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The nutrition and health transition in Malaysia

Noor MI

Public Health Nutr, 2002 Feb;5(1A):191-5.
PMID: 12027284

The accelerated phase of industrialisation and urbanisation in recent decades has inevitably brought about changes in the lifestyle of Malaysians. Changes in dietary habits and sedentary lifestyles are known to be associated with changes in health and increased prevalence of chronic diseases in the population. The objective of this paper is to provide a better understanding of the link between demographic variables and food consumption patterns related to the nutrition transition in Malaysia. This review uses various reports and publications from several ministries and selected local studies. The statistics compiled over the last two decades have shown that as the population achieves affluence, intakes of calories, fats and sugars increase, which may account for the substantial increase in food importation bills over the same period. Similarly, the rapid growth of the fast food industry during the last decade has added another dimension to the change in food consumption patterns of Malaysians. With the exception of a study on adolescents, the prevalences of overweight and obesity in children and adults are not strictly comparable due to the difference in body mass index (BMI) cut-off points in children and the study protocol in adults, and hence should not be misinterpreted as trends. The recent recommendation to lower the BMI cut-off points for Asians would only increase the magnitude of the existing prevalence among adults. The need to promote healthy nutrition for the population must be pursued vigorously, as the escalation of nutrition-related chronic degenerative diseases - once an urban phenomenon--has now spread to the rural population at an alarming rate. This paper indicates that the problem is real and needs urgent attention because it may be just the tip of the iceberg.

Matched MeSH terms: Chronic Disease/mortality*; Chronic Disease/epidemiology*
Risk factors and incident coronary heart disease in Chinese, Malay and Asian Indian males: the Singapore Cardiovascular Cohort Study

Lee J, Heng D, Chia KS, Chew SK, Tan BY, Hughes K

Int J Epidemiol, 2001 Oct;30(5):983-8.
PMID: 11689508

OBJECTIVE: This prospective study in Singapore investigated the relationships of established coronary risk factors with incident coronary heart disease (CHD) for Chinese, Malay, and Asian Indian males.
SUBJECTS: A cohort (consisting of 2879 males without diagnosed CHD) derived from three previous cross-sectional surveys.
METHODS: Individual baseline data were linked to registry databases to obtain the first event of CHD. Hazard ratios (HR) or relative risks for risk factors were calculated using Cox's proportional hazards model with adjustment for age and ethnic group and adjustment for age, ethnic group and all other risk factors (overall adjusted).
RESULTS: There were 24,986 person-years of follow-up. The overall adjusted HR with 95% CI are presented here. Asian Indians were at greatest risk of CHD, compared to Chinese (3.0; 2.0-4.8) and Malays (3.4; 1.9-3.3). Individuals with hypertension (2.4; 1.6-2.7) or diabetes (1.7; 1.1-2.7) showed a higher risk of CHD. High low density lipoprotein cholesterol (LDL-C) (1.5; 1.0-2.1), high fasting triglyceride (1.5; 0.9-2.6) and low high density lipoprotein cholesterol (HDL-C) (1.3; 0.9-2.0) showed a lesser but still increased risk. Alcohol intake was protective with non-drinkers having an increased risk of CHD (1.8; 1.0-3.3). Obesity (body mass index > or =30) showed an increased risk (1.8; 0.6-5.4). An increased risk of CHD was found in cigarette smokers of > or =20 pack years (1.5; 0.9-2.5) but not with lesser amounts.
CONCLUSIONS: The increased susceptibility of Asian Indian males to CHD has been confirmed in a longitudinal study. All of the examined established risk factors for CHD were found to play important but varying roles in the ethnic groups in Singapore.

Matched MeSH terms: Coronary Disease/blood; Coronary Disease/ethnology*
HIV in Southeast Asia

Abrams S

Harv AIDS Rev, 1998.
PMID: 12294443
Matched MeSH terms: Disease; Disease Outbreaks*; Virus Diseases
Fulltext Hand, foot and mouth disease: University Malaya Medical Centre experience

Hooi PS, Chua BH, Lee CSM, Lam SK, Chua KB

Med J Malaysia, 2002 Mar;57(1):88-91.
PMID: 14569723 MyJurnal

The prevalence of HFMD as well as the causative agents was unknown in peninsular Malaysia prior to May 1997. From May 1997 to June 2001, 585 patients suspected to have enterovirus infections, with 467 patients clinically diagnosed as having HFMD, were investigated in the diagnostic virology unit of the University Malaya Medical Centre. Data from this study showed that HFMD is endemic in Malaysia with the occurrence of two outbreaks during the study period. In each outbreak, a number of viruses were isolated but enterovirus 71 was the main virus isolated in both outbreaks. Echovirus 7 (Eo7) was isolated from 5 patients with HFMD in the second outbreak, a clinical entity that has not been attributed to it previously. Children aged 4 years and below, particularly those between 1 and 2 years of age, were in the main group of patients affected by the illness. HFMD by itself and without neurological involvement was relatively benign and self-limiting. There was no significant difference in the virus isolation rate with respect to gender and ethnic groups. Virus isolation was attempted in a total of 764 clinical specimens consisting of 342 stool specimens, 285 oral secretions specimens and 137 vesicular fluid specimens. Oral specimens gave the highest virus isolation rate (33.3%) followed by vesicular specimens (27.0%). Stool specimens only yielded an isolation rate of 14.0%.

Matched MeSH terms: Hand, Foot and Mouth Disease/epidemiology*; Hand, Foot and Mouth Disease/virology
The effect of bradykinin and its antagonist on survival time after coronary artery occlusion in hypertensive rats

Abbas SA, Sharma JN, Yusof AP

Immunopharmacology, 1999 Oct 15;44(1-2):93-8.
PMID: 10604530

It is known that BK does play a role in the cardioprotective effect of angiotensin converting enzyme (ACE) inhibitors. The present study therefore was conducted to examine the effects of bradykinin (BK) and its antagonist on survival time in spontaneously hypertensive rats (SHR) with coronary artery ligation for 15 min and continuously. We also evaluated the heart rate and blood pressure (BP) in the presence and absence of BK and BK2 receptor antagonist, D-Arg-[Hyp-D-Phe7]BK. Coronary artery was ligated in anaesthetized rats and they were artificially ventilated with room air (stroke volume, 4 ml; 48 strokes/min) as described by the previous investigators. Lead II elecrocardiogram (ECG) was recorded from subcutaneous steel needle electrodes. Results of this investigation indicated that BK treatment 4 microg/kg (i.v.) and 8 microg/kg (i.v.) caused significant (P < 0.05) increase in survival time in SHR with coronary artery ligation for 15 min and continuously as compare to their respective saline-treated controls. However, BK antagonist treatment 4 microg/kg (i.v.) abolished the increase in survival time caused by BK treatment. The mean values of survival time between the saline-treated and BK antagonist plus BK-treated rats did not differ significantly (P > 0.05). The heart rate and BP responses were greatly reduced (P < 0.001) in the presence of coronary artery ligation. These findings suggest that BK might have cardioprotective effect to increase the survival time in rats by activating BK2 receptors after coronary artery ligation.

Matched MeSH terms: Coronary Disease/metabolism*; Coronary Disease/mortality*
Corneal arcus and cardiovascular risk factors in Asians in Singapore

Hughes K, Lun KC, Sothy SP, Thai AC, Leong WP, Yeo PB

Int J Epidemiol, 1992 Jun;21(3):473-7.
PMID: 1634308

This study was a cross-sectional random survey of the whole of Singapore, based on 2143 subjects (aged 18-69 years, response rate 60.3%). The presence of corneal arcus was determined by a doctor using the naked eye in good light. Cardiovascular risk factors were measured by standardized techniques. The prevalence rates overall of corneal arcus were: 18-29 years (males 0.5%, females 0.3%), 30-49 years (males 18.1%, females 13.3%) and 50-69 years (males 70.7%, females 55.3%). In the 30-49 age group, people with arcus had higher serum low density lipoprotein (LDL) cholesterol concentrations than people without arcus, the mean differences being, males 0.31 mmol/l (P = 0.040) and females 0.62 mmol/l (P less than 0.001) with an increased likelihood of having values greater than 5.5.mmol/l of males 1.8 (95% confidence interval (95% CI): 1.0-3.4) and females 2.6 (95% CI: 1.4-4.8). There were no significant differences for LDL-cholesterol in the 50-69 age group. Arcus was weakly associated with fasting plasma glucose in the 30-49 age group. Arcus was not associated with serum high density lipoprotein (HDL) cholesterol, serum fasting triglyceride, blood pressure and cigarette smoking. It is concluded that while corneal arcus is primarily an age-related change, its formation is accelerated by high serum LDL-cholesterol so that in people under 50 years it is a marker for the condition.

Matched MeSH terms: Coronary Disease/ethnology; Coronary Disease/epidemiology*
Percutaneous transvenous mitral commissurotomy in patients with severe kyphoscoliosis

Ramasamy D, Zambahari R, Fu M, Yeh KH, Hung JS

Cathet Cardiovasc Diagn, 1993 Sep;30(1):40-4.
PMID: 8402863

Because transseptal catheterization is felt to be contraindicated in patients with severe kyphoscoliosis, there have been no reports of percutaneous transvenous mitral commissurotomy performed in such patients. This report describes percutaneous transvenous mitral commissurotomy in three patients with severe thoracic kyphoscoliosis, with special emphasis on the transseptal puncture technique. Biplane right atrial angiography and the contrast septal flush method are very useful in landmark selection for a safe transseptal puncture.

Matched MeSH terms: Rheumatic Heart Disease/complications; Rheumatic Heart Disease/therapy
For the sake of purity (and control). Female genital mutilation

Gilbert D

Links, 1993;9(5):6-8, 30.
PMID: 12159278
Matched MeSH terms: Pelvic Inflammatory Disease*; Disease
Indonesia and Vietnam may face AIDS pandemic

AIDS Wkly Plus, 1996 Oct 28.
PMID: 12320487
Matched MeSH terms: Disease; Disease Outbreaks*; Virus Diseases
Fulltext Rheumatic heart disease in Malaysia

Jamal F, Mohd Salleh H, Tan SP

World Health Forum, 1994;15(1):56-7.
PMID: 8141979
Matched MeSH terms: Rheumatic Heart Disease/etiology; Rheumatic Heart Disease/epidemiology*
Fulltext Cholesterol reduction therapy: a double-edged knife

Ong HT

Med J Malaysia, 1993 Jun;48(2):107-12.
PMID: 8350783

Cholesterol reduction reduces ischaemic cardiovascular morbidity and mortality in the asymptomatic healthy population as well as in those with known coronary artery disease. Angiographic studies have also demonstrated regression of atherosclerotic plaques as well as retardation of new atheroma formation with such therapy. Yet, there is a consistent inability to reduce overall mortality in cholesterol-lowering drug trials. An excess of suicide, homicide and violence has been attributed to cholesterol reduction interfering with membrane lipids and receptors, leading to aggressive behaviour. The risk and benefits of cholesterol reduction must thus be weighed in the individual patient; it is more useful in those with known coronary artery disease who are at high risk of subsequent ischaemic cardiovascular events.

Matched MeSH terms: Coronary Disease/mortality; Coronary Disease/prevention & control
Total occlusion of left main coronary artery in Orientals: profile of 4 cases

Soo CS, Ling LH, Yeoh JK, Choo M, Kannan P

Angiology, 1993 Dec;44(12):929-32.
PMID: 8285368

The authors report 4 Oriental cases of total occlusion of the left main coronary artery (LMCA) with differing presentations. The first patient had a twelve-year history of stable angina pectoris. The second patient had angina for a year, which became unstable two months prior to diagnosis. The third patient had myocardial infarction seven years ago and presented with a one-month history of rest angina. The fourth patient had stable effort angina for six years but presented with accelerated angina three months prior to diagnosis. The incidence of total occlusion of the LMCA is rare and survival depends on the existence of collateral circulation. In LMCA disease, there is usually disease in other parts of the coronary arterial tree, and hence, the need for urgent coronary bypass surgery.

Matched MeSH terms: Coronary Disease/complications; Coronary Disease/ethnology*
Fulltext The surgical treatment of multiple small bowel strictures in Crohn's disease by combined resection and stricturoplasty

Kum CK, Sim EK, Ngoi SS, Goh P, Sinniah R

Med J Malaysia, 1992 Dec;47(4):323-7.
PMID: 1303488

Crohn's disease is extremely rare among Asians. Resection of strictures causing obstruction has traditionally been the accepted choice in surgical therapy. This may lead to problems such as iatrogenic short bowel syndrome and its sequelae. Stricturoplasty is an acceptable and safe alternative. We report a case where combined stricturoplasty and resection was performed safely and advocate its use.

Matched MeSH terms: Crohn Disease/complications*; Crohn Disease/pathology
Fulltext Coronary risk factors among Malaysian male executives in two urban areas

Teo PH, Chong YH, Abdul Rahman MZ

Med J Malaysia, 1988 Jun;43(2):125-33.
PMID: 3237128
Matched MeSH terms: Coronary Disease/ethnology; Coronary Disease/epidemiology*
Fibroadenomatoid mastopathy: another distractive breast lesion?

Tan PE, Looi LM

Malays J Pathol, 1991 Dec;13(2):101-4.
PMID: 1823090

Although most anatomical pathologists have encountered breast lesions with the composite histological features of fibroadenoma (FA) and fibrocystic change (FC), referred to as fibroadenomatosis or fibroadenomatoid mastopathy (FAM), little is known about its prevalence or clinico-pathological significance. In a retrospective histological review of 400 consecutive breast lesions, among both East and West Malaysians, coded either as FA or FC in the files of the Department of Pathology, University of Malaya, we found 45 (11.3%) cases of FAM. Typically, FAM lesions showed fibroadenomatoid foci in a background of fibrocystic change. The finding of FAM among lesions coded as FC was higher (18.5%) than among FA (4%). The mean age of patients with FAM (32.1 years) was similar to FC (35.1 years) but significantly older than that of FA (26.1 years). The notion that FA and FC are lesions at two ends of a spectrum of growth disorder of breast related to oestrogen-progesterone interplay, and that FAM occupies a position intermediate between the two, may explain its morphological and age patterns, but remains speculative. It is hoped that increasing awareness of this condition will lead to better understanding of breast pathophysiology. Nevertheless, until its biological nature, histogenesis and malignant potential are more clearly understood, defining FAM as a distinct form of breast disease may not be meaningful to patient management.

Matched MeSH terms: Fibrocystic Breast Disease/epidemiology; Fibrocystic Breast Disease/pathology*
Fulltext Smoking profile and coronary risk among patients admitted to the Coronary Care Unit, General Hospital, Kuala Lumpur

Leng DQ, Ying LL, Moy YA, Leng SO

Med J Malaysia, 1987 Sep;42(3):156-65.
PMID: 3506637

A six-month survey of 828 patients admitted to the Coronary Care Unit (CCU) of the General Hospital, Kuala Lumpur was carried out to ascertain whether the smoking habits of the patients predisposed them to definite coronary events and its immediate outcome i.e. early mortality (within seven days). The various ethnic groups were also screened to determine if they were at increased risk to coronary events in relation to other known risk factors. Three hundred and eleven patients - 239 males, and 72 females - had confirmed acute myocardial infarctions of whom 190 were smokers (172 males, and 18 females). Sixty-nine infarct patients died within the first seven days post-Ml: 35 were smokers (50.7%). Two-hundred and eighty other patients had non-infarct coronary events. Of these, 167 were smokers. In contrast, only 99 out of 237 patients admitted for non-coronary events, were smokers. It thus appeared that patients admitted to the CCU for suspected cardiac events had a greater incidence of confirmed acute myocardial infarction or acute coronary events if they were smokers (p < 0.001). Mortality from these coronary events was not seen to increase among smokers in this population sample. Women who smoked as a whole, were not found to be at increased risk to coronary events, but women smokers 60 years and older were shown to be at increased risk to developing confirmed coronary events (p < 0.01).

Matched MeSH terms: Coronary Disease/ethnology; Coronary Disease/etiology*
Major gynaecological surgery in patients with severe coronary artery disease--the combined approach

Kannan P, Sivanesaratnam V, Jeyamalar R, Delilkan A, Ong G

Aust N Z J Obstet Gynaecol, 1990 May;30(2):146-9.
PMID: 2400358

The gynaecologist today is likely to encounter elderly patients with severe coronary heart disease requiring major gynaecological surgery. The successful outcome in 2 such patients with compromised coronary circulation and impaired left ventricular function emphasized the importance of combined care with the cardiologist and the anaesthetist. The insertion of a Swan-Ganz catheter for close perioperative monitoring is vital. The intra-and postoperative problems are discussed.

Matched MeSH terms: Coronary Disease/complications*; Coronary Disease/physiopathology
Fulltext Coronary artery bypass graft (CABG) surgery: current University Hospital (K.L.) experience

Ghani SA

Med J Malaysia, 1991 Mar;46(1):21-7.
PMID: 1836034

A personal series of 163 patients who underwent coronary artery bypass surgery (CABG) in the University Hospital, Kuala Lumpur between March 1988 and December 1990 were reviewed retrospectively to determine factors affecting hospital morbidity and mortality. One hundred and thirty eight were elective cases while 25 patients underwent emergency CABG surgery. Of these, 15 patients had recent myocardial infarction, with unstable haemodynamics or post infarct angina; six had failed angioplasty procedures and four patients immediately following coronary angiogram. The elective hospital mortality rate was 2.2% (three cases) and there were two deaths in the emergency group. Pre-operatively 20 patients (13%) had very poor left ventricular function of less than 30% ejection fraction. Significant improvement in ejection fraction was observed following surgery. The follow-up periods were between three months to three years. Ninety eight percent of patients showed improvement in their functional status (NYHA classification) in relation to angina and exercise performance.

Matched MeSH terms: Coronary Disease/mortality; Coronary Disease/surgery*
Fulltext Aspirin and vascular disease--an update

Med J Malaysia, 1988 Sep;43(3):267-8.
PMID: 3241590

Reproduced from Quarterly Review, National Dairy Council Nutrition Services, London (NIS/9/88)

Matched MeSH terms: Coronary Disease/drug therapy; Coronary Disease/prevention & control
Off-pump coronary artery bypass grafting in a high-risk dextrocardia patient: a case report

Abdullah F, Mazalan SL

Heart Surg Forum, 2004;7(3):E186-8.
PMID: 15262598

We present an interesting but high-risk case of an obese male patient aged 56 years with dextrocardia and a left diaphragmatic hernia. Anterior myocardial infarction was diagnosed in 1994, and the patient later presented with a history of unstable angina. The diagnosis for this chronic smoker was triple-vessel disease, impaired left ventricular function, chronic renal failure, chronic bronchitis, impaired lung function, pulmonary hypertension, hypertension, diabetes, and chronic active gastritis (EuroSCORE of 10). The patient underwent successful off-pump coronary artery bypass grafting with 3 saphenous vein grafts to the left anterior descending, obtuse marginal, and right posterior descending arteries. He was discharged home 8 days later.

Matched MeSH terms: Coronary Artery Disease/complications*; Coronary Artery Disease/surgery*

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