This study was conducted on 215 working women from four private corporate companies in a suburb in Malaysia to determine the factors related to their physical activity levels.
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.
A cross-sectional study was conducted to determine the physical activity levels of 400 adolescents (13 years old) in Kuantan, Pahang using the Physical Activity Questionnaire for Older Children (PAQ-C). The associations of physical activity levels with sex, ethnicity and body mass index were also determined. About one third (35.3%) of the adolescents were in the low physical activity level category, 61.5% in the moderate physical activity level and only 3.0% of the adolescents were in the high physical activity level category. More males (77.9%) were physically active than females (54.9%). Twice as many female adolescents (45.1%) were in the low physical activity level category compared to the male adolescents (22.1%). The associations between physical activity with ethnicity and body mass index were not significant. However, there was a significant interaction effect of sex and ethnicity in mean physical activity score (F = 2.36, p<0.01). Malay males had a significantly higher mean physical activity score as compared to Chinese males (t=2.13; p<0.05). Although Chinese females had a higher mean physical activity score than Malay females, the difference was not statistically significant. Conversely, there was no interaction effect of sex and BMI status in mean physical activity score. This study suggests that physical activity intervention to promote regular physical activity is needed since a high proportion of the adolescents fall within the low physical activity level category.
Introduction: Nutrition screening is recommended as a first step of nutrition care to allow early identification and intervention of malnourished patients. The present study determined the validities and reliabilities of two malnutrition screening tools namely, the Malnutrition Universal Screening Tool (MUST) and Malnutrition Screening Tool (MST) among adult patients at the Hospital Kuala Lumpur. Methods: The sensitivity, specificity and predictive value of MUST and MST were conducted against the Subjective Global Assessment (SGA), anthropometric parameters including body mass index (BMI), calf circumference (CC), mid-upper arm circumference (MUAC) and energy intake. Inter-rater reliability was evaluated using kappa value (κ) to determine the level of agreement between raters. Results: A total of 151 subjects with mean age of 45.2 ± 13.7 years participated in this study. Prevalence of malnutrition according to MUST, MST and SGA was 34.4%, 33.8% and 19.9%, respectively. As compared to SGA, MUST and MST had a sensitivity of 96.6% and 93.3% respectively, whereas the specificity was 80.9% for both tools. The sensitivity and specificity of MUST against the anthropometric parameters (BMI, CC and MUAC) were between 53.8% to 88.8% and 67.4% to 69.9%, respectively. The sensitivity values for MST were between 46.1% to 63.6% and specificity values were between 64.4% to 67.6%. The inter-rater reliability of MUST was higher (substantial, mean (κ) = 0.78) than for MST (moderate, mean (κ) = 0.52). Conclusions: In conclusion, MUST was found to have similar validity levels but higher reliability result than MST. Based on our result, MUST is recommended for use in identifying adult patients who are at high risk of malnutrition. It can be used as a malnutrition screening tool but there is a need to evaluate the cost effectiveness of its implementation.
Selenium is a micronutrient mineral found mainly in soils. Studies on selenium have increased rapidly worldwide especially after it has been shown to reduce the risk of certain types of cancer in humans and animals. The exact mechanism of action on how selenium inhibits diseases, in particular cancer, is still unknown. To date, the use of selenium in preventing or treating diseases is limited. However, many aspects about the biochemistry of selenium have been identified. This article reviews a number of key clinical, experimental and epidemiological studies on selenium as an anti-carcinogenic agent for some types of cancers. Some nutritional information on selenium and its recommended intake are also included. More clinical and experimental studies are needed to confirm previous findings on the role of selenium as an anticarcinogenic agent.
Introduction: Tocotrienol exerts neuroprotective effects resulting in an improved circulating oxidative status. However, accumulation of tocotrienol due to longterm intake may exert pro-oxidant effects. Thus the effects of short- and longterm supplementation of vitamin E tocotrienol rich fraction (TRF) on the parameters of oxidative status in rat brains were determined. Methods: Wistar rats aged 3 months were supplemented with TRF for 3 or 8 months. Control groups received equivolume of distilled water. Rats were sacrificed and brains
harvested, weighed and homogenised. Supernatants were analysed for catalase (CAT), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) activities, vitamin E and protein carbonyl. Results: A significant decline in the level of total vitamin E and its isomers with increasing age were found. TRF supplementation increased the level of total vitamin E with alpha-tocotrienol (ATT) being the major isomer raised. Glutathione peroxidase activity was also
significantly increased in the long-term supplemented group compared to the short-term supplemented and control groups. The results also showed significantly higher superoxide dismutase activity (p
Introduction: This study aimed to investigate the effect of saffron extract and crocin on blood biomarkers associated with obesity using the rat model.
Methods: Obesity was induced by feeding a high-fat diet to 42 male Sprague-Dawley rats for 12 weeks, after which they were equally distributed into seven groups. Three groups served as controls namely, normal diet (ND), high-fat diet (HFD), and high-fat diet plus orlistat (HFD + ORL), while the remaining four treatment groups consisted of HFD added low or high dose (40 and 80 mg/kg/day) of either saffron extract or crocin in the food. At the end of 8 weeks, blood samples were collected by cardiac puncture for biochemical analysis.
Results: Obese rats treated with a high dose of saffron extract and crocin showed significantly lower plasma glucose levels (5.26 and 5.67 mmol/L respectively) than the HFD rats (6.92 mmol/L). Saffron extract and crocin at a high dose showed significantly lower levels of plasma insulin (3.97 and 3.88 ng/mL respctively) compared to HFD control (5.41 ng/mL). Adiponectin levels significantly increased in obese rats fed saffron extract and crocin at high doses (7.44 and 7.92 µg/mL respectively) compared to HFD control (5.34 µg/mL). Ghrelin level significantly increased from 419.10 to 284.10 pg/mL,while leptin level significantly decreased from 8.08 to 5.68 ng/mL for the high dose crocin groups compared to HFD control. No significant differences in plasma serotonin levels were found among the groups.
Conclusion: Saffron extract and crocin show potential in reducing blood biomarkers associated with obesity as well as anti-inflammatory and regulatory potential of adipocytokines in an animal model.
This paper highlights the marked presence of nutritional disorders in a sample (190 males, 237 females, aged 18-80 years) obtained from the adult population in three kampungs i.e. Pasang Api, Sungai Nipah Baroh and Sungai Balai Darat, in the Mukim of Bagan Datoh, Perak in 1992. All subjects (except pregnant females) were measured for blood pressure, weight, height, waist circumference, and hip circumference from which the body mass index (BMI) and waist-hip ratios (WHR) were calculated. A random blood sample was obtained by finger-prick from each subject and analysed for total cholesterol (TC) and glucose, using the Reflotron compact analyser. Elevated means for BMI and WHR indicated that obesity (BMI ≥30.0) was a serious public health problem in these three kampungs, affecting about 5% of males and 14% of females. Another 24% of males and 46% of females had an overweight problem (BMI 25.0-29.9), indicating that on the average, about half the adult population in these kampungs were either overweight or obese. This contrasted with the situation a decade ago in similar-type kampungs in the Peninsula where underweight was the major nutritional disorder in adults, especially males. Overall, there was a shift of an underweight problem to one of overweight, as exemplified by increments of 2.0 to 3.0 BMI units in the adult population, with the phenomenon being more marked in the females. Hypertension (21%) and hyperglycaemia (6.5%) affected the males and females approximately equally. Female adults had higher mean plasma TC compared to males (204 versus 199 mg/dl); these means were some 20 mg/dl (0.52 mmol/L) higher than the corresponding means for adults in similar rural communitites in the early eighties, and approximate the corresponding means for present-day urban adults. The above findings serve to emphasise the nutritional transition undergoing in the rural communities in the Peninsula, viz, the marked emergence in these rural communities of nutritional disorders normally associated with affluent populations.
Introduction: Childhood obesity is one of the most serious public health challenges of the 21st century. The problem is global and is steadily affecting many low- and middle-income countries, particularly in urban settings. Risk factors for obesity in this context have not been explored. The objective of this study was to identify the risk factors associated with childhood obesity/overweight among young children and adolescents 5-15 years of age in urban Bangladesh.
Methods: A scoping review based on York methodology was performed. This methodology involves a comprehensive search of published academic articles, conference proceedings and grey literature through PubMed, Bangla JOL, Google and Google scholar, limited to English-written papers.
Results: Findings revealed that having at least one overweight parent and engaging in sedentary activities for more than 4 h a day were independent risk factors for childhood overweight and/or obesity.Children who spent ≥ 30 min each day in outdoor games at home that involved physical exercise had decreased odds (OR = 0.38, 95% CI: 0.1–0.8) of being overweight or obese compared to children who did not exercise at home.
Conclusion: Spending much time seated or somewhat inactive were key risk factors for childhood obesity and overweight. More research, prevention and management of childhood obesity/overweight in young children and adolescents in urban Bangladesh should be a policy priority.
The objective of this study was to determine the levels of knowledge, attitudes and practices with regards to coronary heart disease (CHD) and its risk factors among CHD patients in the Institut Jantung Negara (National Heart Institute), Kuala Lumpur. All patients admitted for CHD during the study period between 5th May 1997 and 24th May 1997 were included in the study. A total of 105 patients were interviewed by using a pretested questionnaire. Four CHD risk factors were included in the study, namely dietary intake, smoking habit, alcohol intake and physical activity. The majority of the patients (92.4%) were above 45 years old. Most of them (85.7%) had at least one chronic health problem such as diabetes mellitus and hypertension before admission into IJN. Their average total blood cholesterol was 6.1 ± 1.3 mmol/L and 75.2% were hypercholesteromic (≥ 5.2 mmol/L). Mean systolic blood pressure was 151.2 ± 27.5 mmHg. The mean body mass index of the patients was 25.9 ± 3.9 kg/m2 and 58.1% were overweight (BMI ≥ 25.0). Almost half of the patients (49.6%) had smoked before but only 8.6% still smoke. Out of the 56 non-Muslim patients, 9 of them (16.1%) consumed alcoholic drinks on a regular basis. Most of the patients reported walking as the only form of exercise that they do. Most of the patients consume rice, vegetables and fruits almost daily. This study indicated significant relationships between (i) knowledge level and attitude towards CHD risk factors (r = 0.624, p < 0.001), (ii) knowledge level and modifying practices related to CHD risk factors (r = 0.316, p < 0.01) and (iii) attitude and modifying practices (r = 0.234, p
The relationship between dietary habits and bone health status was evaluated in 61 pairs of premenopausal mothers and their biological daughters aged 10-19 years. Subjects were volunteers living in Kuala Lumpur. Bone status of the calcaneus was assessed using Quantitative Ultrasound (QUS) which measured the Broadband Ultrasound Attenuation (BUA; in units of dB/MHz) of the bone. Daily nutrient intake of all subjects was evaluated using a 3-day dietary record. Reproductive history, food intake habits, and physical activity level were assessed using questionnaires. Bone health status of mothers (mean BUA of 98.0 ± 15.8 dB/MHz) was significantly higher (p<0.001) compared to their daughters (mean BUA of 86.4 ± 17.0 dB/MHz). BUA (r=0.30, p<0.05), weight (r=0.30, p<0.05) and BMI (r=0.32, p<0.05) were significantly correlated within mother-daughter pairs. Lifestyle characteristics such as calcium intake and physical activity were not correlated. However, other dietary habits (energy intake, milk intake and frequency of skipping meals) in daughters were significantly correlated with their mothers. This study suggests that mothers play an important role in influencing the dietary habits of their daughters, which in turn may affect their bone health status.
The theoretical impact of the use of coconut cream (santan) powder and palm oil santan powder on the dietary levels of C12-16 saturated fatty acids (SFAs) and linoleic acid (18:2), and on serum total cholesterol (TC), was evaluated holding non-santan dietary variables constant. The prediction was based on a 2,300-kcal hypothetical diet, containing one santan-based dish or snack in each of the 5 daily meals with fat contributing 30% of total calories, while the santan contributed a total of 14% kcal (36g). Replacing coconut santan with palm oil santan reduced the overall dietary C12-16 SFAs from 10.8% kcal to 4.8% kcal (i.e. 6.0% kcal) and the virtual removal of lauric (12:0) + myristic (14:0) acids, while palmitic acid (16:0) rose by 3.3% kcal, and the polyunsaturated linoleic acid (18:2) increased by 1.13% kcal. Applying the Hegsted equation to these dietary fatty acid (FA) changes, predicted a serum TC reduction of 24 -31 mg/dL (0.62- 0.80 mM/L), with the hypocholesterolemic effect being influenced by the low-density lipoprotein receptor (LDLr) set-point of the individual(s) concerned. Thus, the prediction indicated that replacing coconut santan with palm oil santan in santan-based Malaysian dishes or snacks would have a significant beneficial impact on serum TC and hence, cardiovascular risk.
The objective of this paper is to report on the reliability and validity of a knowledge, attitude and practice instrument used among young primary school children. The instrument was developed as an evaluation tool in the HELIC study and consisted of 23 knowledge, 11 attitude and 10 practice items. A total of 335 Year 2 students from 4 randomly selected primary schools in Selangor and Wilayah Persekutuan participated in the HELIC study. Students were divided into small groups and an enumerator verbally administered the instrument to each group. Reliability for each construct (knowledge, attitude and practice) was estimated as item to total score correlation and internal consistency (Cronbach's alpha). Construct validity was determined through factor analysis and Pearson correlation. Results indicated that 3 attitude and 3 practice items did not correlate significantly to the total score (p>0.05). However, the deletion of these items did not significantly alter the Cronbach's alpha coefficients. Internal consistency was good for knowledge (a=0.68) but low for attitude (a=0.37) and practice (a=0.36) constructs. Based on factor analysis, 5 factor-solutions emerged for knowledge and 4 factor solutions for attitude and practice. Sufficient variance was obtained for the factors in knowledge (51.7%), attitude (51.2% and practice (51.0%). There were also significant positive correlations among the constructs ( ~ 4 . 0 1 ) . In conclusion, the instrument was valid and reliable, especially for the knowledge construct. Further improvements, particularly on the attitude and practice constructs, are needed in order for the instrument to be an effective assessment or evaluation tool in various settings.
This study sought to examine the reliability of two measurements; Calf Circumference (CC) and Mid-half Arm Span (MHAS). A sample of 130 elderly persons aged 60 years and above seen consecutively in the Kuala Lumpur Hospital outpatient clinic during the period of December 2005 to January 2006, upon consent, were recruited to the study. There was a high degree of reliability for both inter- and intra-examiner (r close to 1). For inter-examiner, on average the CC measurements taken by the first examiner were 0.3 cm lower than that of the second examiner. The upper and lower limit of the differences were +0.4 to -0.9 cm respectively. Inter-examiner MHAS measurements on average by the first examiner were 0.2 cm lower than that of the second examiner. The limits were +1.7 to -2.1 cm. By comparison, the inter-examiner CC measurements were more reliable than the MHAS measurements. For intra-examiner, on average the CC measurements at Time 1 were consistent with Time 2 (mean difference=0) with limits of the difference at + 0.5 cm. MHAS measurements at Time 1 were on average 0.1 cm less than at Time 2 with limits at +1.7 and -1.8 cm. The technical error of measurement (TEM) and coefficient of variation of CC and MHAS for both interexaminer and intra-examiner measurements were within acceptable limits with the exception of MHAS TEM. This study suggests that CC and MHAS measured in elderly persons 60 years and above, using Seca Circumference Tape ® 206, Germany (0.05 cm) are reliable and can be used in a community survey.
Study site: Outpatient clinic, Hospital Kuala Lumpur
This study aims to determine the relationship between calcium intake and lifestyle factors with bone health status among 56 postmenopausal women in the Evergreen Senior Citizens Club, Petaling Jaya. Purposive sampling technique was used for sample selection. Bone mineral density (BMD) of the femur proximal and lumbar L2-L4 was measured based on the Dual Energy X-ray Absorptionmetry (DEXA) technique at KVOTC Clinic, Subang Jaya. The interview sessions were conducted using a questionnaire followed by anthropometric measurements. The results revealed that the average age of the respondents was 64.0 years old. The average weight and height of the respondents were 53.68 kg and 1.55 meters, respectively. Overall, the average body mass index (BMI) of the respondents was quite satisfactory (22.4 kg/m²) with only 17.9% of them categorized as overweight (>25 kg/m²). The average total calcium intake was 807.31 mg and about 76.2% was contributed by food intake. About 83.9% of the respondents met the recommended calcium intake according to the Malaysian RDA. The average BMD of the lumbar, neck, wards and trochanter was 9.983 ± 0.178 g/cm², 0.745 ± 0.126 g/cm², 0.604 ± 0.150 g/cm² and 0.674 ± 0.127 g/cm², respectively. About 32.1% of the respondents were categorized as osteoporotic at the femoral wards, while 10.7% respectively was at the lumbar L2-L4 and femoral neck. Half of the respondents had osteopenia at the femoral neck (53.6%) and wards (50.0%) and at the lumbar L2-L4 (53.6%). Pearson correlation test showed significant negative correlations between age and BMD in the neck (r = -0.419, p
Introduction: Malnutrition is associated with poorer outcomes following treatment for colorectal cancer (CRC). This study evaluates the relationship between nutritional status using scored Patient Generated-Subjective Global Assessment (PG-SGA) with the validated European Organisation for Research and Treatment of Cancer questionnaire (EORTC-QLQ C30) which consists of five functional scales, three symptoms scales and one item of global health/quality of life (QOL).
Methods: A total of 42 CRC patients at oncology outpatient clinics from two hospitals in Malaysia participated in the study from March 2011 to March 2012. The participants were classified as either well-nourished (PG-SGA A) or malnourished (PG-SGA B and C).
Results: The majority of patients were Chinese, male, with a mean age of 57.1 ± 9.8 years and had been diagnosed with stage 2 CRC. Well-nourished patients had statistically significantly better QOL scores on symptom scales: fatigue (p<0.001), nausea and vomiting (p<0.05), and pain (p<0.001) compared to malnourished patients. PG-SGA was strongly correlated with the main domains of the QOL: global health status (r = -0.395, p<0.05), fatigue (r = 0.816, p<0.001), nausea and vomiting (r = 0.730, p<0.001) and pain (r= 0.629, p<0.001). The better the nutritional status (lower total mean score of PG-SGA), the higher the QOL (high mean score of global health status).
Conclusion: The scored PG-SGA is suitable for use as a nutrition assessment tool to identify malnutrition and it is associated
with QOL among this population.
Key words: Chemotherapy, colorectal cancer patient, malnutrition, nutritional status, PGSGA score, quality of life
Study site: Oncology clinics, Hospital Kuala Lumpur, Hospital Selayang, Kuala Lumpur, Malaysia
The objective of this study was to determine the relationship between nutritional status, physical activity and quality of life among gastrointestinal cancer survivors.
Despite the many benefits of family meals, data on association between family meals away from home (FMAFH) and nutritional status of adolescents is limited. This study determined the association between FMAFH with dietary intake and body mass index of adolescents (N = 408).
Dental caries are attributed to various factors including diet. The present crosssectional study determined the frequency of sugary food and drink consumption and defined its relationship to dental caries among preschool children. A total of 50 preschoolers (aged 5-6 years) in three kindergartens of the Department of Community Development (KEMAS) in Titiwangsa, Kuala Lumpur participated in this study. A set of structured questionnaires was used to assess the frequency of sugary food and drink consumption. Dental check ups were performed by a dentist. The dft index (decayed, filled teeth) was used to describe incidence of caries in subjects. Results showed that 62% of the subjects had dental caries. with the mean dft score being 3.72. The frequency of sugary food consumption by the majority of subjects was 2 times a day, while the frequency of sugary drink consumption was more than 3 times a day. There was no significant relationship between frequency of sugary food and drink consumption with incidence of caries. Subjects with high dft scores were more likely to report dental pain. The prevalence of dental caries in preschoolers in this study was high, indicating a need for effective dental health promotion to improve dental health status of this age group.
Loss of appetite, decrease in food intake and changes in body composition appear to be inter-related factors that can influence the well-being of older individuals. Therefore, a study was conducted to determine the level of appetite, food intake and its relation to body composition and functional status among noninstitutionalised elderly Malays in Cheras, Kuala Lumpur. The Council on Nutrition Appetite Questionnaire (CNAQ), Diet History Questionnaire (DHQ), Bio-impedance Analysis (BIA) and Instrumental Activity of Daily Living (IADL) questionnaire and handgrip dynamometer were used to measure appetite, food intake, body composition and functional status respectively. A total of 112 subjects (41.1% men and 58.9% women) participated with mean age being 66.0 ± 5.0 years for men and 66.3 ± 6.2 years for women. Prevalence of poor appetite was higher in elderly women (72.3%) than in men (52.3%) (p<0.05). Pearson's correlation test showed that CNAQ score correlated significantly with age (r=-0.255, p<0.01), energy intake (r=0.272, p<0.01), IADL score (r=0.408, p<0.01) and handgrip strength (r=0.263, p<0.05). Energy intake correlated significantly with fat free mass (r=0.424, p<0.05), muscle mass (r=0.456, p<0.05) and total body water (r=0.403, p<0.05). Multiple regression analysis showed that 27.0% of poor appetite could be explained by advanced age, low energy intake and decreased functional status. In conclusion, the study showed that poor appetite was prevalent among the subjects, especially women and this was influenced by aging, inadequate energy intake and decreased functional status.