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Major Bioactive Compounds in Essential Oils Extracted From the Rhizomes of Zingiber zerumbet (L) Smith: A Mini-Review on the Anti-allergic and Immunomodulatory Properties

Tan JW, Israf DA, Tham CL

Front Pharmacol, 2018;9:652.
PMID: 29973880 DOI: 10.3389/fphar.2018.00652

Zingiber zerumbet (L) Smith is part of the Zingiberaceae family, one of the largest families of the plant kingdom. Z. zerumbet is a perennial, aromatic and tuberose plant that grows in humid locations where its center of distribution is located in the South-East Asia region. This plant has been traditionally used in foods and beverages and for ornamental purposes. Although many studies have reported on the biomedical applications of Z. zerumbet, the anti-allergic effects of Z. zerumbet and its major bioactive compounds have not yet been summarized in detail. Many major metabolites that have been reported to contain anti-allergic properties are terpene compounds which can be found in the essential oil extracted from the rhizomes of Z. zerumbet, such as zerumbone, limonene, and humulene. The rhizome is among the part of Z. zerumbet that has been widely used for many studies due to its exceptional biomedical applications. Most of these studies have shown that the essential oil, which can be obtained through hydro-distillation of the rhizomes from Z. zerumbet, is enriched with various active metabolites. Therefore, this mini-review provides an overview of the main aspects related to the anti-allergic and immunomodulatory properties of the major bioactive compounds found in the essential oils extracted from the rhizomes of Z. zerumbet, with the aim of demonstrating the importance of essential oil extracted from the rhizomes of Z. zerumbet and its bioactive compounds in the treatment of allergy and allergy-related diseases, in addition to other widely reported and extensively studied biomedical applications.
Fulltext Comparative study of crude and refined kenaf (Hibiscus cannabinus L.) seed oil during accelerated storage

Chew SC, Tan CP, Nyam KL

Food Sci Biotechnol, 2017;26(1):63-69.
PMID: 30263511 DOI: 10.1007/s10068-017-0009-2

This study assessed the changes of antioxidant activity and bioactive compounds of crude and refined kenaf seed oil during accelerated storage at 65°C for 24 days. 2,2-Diphenyl-1-picrylhydrazyl and 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) radical scavenging assays were used to determine their antioxidant activity. The changes of phenolic, tocopherol, and phytosterol contents during the storage were also studied. The phenolic content and antioxidant activity of refined oil were significantly lower than those of crude oil after the accelerated storage. There was a decrease of 72.5% tocopherol content and 31.1% phytosterol content in the crude oil and a decrease of 67% tocopherol content and 12.1% phytosterol content in the refined oil during the accelerated storage. There was no significant difference in tocopherol and phytosterol contents for crude and refined oils after the storage. The rate of degradation of tocopherol and phytosterol contents in refined oil was slower than that in crude oil during the storage.
Fulltext Dimensions of Interactive Pervasive Game Design: Systematic Review

Kai L, Tan WH, Saari EM

JMIR Serious Games, 2023 Aug 22;11:e42878.
PMID: 37463860 DOI: 10.2196/42878

BACKGROUND: As the gaming industry grows around the world, playing pervasive games is becoming an important mode of entertainment. A pervasive game is one in which the game experience extends into the actual world or where the fictive world of the game merges with the physical world. How pervasive games can adapt to the ever-changing nature of technology and design in current society requires a comprehensive review.
OBJECTIVE: In this systematic review, we aimed to measure and analyze 4 dimensions of pervasive games through development, technology, experience, and evaluation. Moreover, we also aimed to discover and interpret their relationship with game, interaction, experience, and service design.
METHODS: We first chose 3 well-known databases, Web of Science, Scopus, and EBSCO, and searched from 2013 to April 2022. A strictly thorough Boolean search for research keywords such as "pervasive game," "design," and "interactive" resulted in 394 relevant articles. These articles were identified, screened, and checked for eligibility to find valid and useful articles, which were then categorized and analyzed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) method.
RESULTS: The systematic selection was finally left with 40 valid and valuable articles. After categorization and analysis, all articles were classified according to 4 main themes, which were design and development (11/40, 28%), interaction and technology (15/40, 38%), users and experience (9/40, 23%), and evaluation and service (5/40, 13%). These 4 main areas can be subdivided into several smaller areas.
CONCLUSIONS: In the 4 areas of game design, interaction design, experience design, and service design, many scholars have studied pervasive games and made contributions. Although the development and technology of pervasive games have evolved with the times, there is still a need to strengthen emerging design concepts within pervasive games.
Family medicine training during the COVID-19 pandemic: Beyond technological advances

Abdullah A, Hanafi NS, Tan CPL

Malays Fam Physician, 2023;18:47-100.
PMID: 37719693 DOI: 10.51866/mol.331
Out-of-Pocket Cost for Transfusion-Dependent Thalassaemia in Sabah

Liew AC, Shafie AA, Tan BY

Asia Pac J Public Health, 2023 Sep;35(6-7):453-455.
PMID: 37649258 DOI: 10.1177/10105395231197909
Fulltext A Systematic Stereo Camera Calibration Strategy: Leveraging Latin Hypercube Sampling and 2k Full-Factorial Design of Experiment Methods

Hao Y, Tai VC, Tan YC

Sensors (Basel), 2023 Oct 03;23(19).
PMID: 37837069 DOI: 10.3390/s23198240

This research aimed to optimize the camera calibration process by identifying the optimal distance and angle for capturing checkered board images, with a specific focus on understanding the factors that influence the reprojection error (ϵRP). The objective was to improve calibration efficiency by exploring the impacts of distance and orientation factors and the feasibility of independently manipulating these factors. The study employed Zhang's camera calibration method, along with the 2k full-factorial analysis method and the Latin Hypercube Sampling (LHS) method, to identify the optimal calibration parameters. Three calibration methods were devised: calibration with distance factors (D, H, V), orientation factors (R, P, Y), and the combined two influential factors from both sets of factors. The calibration study was carried out with three different stereo cameras. The results indicate that D is the most influential factor, while H and V are nearly equally influential for method A; P and R are the two most influential orientation factors for method B. Compared to Zhang's method alone, on average, methods A, B, and C reduce ϵRP by 25%, 24%, and 34%, respectively. However, method C requires about 10% more calibration images than methods A and B combined. For applications where lower value of ϵRP is required, method C is recommended. This study provides valuable insights into the factors affecting ϵRP in calibration processes. The proposed methods can be used to improve the calibration accuracy for stereo cameras for the applications in object detection and ranging. The findings expand our understanding of camera calibration, particularly the influence of distance and orientation factors, making significant contributions to camera calibration procedures.
Is Using Sodium-Glucose Cotransporter-2 Inhibitors to Treat Adults with Chronic Heart Failure Cost-Effective? A Systematic Review of Cost-Effectiveness Studies

Tan YJ, Ong SC, Kan YM

Appl Health Econ Health Policy, 2023 Nov;21(6):857-875.
PMID: 37646915 DOI: 10.1007/s40258-023-00825-5

OBJECTIVE: This systematic review aimed to summarise the outcomes of economic evaluations that evaluated sodium-glucose cotransporter-2 inhibitors (SGLT2i) in combination with standard of care compared to standard of care alone for patients with chronic heart failure.
METHODS: This systematic review searched MEDLINE, CINAHL+, Econlit, Scopus, the Cochrane Library, the National Health Service Economic Evaluation Database and the Cost-Effectiveness Analysis Registry from inception to 31 December, 2022, for relevant economic evaluations, which were critically appraised using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) and Bias in Economic Evaluation (ECOBIAS) criteria. The costs, quality-adjusted life-years, incremental cost-effectiveness ratios and cost-effectiveness thresholds were qualitatively analysed. Net monetary benefits at different decision thresholds were also computed. Subgroup analyses addressing the heterogeneity of economic outcomes were conducted. All costs were adjusted to 2023 international dollar (US$) values using the CCEMG-EPPI-Centre cost converter.
RESULTS: Thirty-nine economic evaluations that evaluated dapagliflozin and empagliflozin in patients with heart failure were found: 32 for the left ventricular ejection fraction (LVEF) ≤ 40% and seven for LVEF > 40%. Sodium-glucose cotransporter-2 inhibitors were cost-effective in all but two economic evaluations for LVEF > 40%. Economic outcomes varied widely, but favoured SGLT2i use in LVEF ≤ 40% over LVEF > 40% and upper-middle income over high-income countries. At a threshold of US$30,000/quality-adjusted life-year, ~ 90% of high to upper-middle income countries would consider SGLT2i cost-effective for heart failure treatment. The generalisability of study findings to low- and low-middle income countries is limited because of insufficient evidence.
CONCLUSIONS: Using SGLT2i to treat heart failure is cost-effective, with more certainty in LVEF ≤ 40% compared to LVEF > 40%. Policymakers in jurisdictions where economic evaluations are not available could potentially use this study's findings to make informed decisions about treatment adoption.
SYSTEMATIC REVIEW PROTOCOL REGISTRATION: This study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD42023388701).
Fulltext Efficacy of DNA barcode internal transcribed spacer 2 (ITS 2) in phylogenetic study of Alpinia species from Peninsular Malaysia

Tan WH, Chai LC, Chin CF

Physiol Mol Biol Plants, 2020 Sep;26(9):1889-1896.
PMID: 32943824 DOI: 10.1007/s12298-020-00868-1

Alpinia belongs to a large genus with many species found in Peninsular Malaysia. Several species of Alpinia exhibit important medicinal potential. However, progressive studies on the genus Alpinia were hampered by difficulties encountered in species identification. With the advancement achieved in genomic technology, more sensitive tools such as DNA barcoding were developed, which can be used for species identification. Internal Transcribe Spacer 2 (ITS2) is a DNA barcode which has proven to be a promising tool for species identification. The criterions of ITS2 efficacy namely universality and efficacy for species identification were tested on Alpinia species collected from Peninsular Malaysia. The results showed that a success rate of 96.97% was achieved using ITS2 for screening 11 species of Alpinia and an outgroup sample (Zingiber specatabile). Combined with 15 additional sequences from the Genbank for five Alpinia species, ITS2 demonstrated high species identification efficacy with 88.2% of species identified using phylogenetic and distance analysis. The analysis was further improved with the use of ITS2 secondary structure. The results of both criterions demonstrated the ability of ITS2 to successfully discriminate Alpinia species, which will help to improve species identification of Alpinia species in Peninsular Malaysia.
Fulltext Hyperinflammatory Immune Response and COVID-19: A Double Edged Sword

Tan LY, Komarasamy TV, Rmt Balasubramaniam V

Front Immunol, 2021;12:742941.
PMID: 34659238 DOI: 10.3389/fimmu.2021.742941

The coronavirus disease-19 (COVID-19) elicited by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused devastating health, economic and social impact worldwide. Its clinical spectrum ranges from asymptomatic to respiratory failure and multi-organ failure or death. The pathogenesis of SARS-CoV-2 infection is attributed to a complex interplay between virus and host immune response. It involves activation of multiple inflammatory pathways leading to hyperinflammation and cytokine storm, resulting in tissue damage, acute respiratory distress syndrome (ARDS) and multi-organ failure. Accumulating evidence has raised concern over the long-term health effects of COVID-19. Importantly, the neuroinvasive potential of SARS-CoV-2 may have devastating consequences in the brain. This review provides a conceptual framework on how the virus tricks the host immune system to induce infection and cause severe disease. We also explore the key differences between mild and severe COVID-19 and its short- and long-term effects, particularly on the human brain.
Fulltext Endovascular Treatment of Cavernous Sinus Dural Arteriovenous Fistula via Radial Artery and Median Cubital Vein

Tan WN, Rajadurai A, Balakrishnan D

Neurointervention, 2021 Jul;16(2):194-198.
PMID: 34107596 DOI: 10.5469/neuroint.2021.00157

Cavernous sinus dural arteriovenous fistula (CS-DAVF) is an arteriovenous shunt where there is fistulous blood flow from the dural arteries from the internal or external carotid artery into the cavernous sinus. The current mainstay of therapy is endovascular treatment. We present a case of restrictive type of CS-DAVF in a 75-year-old male who presented with right eye symptoms. He was treated with embolisation using trans-radial artery access for angiographic runs and a median cubital vein access navigating into the cavernous sinus for coil deployment. This technique completely avoids the conventional technique of a femoral approach and confines all access to the arm. Therefore, there are less risks and complications associated with an arm access, improves patients' comfort and mobility post procedure. Transradial artery and cubital vein access allows for a safe and convenient alternative technique using the arm as compared with conventional transfemoral approach for treatment of CS-DAVF.
Fulltext BZD9L1 Differentially Regulates Sirtuins in Liver-Derived Cells by Inducing Reactive Oxygen Species

Lee YT, Tan YJ, Oon CE

Biomedicines, 2023 Nov 15;11(11).
PMID: 38002059 DOI: 10.3390/biomedicines11113059

Growing evidence has highlighted that mitochondrial dysfunction contributes to drug-induced toxicities and leads to drug attrition and post-market withdrawals. The acetylation or deacetylation of mitochondrial proteins can affect mitochondrial functions as the cells adapt to various cellular stresses and other metabolic challenges. SIRTs act as critical deacetylases in modulating mitochondrial function in response to drug toxicity, oxidative stress, reactive oxygen species (ROS), and energy metabolism. We previously showed that a recently characterised SIRT inhibitor (BZD9L1) is non-toxic in rodents in a short-term toxicity evaluation. However, the impact of BZD9L1 on mitochondrial function is unknown. This work aims to determine the effects of BZD9L1 on mitochondrial function in human normal liver and kidney-derived cell lines using the Agilent Seahorse Cell Mito Stress Test to complement our short-term toxicity evaluations in vivo. The Mito Stress assay revealed that BZD9L1 could potentially trigger oxidative stress by inducing ROS, which promotes proton leak and reduces coupling efficiency in liver-derived THLE cells. However, the same was not observed in human kidney-derived HEK293 cells. Interestingly, BZD9L1 had no impact on SIRT3 protein expression in both cell lines but affected SOD2 and its acetylated form at 72 h in THLE cells, indicating that BZD9L1 exerted its effect through SIRT3 activity rather than protein expression. In contrast, BZD9L1 reduced SIRT1 protein expression and impacted the p53 protein differently in both cell lines. Although BZD9L1 did not affect the spare respiratory capacity in vitro, these findings call for further validation of mitochondrial function through assessment of other mitochondrial parameters to evaluate the safety of BZD9L1.
Care for the Environment as a Consideration in Bioethics Discourse and Education

Calderon PEE, Tan MKM

New Bioeth, 2023 Dec;29(4):352-362.
PMID: 37262398 DOI: 10.1080/20502877.2023.2219021

This article argues that environmental considerations fall within the scope of medical bioethics, and there are implications specific to medical education. It endorses the need to expand the scope and epistemology of contemporary medical bioethics discourse by including themes related to environmental considerations. Our discussion begins by providing a brief history of environmental bioethics. It then offers a critique of three specific health and environmental issues, namely technology, toxics, and consumption, and discusses how these issues are key to articulating moral considerations of human health and subsequently medicine and its teaching. Lastly, it explores criticisms of including environmental issues into the bioethical debate before providing suggestions of how environmental ethics can be included into the medical curriculum. This article concludes by suggesting theoretical possibilities for environmentally inclusive bioethics, such as reorienting bioethical discussions to its original environmental advocacy and supporting environmental bioethics as a competency in medical education.
Transitional Care in Anorectal Malformation and Hirschsprung's Disease: A Systematic Review of Challenges and Solutions

Plascevic J, Shah S, Tan YW

J Pediatr Surg, 2023 Nov 02.
PMID: 37996349 DOI: 10.1016/j.jpedsurg.2023.10.066

BACKGROUND: The literature on transitional care in anorectal malformation (ARM) and Hirschsprung's disease (HD) is diverse and heterogeneous. There is a lack of standards and guidelines specific to transitional care in these conditions. We aim to establish and systematically categorize challenges and solutions related to colorectal transition care.
METHODS: Systematic review of qualitative studies from MEDLINE, EMBASE, PubMed and Scopus databases (2008-2022) was conducted to identify the challenges and solutions of healthcare transition specific to ARM and HD. Thematic analyses are reported with reference to patient, healthcare provider and healthcare system.
RESULTS: Sixteen studies from 234 unique articles were included. Fourteen themes related to challenges and solutions, each, are identified. Most challenges identified are patient related. The key challenges pertain to: (1) patient's lack of understanding of their disorder, resulting in over-reliance on the pediatric surgical team and reluctance towards transitioning to adult services; (2) a lack of education and awareness among adult colorectal surgeons in caring for pediatric colorectal conditions and inadequate communication between pediatric and adult teams; and (3) a lack of structured transition program and joint-clinic to meet the needs of the transitioning patients. The key solutions are: (1) fostering young adult patient's autonomy and independence; (2) conducting joint pediatric-adult transition clinics; and (3) ensuring a structured and coordinated transition program is available using a standardized guideline.
CONCLUSION: A comprehensive framework related to barriers and solutions for pediatric colorectal transition is established to help benchmark care quality of transitional care services.
LEVEL OF EVIDENCE: IV.
TYPE OF STUDY: Systematic review without meta-analysis.
Sonication reduces the attachment of Salmonella Typhimurium ATCC 14028 cells to bacterial cellulose-based plant cell wall models and cut plant material

Tan MSF, Rahman S, Dykes GA

Food Microbiol, 2017 Apr;62:62-67.
PMID: 27889167 DOI: 10.1016/j.fm.2016.10.009

This study investigated the removal of bacterial surface structures, particularly flagella, using sonication, and examined its effect on the attachment of Salmonella Typhimurium ATCC 14028 cells to plant cell walls. S. Typhimurium ATCC 14028 cells were subjected to sonication at 20 kHz to remove surface structures without affecting cell viability. Effective removal of flagella was determined by staining flagella of sonicated cells with Ryu's stain and enumerating the flagella remaining by direct microscopic counting. The attachment of sonicated S. Typhimurium cells to bacterial cellulose-based plant cell wall models and cut plant material (potato, apple, lettuce) was then evaluated. Varying concentrations of pectin and/or xyloglucan were used to produce a range of bacterial cellulose-based plant cell wall models. As compared to the non-sonicated controls, sonicated S. Typhimurium cells attached in significantly lower numbers (between 0.5 and 1.0 log CFU/cm2) to all surfaces except to the bacterial cellulose-only composite without pectin and xyloglucan. Since attachment of S. Typhimurium to the bacterial cellulose-only composite was not affected by sonication, this suggests that bacterial surface structures, particularly flagella, could have specific interactions with pectin and xyloglucan. This study indicates that sonication may have potential applications for reducing Salmonella attachment during the processing of fresh produce.
Fulltext Traumatic diaphragmatic herniation following esophageal intubation in neonatal death

Tan LJ, Zainun KA, Koh CP

Pediatr Neonatol, 2024 Jan;65(1):91-93.
PMID: 37658028 DOI: 10.1016/j.pedneo.2023.05.005
Horseshoe crab, Tachypleus gigas (Müller, 1785) spawning population at Balok Beach, Kuantan, Pahang, Malaysia

Tan AN, Christianus A, Shakibazadeh S, Hajeb P

Pak J Biol Sci, 2012 Jul 01;15(13):610-20.
PMID: 24218930

Local and regional decline of Asian horseshoe crabs has spurred a study on its spawning population at Balok Beach, Kuantan, Pahang, Malaysia. This location was identified as spawning site due to the occurrence of horseshoe crab spawning pairs and nests. Size-frequency, length-weight relationships, sex ratio and epibiont infestation of Tachypleus gigas were studied. Instar stage was estimated based on prosomal width. Condition of the horseshoe crab carapace was reported. Visual search technique of horseshoe crab was conducted during high tide of new and full moons. Prosomal, opisthosomal and telson length and weight of each horseshoe crab were measured. Largest female was recorded with mean prosomal length and width of 154.4 and 246.9 mm, respectively. About 69.8% of the males belonged to size group of 151-200 mm and 53.3% of females were grouped into 201-250 mm. All individuals were of fourteenth to sixteenth instar stages. Sex ratio varied from 0.313 to 2.5 and attributed to commercial harvest and monsoon season. Sand sediment of study site showed 93% of fine sands with grain size ranged from 120 to 250 microm. Acorn and pedunculate barnacle, conical and flat slipper shells were found on the carapace of the specimens. Most males had damaged eyes and carapaces while females with broken telsons. Body damages of about 19.9% on the specimens were likely due to nearby fishing activities. Lack of satellite male indicated low spawning population. The finding of this study showed that the species is extremely threatened by human activities and coastal development.
Development of a novel questionnaire to assess knowledge, attitude and practice towards medical disorders in pregnancy among clinicians

Tan TL, Lau Q, Chiew SC, Thanusha, Mahmoud D, Manisha

Med J Malaysia, 2024 Jan;79(1):52-59.
PMID: 38287758

INTRODUCTION: Maternal medicine is important and complex. It focuses on the care of mothers with comorbidities or medical disorders during pregnancy. To date, there are limited tools to assess clinicians' knowledge, attitude and practice (KAP) in this field.
MATERIALS AND METHODS: This study aims to develop and validate a questionnaire measuring the KAP of clinicians towards maternal medicine. Literature reviews, item generation and multiple experts' reviews were conducted during the questionnaire development phase. Convenient sampling was undertaken for this cross-sectional survey. A total of 168 clinicians from one tertiary hospital and three health clinics participated in thepilot testing using the modified questionnaire. In addition, test-retest was performed on 30 participants to examine its reliability, whilst exploratory factor analysis (EFA) was undertaken to determine its construct validity.
RESULTS: This finalised questionnaire contained 36 items with excellent content validity. Pertaining to test-retest reliability, all knowledge domain items showed Kappa values > 0.20, except item K29; attitude domain items overall Cronbach's alpha was 0.787 with corrected item-total correlation > 0.300 and lastly, all items in practice domain achieved intra-class correlation index > 0.700, except P2.5. EFA supported four factor structures, but six items were removed due to the following reasons: cross loading, negative or poor loading factor (< 0.3).
CONCLUSION: Overall, this instrument has an acceptable psychometric property, content validity, internal reliability and construct validity. It is hope that this questionnaire would be validated in other populations and be used in future research to enrich our understanding of clinicians' KAP towards maternal medicine.
Nerve ultrasound: Unravelling the different patterns of nerve enlargement in CIDP subtypes

Tan CY, Liu M, Shahrizaila N

Clin Neurophysiol Pract, 2023;8:226-227.
PMID: 38152242 DOI: 10.1016/j.cnp.2023.11.003
Corneal Epithelial Development and the Role of Induced Pluripotent Stem Cells for Regeneration

Selvarajah K, Tan JJ, Shaharuddin B

Curr Stem Cell Res Ther, 2024;19(3):292-306.
PMID: 36915985 DOI: 10.2174/1574888X18666230313094121

Severe corneal disorders due to infective aetiologies, trauma, chemical injuries, and chronic cicatricial inflammations, are among vision-threatening pathologies leading to permanent corneal scarring. The whole cornea or lamellar corneal transplantation is often used as a last resort to restore vision. However, limited autologous tissue sources and potential adverse post-allotransplantation sequalae urge the need for more robust and strategic alternatives. Contemporary management using cultivated corneal epithelial transplantation has paved the way for utilizing stem cells as a regenerative potential. Humaninduced pluripotent stem cells (hiPSCs) can generate ectodermal progenitors and potentially be used for ocular surface regeneration. This review summarizes the process of corneal morphogenesis and the signaling pathways underlying the development of corneal epithelium, which is key to translating the maturation and differentiation process of hiPSCs in vitro. The current state of knowledge and methodology for driving efficient corneal epithelial cell differentiation from pluripotent stem cells are highlighted.
Fulltext Association of Serum Beta-Carotene with Metabolic Risk Factors among a Work Cohort in Malaysia

Moy FM, Ng YH, Tan SS

J Nutr Sci Vitaminol (Tokyo), 2023;69(6):463-470.
PMID: 38171819 DOI: 10.3177/jnsv.69.463

Metabolic syndrome (MetS) poses increased risks for non-communicable diseases, increasing all-cause mortality, disability, and healthcare costs. Beta-carotene as the major carotenoid is identified to play an important role in the pathophysiology of MetS. The present study aimed to investigate the association between serum beta-carotene levels with metabolic syndrome and metabolic risk factors among a cohort of teachers in Peninsular Malaysia. This cross-sectional study investigated a sub-sample of 645 serum samples which were randomly selected for beta-carotene determination. Socio-demographic, lifestyle and metabolic risk factors were measured following standard protocols. There were equal proportions of males and females, with majority Malays (69%) followed by the Chinese (24%) and Indians (6.5%). The prevalence of MetS was 24.8% with abnormal waist circumference and high blood pressure as the most commonly reported metabolic risk factors. The median serum beta-carotene was 5.15 (5.07) μmol/L. Serum beta-carotene in the lowest quartile (Q1) was found to be significantly associated with MetS (OR: 5.81; 95% CI: 2.96, 11.38) and metabolic risk factors, namely triglycerides (OR: 6.38; 95% CI: 3.04, 13.35), fasting blood sugar (OR: 3.32; 95% CI: 1.48, 7.43), HDL-cholesterol (OR: 2.88; 95% CI: 1.58, 5.26) and waist circumference (OR: 2.94; 95% CI: 1.73, 5.01), after adjusted for potential confounders. In summary, participants with lower serum beta-carotene had higher odds for MetS and the above-mentioned metabolic risk factors.

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