INTRODUCTION: In Malaysia, hypertension prevalence has increased from 13% in 1996 to 43% in 2006 based on the Third National Health and Morbidity Survey.
METHODOLOGY: Recognising the importance of hypertension control to prevent cardiovascular morbidity and mortality, a cross-sectional study was carried out to assess factors influencing blood pressure among 74 hypertensive adults (22 men, 52 women, mean age 61.1 +/- 8.8 years old) attending an outpatient clinic of a government health clinic in Klang Valley. Subjects were interviewed to obtain information on social and health, physical activity level and food intake using Diet History Questionnaire (DHQ) and Food Frequency Questionnaire (FFQ). Anthropometric measurements including weight, height, waist circumference and percentage of body fat were also conducted.
RESULTS: The majority of the subjects (71.6%) had poor hypertension control as determined using blood pressure. Women aged 30-59 years old had a higher mean diastolic blood pressure (87.3 +/- 11.6 mmHg) than women aged 60 years old (78.5 +/- 9.5 mmHg) (p < 0.05). Most of the men (36.4%) achieved three out of six Medical Nutrition Therapy (MNT) for Hypertension Recommendations as outlined by the Malaysian Dietitians' Association. About one-third (30.8%) of the women achieved two out of six of the guidelines. High sodium intake (adjusted OR 3.501, 95% CI 1.116-10.985, p < 0.05), daily consumption of coffee (adjusted OR 0.302, 95% CI 0.093-0.983, p < 0.05) and less intake of milk (adjusted OR 3.328, 95% CI 1.055-10.493, p < 0.05) were associated with uncontrolled hypertension.
CONCLUSION: Three quarters of the subjects had unsatisfactory hypertensive control and was related to food intake and eating habits including high salt diet, coffee consumption and inadequate milk intake were unsatisfactory. There is a need to implement a nutrition intervention programme based on MNT to achieve good hypertensive control among subjects.
Study site: klinik kesihatan, Klang Valley, Malaysia
A cross-sectional study was carried out to assess the physical activity levels among patients with type 2 diabetes mellitus (DM) at Cheras Health Clinic in Kuala Lumpur. A total of 132 subjects (62 men and 70 women) aged 30 years and above participated in this study. Data was collected using an interview based questionnaire to obtain socio-demographic and health profile information. Physical activity was assessed using a shortened version of the International Physical Activity Questionnaire (IPAQ). Anthropometric measurements and body fat were also taken. Glycaemic status, that is, HbA1c, fasting blood sugar (FBS) and 2 hours post-prandial (2-HPP) were obtained from medical records. Results showed that the mean age of the patients was 51.9 + 5.8 years. The majority of patients had poor glycaemic control based on HbA1c (70.7%), FBS (71.9%) and 2HPP (85.4%). Patients who were unmarried and aged(60 years and above had a lower physical activity level (p< 0.05). In the older age group, low physical activity was associated with poor glycaemic control (p< 0.05). Patients in the moderate and high physical activity level were motivated to perform physical activity so as to be healthy (68.1%). Low physical activity level among patients was due to lack of time (54.5%) and lack of energy (21.2%). In conclusion, physical activity levels of the patients were unsatisfactory and associated with poor glycaemic control, especially in the elderly. There is a need to encourage diabetic patients to undertake regular physical activity in order to achieve optimal glycaemic control.
Study site: Klinik Kesihatan Cheras, Kuala Lumpur, Malaysia
Iron deficiency and anaemia affect millions of children worldwide. This study aimed to investigate the effect of iron deficiency with or without anaemia on cognitive functions, specifically with short-term memory, attention and visual motor coordination in children. A total of 173 primary school children was enrolled. Cognitive functions were assessed using the Wechsler Intelligence Scale for Children. Three sub-tests were selected to assess processing speed (coding test), immediate auditory memory (digit span test) and visual processing and problem solving ability (maze test). The results showed significant correlation between age and coding test (r =0.38, p< 0.001), digit span test (r =0.16, p = 0.028), and maze test scores (r =0.28, p< 0.001), and the total sub-test scores (r=0.43, p < .001). After age adjustment of the cognitive function tests, iron deficient children without anaemia scored significantly lower than the healthy children (p< 0.001) on coding test, while iron deficient children with anaemia and iron deficient children without anaemia scored significantly lower (p< 0.001) than the healthy counterparts on maze test. No significant differences were observed on digit-span score among the groups. This study confirms the negative effect of both iron deficiency and iron deficiency anaemia on processing speed and visual motor coordination in children.
It is known that dietary diversity improves diet quality and nutritional status of young children. This study aimed to determine the relationship between dietary diversity and nutritional status of Orang Asli children in Krau Wildlife Reserve.
Shifts in lifestyles and eating patterns have led to an increasing prevalence of chronic non-communicable diseases in the adult population in Mongolia. This article reports the prevalence of obesity, abdominal obesity and body fat among 408 Mongolian adults aged 25 years and above. The subjects included 61.2% from urban areas and 38.8% from rural areas, reflective of the 60: 40 urban rural ratio in the general population. Anthropometric measurements were taken according to standard methods. Classification of overweight/obesity was based on body mass index of WHO while abdominal obesity was based on WPRO for Asians. Men made up 47.8% (200) and women 52.2% (218) of the sample. The mean age of the subjects was 46.7±12.7 years. About one-third (32.8%) of the subjects were overweight and 10.5% obese. A higher proportion of women (13.3%) than men were obese (7.5%). The age groups of 35-54 years in men and 55-64 years in women showed the highest prevalence of overweight. Prevalence of abdominal obesity was found in 46.5% of the men and in 65.1% of the women. Women aged 55-64 years had the highest proportion (78.4%) of abdominal obesity. In terms of body fat, 20.0 % and 51.5% of the men had high and very high levels of body fat respectively, while among the women, 15.1% and 55.5% respectively had high and very high levels of body fat. Mongolian adults face serious risk of cardiovascular diseases and other aspects of ill-health brought about by obesity. Prevention and control of obesity should be targeted as an urgent public health agenda in Mongolia.
Introduction: There is a lack of information on bone health status of premenopausal women in Malaysia. This study investigated the bone health status of premenopausal women and its associations with anthropometric, dietary and physical activity. Methods: Bone mineral density (BMD) was measured using dual X-ray absorptiometry (DEXA) at the lumbar spine, femoral neck, total hip and total body. Serum osteocalcin, parathyroid hormone (PTH), beta-crosslaps were also determined. Results: A total of 73 Chinese premenopausal women were recruited in the study with a mean age of 39.3 ± 5.0 years. Average BMI, body fat percentage and lean body mass were 22.2 ± 3.4 kg/m2, 33.9 ± 4.6% and 34.5 ± 4.4 kg, respectively. Mean BMD at the spine, total hip, femoral neck, and total body were 1.025 ± 0.118 g/cm2, 0.876 ± 0.109 g/cm2, 0.739 ± 0.110 g/cm2, and 1.061 ± 0.755 g/cm2, respectively. Their serum beta-crosslaps and PTH were within normal range, but serum osteocalcin (8.5 ± 4.2 ng/ ml) was low. On average, calorie intake (1506 ± 427 kcal/ day) was below the Malaysian Recommended Nutrient Intake (RNI) while their calcium intake achieved only 67% of RNI. Their mean metabolic equivalent score (MET) was 771.4 ± 926.1 min/week. Body weight and related indices (BMI, lean mass, fat mass) were significantly positively correlated with BMD at all skeletal sites. Conclusion: The study revealed that Chinese premenopausal women in the Klang Valley have low calcium intake and low level of physical activity.
Introduction: High sensitivity C-reactive protein (hs-CRP) is an emerging risk marker for cardiovascular diseases (CVD). In Malaysia, CVD has become a major health problem and the risk factors of CVD have also increased among the middle- aged. Thus, this study aimed to determine factors that influence the level of hs- CRPamongMalaysianadultsaged30-55years-old. Methods:One-hundredand twenty-two (n=122) adults working at an institution were selected systematically in this cross-sectional study. Body weight, height, hip and waist circumference, systolic and diastolic blood pressure, hs-CRP level, total cholesterol, triglycerides, low-density lipoprotein, and high-density lipoprotein were measured. Body mass index (BMI), waist-to-hip ratio, and total cholesterol: high-density lipoprotein ratio were calculated. Results: The sample consisted of 40.2% male and 59.8% female subjects with a mean age± SD of 41.93 ± 8.26 years. Pearson's correlation coefficient showed significant positive correlations between log hs-CRP level (mean± SD= 0.22 ± 0.50 mg/L; 95% CI= 0.13 - 0.31) and age, waist circumference, hip circumference, BMI, systolic blood pressure, total cholesterol, low-density lipoprotein, triglycerides, and total cholesterol: high-density lipoprotein ratio. However, multivariate analysis showed only BMI (R = 0.489, R2 = 0.239, adjusted R2 = 0.232, F = 37.626, p< 0.001) was a predictor of hs-CRP, the risk marker of CVD. Hs-CRP level was greater in overweight (25 - 29.9 kg/m2), and obese(> 30 kg/ m2) subjects (ANOVA p< 0.05) compared to normal weight subjects. Conclusion: BMI is a modifiable risk factor with the change being important for reducing CVD events among adults.
The inhibitory effect of phytate on the bioavailability of iron, zinc and calcium was determined by measuring their molar ratios. A total of 29 food samples consisting of 12 rice and rice products, 5 wheat and wheat products, 5 grains and cereal based products and 7 different popular varieties of cooked rice and rice products were selected. The phytate content was analysed using anion-exchange chromatography whereas mineral contents were analysed using atomic absorption spectrophotometry(AAS). One-way ANOVA test was used to statistically analyse the mean difference between the phytate and mineral contents between the food group samples. In general, results show that cooked products have lower content of phytate and minerals as compared to raw products. This could be due to the influence of the cooking method on phytate and mineral content in the food. Based on one-way ANOVA test, there were no significant difference in phytate and zinc content between four food groups (p >0.05). Significant differences were found only in iron and calcium content (p <0.05). Of the 29 food samples, 25 food samples had a phytate/iron molar ratio > 1, 5 food samples had a phytate/zinc molar ratio > 15 and 23 food samples had a phytate/calcium molar ratio of 0.24. These results show that although many of the food samples analysed had high mineral content, the high phytate content may impair the bioavailability of the mineral in the body.
Introduction: The aging population is a matter of global concern. Age-related
physiological, pathological, psychosocial, economic, cultural and environmental
changes are common and may greatly influence the quality of life of the elderly.
The aim of this review was to explore the determinants and motivations that drive
the elderly in making food choices. Methods: The search strategy of this literature
review used the PRISMA protocol. Potential literature that was related to food
choices was identified using two different combinations of keywords and two major
electronic search engines, namely Pubmed and Science Direct. The articles that
were selected for this review had to be in the English language, open-accessed and
published between January 2007 and December 2017. Results: From a search of
1398 articles, 15 articles (seven quantitative and eight qualitative) were identified
that were related to food choices among the elderly. The key factor that determined
food choices among the elderly population was identified to be health. Others
included convenience, sensory appeal, price, early food experience and more. The
limitations of these studies that were reported were the small sample size and the
reliance on self-reporting. The conclusions that were drawn were for specific groups
that were studied in this review should be extrapolated or generalised with caution.
Conclusion: Strategies for intervention programmes should be undertaken in
collaboration with health professionals, researchers, policymakers, and the food
industry. Future research is needed in the elderly who have chronic diseases, are
dependent or who have disabilities.
Introduction: This study aimed to determine the relationship of maternal dietary
intake with human milk nutritional composition, among Malay mothers during the
postpartum period of exclusive breastfeeding. Methods: Human milk samples (20-
30ml) were collected from mothers (n=32) at least once monthly for six months
postpartum. Macronutrients and fatty acids contents were determined using
proximate analysis and gas chromatography methods, respectively. Maternal
dietary intakes were recorded using the multiple-pass diet recall method prior
to each milk sampling and were analysed using the Nutritionist ProTM software.
Associations between the milk composition and maternal diet were tested using
Spearman correlation. Results: The energy content ranged between 49.6-59.2
kcal/100ml, protein 1.3-1.4 g/100ml, carbohydrate 6.5-9.7 g/100ml and total
fat 6.5-9.7 g/100ml. The polyunsaturated, monounsaturated, and saturated fatty
acids concentrations were 10.5-19.1 %, 40.6-43.5 %, and 38.0-49.7 %, respectively.
During confinement (first month postpartum), total energy and total fat content of
human milk were the highest whereas total carbohydrate was the lowest, compared
to the rest of the exclusive breastfeeding period. In contrast, intakes of total calorie
and total fat were the lowest, whereas protein was the highest during this period.
However, no associations were detected between human milk nutritional contents
and maternal dietary intake. Conclusion: In our study population, the composition
of maternal diet and nutritional content of human milk differed between confinement
and post-confinement periods. However, the association between maternal diet and
human milk composition itself warrants further investigation.
Introduction: Gestational diabetes mellitus (GDM) increases risks for type 2
diabetes and cardiovascular diseases. Low glycaemic index (GI) diets improve
cardio-metabolic outcomes in insulin-resistant individuals. We examined the
feasibility of lowering GI through GI-based-education among Asian post-GDM
women. Methods: A 3-month investigation was carried out on 60 Malaysian
women with a mean age of 31.0±4.5 years and a history of GDM. Subjects were
randomised into two groups: LGIE and CHDR. The CHDR group received
conventional healthy dietary recommendations only. The LGIE group received
GI based-education in addition to conventional healthy dietary recommendations.
At baseline and after 3-months, dietary intake of energy and macronutrient
intakes including GI diet and glycaemic load was assessed using 3-day food
records. Diabetes-Diet and GI-concept scores and physical activity levels were
assessed using a questionnaire. Adherence to dietary instructions was measured
at the end of 3 months. Results: At the end of 3 months, the LGIE group had
significant reductions in energy intake (241.7±522.4Kcal, P=0.037, ES=0.463), total
carbohydrate (48.7±83.5g, P=0.010, ES=0.583), GI (3.9±7.1, P=0.017, ES=0.549) and
GL (39.0±55.3, P=0.003, ES=0.705) and significant increases in protein (3.7±5.4g,
0.003, ES=0.685) and diet fibre (4.6±7.3g, P=0.06). The CHDR group had a significant
reduction in fat only (5.7±9.4g, P=0.006, ES=0.606). There was a 30% increase in
GI-concept scores in the LGIE group (p< 0.001). Changes in GI-concept scores
correlated significantly to the reduction in dietary GI (r = -0.642, P=0.045). Dietary
adherence was comparable in both groups. Conclusion: GI-education improves
GI-concept knowledge and helps lower dietary glycaemic index among women
with a history of GDM.
Keywords: Diet, gestational diabetes mellitus, glycaemic index, glycaemic load,
prevention, type 2 diabetes
A cross-sectional study was carried out to evaluate the nutritional status of 51 subjects with leukemia aged 4 to 12 years from the Haematology and Oncology Paediatric Ward, Universiti Kebangsaan Malaysia Medical Centre (PPUKM) and the Paediatric Institute of Kuala Lumpur. Nutritional status was assessed using anthropometric measurements, biochemical and haematological parameters. Subjects comprised 32 (62.7%) males and 19 (27.3%) females. Most of the subjects (41.2%) were in the age group of 4 to 6 years. More than half of the children were Malays (70.6%) followed by Indians (15.7%) and Chinese (13.7%). The subjects were diagnosed as acute lymphoblastic leukemia (ALL) (84.3%) followed by acute myelogenous leukemia (AML) (13.7%) and chronic myelogenous leukemia (CML) (2.0%) respectively. Most of the children were in remission status (54.9%). Underweight (
Despite evidence from various studies on exclusive breastfeeding (EBF) being best for infants, many women do not or are unable to practise EBF. This study aimed to examine perceptions on EBF and its influencing factors among a sample of Malay women in rural and urban areas in Kelantan, Malaysia.
The recommendation to lose weight has been the guiding principle in the treatment of type 2 diabetic patients. However, to facilitate this process, it is vital to understand factors associated with personal feelings about body weight and related behaviour.
Omega-3 fatty acid nutrition is widely recognised as essential to health and general well-being. However, health professionals and the general public in Malaysia may lack knowledge on the sources or the amounts of these essential fat components in foods. This paper attempts to correct this scenario by identifying the potential sources of omega-3 fatty acids [a-linolenic acid (ALA), or eicosapentaenoic acid (EPA) + docosahexaenoic acid (DHA)] in the Malaysian diet and calculating the amounts of these “nutrients†provided per serving of a wide variety of foods. The information generated provides Malaysian health professionals and consumers with options in food choices or meal planning with the goal towards achieving the recommended nutrient intakes for omega-3 fatty acids. The findings in the present study revealed that the potential sources of omega-3 fatty acids in the Malaysian diet in decreasing order are: edible oils (ALA), fish and fish products (EPA+DHA), vegetables (ALA), meat and eggs (EPA+DHA), and milk/milk products (EPA+DHA). Edible oils which are exceptionally high in ALA such as flaxseed oil and perilla oil are presently unavailable at local retail outlets and supermarkets. However, consumers can still meet the recommended nutrient intakes (RNIs) for omega-3 fatty acids of 0.3 to 1.2% energy (equivalent to 0.67g-2.67g) by choosing a wellbalanced diet prepared preferably with a cooking oil blend containing ALA, and one or more servings daily from at least three of the following food groups: (i) fish (“jelawatâ€, “siakapâ€, sardines, tuna, mackerel, salmon)/seafoods (shrimps, crab)/meat, (ii) vegetables/soybean/ soybean-based products/beans and peas, (iii) omega-3 enriched/fortified foods (eg. “omega-3 eggsâ€), and (iv) ready-to-drink omega-3 milk preparations/soybean milk.
Thirty-two samples of chocolate products were analysed by HPLC for caffeine and theobromine contents. Defatted residues of samples were extracted with 80% aqueous acetone. After extraction into boiling water, the methylxanthines were identified and quantified with the use of μ-Bondapak column and mobile phase of methanol:water:acetic acid (20:79:1). Levels of caffein and theobromine in 32 samples of chocolate products averaged 0.62-1.14 mg/g and 0.026-0.153 mg/g respectively. Mean values for theobromine and caffeine content for chocolate coating were 0.82 and 0.07 mg/g respectively. The chocolate coating made from fat substitute had theobromine and caffeine levels ranging from 0.36-0.70 mg/g and 0.027-0.061 mg/g respectively, with mean values of 0.49 mg theobromine/g and 0.039 mg caffeine/g. In local chocolate, the mean theobromine and caffeine levels respectively were 0.72 mg/g and 0.04 mg/g in milk chocolate, and 0.85 mg/g and 0.06 mg/g in dark chocolate. Meanwhile, for imported chocolate, the mean theobromine and caffeine levels respectively were 1.05 mg/g and 0.12 mg/g in dark chocolate; 0.76 mg/g and 0.04 mg/g in milk chocolate; and 0.74 mg/g and 0.03 mg/g in white chocolate. Compared with the local chocolates, imported chocolates had higher levels of theobromine and caffeine at 1.141 mg/g and 0.1533mg/g. The average theobromine and caffeine concentrations in local chocolate were 0.082mg/g and 0.066mg/g. Theobromine concentration in chocolate samples is within the range of 0.62mg/g-1.141mg/g and the range of caffeine concentration is 0.026mg/g-0.153mg/g respectively. Bittersweet chocolates were found to have higher theobromine and caffeine concentrations than normal sweet chocolates and milk chocolates.
Studies were carried out in two estates in Kedah and Johor to characterize the anthropometry and dietary patterns of 334 (169 females, 165 males) Malaysian estate workers. Subjects were Malay and Indian adults (aged 18 to 60 years) engaged in various work activities including rubber tappers, palm fruit harvesters, field supervisors and workers in the estate factories. Anthropometric results showed that the prevalence of overweight (26% in men, 25% in women) and obesity (5% in men, 11% in women) were higher compared to prevalence of underweight (11% in men, 9% in women) in these workers despite being engaged in moderate to heavy activities. The dietary intake pattern revealed that the main sources of calories in the diet were rice, cooking oil and sugar. Major sources of protein in the Malay diet were anchovies and fish whilst in the Indian diet protein was provided by salted fish, anchovies, eggs, fish, and pulses. The consumption of poultry, meat and dairy products were low for both ethnic groups. The dietary intakes of a subsampel of 108 normal weight subjects (56 females, 52 males) were recorded for 3 days. The results showed that the mean energy intake was 8.44 ± 2.12 MJ in males and 6.48 ± 1.29 MJ in females. The contribution of calories from protein, fat and carbohydrate were 13%, 22% and 60% in males and 12%, 23% and 65% in females, respectively. Alcohol intake was found to contribute five percent of energy in the diet of the Indian male subjects. Calcium, iron, vitamin A, thiamin, riboflavin and niacin intake were below 66% of the Malaysian RDA, particularly amongst the women. Income appeared to have a significant correlation with energy and iron intakes of the female workers as well as thiamin, niacin and riboflavin intakes of the male workers. There is a need for improving the quality of the dietary intakes of these workers as well as nutrition education on the prevention of obesity and its consequences.
Anthropometry is the single most portable, easily applied, inexpensive and non-invasive method of assessing body composition. It reflects both health and nutrition and predicts performance, health and survival. The use of body mass index (BMI) as a measure of obesity has been widespread and has recently been promoted for assessment of chronic energy deficiency (CED) in adults. This report provides BMI values of 2636 adult males and 2111 adult females from the three main ethnic groups residing in urban areas and BMI of adult Malay and Dayak (380 males and 496 females) residing in rural areas in Peninsular Malaysia, Sabah and Sarawak. The percent prevalence of obesity and CED in males for the three ethnic groups were apparently quite similar. However, in the females, CED were higher in the Malays and Chinese while overweight problems were more serious in the Indians. Among the Malays, prevalence of CED for males and females were 7% and 11% in urban areas and 11% and 14% in rural areas, respectively. In the males, it is interesting to note that there is a two-fold difference between urban and rural, while a high prevalence of overweight women (20%) even in the rural areas should be viewed as a potential health problem of the future.
This is a descriptive study on nutritional status of Orang Asli (Che Wong tribe) adults in Krau Wildlife Reserve. Twenty-six households, comprising 29 men and 28 women,participated in the study. Dietary diversity was assessed using food frequency questionnaire with 37 food groups. Weight, height and waist circumference were measured using standard instruments. The mean age for men and women was 39.9 ± 17.1 years and 33.7 ± 16.1 years, respectively. Most (89.5%) of the adults had no formal education and about 89.5% of households were categorised as poor. There were 13.8% underweight, 72.4% normal, 10.3% overweight and 3.3% obese men. For women, 25.0%, 46.4%, and 28.6% were underweight, normal and overweight, respectively. While none of the men had at-risk waist circumference (men >90 cm), about 21.4% of women had waist circumference of >80 cm. The mean dietary diversity score was 9.47 ± 4.15 with men (9.48 ± 3.70) and women (9.46 ± 4.63) having similar scores. There was a significant correlation between waist circumference and household income (r=0.36, p< 0.01); however, the association was only significant in women (r=0.50, p< 0.01). Although under-nutrition still prevails, there are emerging cases of overweight and obesity in this rural Orang Asli community undergoing nutrition transition especially among the females.
A food habits and health status study was carried out among 100 Malay adults aged 40 years and above. The study protocol incorporated anthropometric measurements, evaluation of food habits and determination of blood glucose, cholesterol and blood pressure. Mean body mass index (BMI) for men and women were 27.2 ± 4.2 kg/m2 and 27.0 ± 5.2 kg/m2 respectively, which on average showed that the subjects were overweight. Food habits evaluation indicated that rice, fish and vegetables were the foods consumed almost everyday by the majority of the subjects. Meat, dairy products and fruits were eaten once to three times per week. Food intake score for sugar and salt demonstrated that a majority of men and women consumed moderate amounts of these foods. Most subjects exercised twice to three times a week for 15 min per session. Blood glucose tests revealed a mean of 5.04 ± 1.60 mmol/l in men and 4.86 ± 2.10 mmol/l for women. Mean cholesterol for men was 5.06 ± 1.22 mmol/l while it was 4.90 ± 1.34 mmol/l in women. Mean systolic and diastolic blood pressure in men was normal of 127.69 ± 13.60 mm Hg dan 85.87 ± 7.97 mm Hg, while in women it was 127.42 ± 17.54 mm Hg, 83.53 ± 9.50 mm Hg. The mean value for glucose, cholesterol and blood pressure increased with age. The food habits of these adults were satisfactory; however blood test for the nutrients of interest exhibited an increasing trend towards blood pressure, blood cholesterol and glucose with age. Middle-aged adults should adapt to a more active lifestyle and be more cautious of their food habits. This is to ensure a healthy well being throughout their life span.