This article presents findings from three separate data sets on food consumption in apparently healthy Malaysian adult males and females aged 22-60 years, and secondary data extracted from the Malaysian Adult Nutrition Survey (MANS) 2003. Assessment of food intake by 24-hour recall or the food diary method and use of the nutrient calculator- DietPLUS- to quantify intake of macronutrients and dietary fibre (DF) in the primary data, revealed low mean DF intakes of 10.7±1.0 g/day (Course participants, n=52), 15.6 ±1.2 (University sample, n=103), and 16.1±6.1 (Research Institute staff, n=25). An alarmingly high proportion of subjects (75 to 95%) in these three data sets did not meet the national population intake goal of 20-30 g DF/day. A list of 39 food items which contain fibre, extracted from the MANS 2003 report as being average amounts consumed daily by each Malaysian adult, provided 19.2 g DF which meant that >50% of Malaysian adults consumed less than the recommended DF intake of 20-30 g/day. This large deficit of actual intake versus recommended intakes is not new and is also observed in developed western nations. What is of great concern is that the preliminary findings presented in this article indicate that the national population goal of 20-30 g DF/day may be beyond the habitual diets of the majority of Malaysians. Appropriately, the authors propose the inclusion of a daily minimum requirement for DF intake in the Malaysian Dietary Guidelines, which would somewhat mimic the Malaysian Dietary Guidelines 1999 for dietary fat, as well as the stand taken by the Scientific Advisory Committee on Nutrition (SACN) of the United Kingdom. This minimum requirement, if agreed to, should not be higher than the 16 g DF or so provided by the hypothetical 'high-fibre' healthy diet exemplified in this article.
Study name: Malaysian Adult Nutrition Survey (MANS-2003)
There is mounting evidence demonstrating the importance of adequate physical activity to promote better well-being among hemodialysis patients. Available data pertaining to the levels of physical activity and its determinants among hemodialysis patients is, however, scarce in Malaysia. The objectives of this study are hence to determine the levels of physical activity and it associated factors among hemodialysis patients.
Introduction: The high amounts of polyunsaturated fatty acid (PUFA) in kenaf seed oil (KSO) is susceptible to oxidation. However, KSO is rapidly oxidised due to its high PUFA content.
Methods: In order to prevent oxidation, kenaf seed oil was encapsulated using a co-extrusion technique to produce microencapsulated kenaf seed oil (MKSO). The shell materials used were formulated from alginate with high methoxy pectin and chitosan. MKSO was freeze-dried and in vitro behaviour of MKSO was investigated and compared with oven-dried MKSO. After in vitro digestion, the antioxidant and bioactive compounds in freeze-dried MKSO were investigated.
Results: Freeze-dried MKSO released more oil (95.35%) compared to oven-dried MKSO (83.88%) after in vitro digestion. Total phenolic content (TPC) and 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging activities showed decreases, compared to before in vitro digestion while 2,2’-azino-bis(3- ethylbenzothiazoline-6-sulphonic acid) (ABTS) radical-scavenging assay and tocopherol content showed increases in released oil from MKSO after in vitro digestion compared to before in vitro digestion. For phytosterol composition, the decreases in released oil were not significant.
Conclusion: The studies showed that microencapsulation allowed for sitecontrolled oil delivery and protected the bioactive compounds.
Metabolic syndrome (MetSyn) as defined by the latest Harmonised definition and the agreement between the Harmonised definition and other definitions is poorly studied among Malaysians. This study was conducted to determine and compare the prevalence of MetSyn according to the Harmonised, International Diabetes Federation (IDF) and National Cholesterol Education Program (NCEP ATPIII) definitions among Malay staff of Universiti Putra Malaysia (UPM).
Introduction: The prevalence of child undernutrition and micronutrient deficiencies
are higher in the Orang Asli (OA) than the general Malaysian population. The World
Health Organization recommends the use of multiple micronutrient supplement
(MMS) that is a blend of micronutrients in powder form that can be sprinkled onto
foods for home fortification to prevent undernutrition among children. This pilot
study aimed to assess the feasibility of using MMS among OA children. Methods: A
total of 25 OA children (14 boys and 11 girls) aged 6-31 months (mean±SD = 15.7±7.2
months) in Negeri Sembilan were given three sachets of MMS weekly for 5 weeks.
Caregivers were instructed to add MMS to three types of food from the same food
group per week varying with a different food group weekly. Written instruction for
using MMS in simple language was given prior to the supplementation. Caregivers
were interviewed for information on socio-demographics, compliance, acceptance,
preference and adverse effect of MMS. Results: A high level of compliance was
observed (85%). All caregivers reported that the instructions for use were easy to read.
No noticeable changes to the foods mixed with MMS were observed and no adverse
effects were reported. Conclusion: This study demonstrated feasibility of the use of
MMS for future trials among OA children. The easy to read information that comes
with the MMS, frequent monitoring of MMS use and support to caregivers were
required to ensure compliance. Cultural feeding practices and financial constraints
may limit the types of food that can be mixed with MMS.
As Malaysia is moving towards a rapidly developing economy, its elderly population is also expected to increase not only in numbers and proportion but also in their life expectancies. This demographic shift from a relatively young population to one that includes an increasing number of old and very old age group presents a real challenge to nutritionists and health professionals. The challenge is to maintain a healthy and vigorous elderly population who can lead fulfilling and independent lives. Health promotion and disease prevention efforts, including nutrition education, targeted towards this group can contribute important elements in meeting the challenge. The objective of the study was to assess the nutrition education needs of a sample of elderly Chinese in an urban area. The sample consisted of 34 males and 36 females, whose age ranged from 55 to 86 years. They were generally affluent and well-educated with a mean income of RM101 1.86 and 8.0 years of formal education. A self-administered questionnaire which requires 20 to 30 minutes to complete was used to collect the information. The results of the nutrition knowledge assessment indicated that the typical respondent correctly identified 16 of the 22 nutrition knowledge statements. A majority (91.4%) of the respondents recognized the fact that tomato, dark green leafy vegetables, and orange juice are good sources of vitamin C, while the statement on vitamin supplementation was correctly answered by only 15.7% of the respondents. The mean nutrition knowledge score was 26.14 with a range of between 18 and 36. The t-test indicated a significant difference (t=3.63, p_0.05) between males and females in their nutrition knowledge scores, with the males having higher mean scores. Although only 8.6% of the respondents reported they had participated before in a nutrition education programme, a majority of them believed that nutrition education can improve the nutritional and health status of the elderly. A majority (80%) of the respondents mentioned newspaper articles as their source of nutrition information, while only 8.6% indicated the dietitian as their source of information. However, the doctor was identified as a more creditable and reliable source of information by a majority.
Chocolate is a popular food and its consumption has long been associated with enjoyment and pleasure. The effect of chocolate on mood too has long been recognised. Chocolate is thought to have interactions with neurotransmitters which contribute to mood modulation and appetite regulation. However, the evidence in chocolate and mood studies remains highly controversial. As more is known about the influence of chocolate on mood, the reasons for these effects appear increasingly complex and inter-related.
Introduction: High sodium consumption over an extended period of time has been associated with hypertension, stroke, cardiovascular disease, renal damage, and other adverse health effects. This study aimed to determine urinary sodium excretion and consequently estimate dietary sodium consumption among normotensive health staff in Malaysia. Methods: A cross-sectional study was conducted to acquire data on sodium excretion among normotensive Ministry of Health staff aged 20 - 56 years (mean age 35.08, SD 9.78) in 14 states and a research institute. Respondents were recruited using quota sampling. Data collection was conducted from December 2011 to February 2012. A single urine sample was collected over 24 hours for sodium concentrations and calculated as 95.0% of total daily sodium intake. Results: Among the 471 enrolled respondents, 445 (94.0%) provided complete information on socio-demography and urine samples. Mean urine sodium excretion was 142.0 mmol/day (SD 71.7), which is equivalent to 3429 mg sodium/day or 8.7 gm of salt intake (1.75 teaspoon, which exceeds the Malaysian recommendation of 2000 mg sodium/day by 1.7 times. About 79.0% (n=353) of respondents (88.0% male and 73.0% female) had daily sodium consumption that was above the recommendation. Excretion was significantly higher among males at 161.7 mmol/day (SD 78.1) (3726 mg sodium/day) than females, 125.3 mmolfday (SD 61.1) (2875 mg/day). There was a positive, low correlation between BMl and sodium intake (r=0.216, p
Introduction: Heavy metals and other contaminants in food have been a concern to food industries, consumers and governing authorities. The purpose of this study was to determine the levels of heavy metals and other elements in edible bird nests (EBNs). Methods: Raw and processed (commercial) EBNs were used in the study. Raw EBNs were collected directly from five house farms in Peninsular Malaysia - Kuala Sanglang (Kedah), Pantai Remis (Perak), Kluang Gohor), Kota Bharu (Kelantan) and Kajang (Selangor). Processed EBNs were pmchased from five Chinese traditional medicinal shops located in Peninsular Malaysia. The levels of 32 elements were determined by inductively coupled plasma-mass spectrometry and findings of the study were compared to the maximum regulatory limits set by the Standards and Industrial Research Institute of Malaysia (SIRIM) for EBNs. Results: Of the seven elements with maximum regulatory limits (As, Cd, Pb, Hg, Sn, Cu, Fe), one raw EBN was detected with mercury level of 70.180 ppb which was above the SIRIM permissible limit of 50 ppb. All the EBNs had iron levels above the SIRIM permissible limit of 30 ppb. The levels of the other 25 elements with no maximum regulatory limits (Ca, Mg, Na, K, P, Co, Cr, Mn, Mo, Se, Zn, Ag, Ba, Be, Bi, B, Li, Ni, Sb, Sr, Ti, U, V, Al, Zr) were also determined. Conclusion: The data obtained for the 25 elements with no permissible limits can serve as baseline data for further studies to establish their maximum regulatory limits.
A survey was carried out in the district of Kemaman, Terengganu, Malaysia to study infant feeding practices in rural and semi-urban communities. A total of 593 mothers were interviewed and their socio-demographic information recorded. Data on infant feeding practices were collected from mothers who had children up to 15 months of age. Among breast-feeding mothers (n =157), 42.0 % fed their babies for less than 3 months and 58.0% bottle fed for more than 6 months. Sixteen children were found to be fed on sweetened condensed milk with 62.5% of them for the first 3 months. Among those who breast fed their babies, 40.1% were found to have bottle fed at one time or another. The majority of breast feeding mothers belonged to the groups having incomplete primary schooling or completed primary education only and household income below RM600 per month. A substantial number of breast fed babies were given weaning foods in the form of porridge mixture (rice + egg, rice + vegetables, rice + meat, rice+ fish and cereals) between the age of 0 - 3 months. The findings of this study concluded that although breast-feeding is widely practiced, however, their duration has dwindled, and early introduction of solid foods is widespread.
An interview administered food frequency questionnaire (FFQ) consisting of 75 food items was developed and calibrated against a four day weighed record (WR). The FFQ was also calibrated against a proxy for biomarker, the energy intake/basal metabolic rate ratio (EI/BMR). A total of 58 subjects (35 women, 23 men) aged between 19 and 76 years of Pakistani and Indian origin in Southampton, United Kingdom (UK) participated in this calibration study. The results for men and women combined together suggested reasonable agreement between FFQ and WR estimates of intake with Spearman rank correlation coefficient ranging between 0.26 and 0.38 (energy unadjusted). Gender specific agreement was however, poor. The percent mean difference between nutrient estimates by FFQ and WR was in general within 10% for energy, fat and protein in women while in the range of 11% to 25% in men. The percent mean difference for other nutrients such as sugar and dietary fibre ranged between 18% and 99% in men and women; while was 9% and 6% for starch in men and women respectively. The ranking of subjects into the thirds of distribution was poor with gross misclassification in the range of 5% to 14% in men and 15% to 29% in women. Comparison of both FFQ and WR with EI/BMR ratio showed that there were more underreporters of energy intake when reporting intake using WR than FFQ in both men and women. Based on these results, it was concluded that further development of the FFQ was needed before the FFQ could be used to evaluate the usual dietary intake in the South Asian population.
INTRODUCTION: Gout and hyperuricaemia attributed to genetic and lifestyle factors have been associated with several chronic diseases. This study aimed to determine the association and interaction effects between vascular endothelial growth factor receptor-2 (VEGFR-2) gene polymorphisms (rs1870377 and rs2071559) and dietary patterns on blood uric acid in Malay and Indian adults.
METHODS: Dietary intakes of 153 Malays and 177 Indians were obtained using a food frequency questionnaire for the construction of dietary patterns using factor analysis. Genotyping of rs1870377 and rs2071559 was performed by real-time PCR using TaqMan probes. Anthropometric measurements, body mass index (BMI) and blood pressure and biomarkers, uric acid, glycated haemoglobin A1c (HbA1c), and blood lipids were determined.
RESULTS: There were significant differences in the mean values for HbA1c (41±-12 vs 45±-8 mmol/mol, p<0.001) and blood lipids levels (p<0.05) between Malays and Indians. Significant correlations were obtained between uric acid with selected blood lipids (p<0.05) and BMI in Malays (r=0.362, p<0.001) and Indians (r=0.212, p<0.01). Four dietary patterns were extracted from dietary intakes of all subjects: ‘Vegetables diet’; ‘Fruits diet’ (FD); ‘Animal protein and rice diet’; and ‘Fast foods and preserved foods diet’. There were no significant associations between dietary patterns (p=0.054-0.609) and VEGFR-2 gene polymorphisms (p=0.348-0.778) with uric acid. In Malay subjects, the interaction of rs2071559 and FD had a borderline effect (p=0.05) on blood uric acid after adjusting for potential confounders.
CONCLUSION: The associations and gene-diet interactions involving VEGFR-2 gene polymorphisms and FD on uric acid provide new information on gout and hyperuricaemia risks in Malays.
Keywords: Gene-diet interaction, VEGFR-2 gene polymorphisms, dietary pattern, uric acid, Malaysians
Nutritional decline is typically accepted as a consequent of the course of treatment for cancer. This study aimed to (1) assess body weight status and dietary intake of breast cancer patients on chemotherapy and (2) to correlate Body Mass Index (BMI), energy and protein intake with health-related quality of life (HRQoL) profile.
Bifidobacteria is a well known bacteria that is found in abundance in the intestine of infants which provides several health and nutritional benefits. Realizing the many benefits of bifidobacteria to human, this study has been conducted with the objective to determine the growth promotional effect of different types of milk and milk proteins on Bifidobacterium species. One strains of Bifiodobacterium species that is B. infantis was used to study the growth promoting effect of human milk, cow's milk, goat's milk, milk based infant formula, soy-based infant formula, lactoferrin (1 mg/ml), lactoperoxidase (1p~g/ml), lysozyme (1 mg/ml) and the mixture of these three proteins. The growth promotion assay was done using the 96-well culture plates which consists of 200 (1 Trypticase-Peptone-Yeast extract (TPY) medium, 50 4 sample and 10 1il of bacteria inoculum. Control consists of PBS instead of the samples. The assay was incubated anaerobically at 370C for 18 hours before being spread on the agar plate containing TPY medium with agar. Comparison was made between the mean count (log cfu/ml) of different types of milks, between infant formula and between milk proteins. From the results, Oneway ANOVA test at P<0.05 showed that there was significant differences in the mean counts (log cfu/ml) between the milks (P = 0.0000). A similar trend was observed in the mean count (log cfu/mI) between the infant formulas (P = 0.0 124) and also between the milk proteins (P = 0.0005). Duncan Multiple Range tests showed that there was significant differences between all the milks and control and among the milks themselves. There was however, no significant difference among the two types of infant formulas. The milk proteins also showed significant differences between the proteins and control and among themselves except for lysozyme which showed no significant differences with lactoferrin. This study showed that the growth of B. infantis could be promoted by different kinds of milks and milk proteins in vitro. Comparing the differences in growth promoting effect between samples and control indicated that human milk has the highest growth promoting effect followed by cow's milk and the mixture of the three milk prtoeins. Lysozyme showed the lowest in term of differences in percentage of growth promoting effect among all these samples. In conclusion the findings of this study supported that human milk ios the best milk choice for infant in comparison to other types of milk in promoting the growth of bifidobacteria. In additon, this tudy also found that milk protein when used in combination may show better growth promoiotive effect than when used singly.
Iron absorption is essential for the maintenance of iron levels in the body, since excretion is poorly regulated. Dietary factors can influence iron absorption including low molecular weight substances such as ascorbic acid which has been shown to enhance iron transport across mucosal cell monolayers. Both in vivo and in vitro work may be carried out to study iron absorption. Studies in vivo have the drawback of dealing with a complex system in which it is difficult to determine the relative importance of different factors. In vitro cell culture models could overcome this difficulty but attempts to establish differentiated enterocyte cell lines in culture have not been successful. However the Caco-2 line, derived from a colon carcinoma, is able to differentiate spontaneously when grown in standard culture conditions. The differentiated cells polarized, formed microvilli and T-junctions associated with the duodenal enterocytes brush border. This cell line thus represents an appropriate model for the study of transport mechanisms related to the intestinal barrier and can be used to study the absorption of nutrients especially iron in relation to dietary intake in particular pertaining to dietary factors that may affect absorption. In this work we have therefore used differentiated Caco-2 cells grown in bicameral chambers as a intestinal cell model to study the absorption of iron from different sources and compared it with INT 407 cells. Transfer of iron across the monolayers in the apical-to-basolateral direction has been found to be greater from feric lactoferrin than from iron citrate, while very little transport occurred from Fe-transferrin. It is concluded that in this in vitro study lactoferrin but not transferrin enhances mucosal iron transport. More importanty this study has also shown that Caco-2 can be used as an in vitro method to investigate not only iron bioavailability but can be applied to other minerals as well.
This paper explores the relationship between household wealth and nutritional status of pre-school children in Bangladesh using the nationally representative 2007 Bangladesh Demographic and Health Survey data. Chronic malnutrition was measured by z-score of height-for-age and the effect of household wealth on adverse childhood growth rate was assessed by multivariate logistic regression analyses. Overall, 43% of the children were stunted. The multivariate binary logistic regression analysis yielded significantly increased risk of stunting among the poorest (OR=2.26, 95% CI=1.77-2.89) as compared to the richest. The multivariate multinomial logistic regression produced elevated risk of moderate stunting (OR=1.98, 95% CI=1.50-2.61) and severe stunting (OR=2.88, 95% CI=2.00-4.14) of children in the poorest category compared to their richest counterparts. Children’s age, duration of breastfeeding, mother’s education, body mass index, mother’s working status and place of region were also identified as important determinants of children’s nutritional status. The findings suggest that apart from poverty reduction, maternal education, and strengthening of child and maternal health care services are important to improve health and nutritional status of the children.
As a part of the recent UPM-IMR collaborative study on the nutritional status of communities in rural villages and estates in Peninsular Malaysia from 1992-1995, this report presents findings on the haemoglobin levels and the prevalence of anaemia amongst these rural dwellers. A total of 69 villages and 7 estates located in 9 states in Peninsular Malaysia were studied. Results of the study on the 5 communities (total n=8024), namely fishing, padi, rubber, coconut and estate communities, are presented according to five age groups, namely less than 7 years (n=1418), 7-12.9 years (n=1778), 13-17.9 years (n=701), 18-59.9 years (n=3241) and 60 years (n=886). The extent of the anaemia problem varied considerably amongst the various age groups and community types. The prevalence of anaemia and mean Hb level (g/dl) for subjects of both sexes were respectively 24% and 12.1 for those < 7 years; 21.9% and 13.0 for the 7-12.9 years old; 17.8% and 13.7 for the 13-17.9 years; 21.0% and 13.8 for 18-59.9 years; and 22.7% and 13.6 for those 60 years of age and above. While the female adults (18-59.9 years) had a significantly higher prevalence rate for anaemia of 25% compared to 14% found in the male adults, no significant difference in the prevalence rates were found between the sexes for the other age groups. The problem was most serious among adult women, young children and the elderly. Amongst the various community types, the fishing community had the highest prevalence of anaemia at an overall rate of 50%, taking into consideration both sexes and all age groups. The rubber smallholders, in contrast, had the lowest prevalence of anaemia, at an overall rate of about 10%. Intervention and preventive health programmes should therefore be continued to be focussed on the above groups of rural subjects, particularly those in the fishing community.
Introduction: Malnutrition is associated with poorer outcomes following treatment for colorectal cancer (CRC). This study evaluates the relationship between nutritional status using scored Patient Generated-Subjective Global Assessment (PG-SGA) with the validated European Organisation for Research and Treatment of Cancer questionnaire (EORTC-QLQ C30) which consists of five functional scales, three symptoms scales and one item of global health/quality of life (QOL).
Methods: A total of 42 CRC patients at oncology outpatient clinics from two hospitals in Malaysia participated in the study from March 2011 to March 2012. The participants were classified as either well-nourished (PG-SGA A) or malnourished (PG-SGA B and C).
Results: The majority of patients were Chinese, male, with a mean age of 57.1 ± 9.8 years and had been diagnosed with stage 2 CRC. Well-nourished patients had statistically significantly better QOL scores on symptom scales: fatigue (p<0.001), nausea and vomiting (p<0.05), and pain (p<0.001) compared to malnourished patients. PG-SGA was strongly correlated with the main domains of the QOL: global health status (r = -0.395, p<0.05), fatigue (r = 0.816, p<0.001), nausea and vomiting (r = 0.730, p<0.001) and pain (r= 0.629, p<0.001). The better the nutritional status (lower total mean score of PG-SGA), the higher the QOL (high mean score of global health status).
Conclusion: The scored PG-SGA is suitable for use as a nutrition assessment tool to identify malnutrition and it is associated
with QOL among this population.
Key words: Chemotherapy, colorectal cancer patient, malnutrition, nutritional status, PGSGA score, quality of life
Study site: Oncology clinics, Hospital Kuala Lumpur, Hospital Selayang, Kuala Lumpur, Malaysia
It is universally known that breastfeeding provides a broad spectrum of nutritional and non-nutritional advantages to the developing infant. Nonnutritive protecting potentials of breast milk towards different infections and non-infectious diseases are still attracting the attention of researchers in different specialties. The neonate, who is suddenly exposed to a wide variety of organisms, is in dire need of protection, enhancement and education of his immature immune system to encounter these organisms. The lactating mammary gland is an integral part of the common mucosal immune system which stands as a sentinel in combating pathogens that enter the body via the mucosal route. The common mucosal immune system also competently controls tolerance mechanisms to innocent proteins and is involved in surveillance of carcinogensis. The diverse roles of general mucosal immunity are nearly well established but the specialised functions of breast tissue and breast milk in boosting the immune responses need more emphasis and highlighting. The detailed understanding and evaluation of breast milk as an immunological tool is reviewed within the domain of the diverse activities of the common mucosal immune system.