Traditionally, Chinese women adhere to special dietary practices during the month following childbirth. This paper discusses the dietary practices and food taboos practised by Chinese women in Kuala Lumpur. A total of 134 Chinese mothers of children below one year were recruited from three Maternal and Child Health Clinics and Maternity Hospital, Kuala Lumpur. Questionnaires and in-depth interviews were used to obtain information on socioeconomic background, dietary practices, food taboos and cooking methods during the confinement period. Food intake was assessed by multiple 24-hour dietary recall among 34 mothers during their confinement month (zuo yuezi). Body weight and height were measured, and body mass index calculated. Majority of the respondents had secondary school education (77.6%), household income between RM1001 and RM3000 (64%), and were homemakers (48.5%). The women were aged 18-39 years, and 68% were of normal weight. Most women (82%) practised 30 days of confinement, during which they adhered to special dietary practices. The diet was directed at attaining yin-yang (cold-hot) balance, whereby “hot†foods were most commonly used and “cold†foods were avoided. Ginger, rice wine and sesame seed oil, considered “hot†foods, were used in large amounts in the cooking. Rice, chicken and pork were also consumed in large amounts. Most vegetables and fruits were considered “cold†and were prohibited during confinement. Most mothers drank specially-prepared teas boiled from Chinese herbs. Mean energy intake was 19% below RNI, while mean protein intake was 93% above RNI (NCCFN, 2005). Mean intakes of thiamin, riboflavin and niacin were above 75% of RNI, while vitamins A and C were at half of RNI or less. Mean iron and calcium intakes were at 222% and 67% of RNI, respectively. It is concluded that most Chinese women in Kuala Lumpur do conform to special dietary practices during zuo yuezi.
Study site: three Maternal and Child Health Clinics and Maternity Hospital, Kuala Lumpur
This experimental study was carried out to investigate the effect of eight types of commercial rice in Malaysia on blood glucose response and to determine their glycaemic index (GI) values. Ten healthy Malay volunteers (7 males, 3 females, BMI=23.6kgm-2, age=25.1years) participated in this study. The eight types of rice tested were three high fibre rice (HFR A, HFR B & HFR C), three white rice (WR D, WR E and WR F) and two fragrant rice (FR G and FR H). The subjects were required to go through the study protocol on eleven separate occasions (eight tests for the test rice samples and three repeated tests for the reference food) after an overnight fasting. Capillary blood samples were taken immediately before (0min) and 15, 30, 45, 60, 90 and 120min after consumption of the test foods. The blood glucose response was obtained by calculating the incremental area under the curve (iAUC). The GI was determined according to the standardised methodology. This study showed that out of eight types of rice tested, three (HFR B, WR E and WR F) could be categorised as having intermediate GI while the remaining five were considered high GI foods (HFR A, HFR C, WR D, FR G and FR H). The GI of HFR B (60 ± 5.8) and WR E (61 ± 5.8) were significantly lower than the reference food (glucose; GI=100) (p0.05). The GI value of the rice tested in descending order were HFR C, 87 ± 9.0 followed by HFR A (81 ± 6.7), FR G (80 ± 5.5), FR H (79 ± 7.6), WR D (72 ± 8.5), WR F (69 ± 8.3), WR E (61 ± 5.8) and HFR B (60 ± 5.8). There was no relationship between the dietary fibre content of the rice with the iAUC (r= -0.05, p=0.63) and GI values (r= -0.08, p=0.46). This shows that the GI values of the test rice were independent of the dietary fibre content of the rice. Other factors that may influence the GI value of rice include amylose content, gelatinisation process and botanical sources. The results of this study will provide useful information for dietitians and nutritionists in selecting the appropriate type of rice for the daily diet of diabetics.
Malaysia has undergone rapid pace of industrialization and urbanization in recent decades and this has brought about imminent changes in the lifestyle of Malaysians. This is a cross-sectional study which attempts to examine the lifestyle practices and the prevalence of obesity of a group of security guards and their spouses of the University of Malaya, Kuala Lumpur. Data collection was conducted by both the methods of face-to-face interview and self-administered questionnaire. The respondents were surveyed on lifestyle practices such as smoking habits, exercise and eating pattern. Anthropometric measurement such as weight and height were also taken to establish the extend of obesity by using Body Mass Index (BMI). This study reveals that the community did have some unhealthy lifestyle practices such as smoking (27.7%; 95%CI 20.2%, 36.2%), low prevalence of adequate exercise (13.8%; 95%CI 8.4%, 21.0%); high prevalence of overweight and obesity (64%; 95%CI 55.1%, 72.3%); and high prevalence of co-morbidities such as diabetes mellitus and cardiovascular diseases. In conclusion, the community is considered to be a vulnerable and high-risk group for morbidity and mortality with the above predisposed risk factors. KEYWORDS: Lifestyle practices, overweight and obesity
The purpose of this study was to report on the estimates and distribution of body mass index in a sample of Malaysian adolescents. The study utilized a cross-sectional design and multi-stage random sampling of secondary schools to select 5 urban and 9 rural schools in Kedah and Penang. A total of 6555 male and female adolescents (11-15 years old) of Malay, Chinese and Indian ethnic groups were measured for weights and heights for body mass index calculation. Information on household demographic and socioeconomic were obtained from parents through self-administered questionnaires. Analyses of body mass index distribution by location, ethnicity, gender and age were conducted using Chi-square test of SPSS 11.5. More of the rural (12.1%) and urban (19.4%) adolescents were underweight and overweight, respectively. While in all ethnic, gender and age groups, rural adolescents were more likely to be underweight, more of the urban adolescents were overweight. The prevalence of underweight was highest among the Indians (19.2%) and lowest in Chinese (7.2%). The prevalence of overweight in the three ethnic groups was in the range of 18-19%. More male than female adolescents were underweight (15% vs 7.8%) and overweight (19.5% vs 16.7%). Consistent patterns were also observed across location, ethnic and age groups. As age increased, the prevalence of overweight decreased across the ethnic and gender groups. The reported findings can serve as current reference on body mass index distribution of Malaysian adolescents and a basis for future efforts in health and nutrition interventions for Malaysian children and adolescents.
A polymorphism in the promoter region of uncoupling protein 2 gene -866G/A has been associated with its expression levels in adipose tissue, the risk of obesity, and metabolic abnormalities. Our purpose was to examine the associations of -866G/A with body fat and the risk of metabolic syndrome in a random sample of 4018 Asians (1858 men and 2160 women) from three ethnic groups (Chinese, Malay, and Indian). The minor allele frequency of -866G/A polymorphism in South Asians was similar to that in whites. After adjustment for covariates including age, cigarette smoking, and physical activity, the -866A/A genotype was associated with higher waist-to-hip ratio as compared with the wild-type genotype in Chinese and Indian men (p = 0.018 and p = 0.046, respectively). Moreover, Indian men with -866A/A genotype had a significantly increased risk of metabolic syndrome as compared with those homozygous for the wild-type (odds ratio, 2.66; 95% confidence interval, 1.21 to 5.88; p = 0.015). Such a risk was mainly caused by the excess presence of hypertriglyceridemia and central obesity. Our findings indicate that the uncoupling protein 2 gene -866G/A polymorphism may increase the risks of central obesity and metabolic syndrome, with greater effects on Asian men.
Comment on: Norsaʼadah B, Rusli BN, Imran AK, Naing L, Winn T. Risk factors of breast cancer in women in Kelantan, Malaysia. Singapore Med J 2005;
46:698-705
INTRODUCTION: Paediatric obesity is a public health concern worldwide as it can track into adulthood and increase the risk of adult morbidity and mortality. While the aetiology of obesity is multi-factorial, the roles of diet and physical activity are controversial. Thus, the purpose of this study was to report on the differences in energy intake, diet composition, time spent doing physical activity and energy expenditure among underweight (UW), normal weight (NW) and at-risk of overweight (OW) Malaysian adolescents (317 females and 301 males) aged 11-15 years.
METHODS: This was a cross-sectional study with 6,555 adolescents measured for weights and heights for body mass index (BMI) categorisation. A total of 618 subjects were randomly selected from each BMI category according to gender. The subjects' dietary intake and physical activity were assessed using self-reported three-day food and activity records, respectively. Dietary intake components included total energy and macronutrient intakes. Energy expenditure was calculated as a sum of energy expended for basal metabolic rate and physical activity. Time spent (in minutes) in low, medium and high intensity activities was also calculated.
RESULTS: The OW adolescents had the highest crude energy intake and energy expenditure. However, after adjusting for body weight, the OW subjects had the lowest energy intake and energy expenditure (p-value is less than 0.001). The study groups did not differ significantly in time spent for low, medium and high intensity activities. Macronutrient intakes differed significantly only among the girls where the OW group had the highest intakes compared to UW and NW groups (p-value is less than 0.05). All study groups had greater than 30 percent and less than 55 percent of energy intake from fat and carbohydrate, respectively.
CONCLUSION: The data suggested that a combination of low energy expenditure adjusted for body weight and high dietary fat intake may be associated with overweight and obesity among adolescents. To prevent overweight and obesity among children and adolescents, strategies that address eating behaviours and physical activity are required. Various segments of the society must be involved in efforts to promote healthful dietary intakes and active lifestyle in children and adolescents.
OBJECTIVE: To revisit cut-off values of BMI, waist circumference (WC), and waist-to-stature ratio (WSR) based on their association with cardiorespiratory fitness (CRF). The derived cut-off points were compared with current values (BMI, 25.0 kg/m(2); WC, 80 cm) as recommended by the World Health Organization.
RESEARCH METHODS AND PROCEDURES: Anthropometric indices were measured in a cross sectional study of 358 Singaporean female employees of a large tertiary hospital (63% Singaporean Chinese, 28% Malays, and 9% Indians). CRF was determined by the 1-mile walk test. Receiver operating characteristic curves were constructed to determine cut-off points.
RESULTS: The cut-off points for BMI, WC, and WSR were 23.6 kg/m(2), 75.3 cm, and 0.48, respectively. The areas under the curve of BMI, WC, and WSR were 0.68, 0.74, and 0.74, respectively. For a given BMI, women with low CRF had higher WSR compared with women with high CRF.
DISCUSSION: These findings provide convergent evidence that the cut-off points for Singaporean women were lower than the World Health Organization's criteria but were in good agreement with those reported for Asians.
The objective of the study was to assess nutritional and health status as well as nutritional knowledge in urban middle-aged Malaysian women. The impact of menopause on diet and health indices was also studied. The study included 360 disease free women, non users of HRT,aged > or =45 years with an intact uterus recruited from November 1999 to October 2001. Personal characteristics, anthropometric measurements and blood sample were acquired followed by clinical examination. Nutrient intake and nutritional knowledge was determined by a quantitative FFQ and KAP. The findings showed that urban middle-aged women, aged 51.65+/-5.40 years had energy intakes (EI) 11% below RDA, consisting of 53% carbohydrates, 15% protein and a 32% fat which declined with age. The sample which comprised of 42.5% postmenopausal women had a satisfactory diet and healthy lifestyle practices. Premenopausal women consumed more dietary fat (6%) with other aspects of diet comparable to the postmenopausal women. Iron intake was deficient in premenopausal women, amounting to 56% RDA contributing to a 26% prevalence of anaemia. Overall, calcium intake reached 440 mg daily but dairy products were not the main source. The postmenopaused had a more artherogenic lipid profile with significantly higher total cholesterol (TC) and LDL-C, but more premenopausal women were overweight/obese (49% versus 35%). EI was the strongest predictor for BMI and waist circumference (WC), with WC itself an independent predictor of fasting blood sugar and TC with BMI strongly affecting glucose tolerance. High nutritional knowledge was seen in 39% whereas 20% had poor knowledge. Newspapers and magazines, followed by the subject's social circle, were the main sources of nutritional information. Nutritional knowledge was positively associated with education, household income, vitamin/ mineral supplementation and regular physical activity but inversely related to TC. In conclusion, middle-aged urban women had an adequate diet with low iron and calcium intakes. Nutritional knowledge was positively associated to healthier lifestyle practices and lower TC. A comparable nutrient intake and lifestyle between pre and postmenopausal women suggested that health changes associated with menopause was largely independent of diet.
A low body mass index in older people has been associated with increased mortality. The main objective of this study was to identify factors associated with low body mass indices [ BMIs] (< 18.5 kg/m2) in older residents of shelter care facilities in Peninsular Malaysia. 1081 elderly people (59% M) over the age of 60 years were surveyed using questionnaires determining baseline demographics, nutritional and cognitive status, physical function and psychological well being. Body mass index was also determined. Subjects were recruited from publicly funded shelter homes in Peninsular Malaysia. 14.3% of residents had BMIs < 18.5 kg/m2. Multivariate analyses (adjusted for age and sex) revealed that having no family (RR 1.98[95%CI 1.40-2.82], p<0.001) and negative responses to statement 3 [I eat few fruits or vegetables or milk products] (RR 0.62 [95% CI 0.42-0.90]; P= 0.013) and statement 5 [I have tooth or mouth problems that make it hard for me to eat] (RR 0.69 [95%CI 0.50-0.96]; P= 0.023) of the ' Determine Your Nutritional Health Checklist' were independently associated with low BMIs (<18.5 kg/m2). Older people with no family support were at risk of becoming underweight. Older people who consumed fruits, vegetables or milk or had good oral health were less likely to be underweight. Nutrient intake, oral health and social support were important in ensuring healthy body weight in older Malaysians.
The aim of this study is to highlight the baseline characteristics of the results of a screening test for anaemia among infants in a village in Okinawa, Japan. The groups were classified into two; infants with and without anaemia. A total of 201 infants were screened at 3-4 months, 9-10 months and 18 months. The study showed that gestational age and BMI were predictive of anaemia at 3-4 months of age. At 9-10 months, types of feeding and weight ratio were the only factors that were found to be significantly predictive of anaemia. However, no factor was found to be predictive of anaemia at 18 months. Anaemia cases were found to occur at 3-4 months and 9-10 months. Most of the anaemia cases have successfully undergone treatment.
Dietary intakes and lifestyle habits during adolescence may predict the occurrence of obesity and other diet-related chronic diseases later in life. The purpose of this study was to determine dietary intake of adolescents in a fishing community in Tuaran District, Sabah. A total of 199 apparently healthy adolescents comprising 94 male and 105 female subjects were purposively selected for the study. The mean age of the subjects was 15.2 f 2.2 years with female subjects having a higher mean age of 15.7 f 2.4 years compared to the males (14.6 k1.8 years). The mean BMI of the subjects was 18.4 f 2.9 kg/m2 with females having a significantly higher BMI (18.9 f 2.8 kg/m2) than the males (17.8 f 3.0 kg/m2). Based on the WHO classification (WHO, 1995), 19.6% of the subjects could be classified as thin while 4.5% were at risk of overweight. Overall for both sexes, intake of energy and most nutrients were below the Malaysian recommended nutrient intake (RNI) levels for adolescents, with the exception of vitamin C and niacin. The male subjects showed higher mean intake for vitamin A, thiamine, niacin and vitamin C than the females. Calcium and iron intake ranked among the lowest levels, at 33.4% and 47.2% respectively of the RNI values for both sexes. The main sources of energy were rice, flour products and tubers while fish and seafood were the chief sources of protein. Majority of the subjects (84%) reported taking breakfast daily, which often consisted of fried noodles, fried banana, doughnuts and coffee. Consumption of snacks was popular and commonly consumed snacks were bread, biscuits, and fried banana. The present study revealed that 25.5% and 14.3% of the male and female adolescents respectively were thin, with majority of them consuming inadequate levels of energy and several key nutrients. The results underscore the need for adolescents to be targeted for nutrition and health education as they go through a period of marked physical, physiological and psychological changes.
Overweight during adolescence has many psychological consequences and low self·esteem is the immediate detrimental effect observed. Adolescents with low self»esteem are at risk for many emotional and behavioural disorders while high self-esteem adolescents experience an incremental improvement in their quality of life. The objective of this study was to compare seh'-esteem between overweight and non-overweight Malay adolescents in Kota Bharu, Kelantan. A cross-sectional study was conducted between January to ]une 2005 among 1364 students selected from ten co-educational government secondary schools in Kota Bharu using stratified multistage cluster sampling. A set of guided self-administered questionnaire which included a Malaysian version of Rosenberg Self-Esteem Scale and Body Mass Index measurement was used. Data was entered using SPSS 12.0 and analysed using STATA 8. O. The prevalence of overweight among secondary school students in Kota Bharu was 12.5% and there was no significant difference in self-esteem between overweight and non-overweight students. However, the findings may not be generalized to out-of-school youth and other ethnic groups in this country. Infomation on other modifers, such as parental acceptance or lack of concern regarding the child’ obesity was not elicited in this study. It is an important protective factor for self-esteem and need to be included in future studies.
Despite awareness of the detrimental effects of smoking, many adolescents initiate or continue to smoke. One possible explanation for smoking 13 the belief that it can control body weight. The objective of this study was to determine the association between Body Mass Index and smoking among Malay adolescents in Kota Bharu, Kelantan. A cross·sectional study was conducted between January to June 2005 among 1364 students selected from ten co»educational government secondary schools in Kota Bharu using stratified multistage cluster sampling. Guided self-administered questionnaire and anthropometric measurement were taken. Data was entered using SPSS 12.0 and analysed using STATA 8.0. The overall prevalence of smoking was 6. 7%. The prevalence of smoking among boys was 13.8% and among girls was 1.1%. There was no association between Body Mass Index and smoking. However, the findings may not be generalized to out-of·school youth and other ethnic groups in this country. The study was not conducted anonymously and the use of questionnaire to report smoking status can lead to measurement bias. Strategies aimed at correcting the belief that smoking can reduce weight should be included as one of the components in the prevention of smoking.
There is concern that shift workers are at higher risk for metabolic syndrome (MS) . The syndrome is characterized by a constellation of metabolic risk factors in one individual. A cross-sectional study of 148 workers in one factory in Kota Bharu, Kelarttan was conducted to examine relationships between shift work and five of the MS rnk factors namely high blood pressure, hyperglycemia, hypertriglyceridaemia, hypo·I·IDL-cholesterolaemia and high body mass index (BMI) . Data was collected through a questionnaire on psychosocial and life-style factors, anthropometric and blood pressure measurements, fasting blood sugar and fasting lipid profile. The National Cholesterol Education Program’s Adult Treatment Panel III Report (NCEPATP III) with some modifications was used to determine the presence of risk factors for the metabolic syndrome, The prevalence of high blood pressure, hypertriglyceridaemia and high BMI were significantly higher among shift workers compared to day workers. There was no difference in the prevalence of hyperglycemia and hypo-HDL-cholesterolaemia. When the shift workers were compared with the
day workers, the proportion of workers having three or more risk factors for the syndrome was higher among shift workers which were 15.8% and 5.6% respectively.
Patient understanding and perception of diabetes control is important if clinicians were to allow diabetes patients to play a central role in management of their illness. We conducted a survey to see what diabetic patients generally thought of their understanding of disease and glycemic control; if these perceptions were accurate and related to complications.
One hundred and eight consecutive patients (mean age 52.7± 13 years, BMI 27±5.2 kg/m2, HbA1c 9.2±2.2 %) attending diabetes clinic participated including 63% women, 60% primary or no education, and 47% duration of diabetes >10 years. 54% claimed to have a good understanding although nearly half answered questions on diabetes management and targets wrongly. 32% perceived their glycemic control to be good and were found to have lower baseline HbA1c (p
Plasma total homocysteine levels (tHcy) is lowered by high insulin levels, and it can be elevated in insulin-resistant states. However, it is uncertain whether plasma tHcy and insulin or any components of the metabolic syndrome has any relationship among hypertensive individuals. In this study the tHcy and insulin concentrations were measured by enzyme immunoassay techniques in samples from 41 (27 male and 14 female) participants. Components of the metabolic syndrome (insulin resistance) profiles were also evaluated. The participants’ age ranged from 31 to 67 years (mean+SEM, 52.1±1.3 years), body mass index from 20.2 to 38.3 kg/m2 (27.2±0.7 kg/m2), plasma tHcy concentration from 6.9 to 16.2 μmol/L (11.0±0.4 μmol/L), and plasma insulin 3.0 to 16.6 μIU/mL (7.3±0.5 μIU/mL). A significant negative correlation was found between tHcy concentrations and insulin levels (r=-0.358, P=0.011), but not with other variables (P>0.05). In conclusion, the tHcy concentration is significantly related to plasma insulin in hypertensive subjects. tHcy concentrations were independent of the components of the metabolic syndrome and other risk factors of coronary heart disease in hypertensive subjects.
Objectives: This study was carried out to determine the nutritional status of primary
school children aged 6 to 11 years in Sepang District and to compare the results with a
similar study carried out in 1999. Methods: This cross-sectional study was carried out in
Sepang District using stratified random cluster sampling technique. A pre-tested, structured
questionnaire was used to collect the data. Weight was recorded using a digital bathroom
scale TANITA model HD-309 and height was measured by using a SECA Body meter
Model 208. Body mass index (BMI) was calculated as weight in kilograms divided by the
square of height in meters. Classifications of the nutritional status of respondents was
based on WHO classification 1983 and 1995. Data were analysed using SPSS. Results:
The overall mean BMI for the 1,910 respondents was 16.8 (95% CI= 16.67 - 16.99;
SE=0.08). The median BMI was 15 .7 ranging from 9.51 to 36.75 kg/m2. The majority
(84.4%) had normal weight-for-age status, 7.6% respondents had weight-for-age status
below -2 SD of the NCHS-WHO median and 8.0% had weight-for-age status above +2 SD
of the NCHS-WHO median. The prevalence of underweight and overweight was significantly
higher in the males compared to the females (p< 0.05). There was a significant association
between underweight and ethnicity (p< 0.05). The majority (90.3%) had normal heightfor-
age status, 8.8% had height-for-age below - 2 SD of the NCHS-WHO standard median
and 0.9% had height-for-age above 2 SD from the NCHS median. The prevalence of
stunting was significantly higher in the male (10.3%) as compared to 7.4% in the females
(X2 = 5.11, P = 0.02). The majority (81.4%) of the respondents were within the normal
weight-for-height, 3.4% were wasted (weight-for-height was below - 2 SD of the NCHSWHO
median) and 15.2% of the respondents were obese (weight-for-height that is more
than +2 SD of the NCHS-WHO median). The prevalence of wasting was higher in the
females (4.1 %) compared to males (2.8%). The prevalence of obesity was slightly higher
in the males (15.4%) compared to females (14.9%). Conclusion: The overall nutritional
status of primary schools children is good. However, there still exists pockets of population
in Sepang where chronic and acute forms of undernutrition persist in these children.
Objective: This study was conducted to determine prevalence and factors associated with obesity in Selangor, Malaysia. Methods: A population-based cross-sectional study was conducted in all districts of Selangor State. All individuals, 15 years and above in the selected households, were included. A pre-tested structured questionnaire was used to collect the data. Weight was recorded using TANITA model HD-309 and height was measured using SECA Body meter Model 208. Statistical analysis was performed using Stata 8.2 taking into account the complex survey design. Results: The overall mean age of the 2219 respondents was 36.6(95% CI 35.7 – 37.6) years. There was no significant difference in the mean age of the males and females (p=0.697). The majority of the respondents were Malays (52.9%), followed by Chinese (30.9%), Indians (15.4%) and
other races (0.9%). The overall mean BMI was 24.1 kg/m2 (95% CI=23.8- 24.4). The overall prevalence of obesity was 12.2% (95% CI 10.6%, 14.0%). There was no significant difference in the prevalence of obesity in the males compared to females (p>0.05). The prevalence of obesity increased with age up to the ages of 40-59 years and then decreased after 60 years. The highest prevalence of obesity was in the 40-59 years age groups in both sexes. The overall prevalence of obesity was significantly higher amongst the Malays (15.2%) compared to the Indians (11.6%) and Chinese (7.3%). Multivariate logistic regression analysis showed that only age and ethnicity were associated with obesity. Sex and educational level were not associated with obesity.