Background: Although body fat percentage (BFP) is a widely accepted indicator of total body fat, it has not been extensively used in studies conducted among the Orang Asli in Peninsular Malaysia. Objective: This study was undertaken to determine the BFP distribution in a group of Orang Asli adults living in Cameron Highlands, Malaysia. Methods: Kampung Sungai Ruil, one of the Orang Asli settlements in Cameron Highlands, was conveniently selected for this crosssectional study. A total of 138 respondents aged 18 years and above were assessed. Skinfold thickness was measured using the Slim Guide skinfold caliper to calculate BFP. Waist circumference, BMI, blood pressure and random plasma glucose were also measured. Results: The mean BFP of the females (29.7%) was higher than the males (18.9%) and the respondents with abdominal obesity (36.2%) had higher mean BFP compared to those with normal waist circumference (23.7%) Those in the age group of 18-28 years old (22.1%) had lower BFP than
respondents in the age groups 29-39 years old (27.3%) and 40-50 years old (29.1%) (p=
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
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
The current study aimed to determine the best dose of methanol extract of Ocimum tenuiflorum L. leaves extract, and it is a fraction to blood-glucose-lowering in diabetic rats, and evaluated the α-amylase, α-glucosidase inhibitors and insulin level of diabetic rats used to achieve greater control over hyperglycemia. The result of the antihyperglycaemic of oral administration of a different dose of methanol extract in streptozotocin-induced rats showed that the highest dose of methanol extract significantly reduced the blood glucose level compared to another dose. Also, the result of repeated administration of methanol fractions indicates that ethyl acetate-butanol fraction exhibited a stronger antihyperglycemic effect than chloroform and ethanol-water fractions. Moreover, the result showed that effect of methanol extract and its fraction on α-glucosidase and α-amylase enzymes activities and its insulin level by in vitro study, ethyl acetate-butanol fraction could control with low concentration compared to other fractions and acarbose that used as a positive control. From the result of insulin level, methanol extract and fraction did not show any significant. These findings indicated that the active crude extract (methanol) and its active fractions (ethyl acetate/butanol) could exert significant glucose-lowering effect due to the presence of polyphenolics active constituents. In conclusion, isolation of the active components of Ocimum tenuiflorum L. may pave the way to the development of new agents for the treatment of diabetes and its complications.
Current international tables published on the glycaemic index (GI) of foods represent valuable resources for researchers and clinicians. However, the vast majority of published GI values are of Western origin, notably European, Australian and North American. Since these tables focus on Western foods with minimal inclusion of other foods from non-Western countries, their application is of limited global use. The objective of this review is to provide the GI values for a variety of foods that are consumed in non-Western countries. Our review extends and expands on the current GI tables in an attempt to widen its application in many other regions of the world.
We investigated the association between polycystic ovarian syndrome, dyslipidemia and glucose intolerance in a cross sectional analysis comparing 50 patients with polycystic ovary syndrome and 50 patients without the disease (control group) who were attending the Infertility clinic. Variables of interest were their body-mass index (Kg/m2), fasting and blood glucose levels after a 75 gram oral glucose tolerance test and their total cholesterol (mmol/L), total triglycerides (mmol/L), high density cholesterol lipoprotein (HDL) cholesterol (mmol/L) and, low density lipoprotein cholesterol (mmol/L) levels. Except for HDL where significantly lower values were observed, significantly higher levels were detected in patients with PCOS than that of the control group. The difference persisted even when the obesity index were adjusted and matched. We conclude that both glucose intolerance and dyslipidemia were significantly associated with PCOS irrespective of the obesity index.
Accepted 07 August 2011.
Introduction Chronic kidney disease (CKD) has emerged as a major medical illness that drew the attention of the community. This research focused on the prevalence of five contributing factors to the progression of CKD, namely blood pressure control, glycaemic control, lipid control, smoking and alcohol intake, and explored significant association between these variables. This was a crosssectional study that examined the progression of CKD based on the worsening of CKD stages.
Methods This study was conducted among CKD patients with type 2 diabetes mellitus who attended Nephorology Clinic, UKMMC from April to May 2011. The progression of CKD was observed for 3 consecutive visits with 3 months intervals between the visits. Information regarding demographic data and social history were obtained through face-to-face interview, followed by case note review of the blood results. Data collected was analysed using SPSS version 19.0.
Results A total of 201 respondents were investigated, which included 39.3% (n=79) female and 60.7% (n=122) male. The mean age for the respondents was 66.9 years old (±SD 9.00). Among the respondents, 71.5% had poor glycaemic control; 59.7% had poor blood pressure control; 65.2% had poor lipid control; 19.9% smoked and 3.5% consumed alcohol. There was poor correlation, there were statistically significant association between systolic blood pressure control with the glomerular filtration rate (GFR) (p=0.001; r=-0.229). From this research, high systolic blood pressure was associated with low GFR, which indicated poor kidney function and resulted in progression of CKD.
Conclusions This study has clearly demonstrated that the control of blood pressure was essential in delaying the progression of CKD.
Delay in childbearing, family history of type 2 diabetes mellitus and obesity in childbearing years increases a possibility of glucose intolerance or overt diabetes in pregnancy which may remain unrecognised unless an oral glucose tolerance test is done.The International Association of Diabetes and Pregnancy Study Group (IADPSG, 2010) recommended the detection and diagnosis of hyperglycaemic disorders in pregnancy at two stages of pregnancy, the first stage looking for ‘overt diabetes’ in early pregnancy based on risk factors like age, past history of gestational diabetes and obesity and the second stage where ‘gestational diabetes’ at 24-28 weeks with 75 g oral glucose tolerance test. Although the one step approach with 75 g of glucose offers operational convenience in diagnosing gestational diabetes, there are concerns raised by the National Institute of Health in the recent consensus statement, supporting the two step approach (50-g, 1-hour loading test screening 100-g, 3-hour oral glucose tolerance test) as the recommended approach for detecting gestational diabetes. Medical nutrition therapy (MNT) with well-designed meal plan and appropriate exercise achieves normoglycemia without inducing ketonemia and weight loss in most pregnant women with glucose intolerance. Rapidly acting insulin analogues, such as insulin lispro and aspart are safe in pregnancy and improve postprandial glycemic control in women with pre-gestational diabetes. The long acting analogues (Insulin detemir and glargine) though proven to be safe in pregnancy, do not confer added advantage if normoglycemia is achieved with intermediate insulin (NPH). Current evidence indicates the safe use of glyburide and metformin in the management of Type 2 diabetes and gestational diabetes as other options. However, it is prudent to communicate to the women that there is no data available on the long-term health of the offspring and the safety of these oral hypoglycemic drugs are limited to the prenatal period.
Mr S is a 38 year old Indian man who has type 2 diabetes mellitus for 3 years. He is currently on metformin 500mg BD. His BMI is 24.9 kg/m2 (weight 72 kg, height 170 cm). His blood glucose is well controlled (HbA1c 6%). His fasting lipid levels are as follow: Total cholesterol 5.0 mmol/L, HDL-C 1.60 mmol/L, LDL-C 2.6 mmol/L and triglyceride 0.9 mmol/L. He has no family history of acute myocardial infarction. He is a smoker (14 sticks/day, 12 years) but non-hypertensive. He asks if he should take atorvastatin, a lipid-lowering drug that his father is taking. Should statins be started in type 2 diabetic patients without pre-existing coronary artery disease whose lipid level is not elevated?
The interest in dietary antioxidants which are mainly found in fruits, has prompted research in
the field of commercial high antioxidant juice for healthy purposes. Fruits also are rich with antioxidants that help in reducing of degenerative diseases such as cancer, arthritis, cardiovascular
disease and inflammation. Based on the health claims from the natural antioxidants, a new healthy juice called Mixed Fruit Juice (MFJ) has been developed by using three combinations of local fruits (soursop, mango and kasturi lime). In order to promote the commercial use of this product, the safety evaluation is needed to be carried out. The 28-days repeated toxicity test has been conducted in female and male rats for pre-clinical safety assessment prior to human study. There was no mortality observed when varying doses of the MFJ (5, 10 and 20%) administered to all rats. Hematological analysis showed no significant differences in most parameters examined. There were no significant changes observed in the liver and kidney functions tests of all treated-rats as compared to control normal rats. Furthermore, lipid profiles and blood glucose level were also within the normal range as noted in control rats. The present data demonstrate that the supplementation of MFJ did not produce adverse effects on the body system of experimental rats. This is the first documented report on the safety assessment of
MFJ in rats.
There is concern that shift workers are at higher risk for metabolic syndrome (MS) . The syndrome is characterized by a constellation of metabolic risk factors in one individual. A cross-sectional study of 148 workers in one factory in Kota Bharu, Kelarttan was conducted to examine relationships between shift work and five of the MS rnk factors namely high blood pressure, hyperglycemia, hypertriglyceridaemia, hypo·I·IDL-cholesterolaemia and high body mass index (BMI) . Data was collected through a questionnaire on psychosocial and life-style factors, anthropometric and blood pressure measurements, fasting blood sugar and fasting lipid profile. The National Cholesterol Education Program’s Adult Treatment Panel III Report (NCEPATP III) with some modifications was used to determine the presence of risk factors for the metabolic syndrome, The prevalence of high blood pressure, hypertriglyceridaemia and high BMI were significantly higher among shift workers compared to day workers. There was no difference in the prevalence of hyperglycemia and hypo-HDL-cholesterolaemia. When the shift workers were compared with the
day workers, the proportion of workers having three or more risk factors for the syndrome was higher among shift workers which were 15.8% and 5.6% respectively.
Pharmacist-managed DMTAC has been set up in Malaysia government healthcare facilities to assist diabetic patients in improving their medication adherence level and glycaemic control. The aim of this study is to determine the effect of pharmacist involvement in a DMTAC programme on patient glycaemic control in 14 government health clinics in Kuala Lumpur and Putrajaya. This multi-centre retrospective study collected DMTAC patient demographics, medication regimens, glycated haemoglobin (HbA1c) levels, Modified Morisky Medication Adherence Scale (MMMAS) data, and percentages of understanding towards their medications (based on information retrieved and reviewed from their DMTAC booklets). The data were analysed using IBM SPSS Statistics Version 21.0. Fifty six patients were involved in this study. The mean HbA1c reduction (SD) of the pre- and post-intervention groups showed a statistically significant
improvement of 1.0% (1.70) (p<0.001); decreasing from 10.7% (1.51) pre-intervention to 9.7% (1.75) post-intervention. The mean medication understanding score for the postintervention group was 97.6% (7.32), which was significantly higher than the preintervention group score of 92.2% (13.61) (p = 0.005). The mean MMMAS of the postintervention group was 7.4 (1.19), which was significantly higher than the pre-intervention group mean MMMAS of 6.5 (2.33) (p = 0.001). This study demonstrated an improvement in glycaemic control, medication understanding, and adherence level among T2DM patients who were enrolled in a pharmacist-managed DMTAC programme.
Keywords: Diabetes, Diabetes Medication Adherence Therapy Clinic (DMTAC), Endocrine, Pharmacist, HbA1c, Medication adherence, Medication understanding
Introduction: Non-alcoholic Fatty Liver Disease (NAFLD) is one of the end organ damage detected
in patients having metabolic syndrome X and it can lead to chronic liver failure. Therefore, it is
important to be able to assess the condition in a quantifiable manner to help clinicians recognize
and treat this disease. Objective: We aimed to determine the prevalence of NAFLD in patients with
metabolic syndrome in Serdang Hospital, Malaysia using contrast-enhanced multidetector computed
tomography (CECT) abdominal scan. The study also aimed to calculate the quantification of NAFLD
using liver to spleen density CT Hounsfield Unit ratio, CTL/S or CTL/S measurement using abdominal
CECT scans. Furthermore, we aimed to verify the correlation of dyslipidemia with NAFLD based on
the CTL/S parameter. Materials and Method: We conducted a cross-sectional retrospective study in
Hospital Serdang, Malaysia using data from January 2012 to December 2013. The sample size was 279
patients with metabolic syndrome who had undergone CECT abdominal scan. Patient demographics
were descriptively analysed. Spearman’s correlation test was used to look for association among lipid
profile, blood sugar level and CTL/S ratio. Results: The prevalence of NAFLD in metabolic syndrome
patients in our population was 82.8%. Prevalence of NAFLD was high among the elderly population (≥
57 years old). Additionally, Indian ethnics with metabolic syndrome had the highest risk of developing
NAFLD (90.9%). There was a significant association between elevated LDL levels and CTL/S ratio
(p
White and whole meal breads have been classified as high glycemic index (GI) foods which in turn produce the greatest rise in blood glucose. One of the commercial bread products in Malaysia known as Brown breads (BB) has been recently marketed as a healthy choice for diabetics due to its low GI value. This study was conducted to examine the effect of BB when eaten with different fillings on blood glucose response among healthy individuals and to describe the influences of these fillings in reducing blood glucose response. Five test meals using BB (BB eaten with baked beans, BB eaten with vegetable, BB eaten with apple, BB eaten with roast chicken and BB eaten with seaweeds) had been prepared for this study. Postprandial blood glucose response was determined for each test meal and reference food (glucose) that contained 50 g carbohydrate respectively. A total of 21 healthy subjects were recruited by advertisement to participate. Only 20 subjects (15 males, 5 females, Mean + SD Age : 24.4 + 3.7 years; BMI 23.4 + 3.0 kgm-2) completed this study. After an overnight fast, subjects consumed BB eaten with fillings according to the assigned group given and three repeated tests of reference food (glucose). Fasting capillary blood glucose samples were taken at time 0 and at 15, 30, 45, 60, 90 and 120 min respectively after the meal began. The blood glucose response was obtained by calculating the incremental area under the curve (AUC). Blood glucose response after consuming reference food (251.8 + 12.1 mmol.min/L) was significantly higher than all the test meals (p < 0.05). Among the test meals, BB eaten with baked beans produced the highest rise in blood glucose (97.0 + 16.9 mmol.min/L) whereas BB eaten with seaweeds demonstrated the lowest response in blood glucose (33.3 + 6.5 mmol.min/L) and the difference was statistically significant (p < 0.05). The postprandial blood glucose response after ingestion of BB when eaten with vegetable was 73.3 + 19.1 mmol.min/L followed by BB eaten with apple (58.9 + 12.2 mmol.min/L) and BB eaten with roast chicken (56.5 + 10.1 mmol.min/L). Generally, BB when eaten with fillings produced a slow rise in blood glucose response than the reference food. Combining this BB with fillings had the effect of reducing the postprandial blood glucose further.
Night work and rotating shift work are found to be detrimental to the health of workers. A cross sectional analytical study was conducted among the employees of a public medical centre in Kuala Lumpur. A total of 380 employees participated in the health screening and questionnaire survey. The majority of the respondents were Malays, females, and with mean age of 49 years old. The shift workers persistently had higher but non-significant proportions of being overweight/obesity and unhealthy clinical indicators such as systolic and diastolic blood pressure, fasting blood glucose and lipid profile except waist circumferences and HDL-cholesterol. There were also slightly more shift workers diagnosed with diabetes mellitus, hypertension or coronary heart disease (p>0.05). Although the present study could not provide established evidence for a relationship between shift work and cardiovascular risks, this could serve as a pilot study for future studies in this area.
Nesidioblastosis is a rare metabolic disease characterised by inappropriate insulin secretion often associated with life-threatening hypoglycaemia. While severe cases present in the newborn period, patients have been described later in infancy. Familial cases suggest an autosomal recessive trait, and recently mutations in the sulphonlurea receptor gene, possibly a regulator of insulin secretion, have been identified and associated with disease expression. We report a twin boy who developed normally until the age of six months when he was noted to regress. The boy is the older twin born to non-consanguinous parents. He presented to a hospital first at the age of 13 months with fever and generalised seizures. Low blood glucose was noted, but he recovered easily and was able to maintain euglycaemia during a 48-hour period of observation. Microcephaly and developmental delay were documented and anticonvulsant therapy was started. At 18 months, low blood glucose with high C-peptide was documented during reevaluation. Follow-ing a short trial of subcutaneous long-acting somatostatin analogue, the child was subjected to near-total pancreatectomy. The histology revealed findings consistent with nesidioblastosis. The child's condition improved but he remained significantly delayed This case emphasises the importance of recognising and treating hypoglycaemia early to avoid irreversible brain damage. It is interesting to note that the twin brother has always been well and is developmentally normal. Further studies to identify the inheritance pattern in the family would be of great interest.
Adequate and proper diabetes care in any practice is paramount and deems to be the fundamental requirement for good diabetes control. This is an audit of type 2 diabetes care process in a public Polyclinic, with the objectives of studying the quality of diabetic care provided in terms of clinical and managerial performance and also to give recommendations on improving its diabetes care delivery. The audit was done on patients' medical records selected via systematic random sampling. Patients who have been diagnosed with type 2 diabetes mellitus for more than 2 years, and those who have come for follow-up at least twice in between 1st October 2008 and 30th September 2009 by the medical officer and/or family medicine specialist. Patients with gestational diabetes mellitus and Type 1 diabetes mellitus were excluded. A total of 100 medical records were audited. 51% were female and 82% were in the 40-69 age group. Measurements of blood glucose and blood pressure were done at each follow-up at the polyclinic at 96% and 93% of the times, respectively. Within the past one year, HbA1c was performed in 46% of the patients, while renal profile was screened in 66% of the patients and urine protein was tested in 59% of the diabetics. Only 15% had their eyes screened by fundus camera. The diabetes care process at this public polyclinic was unsatisfactory, as many annual blood tests were not done and complications screening were also omitted. Thus, an urgent intervention is recommend in order to rectify these inadequacies.
Globally, the prevalence of diabetes mellitus and the average life expectancy is on the rise. As diabetes mellitus is commonly associated with old age, it is very important to ensure good glucose control to reduce complications and improve quality of life. A cross sectional study was conducted among elderly diabetics in Kulim with the aim to determine the prevalence of glucose control and its associated factors. Three hundred and twenty nine respondents were chosen through stratified random sampling in all the seven health clinics in Kulim. Respondents were interviewed personally using a structured questionnaire. HbA1c level of 6.5% and below was considered as good glucose control. Prevalence of good glucose control was 22.5%. Being male (Adjusted prevalence odds ratio, APOR = 1.75, 95% CI: 1.02-3.00), age of 70 years and above (APOR = 2.48, 95% CI: 1.40-4.39) and duration of diabetes less than five years (APOR = 2.10, 95% CI:1.21-3.64 ) were found to have significant association with good glucose control. As a conclusion, this study showed that the low prevalence of good glucose control was determined by gender, age and duration of illness.
Objective: The objectives of this study were to asses body mass index, fasting blood sugar , serum cholesterol levels and prevalence of Diabetes Mellitus among outpatients attending the Clozapine clinic at University Malaya Medical Center. Method: 36 patients had their height and weight taken at the start of the study. Their BMI (body mass index) was calculated. Fasting blood sugar, (FBS) and Fasting Serum Lipid (FSL) were performed. Result: The mean body mass index was 24.63. The prevalence of obesity was 13.89%. The prevalence of overweight was 27.8 % and the prevalence of underweight was 5.55%. The prevalence of Diabetes Mellitus was 2.78 %. Serum triglyceride levels appear to be elevated in those receiving Clozapine.Conclusion: It appears that Clozapine may predispose one to obesity. From our study we cannot conclude if Clozapine causes Diabetes Mellitus. However treatment with Clozapine may be associated with elevated levels of serum triglycerides.
Study site: Clozapine clinic at University Malaya Medical Center
The leading cause of mortality in Malaysia is coronary heart disease (CHD). Several cardiovascular (CVD) risk factors contribute to this problem and smoking is one of the main modifiable risk factor. Most of the patients started smoking early during youth period. This study aimed to determine the association and to predict the cigarette smoking and cardiovascular risk factors among the male youth. A cross sectional study was conducted by self-administered data sheets, physical examinations: blood pressure measurement and body mass index calculation, blood taking procedure for blood glucose, total cholesterol and HDL-C levels. The results showed that the glycemic status was significantly associated with smoking status (p=0.048) however, there was no significant association for smokers and risk of developing diabetes mellitus compared to non smokers although smokers had higher odd ratio (OR: 4.33; 95%CI: 0.900-20.811) (p=0.068). Interestingly, for daily exposure of smoking, those who smoke 5 cigarette and less was significantly associated with high systolic blood pressure (p = 0.036) and smoking showed protective trend against systolic hypertension (OR: 0.57; 95% CI: 0.266-1.230), however, it was not significant (p=0.152). In conclusion, smoking among youth and its association with the cardiovascular risk factor should be addressed tactfully and early screening should be promptly done among the smoking youth for early prevention.