This paper describes body composition and dietary intakes of the three major ethnic groups residing in Singapore and how these are related to cardiovascular risk factors in these groups. When the relationship between body mass index (BMI, kg/m2) and body fat percentage was studied, Singaporeans were found to have higher percentage of body fat compared with Caucasians with the same BMI. At BMIs that are much lower than WHO-recommended cut-off values for obesity, both the absolute and relative risks of developing cardiovascular risk factors are markedly elevated for all three ethnic groups. The excessive fat accumulation and increased risks at lower BMIs signal a need to re-examine cut-off values for obesity among Chinese, Malays, and Indians.
Body Mass Index (BMI) is the most established anthropometric indicator used for assessment of nutritional status. Other anthropometric indicators which are related closely to BMI are waist hip ratio (WHR) and waist circumference. In this paper, receiver operating characteristics (ROC) curves were constructed to assess the value of waist circumference and waist hip ratio as a screening measure for the need of weight management using BMI as the reference test. Sensitivity and specificity were calculated at several cut-offs. The areas under the ROC curve calculated by comparing waist circumference with BMI were high (0.70 - 0.86) while the areas calculated for WHR were low (0.46 - 0.67). Sensitivities of 0.745 and 0.800 were observed at cut-off points of waist circumference at 90cm and 80cm for males and females respectively, while the false positive rates were 0.233 for males and 0.250 for females. These cut-off points could be considered as a fair trade-off. Therefore it is concluded that waist circumference performed better than WHR as a screening test. It is indicative that waist circumference could be used as a tool in raising awareness of weight management in this population.
A cross-sectional comparative study was conducted to determine the nutritional status among physically active groups in Kota Bharu. The study population comprised 83 adult male athletes from 8 different types of sports (athlete group), 80 active men who exercised a minimum of 30 min per day for at least 3 times per week (exercise group), and 80 inactive men (sedentary group). All the respondents were aged between 18 to 44 years. Measurements taken from the respondents were anthropometric measurements, systolic (SBP) and diastolic (DBP) blood pressure, and serum total cholesterol (TC). The results showed that the combined prevalence of pre-obese (BMI 25.0-29.9) and obese (BMI ¡Ã30.0) was 21.7% in athletes, 29.9% in exercise group, and 47.5% in sedentary group. The mean (± SD) percentage of body fat in athletes was 15.7 ± 5.4%, which was lower compared to the exercise (18.9 ± 5.5%) and sedentary (20.6 ± 5.8%) groups. The incidence of waist-to-hip ratio above 0.9 in athlete, exercise and sedentary groups was 9.6%, 18.7% and 31.3%, respectively. The incidence of hypertension (SBP ¡Ã140 and/or DBP ¡Ã90 mmHg) was 13.2% in athletes, 17.5% in exercise group and 42.5% in the sedentary group. The TC values showed that the prevalence of “high risk†individuals (TC ¡Ã6.20 mmol/l) was also lower in athletes (20.5%), compared to the exercise (36.2%) and sedentary (47.5%) groups. The study revealed that individuals who are actively involved in physical activity, particularly in sport activities have better nutritional status compared to sedentary people. However, the nutritional status in the athlete and exercise groups was still unsatisfactory. The incidence of poor health status related to over nutrition in the active groups was rather high and needs attention from health professionals. Further studies are needed to determine nutritional practices among physically active groups.
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.
Ethnic differences exist in patients with diabetes mellitus. Not much is known about such differences in Asian populations. The aim of the study was to determine ethnic differences among Chinese, Malay and Indian patients with type 2 diabetes mellitus in Singapore.
Achieving glycaemic goals in diabetics has always been a problem, especially in a developing country with inadequate facilities such as in Sarawak in Malaysia. There are no reported studies on the control of diabetes mellitus in a diabetic clinic in the primary health care setting in Sarawak. This paper describes the profile of 1031 patients treated in Klinik Kesihatan Tanah Puteh Health Centre. The mean age was 59 years, the mean BMI 27 kg/m2. There was a female preponderance and mainly type-2 diabetes. Mean HbA1c was 7.4%. Glycaemic control was optimal in 28% (HbA1c <6.5%), fair in 34% (HbA1c 6.5-7.5%) and poor in 38% (HbA1c >7.5%). Reasonable glycaemic control can be achieved in the primary health care setting in Sarawak.
Study site: Klinik Kesihatan Tanah Puteh, Sarawak, Malaysia
To examine a possible association between lipoprotein(a) [Lp(a)] levels and diabetic retinopathy in patients with type 2 diabetes mellitus. 100 type 2 diabetic patients were assessed with the following parameters: age, body mass index, duration of diabetes, blood pressure, fasting plasma glucose, total cholesterol, HDL-cholesterol, triglycerides, blood urea nitrogen, creatinine, Lp(a), and albumin excretion rate (AER). Retinopathy was classified as normal retina (NR), non-proliferative diabetic retinopathy (NPDR), and proliferative diabetic retinopathy (PDR) by an ophthalmologist. The PDR group had higher cholesterol (t=-2.24, p<0.05) and creatinine (z=-2.547, p<0.05) levels than the NPDR group. The PDR group had a higher value of AER (z=-2.439, p<0.01) than the NR group. The possibility of developing diabetic retinopathy after 10 years of diabetes was found to be 6.5 fold high (OR; 6.57, 95% CI 1.74-24.79; p<0.05). The Lp(a) levels were similar in the patients with retinopathy and those without retinopathy. In the study, there was no evidence for a relationship between the serum Lp(a) levels and diabetic retinopathy in type 2 diabetic patients.
Study site: diabetic outpatient clinic at Haydarpasa Numune Education and Research Hospital in Istanbul, Turkey.
We determine the familial aggregation and determinants of post challenge blood glucose (BG) in four ethnic populations. A national health survey was conducted in Malaysia in 1996. 18,372 subjects aged 30 years or older had post challenge BG measurements and another 846 subjects were pre-diagnosed to have diabetes on drug treatment. We imputed the BG of diagnosed diabetics by randomly selecting a value from the BG distribution of undiagnosed diabetics. Covariates of interest include ethnicity, gender, age, urban-rural residence, body mass index (BMI), physical activity, education, and household income. Ethnic and gender differences in mean BG persisted after adjustment for other covariates. Age and BMI were the only two factors with strong, positive and consistent effects on mean BG in all ethnic-sex groups. Family resemblance for BG as measured by intraclass correlation was small and homogenous across all ethnic groups and did not differ from resemblance in BG between spouses. In conclusion, BMI was the only consistent modifiable predictor of BG in all ethnic-sex groups. Environmental factors are probably more important than genetic factors as determinant of BG in the four ethnic populations studied.
Backgrounds and aims: The Asian Young Diabetes (ASDIAB) project is a five-year prospective study on the clinical and immunological characterisation of diabetes in newly diagnosed young Asians. This paper aims at evaluating the aetiological classification of diabetes in these patients based on presence/absence of islet autoantibodies and beta cell function at disease presentation and one year.
Materials and methods: A total of 919 patients (from Beijing, Shanghai, Hong Kong, India, Malaysia and Singapore) with age at diagnosis 12-40 years and diabetes duration <12 months were recruited between 1997 and 1999. Complete information on autoantibodies to glutamic acid decarboxylase (GAD) and IA-2 and fasting C-peptide at baseline and 1 year were available in 633 patients. Antibody positivity (Ab+) was defined by presence of GADab and/or IA-2 abo Poor beta-cell function was defined with fasting C-peptide <0.3nM at one year. TlDM was identified in patients Ab+ at diagnosis (irregardless of p cell function status) and in those Ab- at diagnosis and I-year, but demonstrated poor beta-cell function at I-year. Patients who were Ab- at diagnosis and I-year but had good beta cell function (fasting C-peptide >=0.3nM) at I-year were classified as having type 2 diabetes (T2DM).
Results: 139 patients (22%) were classified as having T1DM. Of these, 90 were Ab+ and 49 were Ab- and had poor beta cell function. The remainder 494 patients (78%) were classified as having T2DM. The ethnic distribution of T1DM patients (73% Chinese, 16% Indians and 11 % Malays) was similar to the T2DM. Compared to T2DM, T1DM patients were significantly younger at diagnosis (mean age 28.0 vs 32.9 yrs), leaner (mean BMI 21.5 kg/m' vs 25.9 kg/m' at diagnosis, 22.0 kg/m2 vs 26.1 kg/m2 at 1 year), and had significantly higher HbA1 , (11.8% vs 9.7% at diagnosis; 8.9% vs 8.0% at 1 year) . Median fasting C-peptides were significantly lower in T1DM than T2DM patients (0.2 vs 0.7 nM at diagnosis; 0.2 vs 0.8 nM at 1 year). T2DM were more insulin resistant than T1DM patients as assessed by HOMA index (median 5.8 vs 4.4 at diagnosis, 4.9 vs 3.4 at 1 year).
Conclusions: In Asians with young onset diabetes, assessment at diagnosis and one year for islet autoantibodies (GADab and lor IA-2Aab), together with estimation of p-cell function with fasting serum C-peptide levels, were useful for classifying patients as having T1DM and T2DM .
Grant from Novo Nordisk Asia Pacific, Singapore
40th EASD Annual Meeting of the European Association for the Study of Diabetes : Munich, Germany, 5-9 September 2004
Bioelectrical impedance analysis was introduced more than a decade ago to measure body composition and nutritional status. There are presently limited data on the nutritional status and body composition measured with bioelectrical impedance analysis in renal transplant recipients, especially among the Asian population. The normal values for these data in renal transplant recipients remain unknown.
AIM: To describe the clinical, biochemical and immunological characteristics of young-onset diabetes in Asia.
METHODS: Clinical, biochemical and immunological variables were assessed in 919 newly diagnosed (duration less than 12 months) young onset Asian diabetic patients aged between 12 and 40 years. The subjects constituted 57% Chinese, 29% Indians and 14% Malays, recruited from diabetes centres in China, Hong Kong, India, Malaysia and Singapore.
RESULTS: The mean age (+/- sd) was 31.6 +/- 7.2 years, with the majority (66%) in the 31-40 years age group. Mean body mass index (BMI) (+/- sd) was 25.3 +/- 5.0 kg/m2 with 47% exceeding the suggested Asian cut-off point for obesity (BMI > or = 25). Ethnic difference in clinical characteristics included BMI, blood pressure, mode of treatment and degree of insulin resistance. Most patients had a clinical presentation of Type 2 diabetes. About 10% had a classical combination of ketotic presentation, presence of autoimmune-markers and documented insulin deficiency indicative of Type 1 diabetes. Forty-eight percent were receiving oral hypoglycaemic agents (OHAs) while 31% were on diet only, 18% were receiving insulin and 2% were on a combination of insulin and OHA.
CONCLUSION: Young onset diabetes patients in Asia represent a heterogeneous group in terms of their clinical and biochemical characteristics and classical Type 1 diabetes is relatively uncommon. The 5-year follow up study will determine the progress of these patients and help to clarify the natural history.
Lifestyle and disease patterns in Malaysia have changed following rapid economic development. It is important to find out how these changes have affected the nutritional status and health behaviour of the population, especially school children and adolescents. Therefore a survey on school children's and adolescents' health behaviours and perception in Kuala Lumpur was initiated. This paper only reports the observed body mass status of the school children. A total of 3620 school children were selected in this survey using the method of multi-stage sampling. The students were surveyed using pre-tested questionnaires while weight and height were measured by the research team in the field. Using the cut-off of BMI-for-age >or= 95th percentile and <5th percentile for overweight and underweight respectively, there were a total of 7.3% of overweight students and 14.8% of underweight students. When analysed by gender; 7.5% of boys and 7.1% girls were overweight, while 16.2% of the boys and 13.3% of the girls were underweight. The youngest age group (11 years old) had the highest prevalence of underweight as well as overweight. With increasing age, the prevalence of underweight and overweight decreased and more children were in the normal weight range. The overall prevalence of overweight among the three ethnic groups was similar. However the prevalence of underweight was highest among the Indian students (24.9%), followed by Malays (18.9%) and Chinese (9.5%) (P <0.001). The results showed that both the problems of under- and over-nutrition co-exist in the capital city of Malaysia. The promotion of healthy eating and physical activities is required to address the problems of under- and over-nutrition in order to build up a strong and healthy nation in the future.
Factors related to overweight were examined in a cross-sectional survey that included 1612 women workers from 10 large electronics assembly factories in Peninsular Malaysia. Respondents were Malaysian citizens, direct production workers below the supervisory level, and had worked at least a year in the factory where they were presently employed. Heights and weights were taken to calculate the body mass index (BMI). Weights and BMI increased with increasing age. After adjusting for age, odds ratios for overweight were significantly raised for married women in relation to not married women (OR 1.5, 95% CI=1.15-2.02), lower secondary education in relation to higher than upper secondary education (OR 1.8, 95% CI=1.06-3.14), monthly income RM800-999 (OR 1.7, 95% CI=1.21-2.45) and >/=RM1,000 (OR 1.8, 95% CI=1.23-2.72) in relation to
Iron deficiency anaemia (IDA) is the most prevalent micronutrient deficiency in the world affecting the general health and wellbeing of millions. In Malaysia, moderately high prevalences of anaemia have been reported amongst infants, young children and women of childbearing age. Data is scant for the adolescents. This study was undertaken to assess the iron status and dietary intake of 165 adolescents, comprising 74 male and 91 female subjects, aged 12 to 19 years, from the rural communities in Tuaran District of Sabah, Malaysia. Convenience sampling was used for the selection of study subjects. Multiple iron status indicators namely, serum ferritin (SF), transferrin saturation (TS), mean corpuscular volume (MCV) and haemoglobin (Hb) were determined for the study. The mean age of the subjects was 15.2 +/-2.1 years. While the majority of the subjects (77.6%) had normal body mass index (BMI) values, 17.6% were underweight and 4.8% overweight. About 35% to 40% of the subjects showed deficient values for haematocrit, serum ferritin, serum iron, mean corpuscular haemoglobin (MCH), mean corpuscular volume (MCV) and transferrin saturation (TS), and 20% were anaemic (Hb <12 g/L). Using the multiple criteria of iron status indicators, the prevalence of iron depletion, iron deficiency and IDA in the male and female adolescents were 5.4% vs. 6.6%, 18.9% vs. 26.4% and 5.4% vs. 26.4%, respectively. Iron deficiency anaemia (85.0%) contributed largely to the prevalence of anaemia. The dietary iron intake of the adolescents was unsatisfactory, with approximately 98% of subjects failing to meet the Malaysian RDA level. Almost all the female subjects (91%) had dietary iron intake below two-thirds of the RDA level compared with a much smaller proportion for the male adolescents (68%). The prevalence of IDA in the present study population, especially in the female adolescents, appears to be a significant public health problem. Priority should therefore be given to the eradication of iron deficiency in adolescents from low-income areas by dietary modification and micronutrient supplementation amongst female adolescents.
BACKGROUND: Circulating antibodies to glutamic acid decarboxylase (GADab) and tyrosine phosphatase-like molecule IA-2 (IA-2ab) are major indicators for auto-immune destruction of pancreatic islet cells. They identify a majority of Caucasians with type 1 diabetes and approximately 50% of Asians, providing evidence of an idiopathic aetiology in the latter. The present study investigated these autoantibodies in a mixed ethnic group.
METHODS: Hospital clinic patients with clinically defined type 1 (n = 93) and type 2 (n = 300) diabetes and representing Singapore's major ethnic groups--Chinese, Indians and Malays--were studied. GADab and IA-2ab frequencies, and association of autoimmunity status with clinical and biochemical profiles were analysed.
RESULTS: Radio-immunoprecipitation assays detected either or both antibodies (seropositivity) in 41.9% of subjects with type 1 diabetes. GADab was detected in 36.6% and IA-2ab in 23.7% of type 1 diabetics. Prevalence of IA-2ab showed a reduction in frequency with disease duration (P = 0.026). In clinical type 2 diabetics, seropositivity was 10.0% with higher frequency in Malays (17.5%) than Chinese (9.7%) and Indians (4.5%). Multivariate analysis revealed that low fasting C-peptide was associated with seropositivity (odds ratio (OR) = 0.15; 95% confidence interval (CI) = 0.04-0.58). A significant relationship (OR = 13.5; 95% CI = 5.0-36.7) between insulin requirement and duration (>5 years) was also revealed. In patients with type 2 diabetes there was a trend of gradual progression to insulin dependency. However, there was considerable variation in body mass index between ethnic subgroups of type 2 diabetics, particularly for Chinese (mean (SD) = 26.0 (4.7)) and Malays (mean (SD) = 29.2 (5.9); P < 0.001).
CONCLUSIONS: Presence of both antibodies in our mixed ethnic group of type 1 diabetes patients was much lower than in Caucasians. Significant numbers of patients were seronegative for antibodies. Influences due to ethnicity and adiposity would require further investigations.
Serum levels of 25-hydroxyvitamin D (25 (OH) D) were determined in 276 (103 Malays and 173 Chinese) postmenopausal women, aged 50 to 65 years. The level of 25 (OH) D was significantly lower in the postmenopausal Malay women (44.4 +/-10.6 nmol/L) compared to the Chinese women (68.8 +/- 15.7 nmol/L) (P<0.05). There were 27% Malay women with serum 25 (OH) D in the range of 50 - 100 nmol/L (defined as lowered vitamin D status, or hypovitaminosis D) and 71% with levels in the range of 25 - 50 nmol/L (defined as vitamin D insufficiency) compared to 87% and 11% Chinese women respectively. Serum 25 (OH) D was found to significantly correlate with BMI, fat mass and PTH level. Multivariate analyses showed that race has a strong association with vitamin D status. The high prevalence of inadequate levels of serum vitamin D found in our study may have important public health consequences and warrants the development of a strategy to correct this problem in the older adult Malaysian population.
Cardiovascular disease (CVD) has been the number one cause of death since the last three decades in Malaysia and diabetes mellitus and hypertension are considered as major risk factors. A study to reduce risk factors for cardiovascular diseases in the community (PIKOM) through education and lifestyle changes was undertaken. The study population was from four different areas in Peninsular Malaysia - Kota Bharu and Bachok in Kelantan ; Raub in Pahang; Gunung Besout in Perak and Felda Palong in Negri Sembilan. The subjects invited to participate in this study ware aged between 30 - 65 years, did not have any debilitating illnesses and no known history of diabetes mellitus, hypertension or cardiovascular disease. Subjects were asked to come to the local clinic in a fasting state and after physical examination, blood was taken for plasma glucose and lipids. Oral glucose tolerance test (OGTT) was then performed. A total of 4,121 subjects participated in the study. The proportion of subjects with diabetes mellitus was highest in Felda Palong area (20.3%) and lowest in Raub area (7.1%). The proportion of subjects with hypertension was also highest in Felda Palong area (38.6%) and lowest in Raub area (29.1%). This could be attributable to the subjects in Felda Palong having the highest mean Body Mass Index (BMI) and Waist-to-Hip Ratio (WHR). There were significant associations between diabetes and hypertension with age and obesity. Subjects with diabetes mellitus and hypertension also had the highest mean age, BMI, WHR and plasma cholesterol.In conclusion, the proportion of patients with risk factors for CVD was high and intervention studies through education and lifestyle changes were being carried out to see their effectiveness.
OBJECTIVES: The aim of this study was to determine the: (1) prevalence of undernutrition as determined by the 'DETERMINE Your Nutritional Health Checklist' (NHC) and (2) factors independently associated with undernutrition among the older residents of these publicly funded shelter homes in Peninsular Malaysia.
DESIGN: A total of 1081 elderly people (59%M) over the age of 60 y were surveyed using questionnaires determining baseline demographics, nutritional and cognitive status, physical function and psychological well-being.
SETTING: Shelter homes, Peninsular Malaysia.
RESULTS: In all, 41.4% (n = 447) were nourished (score <3), 32.1% (n = 347) at moderate risk (score between 3 and 5) and 26.6% (n = 287) were at high risk of undernutrition (score>5) according to the NHC. A large proportion of subjects were underweight with 14.3% of subjects recording a low body mass index (BMI) <18.5 kg/m2 and a further 18.2% recording a BMI between 18.5 and 20 kg/m2. The residential geriatric depression score (GDS-12R) (relative risk (RR) = 1.03 (95% confidence interval (CI) 1.01-1.05); P = 0.002) and the number of illnesses (RR = 1.14 (95% CI 1.07-1.21); P < 0.001) were found to be independently associated with nutritional risk (NHC score > or = 3). Using a BMI < 18.5 kg/m2 as an objective marker for nutritional risk, the NHC was shown to have a sensitivity of 66.4% (95% CI 58.0-74.2%), specificity of 42.7% (95% CI 39.3-46.1%), positive predictive value of 16.2% (95% CI 13.3-19.5%) and a negative predictive value of 88.4% (95% CI 84.9-91.4%).
CONCLUSIONS: Many elderly people residing in publicly funded shelter homes in Malaysia may be at-risk of undernutrition, and were underweight. The NHC is better used as an awareness tool rather than as a screening tool.
A study was undertaken to 1) determine the effects of tobacco smoke exposure on maternal and neonatal weight and body mass index (BMI) and placental weight, volume and surface area and 2) establish any correlations between the placental surface area, volume and weight with maternal and neonatal body weight and BMI in mothers exposed to cigarette smoke. A total of 154 full-term placentae, 65 from mothers exposed to tobacco smoke and 89 from non-exposed mothers were collected from Kuala Lumpur Maternity Hospital. The placental surface area was determined using a stereological grid, the volume by Scherle's method and the weight by using an electronic weighing machine. In general there were no differences in maternal, placental and neonatal parameters between the exposed and non-exposed groups. However, there were significant correlations between placental weight with maternal weight and maternal BMI in both exposed (r = 0.315; p = 0.013) and (r = 0.265; p = 0.038), and non-exposed (r = 0.224; p = 0.035) and (r = 0.241; p = 0.023) mothers. It was also found that the maternal weight on admission correlated significantly with placental weight in both Malay (r = 0.405; p = 0.020) and Indian (r = 0.553; p = 0.050) passive smokers. Correcting the placental parameters for the maternal weight had no effect on the results.