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Automated segmentation of metal stent and bioresorbable vascular scaffold in intravascular optical coherence tomography images using deep learning architectures

Lau YS, Tan LK, Chan CK, Chee KH, Liew YM

Phys Med Biol, 2021 Dec 31;66(24).
PMID: 34911053 DOI: 10.1088/1361-6560/ac4348

Percutaneous coronary intervention (PCI) with stent placement is a treatment effective for coronary artery diseases. Intravascular optical coherence tomography (OCT) with high resolution is used clinically to visualize stent deployment and restenosis, facilitating PCI operation and for complication inspection. Automated stent struts segmentation in OCT images is necessary as each pullback of OCT images could contain thousands of stent struts. In this paper, a deep learning framework is proposed and demonstrated for the automated segmentation of two major clinical stent types: metal stents and bioresorbable vascular scaffolds (BVS). U-Net, the current most prominent deep learning network in biomedical segmentation, was implemented for segmentation with cropped input. The architectures of MobileNetV2 and DenseNet121 were also adapted into U-Net for improvement in speed and accuracy. The results suggested that the proposed automated algorithm's segmentation performance approaches the level of independent human obsevers and is feasible for both types of stents despite their distinct appearance. U-Net with DenseNet121 encoder (U-Dense) performed best with Dice's coefficient of 0.86 for BVS segmentation, and precision/recall of 0.92/0.92 for metal stent segmentation under optimal crop window size of 256.
Phytochemistry and biology of Loranthus parasiticus Merr, a commonly used herbal medicine

Moghadamtousi SZ, Kamarudin MN, Chan CK, Goh BH, Kadir HA

Am J Chin Med, 2014;42(1):23-35.
PMID: 24467533 DOI: 10.1142/S0192415X14500025

Loranthus parasiticus Merr (L. parasiticus) is a member of Loranthaceae family and is an important medicinal plant with a long history of Chinese traditional use. L. parasiticus, also known as Sang Ji Sheng (in Chinese), benalu teh (in Malay) and baso-kisei (in Japanese), is a semiparasitic plant, which is mostly distributed in the southern and southwestern regions of China. This review aims to provide a comprehensive overview of the ethnomedicinal use, phytochemistry and pharmacological activity of L. parasiticus and to highlight the needs for further investigation and greater global development of the plant's medicinal properties. To date, pharmacological studies have demonstrated significant biological activities, which support the traditional use of the plant as a neuroprotective, tranquilizing, anticancer, immunomodulatory, antiviral, diuretic and hypotensive agent. In addition, studies have identified antioxidative, antimutagenic, antiviral, antihepatotoxic and antinephrotoxic activity. The key bioactive constituents in L. parasiticus include coriaria lactone comprised of sesquiterpene lactones: coriamyrtin, tutin, corianin, and coriatin. In addition, two proanthocyanidins, namely, AC trimer and (+)-catechin, have been recently discovered as novel to L. parasiticus. L. parasiticus usefulness as a medicinal plant with current widespread traditional use warrants further research, clinical trials and product development to fully exploit its medicinal value.
Fulltext Should I Help? Prosocial Behaviour during the COVID-19 Pandemic

Wider W, Lim MX, Wong LS, Chan CK, Maidin SS

Int J Environ Res Public Health, 2022 Dec 01;19(23).
PMID: 36498158 DOI: 10.3390/ijerph192316084

The Movement Control Order (MCO) enacted during the COVID-19 pandemic has profoundly altered the social life and behaviour of the Malaysian population. Because the society is facing huge social and economic challenges that need individuals to work together to solve, prosocial behaviour is regarded as one of the most important social determinants. Because it is related with individual and societal benefits, participating in prosocial activities may be a major protective factor during times of global crisis. Rather than focusing only on medical and psychiatric paradigms, perhaps all that is necessary to overcome the COVID-19 risks is for individuals to make personal sacrifices for the sake of others. In reality, a large number of initiatives proven to be beneficial in decreasing viral transmission include a trade-off between individual and collective interests. Given its crucial importance, the purpose of this concept paper is to provide some insight into prosocial behaviour during the COVID-19 period. Understanding prosocial behaviour during the COVID-19 pandemic is crucial because it may assist in the establishment of a post-COVID society and provide useful strategies for coping with future crises.
Genetic interaction between GABRA1 and ERBB4 variants in the pathogenesis of genetic generalized epilepsy

Chan CK, Lim KS, Low SK, Tan CT, Ng CC

Epilepsy Res, 2023 Jan;189:107070.
PMID: 36584483 DOI: 10.1016/j.eplepsyres.2022.107070

Epilepsy is a complex neurological disease that can be caused by both genetic and environmental factors. Many studies have been conducted to investigate the genetic risk variants and molecular mechanisms of epilepsy. Disruption of excitation-inhibition balance (E/I balance) is one of the widely accepted disease mechanisms of epilepsy. The maintenance of E/I balance is an intricate process that is governed by multiple proteins. Using whole exome sequencing (WES), we identified a novel GABRA1 c.448G>A (p.E150K) variant and ERBB4 c.1972A>T (p.I658F, rs190654033) variant in a Malaysian Chinese family with genetic generalized epilepsy (GGE). The GGE may be triggered by dysregulation of E/I balance mechanism. Segregation of the variants in the family was verified by Sanger sequencing. All family members with GGE inherited both variants. However, family members who carried only one of the variants did not show any symptoms of GGE. Both the GABRA1 and ERBB4 variants were predicted damaging by MutationTaster and CADD, and protein structure analysis showed that the variants had resulted in the formation of additional hydrogen bonds in the mutant proteins. GABRA1 variant could reduce the efficiency of GABAA receptors, and constitutively active ERBB4 receptors caused by the ERBB4 variant promote internalization of GABAA receptors. The interaction between the two variants may cause a greater disruption in E/I balance, which is more likely to induce a seizure. Nevertheless, this disease model was derived from a single small family, further studies are still needed to confirm the verifiability of the purported disease model.
Fulltext Radiological analysis of the medial epicondyle in the adolescent throwing athlete

Ng WM, Chan CK, Takahashi N, Kawai N, Teh KK, Saravana R, et al.

Singapore Med J, 2017 Feb;58(2):103-106.
PMID: 26976222 DOI: 10.11622/smedj.2016061

INTRODUCTION: Injuries to the medial structures of the elbow due to overhead throwing games are well documented. However, variations of medial epicondyles are not well described, especially in athletes with fused medial epicondyles. In this study, we evaluated variations in the medial epicondyle of baseball players who were aged 15-17 years and had fused epicondyles.

METHODS: In this cross-sectional observational study, 155 skeletally mature baseball players with unilateral medial elbow pain and 310 elbow radiographs were reviewed by two independent reviewers. The medial epicondyles were categorised into three groups: normal, elongated or separated.

RESULTS: Among the 155 patients, 65 (41.9%) had normal epicondyles, 41 (26.5%) had elongated epicondyles and 49 (31.6%) had separated epicondyles. The medial epicondyle was larger on the dominant arm for 125 (80.6%) patients; the mean surface area on the dominant arm was 222.50 ± 45.77 mm2, while that of the non-dominant arm was 189.14 ± 39.56 mm2(p < 0.01). Among the three categories of medial epicondyles, separated epicondyles had the largest surface area, followed by elongated and normal epicondyles.

CONCLUSION: Medial epicondyles in adolescent throwing athletes can be categorised into three different groups according to their shape (normal, elongated and separated). We observed a correlation between the shape and the surface area of the medial epicondyle in adolescent throwing athletes, with separated medial epicondyles having the largest surface area. Further studies and follow-up are needed to determine the prognostic value and clinical significance of these morphological variations.

Study done in Japan
Why Women Are Averse to Facility Delivery in Northwest Nigeria: A Qualitative Inquiry

Tukur I, Chan CK, Tinsu T, Muhammed-Baba T, Aderemi Ijaiya M

Iran J Public Health, 2016 May;45(5):586-95.
PMID: 27398331

In many sub-Saharan African countries the rate of antenatal care (ANC) has been increased but skilled birth attendance rate is still low. The objective of this study was to evaluate the reasons why women prefer home delivery when facility based delivery is available at minimal cost.
Swietenia macrophylla King induces mitochondrial-mediated apoptosis through p53 upregulation in HCT116 colorectal carcinoma cells

Goh BH, Chan CK, Kamarudin MN, Abdul Kadir H

J Ethnopharmacol, 2014 Apr 28;153(2):375-85.
PMID: 24613274 DOI: 10.1016/j.jep.2014.02.036

Swietenia macrophylla King is a traditional herb used to treat various diseases including hypertension, diabetes and cancer. Previous study demonstrated its anti-tumor effect but the potential mechanisms have not been clearly defined. The current study was to further investigate the underlying mechanism of ethyl acetate fraction of Swietenia macrophylla (SMEAF)-induced anti-proliferative effect and apoptosis in HCT116 colorectal carcinoma cell.
Fulltext Femoral Shaft Cortical Pathology associated with longterm Alendronate Therapy: A New Classification

Kwan M, Chan C, Ng W, Merican A, Chung W, Chan S

Malays Orthop J, 2013 Jul;7(2):12-7.
PMID: 25722819 MyJurnal DOI: 10.5704/MOJ.1307.008

There are reported cases of cortical reaction over the tension side of the normal femoral shafts in patients on long term treatment with alendronate, leading to subsequent femoral shaft fractures. We performed a retrospective review of patients with low-energy femoral shaft fracture on alendronate, admitted to our institution during the period 2004 to May 2009. The presence of radiological changes of cortical hypertrophy with or without Looser's zone over the tension side of the femoral bone (normal limb) was determined and correlated with clinical symptoms. Thirteen patients were identified. Average duration of alendronate use was 6.5 ± 3.3 years (ranges, two to 10 years). These radiological changes were noted in four patients. Average duration of alendronate usage in these four patients was 6.5 ± 2.4 years (ranges, 5 to10 years). Prodromal thigh pain was present in a patient, who had cortical hypertrophy with the presence of a Looser's zone traversing the cortex on the femoral shaft. One patient had Looser's zone limited at the lateral hypertrophied cortex without prodromal pain. The interobserver kappa coefficient was 0.96. A femoral radiograph should be performed in all patients who are on long-term alendronate therapy who present with thigh pain. We propose a new grading system based on our observation of the radiological features in these four cases. This new grading of the radiological spectrum of femoral shaft cortical pathology has the potential to stratify the risk of low energy femoral fracture for patients treated with long-term alendronate therapy.
Religiosity, dietary habit, intake of fruit and vegetable, and vegetarian status among Seventh-Day Adventists in West Malaysia

Tan MM, Chan CK, Reidpath DD

J Behav Med, 2016 08;39(4):675-86.
PMID: 27010212 DOI: 10.1007/s10865-016-9736-8

Religion has been shown to be salutary on health, and a possible link between religion and positive health outcomes is diet. Research has shown that religiosity is associated with better diet but most studies were conducted in a multi-denominational context, which might be confounded with theological differences. This study examined the relationship between religiosity and diet within a homogenous group of believers. Data from survey of 574 Seventh-Day Adventists residing in West Malaysia, aged 18-80, were analyzed using multiple regressions. While none of the religious variables were significantly associated with fruit and vegetable intake, a higher level of religiosity was associated with a better dietary habit and vegetarian status. The mixed relationship between religiosity and diet suggest that further research is needed to explore how religion might influence the diet of adherents.
Fulltext Deoxyelephantopin from Elephantopus scaber Inhibits HCT116 Human Colorectal Carcinoma Cell Growth through Apoptosis and Cell Cycle Arrest

Chan CK, Chan G, Awang K, Abdul Kadir H

Molecules, 2016 Mar 21;21(3):385.
PMID: 27007366 DOI: 10.3390/molecules21030385

Deoxyelephantopin (DET), one of the major sesquiterpene lactones derived from Elephantopus scaber was reported to possess numerous pharmacological functions. This study aimed to assess the apoptosis inducing effects and cell cycle arrest by DET followed by elucidation of the mechanisms underlying cell death in HCT116 cells. The anticancer activity of DET was evaluated by a MTT assay. Morphological and biochemical changes were detected by Hoescht 33342/PI and Annexin V/PI staining. The results revealed that DET and isodeoxyelephantopin (isoDET) could be isolated from the ethyl acetate fraction of E. scaber leaves via a bioassay-guided approach. DET induced significant dose- and time-dependent growth inhibition of HCT116 cells. Characteristics of apoptosis including nuclear morphological changes and externalization of phosphatidylserine were observed. DET also significantly resulted in the activation of caspase-3 and PARP cleavage. Additionally, DET induced cell cycle arrest at the S phase along with dose-dependent upregulation of p21 and phosphorylated p53 protein expression. DET dose-dependently downregulated cyclin D1, A2, B1, E2, CDK4 and CDK2 protein expression. In conclusion, our data showed that DET induced apoptosis and cell cycle arrest in HCT116 colorectal carcinoma, suggesting that DET has potential as an anticancer agent for colorectal carcinoma.
Elephantopus scaber induces apoptosis through ROS-dependent mitochondrial signaling pathway in HCT116 human colorectal carcinoma cells

Chan CK, Supriady H, Goh BH, Kadir HA

J Ethnopharmacol, 2015 Jun 20;168:291-304.
PMID: 25861953 DOI: 10.1016/j.jep.2015.03.072

Elephantopus scaber also known as Elephant's foot (Asteraceae family) has a plethora of traditional applications including dysuria, diarrhea, dysentery, leukemia and cancer. This study aimed to investigate the apoptosis inducing effects of E. scaber and the underlying mechanisms in HCT116 colorectal cell line.
Fulltext Femoral Neck Non-Union - A Biomechanical Solution with Valgus Sliding Subtrochanteric Osteotomy: A Case Report

Teh KH, Ruben JK, Chan CK, Abbas AA

Malays Orthop J, 2020 Jul;14(2):134-137.
PMID: 32983389 DOI: 10.5704/MOJ.2007.022

Avascular necrosis and non-union are two most dreaded complications of femoral neck fracture fixations. Hip replacement seems to be a simple solution for this complex problem. However, the long-term efficacy of prosthetic replacement in the young population with higher functional demand is still questionable. Femoral head preserving valgus subtrochanteric osteotomies in properly selected cases have strong support from literature. The conventional technique of valgus subtrochanteric osteotomy involves lateral based wedge resection. Alternatively, a simpler sliding oblique subtrochanteric osteotomy without any wedge removal can also be performed. We hereby describe a successful case of sliding subtrochanteric osteotomy with 135° dynamic hip screw (DHS) plate fixation in treating non-union neck of femur fracture in a young gentleman.
Fulltext Midterm Results of Conversion from Failed Bipolar Hemiarthroplasty to Total Hip Arthroplasty

Park KS, Chan CK, Lee DH, Yoon TR

Indian J Orthop, 2018 8 7;52(4):369-373.
PMID: 30078894 DOI: 10.4103/ortho.IJOrtho_494_16

Background: Conversion from failed bipolar hemiarthroplasty (HA) to total hip arthroplasty (THA) presents a great challenge to orthopedic surgeons for bipolar head removal and cup placement with or without change of femoral stem. Conversion THA after failed bipolar arthroplasty is known to offer both symptomatic and functional improvement. This study evaluates the midterm functional outcome and complications, especially dislocation associated with femoral head diameter, after conversion THA.
Materials and Methods: Forty eight hips with the conversion of bipolar HA to THA were followed up for an average 6.2 years (range 2.0-11.5 years). Twenty one hips had conversion surgery to THA using metal-on-metal articulation (28 or 32 mm head). Nine hips used ceramic-on-ceramic (28-40 mm) and eighteen hips used large head metal-on-metal bearing (>40 mm). Outcome was evaluated using Harris Hip Score (HHS) and Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) score. The radiographs were analyzed for evidence of osteolysis and/or loosening. The complications were evaluated, especially dislocation with different femoral head diameter.
Results: Average HHS significantly improved from 42 preoperatively to 86 postoperatively and the average WOMAC score also significantly improved from 47 to 22 postoperatively. Radiological evaluation showed all the femoral components were stable. There was one acetabular component loosening, which required revision 9 years after conversion to THA. One dislocation and one recurrent dislocation were recorded in isolated acetabular revision hip; whereas one dislocation, one recurrent dislocation, and one trochanteric nonunion occurred in the hips with revision of both components. All dislocations occurred in hips with a femoral head size of 28 mm (P = 0.052). The cup and femoral head interval length was the most significant factor contributing to dislocation (P = 0.013).
Conclusions: Conversion THA after failed bipolar HA offers a reliable pain relief and functional improvement. To prevent dislocation, it is highly recommended to use a larger diameter femoral head, especially where the cup size is big.
Fulltext Multicentric Disappearing Bone Disease treated with Arthroplasty

Chan CK, Mohamed RM, Azlina AA, Azhar MM

Malays Orthop J, 2016 Nov;10(3):42-45.
PMID: 28553448 MyJurnal DOI: 10.5704/MOJ.1611.004

Multicentric disappearing bone disease, or Gorham disease, is a rare entity. A middle age woman, presented to us with left sided antalgic gait and severe bony deformity of her left knee. Radiograph revealed massive bone defect of the medial condyle of the left tibia with subluxation of the knee joint. She was scheduled for knee replacement in six months. However, she developed another lesion over the right hip that typically mimicked the disease progression of disappearing bone disease. The right femoral head vanished progressively within three months without significant history of infection or trauma. Subsequent bone biopsy of the right femoral head and left tibia condyle confirmed the diagnosis. Total knee replacement was carried out for her left knee. She remained pain free on her left knee. A year later, after confirming by sequential radiographs that the osteolysis had stopped, total right hip replacement was performed. Five years later, she remained pain free and both the arthroplasties were stable.
Persistent noise after ceramic-on-ceramic total hip replacement due to bearing coupling size mismatch: A case report

Chan CK, Lee DH, Yoon TR, Park KS

J Orthop Sci, 2019 09;24(5):936-938.
PMID: 28390755 DOI: 10.1016/j.jos.2017.03.010
Dioscorea bulbifera induced apoptosis through inhibition of ERK 1/2 and activation of JNK signaling pathways in HCT116 human colorectal carcinoma cells

Ahmad Hidayat AF, Chan CK, Mohamad J, Abdul Kadir H

Biomed Pharmacother, 2018 Aug;104:806-816.
PMID: 29860114 DOI: 10.1016/j.biopha.2018.05.073

Dioscorea bulbifera, also known as air potato, has been cultivated as food crop mainly in tropical countries in Asia and Australia. The tubers are edible and have often been used in Traditional Chinese Medicine (TCM) and Ayurvedic medicine to treat cancer, diabetes, thyroid disease, and inflammation. This study aimed to investigate the effects of D. bulbifera on HCT116 human colorectal carcinoma cells and to unravel the plausible mechanisms underlying its apoptotic effects. The ethanol crude and fractions (hexane, ethyl acetate and water) of D. bulbifera were subjected to cell viability MTT assay against various cancer cell lines. The lowest IC50 of the extract and fractions on selected cancer cells were selected for further apoptosis assay and western blot analysis. HCT116 cancer cells were treated with D. bulbifera and stained with Annexin/PI or Hoechst 33342/PI for preliminary confirmation of apoptosis. The dissipation of mitochondria membrane potential (MMP) was determined by flow cytometry. The protein expressions of apoptosis-related proteins such as Bcl-2 family, caspases, Fas, PARP, ERK1/2 and JNK were detected by western blot analysis. Moreover, the HCT116 cells were treated with UO126 and SP600125 inhibitors to verify the involvement of ERK1/2 and JNK protein expressions in inducing apoptotic cell death. Based on the result, D. bulbifera ethyl acetate fraction (DBEAF) exhibited the most compelling cytotoxicity on HCT116 cells with an IC50 of 37.91 ± 1.30 µg/mL. The induction of apoptosis was confirmed by phosphatidylserine externalization and chromatin condensation. Depolarization of MMP further conferred the induction of apoptosis was through the regulation of Bcl-2 family proteins. Activation of caspase cascades (caspase-3, -9, -8 and -10) was elicited followed by the observation of cleaved PARP accumulation in DBEAF-treated cells. Furthermore, death receptor, Fas was activated upon exposure to DBEAF. Collective apoptotic evidences suggested the involvement of intrinsic and extrinsic pathways by DBEAF in HCT116 cells. Interestingly, the attenuation of ERK1/2 phosphorylation accompanied by the activation of JNK was detected in DBEAF-treated cells. In conclusion, the findings revealed that DBEAF induced apoptosis through intrinsic and extrinsic pathways involving ERK1/2 and JNK.
Leptospermum flavescens Sm. protect pancreatic β cell function from streptozotocin involving apoptosis and autophagy signaling pathway in in vitro and in vivo case study

Hidayat AFA, Chan CK, Mohamad J, Kadir HA

J Ethnopharmacol, 2018 Nov 15;226:120-131.
PMID: 30118836 DOI: 10.1016/j.jep.2018.08.020

ETHNOPHARMACOLOGICAL IMPORTANCE: Leptospermum flavescens has been used traditionally in Malaysia to treat various ailments such as constipation, hypertension, diabetes and cancer.
AIM OF STUDY: To investigate the potential protective effects of L. flavescens in pancreatic β cells through inhibition of apoptosis and autophagy cell death mechanisms in in vitro and in vivo models.
MATERIALS AND METHODS: L. flavescens leaves were extracted using solvent in increasing polarities: hexane, ethyl acetate, methanol and water. All extracts were tested for INS-1 β cells viability stimulated by streptozotocin (STZ). The extract which promotes the highest cell protective activity was further evaluated for insulin secretion, apoptosis and autophagy signaling pathways. Then, the acute toxicity of extract was carried out in SD rats according to OECD 423 guideline. The active extract was tested in diabetic rats where the pancreatic β islets were evaluated for insulin, apoptosis and autophagy protein.
RESULTS: The methanolic extract of L. flavescens (MELF) was found to increase INS-1 β cells viability and insulin secretion against STZ. In addition, MELF has been shown to inhibit INS-1 β cells apoptosis and autophagy activity. Notably, there was no toxicity observed in SD rats when administered with MELF. Furthermore, MELF exhibited anti-hyperglycemic activity in diabetic rats where apoptosis and autophagy protein expression was found to be suppressed in pancreatic β islets.
CONCLUSION: MELF was found to protect pancreatic β cells function from STZ-induced apoptosis and autophagy in in vitro and in vivo.
Fulltext Test-retest reliability of the single leg stance on a Lafayette stability platform

Zaghlul N, Goh SL, Razman R, Danaee M, Chan CK

PLoS One, 2023;18(1):e0280361.
PMID: 36649257 DOI: 10.1371/journal.pone.0280361

The validity and reliability of the Lafayette stability platform are well-established for double leg testing. However, no evaluation of single leg (SL) stance on the platform was discovered yet. Therefore, this study aimed to investigate the reliability of conducting the SL stance on the Lafayette platform. Thirty-six healthy and active university students (age 23.2 ± 3.2 years; BMI 21.1 ± 3.1 kg/m2) were tested twice, one week apart (week 1; W1, week 2; W2). They stood on their dominant leg with eyes-open (EO) and eyes-closed (EC) in random order. Three successful trials of 20 seconds each were recorded. The duration during which the platform was maintained within 0° of tilt was referred to as time in balance (TIB). At all-time points, TIB was consistently longer in EO (EOW1: 17.02 ± 1.04s; EOW2: 17.32 ± 1.03s) compared to EC (ECW1: 11.55 ± 1.73s; ECW2: 13.08 ± 1.82s). A ±10 seconds difference was demonstrated in the Bland-Altman analysis in both EO and EC. Lower standard error of measurement (SEM) and coefficient of variation (CV) indicated consistent output. High intraclass correlation coefficient (ICC) values were seen between weeks (EO = 0.74; EC = 0.76) and within weeks (EOW1 = 0.79; EOW2 = 0.86; ECW1 = 0.71; ECW2 = 0.71). Although statistical measures (i.e., SEM, CV, and ICC) indicated good reliability of Lafayette for SL tasks, the wide agreement interval is yet to be clinically meaningful. Factors underlying the wide variation need to be identified before Lafayette is used for TIB assessment.
Fulltext Contextualizing chronicity: a perspective from Malaysia

Yasin S, Chan CK, Reidpath DD, Allotey P

Global Health, 2012 Mar 08;8:4.
PMID: 22397462 DOI: 10.1186/1744-8603-8-4
Fulltext Religiosity and spirituality and the intake of fruit, vegetable, and fat: a systematic review

Tan MM, Chan CK, Reidpath DD

Evid Based Complement Alternat Med, 2013;2013:146214.
PMID: 24319472 DOI: 10.1155/2013/146214

Objectives. To systematically review articles investigating the relationship between religion and spirituality (R/S) and fruit, vegetable, and fat intake. Methods. PubMed, CINAHL, and PsycInfo were searched for studies published in English prior to March 2013. The studies were divided into two categories: denominational studies and degree of R/S studies. The degree of R/S studies was further analyzed to (1) determine the categories of R/S measures and their relationship with fruit, vegetable, and fat intake, (2) evaluate the quality of the R/S measures and the research design, and (3) determine the categories of reported relationship. Results. Thirty-nine studies were identified. There were 14 denominational studies and 21 degree of R/S studies, and 4 studies were a combination of both. Only 20% of the studies reported validity and 52% reported reliability of the R/S measures used. All studies were cross-sectional, and only one attempted mediation analysis. Most studies showed a positive association with fruit and vegetable intake and a mixed association with fat intake. Conclusion. The positive association between R/S and fruit and vegetable intake may be one possible link between R/S and positive health outcome. However, the association with fat intake was mixed, and recommendations for future research are made.

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