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Fulltext Dietary and blood folate status of Malaysian women of childbearing age

Khor GL, Duraisamy G, Loh SP, Green T

Asia Pac J Clin Nutr, 2006;15(3):341-9.
PMID: 16837426

The protective role of folic acid taken during the periconceptual period in reducing the occurrence of neural tube defects (NTD) has been well documented by epidemiological evidence, randomized controlled trials and intervention studies. Much of the evidence is derived from western populations while similar data on Asian subjects is relatively nascent. Baseline data on folate status of Malaysian women is lacking, while NTD prevalence is estimated as 10 per 10,000 births. This study was conducted with the objective of determining the dietary and blood folate status of Malaysian women of childbearing age. A total of 399 women comprising 140 Malay, 131 Chinese and 128 Indian subjects were recruited from universities and worksites in the suburbs of Kuala Lumpur. Inclusion criteria were that the subjects were not pregnant or breastfeeding, not taking folic acid supplements, not habitual drinkers or smokers. Based on a 24-hour recall, the median intake level for folate was 66 microg (15.7-207.8 microg), which amounts to 16.5% of the Malaysian Recommended Nutrient Intakes level. The median (5-95th percentiles) values for plasma and red cell folate (RBC) concentrations were 11 (4-33) nmol/L and 633 (303-1209) nmol/L respectively. Overall, nearly 15.1% showed plasma folate deficiency (< 6.8 nmol/L), with Indian subjects having the highest prevalence (21.5%). Overall prevalence of RBC folate deficiency (<363 nmol/L) was 9.3%, and an almost similar level prevailed for each ethnic group. Only 15.2% had RBC concentration exceeding 906 nmol/L, which is associated with a very low risk of NTD. The result of this study point to the need for intervention strategies to improve the blood folate status of women of childbearing age, so that they have adequate protection against the occurrence of NTD at birth.
Dietary calcium intake in postmenopausal Malaysian women: comparison between the food frequency questionnaire and three-day food records

Chee WS, Suriah AR, Zaitun Y, Chan SP, Yap SL, Chan YM

Asia Pac J Clin Nutr, 2002;11(2):142-6.
PMID: 12074181

The objective of this study was to compare the dietary calcium intakes assessed by a quantitative food frequency questionnaire (FFQ) and the three-day food record method in 230 Chinese postmenopausal women aged 50-65 years in Kuala Lumpur. The results showed that the mean calcium intake from the dietary records was 447+/-168 mg/day and 499+/-211 mg/day from the FFQ. The mean difference in intake by the two methods was 51.3 mg (95% CI = -30.8-77.9; SD = 181.2, P>0.05), which did not differ significantly from zero. Pearson's correlation coefficient of 0.56 was obtained between the two methods. Ninety-five percent of the individuals classified by food records fell into the same or within-one-quartile category when classified by FFQ. Forty-eight percent were classified into the same quartile by both methods. No subjects were grossly misclassified by the FFQ. The FFQ correctly identified subjects with calcium intakes below the Malaysian recommended daily allowance (450 mg/day) with 60% specificity and with 92% specificity for women consuming less than 800 mg calcium/day. In conclusion, the FFQ developed was a useful, rapid clinical tool for assessing calcium intake and identifying postmenopausal Chinese women with low calcium intakes in Malaysia.
Fulltext Dual forms of malnutrition in the same households in Malaysia--a case study among Malay rural households

Khor GL, Sharif ZM

Asia Pac J Clin Nutr, 2003;12(4):427-37.
PMID: 14672867

This report is a part of a multi-centre study in Asia on the problem of dual forms of malnutrition in the same households. In Malaysia, the prevalence of underweight and stunting persist among young children from poor rural areas. Overweight in adults, especially women from poor rural areas has been reported in recent years. Thus, this study was undertaken in order to assess the presence of the dual burden of underweight child-overweight mother pairs in a poor rural community. Out of 140 Malay households identified to have at least one child aged 1-6 years and mother aged above 20 years, 52.1% of the mothers were overweight, 15.7% of the children were underweight, 27.1% stunted and 5% wasted. Socio-economic background and food intake frequency data were collected from 54 underweight child/overweight mother pairs (UW/OW) and 41 normal weight child/normal weight mother pairs (NW/NW). Compared with the overweight mothers, a higher percentage of the normal weight mothers had received secondary education, were employed and with a higher household monthly income, although these differences were not significant. Patterns of food intake of the mothers and children appeared to have more similarities than differences between the UW/OW and NW/NW groups. Quantitative dietary intakes for 2 days using 24-hr recall and physical activity energy expenditure over the same period were assessed in a sub-group of UW/OW and NW/NW mothers and children. The NW/NW children showed significantly higher intake of total calories, fat and riboflavin than the UW/OW counterparts. Mean energy and nutrient intake of mothers from both groups were not significantly different, although the NW/NW mothers showed higher intake adequacy for total calories and most nutrients. While most of the mothers from both groups reported having no chronic illnesses, about half of the children in both groups had infections, especially gastrointestinal infections, over a 2-week period. Energy expenditure from physical activity for both UW/OW and NW/NW mothers and children did not differ significantly. This study confirmed inadequate intake of total energy and nutrients as the major factor for underweight in Malay children from rural areas. However, assessing intake and physical activity by interview methods were not sensitive enough to overcome perceived problems of under-reporting of energy intake and over-estimation of energy expenditure, especially by overweight subjects. Further investigations on a larger sample are necessary to understand the family dynamics leading to the double burden of malnutrition within the same household.
Effect of dietary cholesterol, trans and saturated fatty acids on serum lipoproteins in non-human primates

Idris CA, Sundram K

Asia Pac J Clin Nutr, 2002;11 Suppl 7:S408-15.
PMID: 12492627

Nine cynomolgus monkeys were rotated randomly through four dietary treatments with each treatment lasting 6 weeks. A wash-out period of 4 weeks was maintained between each dietary rotation. The animals were fed diets containing 32% energy fat derived from palm olein (POL), lauric-myristic-rich oil blend (LM), American Heart Association (AHA) rich oil blend and hydrogenated soybean oil blend (trans). Diets were fed with (phase 1) or without (phase 2) the addition of dietary cholesterol (0.1%). In phase 1, when animals were fed without dietary cholesterol, plasma total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) was significantly raised and high-density lipoprotein cholesterol (HDL-C) was significantly depressed by the trans diets relative to all other dietary treatments. The resulting LDL-C/HDL-C ratio was also significantly increased. The LM diet increased TC significantly relative to the AHA diet while LDL-C was significantly increased compared to both POL and AHA. Apolipoprotein (apo) B was not affected significantly by these dietary treatments. Apo A1 was significantly increased by POL relative to all other dietary treatments. The trans diet reduced apo A1 and the resulting apo B/A1 ratio was increased significantly by trans relative to all other dietary treatments. Addition of 0.1% dietary cholesterol to these diets almost doubled the plasma TC and LDL-C in all dietary treatments. However, HDL-C was only marginally higher with the addition of dietary cholesterol. The LM + C (cholesterol added) diet resulted in the highest TC and LDL-C that was significant compared to all other dietary treatments. Trans + C increased TC compared to POL + C and AHA + C diets while increases in the LDL-C did not attain significance. The addition of dietary cholesterol did not affect HDL-C between treatments whereas plasma triglycerides were significantly increased by the trans + C diet relative to all other treatments. Both the trans + C and LM + C diets increased apo B and decreased apo A1 relative to the POL + C and AHA + C diets. The resulting apo B/A1 ratio was similarly altered. These results affirm that the lauric + myristic acid combination, along with trans fatty acids, increased lipoprotein-associated coronary heart disease risk factors compared to either POL or AHA.
Effect of iodized oil supplementation on thyroid hormone levels and mental performance among Orang Asli schoolchildren and pregnant mothers in an endemic goitre area in Peninsular Malaysia

Isa ZM, Alias IZ, Kadir KA, Ali O

Asia Pac J Clin Nutr, 2000 Dec;9(4):274-81.
PMID: 24394503

Although endemic goitre is no longer a major public health problem in Malaysia, iodine deficiency still remains a significant problem in a few remote settlements. The aim of this study was to determine the effectiveness of iodized oil intervention in the prevention of endemic goitre among the indigenous people in Malaysia. A pretest and post-test controlled trial was conducted among primary schoolchildren and pregnant mothers in Lasah, Sungai Siput and Perak. Legap Post and Yum Post were selected as the intervention areas, while Perwor Post and Poi Post were taken as controls. The variables studied included thyroid hormone concentrations, thyroid volume, urinary iodine excretions and mental performance. A baseline and two follow-up visits were conducted in both intervention and control areas. Intervention subjects were given iodized oil in the form of capsules which were taken orally (Laboratoire Guerbet, Paris, France). There was a significant increase in serum thyroxine hormone (T4) concentrations (p<0.0001) and a significant decrease in thyroid stimulating hormone (TSH) concentrations (p<0.05) in the schoolchildren following the intervention, however, pregnant mothers did not show any significant changes in T4 and TSH concentrations. Thyroid size was significantly reduced in both groups (p<0.05). Urinary iodine excretions showed a significant increase in both groups following the intervention (p<0.01). However, mental performance in schoolchildren was not affected. In conclusion, iodized oil (oral) is effective in reducing thyroid size, as well as improving the supply of iodine among schoolchildren and pregnant mothers in endemic goitre areas; however, its long-term effects need to be monitored closely. This method can be considered as an alternative while awaiting national coverage for the salt iodization program.
Effect of vitamin E on plasma malondialdehyde, antioxidant enzyme levels and the rates of wound closures during wound healing in normal and diabetic rats

Musalmah M, Fairuz AH, Gapor MT, Ngah WZ

Asia Pac J Clin Nutr, 2002;11 Suppl 7:S448-51.
PMID: 12492633

Vitamin E is composed of various subfamilies that include tocopherols and tocotrienols. These compounds have antioxidant properties but differ in structure, dietary source and potency. In this study we evaluated the efficacy of alpha-tocopherol as an antioxidant and its role in wound closure in normal and streptozotocin-induced diabetic rats. The healing of 6 cm linear incisions created on the back of each male Sprague-Dawley rat (250-300 g) was monitored by measuring the length of the wounds daily. The rats were divided into two categories; normal and streptozotocin-induced diabetic rats. For each category, the animals were further divided into two groups; those untreated and those receiving 200 mg/kg bodyweight alpha-tocopherols daily by oral gavage. All rats were fed standard food and water ad libitum. Blood samples were taken at 0, 5 and 10 days after the wounds were created for the determination of malondialdehyde levels and red cell superoxide dismutase, catalase and glutathione peroxidase activities. The results showed that alpha-tocopherol reduced plasma malondialdehyde levels, increased glutathione peroxidase activity and accelerated the rate of wound closure in treated rats.
Fulltext Effectiveness of traditional Malaysian vegetables (ulam) in modulating blood glucose levels

Bachok MF, Yusof BN, Ismail A, Hamid AA

Asia Pac J Clin Nutr, 2014;23(3):369-76.
PMID: 25164446 DOI: 10.6133/apjcn.2014.23.3.01

Ulam refers to a group of traditional Malaysian plants commonly consumed as a part of a meal, either in the raw form or after a short blanching process. Many types of ulam are thought to possess blood glucose-lowering properties, but relatively little is known on the effectiveness of ulam in modulating blood glucose levels in humans. This review aims to systematically evaluate the effectiveness of ulam in modulating blood glucose levels in humans. A literature review was conducted using multiple databases with no time restriction. Eleven studies were retrieved based on a priori inclusion and exclusion criteria. In these 11 studies, only Momordica charantia, locally known as "peria katak", was extensively studied, followed by Centella asiatica, locally known as "daun pegaga", and Alternanthera sessilis, locally known as "kermak putih". Of the 11 studies, 9 evaluated the effectiveness of M. charantia on blood glucose parameters, and 7 of which showed significant improvement in at least one parameter of blood glucose concentration. The remaining 2 studies reported nonsignificant improvements in blood glucose parameters, despite having high-quality study design according to Jadad scale. None of the studies related to C. asiatica and A. sessilis showed significant improvement in blood glucose-related parameters. Current clinical evidence does not support the popular claim that ulam has glucose-lowering effects, not even for M. charantia. Hence, further clinical investigation is needed to verify the glucose modulation effect of M. charantia, C. asiatica, and A. sessilis.
Fulltext Effects of a nutrition support team on clinical outcomes, metabolic complications and electrolyte abnormalities in patients receiving parenteral nutrition

Chong PF, Paraidathathu T

Asia Pac J Clin Nutr, 2013;22(4):548-56.
PMID: 24231015 DOI: 10.6133/apjcn.2013.22.4.15

The effectiveness of the Nutrition Support Team (NST) at Hospital Sungai Buloh, a large public hospital in Kuala Lumpur, Malaysia, in optimising parenteral nutrition (PN) has not been evaluated. To evaluate the effects of this NST in optimising patient outcomes, treatment outcomes, and adherence to biochemical monitoring guidelines, two groups of patients, those given PN before (n = 106) NST intervention and those given PN after (n=106) NST intervention, were retrospectively compared. Intervention by the NST significantly reduced metabolic abnormalities, reducing sodium abnormalities from 67% to 44% (p<0.01); potassium abnormalities from 42% to 15% (p<0.01); magnesium abnormalities from 13% to 3% (p<0.05) and phosphate abnormalities from 21% to 9% (p=0.01). Intervention by the NST also significantly reduced the incidence of hypertriglyceridemia from 68% to 45% (p=0.002) and significantly improved adherence to biochemical monitoring guidelines from 46% to 72% (p<0.01). However, the length of hospital stay, patient mortality, and duration of PN were similar in both groups. This study failed to demonstrate that the establishment of a NST gave better outcomes in terms of the common measures of effectiveness. In conclusion, although management by an NST significantly reduced metabolic abnormalities and improved adherence to biochemical monitoring guidelines, the NST did not improve patient mortality rates and length of hospital stay.
Effects of consumption of edible oils for a period of 4 months on the ultrastructure of the aorta of spontaneously hypertensive rats

Faizah O, Merican Z, Hassan MF, Khalid BA, Mohamed J, Radzi M

Asia Pac J Clin Nutr, 1999 Jun;8(2):106-12.
PMID: 24393793

Edible oils have different effects on lipid profiles and on the propensity for producing lipid peroxidation products. These two properties of edible oils can affect arterial structure, ultimately leading to atherosclerosis. Hypertension is said to be a predisposing factor for atherosclerosis and can accelerate its process. This paper investigates the effects of three edible oils, namely soya bean oil, palm oil and ghee, on the ultrastructure of the aortas of spontaneously hypertensive rats at the end of a 4 month feeding period. It was found that ghee produced significant structural changes to the aortic wall when compared with palm oil or soya bean oil, and that no noticeable structural differences were seen to occur on the aortas of the palm oil-fed and soya bean oil-fed groups of rats. This study suggests that the consumption of ghee, rather than palm or soya bean oil, is more likely to lead to the development of atherosclerosis.
Fulltext Effects of sun exposure on 25(OH) vitamin D concentration in urban and rural women in Malaysia

Nurbazlin M, Chee WS, Rokiah P, Tan AT, Chew YY, Nusaibah AR, et al.

Asia Pac J Clin Nutr, 2013;22(3):391-9.
PMID: 23945409 DOI: 10.6133/apjcn.2013.22.3.15

Ultraviolet B sunlight exposure is a primary source of vitamin D. There have been reports of low vitamin D status amongst the Malaysian population despite it being a tropical country. This study was conducted to determine the influence of sun exposure on 25(OH)D concentrations in urban and rural women in Malaysia and factors predicting 25(OH)D concentrations. Women aged above 45 years were recruited from urban (n=107) and rural areas (n=293). Subjects were interviewed regarding their outdoor activities and usual outdoor attire over the previous week. 25(OH)D concentrations were analyzed using the vitamin D3 (25-OH) electrochemiluminescence immunoassay. Median (Q1-Q3) age of the participants was 57 (53-61) years old. Median (Q1-Q3) 25(OH)D concentration of rural women was significantly higher [69.5 (59.0-79.1) nmol/L] compared to urban women [31.9 (26.1- 45.5) nmol/L] (p<0.001). Rural women spent more time in the sun compared to urban women (7.83 (3.67-14.7) vs 2.92 (1.17-4.92) hours, p<0.001), although the fraction of body surface area (BSA) exposed to sunlight was significantly higher in the urban group [0.21 (0.21-0.43) vs 0.12 (0.07-0.17), p<0.001]. The calculated sun index (hours of sun exposure per week × fraction of BSA) was significantly higher in rural [0.89 (0.42-1.83)] compared to urban women [0.72 (0.26-1.28)], p=0.018. In the stepwise linear regression, rural dwelling increased the serum 25(OH)D by 31.74 nmol/L and 25(OH)D concentrations increased by 1.93 nmol/L for every unit increment in sun index. Urban women in Malaysia had significantly lower vitamin D status compared to rural women. Rural dwelling and sun index were key factors influencing vitamin D status in Malaysian women.
Effects of tocotrienols on cell viability and apoptosis in normal murine liver cells (BNL CL.2) and liver cancer cells (BNL 1ME A.7R.1), in vitro

Har CH, Keong CK

Asia Pac J Clin Nutr, 2005;14(4):374-80.
PMID: 16326644

The effects of tocotrienols on murine liver cell viability and their apoptotic events were studied over a dose range of 0-32 microg mL(-1). Normal murine liver cells (BNL CL.2) and murine liver cancer cells (BNL 1ME A.7R.1) were treated with tocotrienols (T(3)), alpha tocopherol (alpha-T) and the chemo drug, Doxorubicin (Doxo, as a positive control). Cell viability assay showed that T(3) significantly (P < or = 0.05) lowered the percentage of BNL 1ME A.7R.1 cell viability in a dose-responsive manner (8-16 microg mL(-1)), whereas T did not show any significant (P>0.05) inhibition in cell viability with increasing treatment doses of 0-16 microg mL(-1). The IC(50) for tocotrienols were 9.8, 8.9, 8.1, 9.7, 8.1 and 9.3 microg mL(-1) at 12, 24, 36, 48, 60 and 72 hours respectively. Early apoptosis was detected 6 hours following T(3) treatment of BNL 1ME A.7R.1 liver cancer cells, using Annexin V-FITC fluorescence microscopy assay for apoptosis, but none were observed for the non-treated liver cancer cells at the average IC(50) of 8.98 microg mL(-1) tocotrienols for liver cancer cells. Several apoptotic bodies were detected in BNL 1ME A.7R.1 liver cancer cells at 6 hours post-treatment with tocotrienols (8.98 microg mL(-1)) using Acridine Orange/Propidium Iodide fluorescence assay. However, only a couple of apoptotic bodies were seen in the non-treated liver cancer cells and the BNL CL.2 normal liver cells. Some mitotic bodies were also observed in the T(3)-treated BNL 1ME A.7R.1 liver cancer cells but were not seen in the untreated BNL 1ME A.7R.1 cells and the BNL CL.2 liver cells. Following T(3)-treatment (8.98 microg mL(-1)) of the BNL 1ME A.7R.1 liver cancer cells, 24.62%, 25.53% and 44.90% of the cells showed elevated active caspase 3 activity at 9, 12 and 24 hours treatment period, respectively. DNA laddering studies indicated DNA fragmentation occurred in the T(3)-treated liver cancer cells, BNL 1ME A.7R.1 but not in non-treated liver cancer cells and the T(3)-treated and non-treated normal liver cells. These results suggest that tocotrienols were able to reduce the cell viability in the murine liver cancer cells at a dose of 8-32 microg mL(-1) and that this decrease in percentage cell viability may be due to apoptosis.
Fulltext Energy, protein, fat and carbohydrate intakes of underweight, normal weight and obese government office workers in an urban area

Arshad F, Nor IM, Ali RM, Hamzah F

Asia Pac J Clin Nutr, 1996 Jun;5(2):88-91.
PMID: 24394516

Diet is one of the major factors contributing to the development of obesity, apart from heredity and energy balance. The objective of this cross-sectional study is to assess energy, carbohydrate, protein and fat intakes in relation to bodyweight status among government office workers in Kuala Lumpur. A total of 185 Malay men and 196 Malay women aged 18 and above were randomly selected as the study sample. Height and weight were taken to determine body mass index (BMI). The dietary profile was obtained by using 24-hour dietary recalls and food frequency methods. This was analysed to determine average nutrient intake per day. Other information was ascertained from tested and coded questionnaires. The subjects were categorised into three groups of bodyweight status namely underweight (BMI < 20 kg/m2), normal weight (BMI 20-25 kg/m2) and obese (BMI > 25 kg/m2). The prevalence of obesity was 37.8%. The study showed that the mean energy intake of the respondents was 1709 ± 637 kcal/day. The energy composition comprised of 55.7 ± 7.6% carbohydrates, 29.7 ± 21.7 % fat and 15.6 ± 3.8% protein. There was no significant difference in diet composition among the three groups. The findings indicate that normal weight and overweight individuals had a lower intake of calories and carbohydrates than the underweight individuals (p<0.05). However, there were no significant differences in fat intakes.
Fulltext Ethnic characteristics of coronary heart disease risk factors and mortality in peninsular Malaysia

Khor GL

Asia Pac J Clin Nutr, 1994 Jun;3(2):93-8.
PMID: 24351241

The types and prevalence of coronary heart disease (CHD) risk factors vary somewhat among the three main ethnic groups in peninsular Malaysia. Indians consistently show the highest prevalence for hypercholesterolemia and diabetes mellitus. Among the Malays, a relatively high prevalence of hypertension and hypertriglyceridemia have been reported. Overweight is also a risk factor among the Indians and Malays. In general, Chinese tend to have a lower prevalence for these CHD risk factors than the Indians and Malays. Parallel to the rapid socio-economic development and urbanization in recent decades is a rise in the percentage of deaths due to cardiovascular disease in peninsular Malaysia, that is from 1.8% of total deaths from all causes in 1950 to about 30% in 1991. Coronary heart disease accounts for 40% of all cardiovascular diseases. The mortality rate for CHD has more than doubled between 1965 and 1991, from 24.6 per 100 000 to 57.2. While Indians have been showing the highest CHD mortality rate so far, that of the Malays has been increasing most rapidly since 1970, concomitant with the latter's increase in their proportion of the urban population in peninsular Malaysia.
Fulltext Evaluation of nutritional status among a group of young Chinese adults in Kuala Lumpur, Malaysia

Karim N, Leong SW

Asia Pac J Clin Nutr, 2000 Jun;9(2):82-6.
PMID: 24394392

A nutritional status study was carried out among a group of young Chinese adults, aged between 19 and 25, in Kuala Lumpur, Malaysia. Subjects comprised 108 young adults (55 women, 53 men) who were students at two institutes of higher learning. Physical characteristics were evaluated by anthropometric measurements while food intake was determined with a 3-day food record. Blood cholesterol and triglyceride were assessed using the Reflotron analyser. Birthweight was obtained from birth certificates or by proxy. The results showed that the mean body mass index (BMI) for men and women was 21.4 ± 3.3 and 20.0 ± 2.0, respectively, indicating normal weight. Further analysis of BMI classification demonstrated that 28% of men and 39% of women were underweight, 11% of men and 2% of women were overweight while 2% of men were obese. Mean waist-to-hip ratio showed that the subjects had a low risk of developing cardiovascular disease (0.72 ± 0.03 women; 0.81 ± 0.05 men). Mean energy intake was 8841 ± 1756 kJ per day for men and 6426 ± 1567 kJ per day for women. Closer analysis of energy intake of the subjects showed that 86% of men and 91% of women were consuming below the Malaysian recommendation for energy. Nutrients found to be deficient in at least one third of women were calcium, vitamin A, niacin and iron. Mean cholesterol intake in the diet was 278.7 ± 108.7 mg in men and 207.0 ± 82.5 mg in women and there was a significant difference between genders. Blood cholesterol and triglyceride levels were 3.88 ± 0.76 mmol/L and 1.08 ± 0.33 mmol/L, respectively in men, while these levels were lower in women, 3.87 ± 0.80 mmol/L for cholesterol and 0.99 ± 0.29 mmol/L for triglyceride. A general trend of higher mean blood cholesterol and triglyceride levels was shown in adults who were born with lower birthweights.
Fulltext Evolution of diabetes management in the 21st century: the contribution of quality of life measurement in Asians

Goh SG, Rusli BN, Khalid BA

Asia Pac J Clin Nutr, 2015;24(2):190-8.
PMID: 26078234 DOI: 10.6133/apjcn.2015.24.2.04

Diabetes mellitus (DM) is a complex and chronic disease with multiple complications leading to increased mortality and poor quality of life. Current studies have shown that lowering glycosylated haemoglobin (HbA1c) confers protection against microvascular complications. However, with more intensive glucose control to achieve HbA1c of less than 6.5%, there seems to be a significant increased risk of mortality and cardiovascular events. The current recommendation worldwide is for "tailoring" of DM management to risk and also quality of Life (QOL) which is a crucial component in determining the success or failure of DM management. In Asia, DM has become a health crisis but there is a lack of QOL assessment tool that is specific for Asians with wide spectrum of ethnicity, languages, religions and socio-economic differences. In this review, we discuss the evolution of DM management over the decade and the issues pertaining to QOL among people living with diabetes in Asia.
Fulltext Factors predicting health-related quality of life of the Malaysian B40 school-aged children living in urban-poor flats in the central region of Malaysia

Cheah MHJ, Chin YS, Saad HA, Lim PY, Chan YM, Shariff ZM

Asia Pac J Clin Nutr, 2022;31(4):740-747.
PMID: 36576290 DOI: 10.6133/apjcn.202212_31(4).0015

BACKGROUND AND OBJECTIVES: Health-related quality of life (HRQoL) is a multidimensional concept that indicated an individual's holistic health, whereby the urban-poor community are susceptible to low HRQoL due to their high vulnerability. This study aimed to determine factors that predicted the HRQoL among the urban-poor school-aged children.
METHODS AND STUDY DESIGN: This is a cross-sectional study and a total of 408 primary school-aged children (male: 72.3%; female: 27.7%), with a mean age of 9.68±1.48 years, were recruited from 10 urban-poor flats through cluster sampling at the central region of Malaysia. Their anthropometry, nutrition knowledge, attitude and practice, physical activity, dietary practices, and HRQoL were assessed.
RESULTS: A quarter (24.5%) of the urban-poor children were either overweight or obese in the present study. The HRQoL total score among the urban-poor children was 65.0±18.5. The result of multiple linear regression analysis shown that higher nutrition attitude (B=0.34, p=0.001) and practices (B=0.39, p=0.001), higher physical activity (B=3.73, p=0.004), higher lunch intake (B=1.35, p<0.001), lower supper intake (B=-1.35, p<0.001), and lower fast-food intake (B=-1.61, -1.17, p<0.001) are the significant predictors of better HRQoL among the urban-poor children (R2=0.32, F(8,399)=23.72, p<0.001).
CONCLUSIONS: Future studies should focus on these predictors to formulate interventions that could enhance the HRQoL among the Malaysian urban-poor children.
Fulltext Fish oil supplementation is beneficial on caloric intake, appetite and mid upper arm muscle circumference in children with leukaemia

Abu Zaid Z, Shahar S, Jamal AR, Mohd Yusof NA

Asia Pac J Clin Nutr, 2012;21(4):502-10.
PMID: 23017308

A randomised trial was carried out to determine the effect of supplementation of fish oil among 51 children with leukaemia aged 4 to 12 years on appetite level, caloric intake, body weight and lean body mass. They were randomly allocated into the trial group (TG) and the control group (CG). At baseline, 30.8% of TG subjects and 44.0% of CG subjects were malnourished and 7.7% of subject from TG and 28.0% from CG were classified as stunted. The majority of subjects from TG and CG were in the mild malnutrition category for mid upper arm muscle circumference (MUAMC)-for-age. The TG group showed significant increment in MUAMC (0.13 cm vs -0.09 cm) compared with CG at 8 weeks (p<0.001). There was a significant higher increase for appetite level (0.12±0.33) (p<0.05) and an increasing trend on energy and protein intake in the TG group (213±554 kcal; 3.64 ±26.8 g) than in the CG group. In conclusion, supplementation of fish oil has a positive effect on appetite level, caloric intake and MUAMC among children with leukaemia.
Fulltext Food insecurity and the metabolic syndrome among women from low income communities in Malaysia

Shariff ZM, Sulaiman N, Jalil RA, Yen WC, Yaw YH, Taib MN, et al.

Asia Pac J Clin Nutr, 2014;23(1):138-47.
PMID: 24561982 DOI: 10.6133/apjcn.2014.23.1.05

This cross-sectional study examined the relationship between household food insecurity and the metabolic syndrome (MetS) among reproductive-aged women (n=625) in low income communities. The Radimer/Cornell Hunger and Food Insecurity instrument was utilized to assess food insecurity. Anthropometry, diet diversity, blood pressure and fasting venous blood for lipid and glucose profile were also obtained. MetS was defined as having at least 3 risk factors and is in accordance with the Harmonized criteria. The prevalence of food insecurity and MetS was 78.4% (household food insecure, 26.7%; individual food insecure, 25.3%; child hunger, 26.4%) and 25.6%, respectively. While more food secure than food insecure women had elevated glucose (food secure, 54.8% vs food insecure, 37.3-46.1%), total cholesterol (food secure, 54.1% vs food insecure, 32.1-40.7%) and LDL-cholesterol (food secure, 63.7% vs food insecure, 40.6-48.7%), the percentage of women with overweight/ obesity, abdominal obesity, hypertension, high triglyceride, low HDL-cholesterol and MetS did not vary significantly by food insecurity status. However, after controlling for demographic and socioeconomic covariates, women in food insecure households were less likely to have MetS (individual food insecure and child hunger) (p<0.05), abdominal obesity (individual food insecure and child hunger) (p<0.01), elevated glucose (household food insecure), total cholesterol (child hunger) (p<0.05) and LDL-cholesterol (household food insecure and child hunger) (p<0.05) compared to food secure women. Efforts to improve food insecurity of low income households undergoing nutrition transition should address availability and accessibility to healthy food choices and nutrition education that could reduce the risk of diet-related chronic diseases.
Fulltext Food intakes and habits of rural elderly Malays

Shahar S, Earland J, Rahman SA

Asia Pac J Clin Nutr, 2000 Jun;9(2):122-9.
PMID: 24394398

A cross-sectional nutritional survey was carried out on 350 elderly Malays aged 60 and above from 11 randomly selected villages in a rural area on the east coast of Malaysia. The findings indicated that the mean intakes of energy and of all of the nutrients investigated were below the Malaysian Recommended Dietary Allowances, except for protein and vitamin C. With respect to dietary habits, almost all of the subjects reported that they had breakfast (99.3%), lunch (97.9%) and dinner (90.4%) daily or almost daily (5-6 times/week). However, approximately half of the subjects, especially women, had particular beliefs and prohibitions about specific foods. Most of the subjects usually ate their meals at home, particularly dinner, with 99.3% always having dinner in their own home. Thus, although the rural elderly Malays studied had regular meal intakes, the dietary intake was inadequate. There is a need to plan community-based intervention programmes in order to prevent the subsequent consequences of malnutrition that lead to increased morbidity and mortality.
Fulltext Food variety score is associated with dual burden of malnutrition in Orang Asli (Malaysian indigenous peoples) households: implications for health promotion

Saibul N, Shariff ZM, Lin KG, Kandiah M, Ghani NA, Rahman HA

Asia Pac J Clin Nutr, 2009;18(3):412-22.
PMID: 19786390

This paper reports on the presence of dual burden households in Orang Asli (OA, indigenous people) communities and its associated factors. A total of 182 OA households in two districts in Selangor with the required criteria (182 non-pregnant women of child bearing age and 284 children aged 2-9 years old) participated in the study. Height and weight of both women and children were measured. Energy intake and food variety score (FVS) were determined using three 24-hour diet recalls. While 58% were underweight and 64% of the children were stunted, the prevalence of overweight and obesity in women were 31% and 20% respectively. The percentage of dual burden households (overweight mother/underweight child) was 25.8% while 14.8% households had normal weight mother/normal weight child. The mean food variety score (FVS) was similar for women (7.0+/-2.1) and children (6.9+/-1.9). Dual burden households were associated with women's employment status (OR: 3.18, 95% CI: 2.65-5.66), FVS of children (OR: 0.71, 95% CI: 0.51-0.95) and FVS of women (OR: 1.39, 95% CI: 1.02- 1.89). The FVS of children (OR: 0.49, 95% CI: 0.25-0.89) and women (OR: 1.92, 95% CI: 1.64-2.77) remained significant even when dual burden households were compared to only households with normal weight mother/normal weight child. In these OA communities, food variety may predict a healthier diet in children, but may increase the risk of overweight and obesity in adults. Efforts to address households with dual burden malnutrition should consider promotion of healthy diets and lifestyle for all members.

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