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Fulltext Development, validity and reproducibility of a food frequency questionnaire in pregnancy for the Universiti Sains Malaysia birth cohort study

Loy SL, Marhazlina M, Nor AY, Hamid JJ

Malays J Nutr, 2011 Apr;17(1):1-18.
PMID: 22135861 MyJurnal

Introduction: This study aimed to develop and examine the validity and reproducibility of a semi-quantitative food frequency questionnaire (FFQ) among Malay pregnant women in Kelantan, Malaysia.
Methods: A total of 177 Malay pregnant women participated in the validation study while 85 of them participated in the reproducibility study which was carried out in the antenatal clinic of Universiti Sains Malaysia Hospital. The newly developed FFQ was validated against two 24-hour dietary recalls (DR). The FFQ was repeated 20 to 28 days apart.
Results: Results showed that the FFQ moderately over estimated the nutrient and food intakes compared to the DR. Spearman correlation
coefficients for nutrients ranged from 0.24 (fat) to 0.61 (calcium) and for foods, ranged from 0.13 (organ meats, onion and garlic) to 0.57 (malt drink). For nutrients, 72 to 85% of women were classified into the correct quartiles from the FFQ and the DR while for foods, 67 to 85% of women were classified correctly. Bland-Altman plot showed relatively good agreement between these two dietary methods. The intra-class correlation (ICC) was used to estimate reproducibility. It ranged from 0.75 (vitamin C) to 0.94 (phosphorus) for nutrients while it ranged from 0.73 (confectionary) to 0.96 (coffee) for foods.
Conclusion: On average, at least 90% of pregnant women were correctly classified into the quartiles for nutrients and foods from the two sets of the FFQ. The FFQ presented acceptable reproducibility and appears to be a valid tool for categorising pregnant women according to dietary intake.
Keywords: Assessment of nutritional status, diet, food frequency questionnaire, maternal nutrition
Fulltext Economic evaluation of type 2 diabetes management at the Malaysian Ministry of Health primary care clinics, in Machang, Kelantan

Rohana, D., Wan Norlida, W.l., Nor Azwany, Y., Mazlan, A., Zawiyah, D., Che Karrialudin, C.A., et al.

Malaysian Journal of Public Health Medicine, 2007;7(1):5-13.
MyJurnal

Public health care programme evaluation includes determining the programme effectiveness (outcome assessment), efficiency (economic evaluation), accessibility (reachability of services) and equity (equal provision for equal needs). The purpose of this study was to make comparison on cost·( efficiency and costeffectiveness in managing type 2 diabetes between the Ministry of Health (MOH) health clinics with family medicine specialist (FMS) and health clinics without FMS. A costeffectiveness analysis was conducted alongside across-sectional study at two government health clinics in Machang, Kelantan, one with FMS and the other without FMS. A total of 300 patients, of which 155 from the health clinic without FMS and 145 from the other group were evaluated for sociodemographic and clinical characteristics from August 2005 to May 2006. HbA1c
analysis was measured for each patient during the study period. Macrocosting and microcosting were used to determine costs. The provider cost for diabetic management ranged from RM270.56 to RM4533.04 per diabetic patient per year, withla mean cost of RM1127.91(t906.08) per diabetic patient per year in health clinic with FMS. In health clinic without FMS, the provider cost ranged from RM225.93 to RM4650.13, with a mean cost of RM802.15 (:626.26). Proportion ofgood HbA1c was 17.2% for health clinic with FMS and 10.3% for the health clinic without FMS. The annual mean provider cost per proportion of good HbA1c control (< 7%) (Costefkctiveness ratio/ CER) was RM6557.65.for health clinic with FMS and RM7787.88 for health clinic without FMS. This provider cost-epfectiveness ratio was not different statistically between the health clinic with FMS and health clinic without FMS (p=0.063). The cost of building, equipments, overheads, staff and consumables were higher for FMS group. Sensitivity analysis was performed for three discount rates (0, 5 and 7%). Relative cost-effectiveness of diabetes management in health clinic with FMS and health clinic without FMS was unchanged in all sensitivity scenarios. Even though, there was no significantly difference in provider CER in type 2 diabetes management at Malaysian MOH health clinics, but the provider CER in health clinic with FMS was lower compared to health clinic without FMS. Therefore, we can conclude that the presence of FMS in the health clinic will effectively improved the management of type 2 diabetes.
Higher intake of fruits and vegetables in pregnancy is associated with birth size

Loy SL, Marhazlina M, Azwany YN, Hamid Jan JM

Southeast Asian J. Trop. Med. Public Health, 2011 Sep;42(5):1214-23.
PMID: 22299448

Maternal nutrition has a programming effect on fetal growth. This cross-sectional study investigated the association between maternal micronutrient, fruit and vegetable intake with birth size. Nutrient and food intake were examined using a validated semi-quantitative food frequency questionnaire. One hundred twenty-one pregnant women at 28 to 38 weeks gestation aged 19-40 years, were recruited from the Universiti Sains Malaysia Hospital, Malaysia. Birth weight, length and head circumference were obtained from the medical records. Data were analyzed using multiple linear regression. Results indicate no significant association between any of the measured micronutrients and birth size. However, 2 of the 6 vegetable subgroups and those consumed fruit during pregnancy had children whose birth size was significantly associated with consumption. An increase of 10 g of leafy vegetables per day was associated with a 1.78 cm increase in head circumference (p = 0.04), and tuber vegetable intake was associated with birth length (beta = 0.21, p = 0.03) and head circumference (beta = 0.21, p = 0.01). Fruit intake was associated with birth weight (beta = 0.19, p = 0.04), birth length (beta = 0.20, p = 0.04) and head circumference (beta = 0.19, p = 0.03). The lack of association between maternal nutrient intake and fetal growth and the significant association between fruit and vegetable intake and birth size suggests the existence of other micronutrients and phytochemicals present in foods that play an important role in birth size. The types of nutrients and their roles in birth size warrant further investigation.
Fulltext Diagnostic value of anti-modified citrullinated vimentin in rheumatoid arthritis

Maraina CH, Nurdayana AK, Rusni D, Azwany Y

Int J Rheum Dis, 2010 Oct;13(4):335-9.
PMID: 21199468 DOI: 10.1111/j.1756-185X.2010.01552.x

BACKGROUND: Rheumatoid factors (RF) are currently used in the diagnosis of rheumatoid arthritis (RA). Several other autoantibodies found in RA are directed to epitopes in citrullinated proteins such as anti-cyclic citrullinated and recently anti-modified citrullinated vimentin (MCV).
OBJECTIVE: In this study we determined the sensitivity and specificity of anti-MCV in comparison with anti-cyclic citrullinated peptide (CCP) antibodies and RF in RA patients and in a control group using the American College of Rheumatology (ACR) criteria as the gold standard.
MATERIALS AND METHODS: A cross sectional study was conducted from January to December 2008 on 100 patients with RA and 153 patients with arthritis or arthralgia but not fulfilling ACR criteria for RA. Serum from each subject was tested for anti-MCV, anti-CCP antibodies and immunoglobulin G (IgG) RF by enzyme-linked immunosorbent assay. Sensitivity and specificity of the tests were evaluated using the ACR criteria as the gold standard.
RESULTS: The sensitivity of RF was 85% with 74.5% specificity. For anti-CCP antibodies the sensitivity was 71% and the specificity was 94.8%. The sensitivity of anti-MCV antibodies was 80% with 59.5% specificity. The area under the curve for RF was 0.759, for anti-CCP antibodies was 0.866 and for anti-MCV antibodies was 0.681, while for at least one positive test it was 0.691.
CONCLUSION: Anti-CCP antibodies have higher diagnostic specificity and positive predictive value than RF and anti-MCV antibodies. RF has the highest sensitivity when compared to anti-CCP and anti-MCV antibodies. Thus anti-MCV antibody is not a better marker when compared to RF or anti-MCV antibody in the diagnosis of RA patients.

Study site: family medicine clinic, rheumatology clinic and immunology laboratory of Hospital Universiti Sains Malaysia (HUSM), Kubang Kerian, Kelantan, Malaysia
Fulltext Effect of therapeutic lifestyle changes on insulin sensitivity of non-obese hyperlipidemic subjects: preliminary report

Al-Mahmood AK, Ismail AA, Rashid FA, Azwany YN, Singh R, Gill G

J Atheroscler Thromb, 2007 Jun;14(3):122-7.
PMID: 17587763 DOI: 10.5551/jat.14.122

AIM: To determine the effects of lipid lowering by TLC on insulin sensitivity and secretory status of non-obese normoglycemic hyperlipidemic subjects.
METHODS: An intervention study was undertaken on 16 non-obese normoglycemic hyperlipidemic subjects. They underwent 6 months of a TLC regimen. Their insulin sensitivity and lipid status were assessed at baseline and after six months. A control group containing 16 age, sex and body mass index (BMI) matched normolipidemic subjects was also enrolled to compare the change in lipid levels and insulin sensitivity in the hyperlipidemic subjects.
RESULTS: The intervention showed significant reductions in insulin resistance (HOMA-IR reduced from 3.8 to 1.4, p<0.001) and improvement of insulin sensitivity (HOMA%S increased from 50.1% to 121.2%, p=0.004) in hyperlipidemic subjects with associated reductions in lipid levels.
CONCLUSION: Lipid lowering in non-obese hyperlipidemic subjects may be associated with improvement of insulin sensitivity.
Study site: Staff of university and offices, Kelantan, Malaysia
Fulltext Association of anti-CLIC2 and anti-HMGB1 autoantibodies with higher disease activity in systemic lupus erythematosus patients

Syahidatulamali CS, Wan Syamimee WG, Azwany YN, Wong KK, Che Maraina CH

J Postgrad Med, 2017 9 2;63(4):257-261.
PMID: 28862243 DOI: 10.4103/jpgm.JPGM_499_16

BACKGROUND: Systemic lupus erythematosus (SLE) is a systemic autoimmune disease characterized by numerous autoantibodies. In this study, we investigated the presence of anti-chloride intracellular channel 2 (anti-CLIC2) and anti-high mobility group box 1 (anti-HMGB1) autoantibodies in SLE patients (n = 43) versus healthy controls ([HCs] n = 43), and their association with serological parameters (antinuclear antibody [ANA], anti-double-stranded DNA [anti-dsDNA], and C-reactive protein [CRP]) and disease activity using Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score (active or inactive).
SETTINGS AND DESIGN: Case-control study at Rheumatology Clinic of Universiti Sains Malaysia Hospital.
SUBJECTS AND METHODS: The sera of SLE patients and HCs were tested for the presence of anti-CLIC2 and anti-HMGB1 autoantibodies using human recombinant proteins and ELISA methodologies. Other serological parameters were evaluated according to routine procedures, and patients' demographic and clinical data were obtained.
STATISTICAL ANALYSIS: Mann-Whitney U-test, Chi-square test, Fisher's exact test, and receiver operating characteristic analysis.
RESULTS: Anti-CLIC2 autoantibody levels were significantly higher in SLE patients compared to HCs (P = 0.0035), whereas anti-HMGB1 autoantibody levels were not significantly elevated (P = 0.7702). Anti-CLIC2 and anti-HMGB1 autoantibody levels were not associated with ANA pattern, anti-dsDNA, and CRP. Interestingly, SLEDAI score (≥6) was associated with anti-CLIC2 (P = 0.0046) and with anti-HMGB1 (P = 0.0091) autoantibody levels.
CONCLUSION: Our findings support the potential of using anti-CLIC2 autoantibodies as a novel biomarker for SLE patients. Both anti-CLIC2 and anti-HMGB1 autoantibody levels demonstrated potential in monitoring SLE disease activity.
Fulltext Knowledge, attitude and practice about leptospirosis prevention among town service workers in northeastern Malaysia: a cross sectional study

Azfar ZM, Nazri SM, Rusli AM, Maizurah O, Zahiruddin WM, Azwany YN, et al.

J Prev Med Hyg, 2018 Mar;59(1):E92-E98.
PMID: 29938244 DOI: 10.15167/2421-4248/jpmh2018.59.1.776

INTRODUCTION: Many efforts have been done to reduce leptospirosis infections in Malaysia especially among high risk groups including town service workers. Town service workers are more likely to be exposed to the leptospiral infection resulting from their occupational activities.
METHODS: A cross sectional study was conducted in northeastern Malaysia involving 321 town service workers who were subjected to answer an interviewer-guided validated questionnaire which consists of sociodemographic, knowledge, attitude and practice information. Data were entered and analyzed using SPSS Version 20.
RESULTS: All of the respondents were Malay with mean (SD) age of 40.6 (10.28) years old. The mean (SD) duration of employment was 12.1 (9.62) years. Fifty four respondents (16.8%) had never heard of leptospirosis. Among the respondents, 215 (67.0%) of them had poor knowledge on leptospirosis. Meanwhile, 167 (52.0%) and only 128 (39.9%) of them had satisfactory attitude and practice respectively. It was found that knowledge on risk factors for leptospirosis was lacking. There were high risk attitudes such as drinking habit and protective equipment used during working with the favourable answers ranged from 67.3% to 89.1%. The weakest area identified in their practice was also on the use of protective equipment.
CONCLUSIONS: The workers' level of knowledge and practice were relatively poor despite an overall good practice on leptospirosis. This finding might expose them to an increased risk of contracting leptospirosis. Identified weak areas in their knowledge, attitude and practice will assist the policy makers to develop a focused and well-directed intervention program on leptospirosis infection.
Predictors of ischaemic heart disease in a Malaysian population with the metabolic syndrome

Yeow TP, Khir AS, Ismail AA, Ismail IS, Kamarul Imran M, Khalid BA, et al.

Diabet Med, 2012 Nov;29(11):1378-84.
PMID: 22803824 DOI: 10.1111/j.1464-5491.2012.03741.x

AIMS: Cardiovascular disease is the foremost cause of mortality in Malaysia but little is known about the prevalence of the metabolic syndrome and its associations with other known cardiovascular risk markers. We undertook a population-based study to examine these.
METHODS: For the study, 4341 subjects were selected using a multistage stratified sampling method. Subjects were interviewed for personal and past medical history. Biomedical markers and anthropometric indices were measured. The metabolic syndrome was defined using the harmonized criteria. The associations between the metabolic syndrome and cardiovascular risk markers, including high-sensitivity C-reactive protein, microalbuminuria and HbA(1c) were examined.
RESULTS: The prevalence of the metabolic syndrome was 42.5%. Subjects with the metabolic syndrome are significantly more likely to have higher BMI (> 25 kg/m(2)), HbA(1c) [≥ 42 mmol/mol (6.0%)], LDL (≥ 2.6 mmol/l), elevated albumin:creatinine ratio (> 2.5 μg/mmol creatinine for men, 3.5 μg/mmol creatinine for women) and high-sensitivity C-reactive protein (> 3 mg/l); odds ratio 5.48, 6.14, 1.44, 3.68 and 1.84, respectively, P < 0.001. The presence of an elevated albumin:creatinine ratio and high-sensitivity C-reactive protein are strong predictors for the presence of a higher number of positive criteria of the metabolic syndrome. HbA(1c) > 48 mmol/mol (6.5%) is associated with increased relative risk of elevated albumin:creatinine ratio, high-sensitivity C-reactive protein and LDL (relative risk 3.10, 2.46 and 1.65 respectively, P < 0.001).
CONCLUSIONS: We confirmed the high prevalence of the metabolic syndrome in Malaysia. Our study revealed a strong relationship between risk markers of elevated BMI, HbA(1c), LDL, albumin:creatinine ratio and high-sensitivity C-reactive protein with the presence of the metabolic syndrome, putting them at a statistically high risk for cardiovascular mortality.
Fulltext A hospital-based study on seroprevalence of leptospirosis among febrile cases in northeastern Malaysia

Rafizah AA, Aziah BD, Azwany YN, Imran MK, Rusli AM, Nazri SM, et al.

Int J Infect Dis, 2013 Jun;17(6):e394-7.
PMID: 23357246 DOI: 10.1016/j.ijid.2012.12.012

To determine the seroprevalence of leptospirosis among febrile inpatient cases in northeastern Malaysia.
Risk factors of leptospirosis among febrile hospital admissions in northeastern Malaysia

Rafizah AA, Aziah BD, Azwany YN, Imran MK, Rusli AM, Nazri SM, et al.

Prev Med, 2013;57 Suppl:S11-3.
PMID: 23295174 DOI: 10.1016/j.ypmed.2012.12.017

Leptospirosis is a worldwide zoonotic disease. Risk factors for the disease may vary among countries.

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