nutritional risk. Main outcome was 28-
day mortality from all causes; ICU length of stay (LOS) and prolonged mechanical
ventilation (MV) (>2 days) were secondary outcomes. Results: From a total of 432
admissions, 382 (88.4%) patients fulfilled the study criteria. Seventy-seven (20.2%)
of these patients were at high nutritional risk. They had longer mean ICU LOS
(7.1±7.5 days versus 4.2±4.0 days, p=0.001), greater proportion of prolonged MV
(57.1% versus 14.4%, p
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: Meal patterns have received little attention in nutrition studies. The aim of this study is to present the findings on general meal patterns of Malaysian adults.
METHODS: The Malaysian Adults Nutrition Survey (MANS), carried out in 2002 and 2003, involved 6,928 adults selected by stratified random sampling from all households by zone in Peninsular Malaysia, Sabah and Sarawak.
RESULTS: In general, the results showed that most respondents (74.16%) ate three meals per day; 89.20% of the respondents consumed breakfast, while 88.57% consumed lunch and 91.97% consumed dinner with no significant difference in terms of sex. In Peninsular Malaysia, the Northern Zone had the highest number of people consuming breakfast compared to other zones. Meanwhile, the population in Sarawak had the largest proportion of people consuming lunch and dinner, but the smallest proportion of people consuming breakfast. A significantly higher number of the rural population consumed breakfast and lunch than urbanites; however there was no significant difference in dinner consumption. Generally, breakfast consumption increased with age whereby significant difference existed between the 18 to 19 years age group and the age group of 30 years and older. Lunch intake among the age groups showed no significant difference. In contrast, dinner consumption was significantly lower among the 18 to 19 years age group compared to all other age groups. Comparison among the ethnic groups showed that the Indian population had the lowest percentage of having breakfast and lunch while the Orang Asli had the lowest percentage of consuming dinner. However, the Orang Asli recorded the highest percentage for taking breakfast and lunch while the Chinese had the highest percentage of taking dinner.
CONCLUSION: Considering that Malaysian adults consumed their conventional breakfast, lunch and dinner, these findings indicatethat Malaysians are maintaining their traditional meal patterns.
Study name: Malaysian Adult Nutrition Survey (MANS-2003)
The increasing prevalence of overweight and obesity among children has become a major public health problem in Malaysia. Parents play an important role in child feeding especially among younger children.
This study investigated the role of antioxidant enzyme system following crude hydroethanolic extract of Moringa oleifera leaves (MO) in acute paracetamol (PCM) induced hepatotoxicity. Hydroethanolic extract (80%) of MO (200 mg/kg and 800 mg/kg; p.o) was pre-administered before a single oral dose of 3 g/kg PCM intoxication to male Sprague-Dawley rats. Pre-treatment of the extract was found to have reduced lipid peroxidation level when compared to the group treated with PCM only. The level of glutathione peroxidase (GPx), glutathione-Stransferase (GST) and glutathione reductase (GR) was restored to near normal in groups that were pre-treated with MO. Histopathological studies have further confirmed the hepatoprotective activity of MO compared to group treated with PCM only. The results obtained were comparable to silymarin (200 mg/kg; p.o). The MO extract was found to have significantly protected the liver against toxicity following PCM intoxication by enhancing the level of antioxidant enzyme activity.
Body fatness distribution is a useful epidemiological and clinical marker of health risk among European and other populations. Prevalence of obesity among adults is rising in many parts of Malaysia, and it is important to understand the extent to which fat patterning is robust across different age groups and between the sexes. This analysis examines fatness and fat distribution in rural Sarawakian adults aged 20 to 80 years to determine the extent to which fat patterning varies by sex and age. Principal component analysis of five skinfolds (biceps, triceps, subscapular, suprailiac and medial calf) shows upper body-lower body fat distribution as contributing most to within-group variation in the sum of five skinfolds for both males and females. When divided into younger and older age groups, clear differences were identified. For the males, while absolute fatness does not change with age, there is a change in fat patterning, with a trunk-extremity component disappearing, and a trunk-lower body pattern persisting. Females experience a decline in subcutaneous fatness across age groups, and while the most important component of fat distribution, trunk to lower body subcutaneous fatness, the same for younger and older women, the second component is different, with upper limb-lower body distribution in the younger age group being replaced with upper to lower trunk distribution. The similarities in fat patterning among males and females suggest that the use of fat patterning indices in this Malaysian population need not be sex-specific, but age group- and sex-dependent differences in the second principal component indicate that they should be used with caution, since the relationships between fat patterning and mortality are still poorly understood among Malaysian populations.
The teaching and research tool called 'DietPLUS', developed by the present author at an institution of higher learning in 2007, contains nutrient information of 840 food items in Excel format. DietPLUS functions as a '2-in-1' food composition database plus a rapid calculator of nutrient intakes, with the option of 'collapsing' the food composition face leaving only the nutrient calculator face. The macronutrients featured in the programme are energy, protein, fat, carbohydrates, dietary fibre, sugars (intrinsic + added), polyunsatuared omega-6 fatty acids (mainly linoleic acid, LA) and polyunsaturated omega-3 fatty acids [alphalinolenic acid (ALA) or eicosapentaenic acid (EPA) + docosahexaenolic acid (DHA)]. The micronutrients in the programme are vitamin A (as retinol equivalents, RE), vitamin C, thiamin (vitamin B1), riboflavin (vitamin B2), and niacin. Cholesterol content was included to complete the list of food components tabled. Food items consumed are converted into gram quantities (edible portion) and are entered in one column in the Excel programme which emphasises the simplicity and user-friendliness of the present nutrient calculator. DietPLUS instantaneously sums up the macronutrients and micronutrients consumed with each subsequent entry. Macronutrients (protein, fat, carbohydrate, sugars and dietary fibre) consumed are presented as gram quantities and a percentage of the Recommended Nutrient Intakes for Malaysia 2005. An approximate number of servings are also provided for vegetables, fruits, legumes, fish and meat, which may be useful in meal planning and nutrition/dietetic counselling.
Despite evidence from various studies on exclusive breastfeeding (EBF) being best for infants, many women do not or are unable to practise EBF. This study aimed to examine perceptions on EBF and its influencing factors among a sample of Malay women in rural and urban areas in Kelantan, Malaysia.
Introduction: Hypercholesterolemia is an important modifiable risk factor for coronary heart disease. Lifestyle changes in diet and physical activity can improve cholesterol levels. This study aimed to compare the fruits and vegetables (FV) intake and physical activity (PA) between hypercholesterolemic adults and non- hypercholesterolemic adults in Malaysia, and to investigate factors associated with meeting the recommended levels of FV intake and PA in a hyper- cholesterolemic population. Methods: This study was based on 17,988 participants (response rate 98.7%) aged 18 years and above who responded to the hypercholesterolemia questionnaire in the 2011 Malaysian National Health and Morbidity Survey (NHMS), a cross-sectional study with two-stage stratified sampling design. Data were obtained by trained enumerators via face-to-face interviews and were analysed by descriptive analysis, chi-square test, and univariable and multivariable logistic regression. Results: Out of the total population assessed, 39.0% had hypercholesterolemia. The prevalence of consuming five or more servings of FV per day is low (7.8%) while 36.0% were physically inactive among the hypercholesterolemic adults. No significant differences were observed in FV intake and PA between hypercholesterolemic and non-hypercholesterolemic populations. Gender, age and educational levels were associated with FV intake and PA among hypercholesterolemic adults. Hypercholesterolemic adults who were underweight or obese were less likely to consume FV, while those who were former smokers and those who had diabetes and heart disease were less likely to be physically active. Conclusion: These findings are relevant for future health promotion strategies, suggesting that more intensive interventions are needed to increase FV intake and PA level in hypercholesterolemic population and in the general population.
Study name: National Health and Morbidity Survey (NHMS-2011)
Rapid and marked socioeconomic advancements in Malaysia for the past two decades have brought about significant changes in the lifestyles of communities. These include significant changes in the dietary patterns of Malaysians, eg the increase in consumption of fats and oils and refined carbohydrates and a decreased intake of complex carbohydrates. This resulted in a decline in the proportion of energy from carbohydrates, while an increase in the percentage contribution of fat has been observed. Changes in meal patterns are also evident: more families eat out, busy executives skip meals, the younger generation miss breakfasts and rely too much on fast foods. Many Malaysians have the mistaken belief that the taking of vitamin and mineral supplements can make up for the lack of these nutrients in their daily diets. In addition, communities have become generally more sedentary. All these changes have brought about undesirable effects with significant proportions of the affluent segments of the population being afflicted with various non-communicable diseases associated with overnutrition, namely obesity, hypertension, coronary heart disease and cancers. Nutrition activities and programmes are now being directed to tackle this increasing trend, whilst still attempting to eliminate the undernutrition problems. The ultimate strategy towards achieving a healthy nation is the promotion of a healthy lifestyle, including inculcating a culture of healthy eating. Comprehensive long term programmes, including a series of Healthy Lifestyle (HLS) Programmes have been carried out by the government. Launched in 1991 for six consecutive years, the first phase of the Programme comprised one thematic campaign each year, commencing with coronary heart disease and ending with diabetes mellitus. To further strengthen this long-term strategy, another series of activities to be carried out under the second phase of the HLS programme from 1997 to 2002 was launched within the framework of the National Plan of Action on Nutrition (NPAN) for Malaysia. The implementation of these programmes is, however, a challenge to health and nutrition workers. There is a need to examine the strategies for nutrition education to ensure more effective dissemination of information. The challenge is to determine how best to promote healthy eating within the present scenerio of rapid urbanisation, "western" dietary pattern influence, a whole barrage of convenience and "health" foods and nutrition misinformation. Malaysia continues to march ahead with its development plans to elevate the nation and its people to an even higher level of socio-economic status. The crucial question is: are we able to arrest the increase in these diet-related chronic diseases ? Or are we heading towards further deterioration in dietary pattern and increase in these diseases ? It will be a difficult and challenging journey ahead, requiring the concerted effort of all in the country. It is hoped that through this conference of sharing experiences with other Asian countries, a better understanding and improved strategies could be arrived at.
The determination of serum vitamins having antioxidant properties has gained in importance in recent years. This is mainly due to the observation that an inverse correlation exists between blood levels of these vitamins, including retinol, carotenoids and tocopherol, and diet-related chronic diseases such as coronary heart disease and cancers. This laboratory has been carrying out a series of studies into the nutritional and analytical aspects of retinol and carotenoids. A simple reversed-phase HPLC method has been developed in an effort to improve methodologies for the separation and quantitation of carotenoids and retinol in foods and biological specimens, especially blood serum. As an extension to these studies, trials were carried out to determine the feasibility of analysing tocopherols using the same chromatographic procedure. With the addition of another detector wavelength, the same procedure detected and quantitated 3 major tocopherols simultaneously with retinol and five carotenoids. Within-day and between-day precision of the procedure was satisfactory. Trials carried out were able to improve recovery of the vitamins. Experiments conducted also showed that the addition of ascorbic acid to the extracting ethanol was beneficial for the analytical procedure. The presence of peroxide in ethyl acetate used in the chromatography mobile phase caused drastic destruction to the vitamins analysed. The addition of ascorbic acid during sample preparation was able to inhibit this destruction. The method was used for the analysis of sera from 65 apparently healthy Malaysians with a mean age of 52.8 years (range 24-76 years). Mean retinol concentration of the group was 69.8 ± 18.8 mg/dl. The mean β-carotene concentration of the subjects studied was 33.8 ± 24.3 mg/dl, while the mean total carotenoid concentration was 180.2 ± 3.0 mg/dl. The most abundant carotenoid in the serum samples studied was lutein, comprising about one-third of all carotenoids quantitated. The concentrations of δ- and γ-tocopherols in the serum samples studied were too low to be identified with certainty and quantitated accurately. The mean α-tocopherol level was 1840 ± 528 μg/dl. For retinol, α-tocopherol and most of the carotenoids determined, there was no statistically significant difference in the mean levels between male and female subjects as well as among the three different ethnic groups. Results obtained in this study were very similar to those previously reported by this laboratory. It is hoped that more data on the serum concentrations of these vitamins can become available for various population groups, including during various disease conditions.
As a part of the recent UPM-IMR collaborative study on the nutritional status of communities in rural villages and estates in Peninsular Malaysia from 1992-1995, this report presents findings on the haemoglobin levels and the prevalence of anaemia amongst these rural dwellers. A total of 69 villages and 7 estates located in 9 states in Peninsular Malaysia were studied. Results of the study on the 5 communities (total n=8024), namely fishing, padi, rubber, coconut and estate communities, are presented according to five age groups, namely less than 7 years (n=1418), 7-12.9 years (n=1778), 13-17.9 years (n=701), 18-59.9 years (n=3241) and 60 years (n=886). The extent of the anaemia problem varied considerably amongst the various age groups and community types. The prevalence of anaemia and mean Hb level (g/dl) for subjects of both sexes were respectively 24% and 12.1 for those < 7 years; 21.9% and 13.0 for the 7-12.9 years old; 17.8% and 13.7 for the 13-17.9 years; 21.0% and 13.8 for 18-59.9 years; and 22.7% and 13.6 for those 60 years of age and above. While the female adults (18-59.9 years) had a significantly higher prevalence rate for anaemia of 25% compared to 14% found in the male adults, no significant difference in the prevalence rates were found between the sexes for the other age groups. The problem was most serious among adult women, young children and the elderly. Amongst the various community types, the fishing community had the highest prevalence of anaemia at an overall rate of 50%, taking into consideration both sexes and all age groups. The rubber smallholders, in contrast, had the lowest prevalence of anaemia, at an overall rate of about 10%. Intervention and preventive health programmes should therefore be continued to be focussed on the above groups of rural subjects, particularly those in the fishing community.
Introduction: Compliance with medical nutrition therapy is important to improve patient outcomes. The purpose of this study was to determine dietary compliance and its association with glycemic control among outpatients with poorly controlled type 2 diabetes mellitus (T2DM) in Hospital Universiti Sains Malaysia (HUSM).
Methods: In this cross-sectional study, patients who had a glycosylated hemoglobin (HbA1c) level of at least 6.5%, after attending a diet counseling session at the Outpatient Dietetic Clinic, HUSM, were enrolled. Out of 150 diabetic patients reviewed between 2006 and 2008, 61 adults (32 men and 29 women) agreed to participate in this study. A questionnaire-based interview was used to collect socio-demographic, clinical and diabetes self-care data. The patient’s dietary compliance rate was determined by the Summary of Diabetes Self-Care Activities (SDSCA) measure. Anthropometric and biological measurements were also taken.
Results: Only 16.4% of the respondents adhered to the dietary regimen provided by dietitians. Among the 7 dietary self-care behaviours, item number 6 (eat lots of food high in dietary fibre such as vegetable or oats) had the highest compliant rate (54.1%); whereas item number 3 (eat five or more servings of
fruits and vegetables per day) had the lowest compliant rate (23.0%). There was a significant association between gender (p=0.037) and fasting blood sugar (FBS) (p=0.007) with the compliance status. Conclusion: Dietary non-compliance is still common among T2DM patients. Dietitians need to improve their skills and use more effective intervention approaches in providing dietary counseling to patients.
Keywords: Dietary compliance, diet counseling, type 2 diabetes mellitus
This is a cross-sectional study which investigated the association between non-exclusive breastfeeding and maternal, paternal, obstetric and infant factors. Data on maternal, paternal, obstetric and infant factors were collected through face-to-face interview using a structured questionnaire from 498 mothers with four-week-old infants who attended government clinics in Klang district between 17 and 28 July 2006. The prevalence of non-exclusive breastfeeding at four weeks was 45.8%. Factors significantly associated with non-exclusive breastfeeding at four weeks included Indian ethnic mother (OR = 4.06), working mother (OR = 3.55), mother from high household income (OR = 1.90), mother who smokes (OR = 7.27), primiparous (OR = 1.97), infant not sharing a bed with mother (OR = 1.75) and infant born prematurely (OR = 7.69). Identification of risk factors should assist in targeting women who are at increased risk of non-exclusive breastfeeding.