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Fulltext Determinants of metabolic syndrome among Malaysian government employees

Chee, Huei Phing, Hazizi Abu Saad, Barakatun Nisak Mohd Yusof, Mohd Nasir Mohd Taib

International Medical Journal Malaysia, 2018;17(1):87-92.
MyJurnal

Introduction: The metabolic syndrome comprises a collection of cardiovascular disease risks, which has been demonstrated to predict type 2 diabetes mellitus and cardiovascular disease. Metabolic syndrome is a crucial health concern in Malaysia, with a prevalence of about 42.5% in the general population based on the ‘Harmonized’ definition. The aim of this study was to ascertain the association between socioeconomic status among Malaysian government employees with metabolic syndrome, compared with those without metabolic syndrome. Furthermore, this study also aimed to ascertain the associated obesity indicators for metabolic syndrome among employees—explicitly body mass index, waist circumference, waist-to-hip ratio, body fat percentage, fat mass index, and waist-to-height ratio. Methods: This cross-sectional study was
undertaken at government agencies in Putrajaya, Malaysia, via multi-stage random sampling. A total of 675 government employees were randomly sampled from a list of 3,173 government employees working in five government agencies under five geographical areas. Data on socioeconomic status, anthropometric, biochemical, and clinical assessments were collected. Results: Employees who were males had higher metabolic syndrome prevalence compared to their counterparts (p=0.019). In addition, employees aged between 20 to younger than 30 years had lowest metabolic syndrome prevalence (p=0.002). The risk of having metabolic syndrome was almost 10 times more likely in men with a waist-to-hip ratio of ≥0.90 compared to men with a waist-to-hip ratio of
Fulltext Dietary nutrient intake and meal-related situations among elderly outpatients with chronic obstructive pulmonary disease from respiratory clinics, Malaysia

Nor-Farahain Yahya, Noraida Omar, Ummi-Nadira Daut, Siti-Nur’Asyura Adznam, Barakatun-Nisak Mohd Yusof

Malaysian Journal of Medicine and Health Sciences, 2020;16(106):170-177.
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Introduction: Chronic obstructive pulmonary disease (COPD) patients usually have dietary problems leading to malnutrition issues. Therefore, this study aimed to determine macro and micronutrient intakes and meal-related sit- uations among outpatients COPD elderly and its adequacy according to their requirements. Methods: 140 patients were included in this cross-sectional study at Respiratory Clinics of Hospital Serdang and Institut Perubatan Respira- tori. Socio-demographic and health status data were collected by interviewing patients and reviewing their medical records. A three-day diet history (two-day on weekdays, one day on weekend) was analysed using Nutritionist Pro and compared against their requirements. Meal-related situation was assessed using three open-ended questions that related to food shopping, cooking and eating and analysed using content analysis. Results: Patients were 70±7 years old, 97% male, 59% Malay, 48% had primary education, 75% married, 72% ex-smokers and 54% presented with comorbidities. Majority of them had no episode of exacerbation for the past one year and in moderate stage of the COPD severity. Mean energy intake was 916±221 kcal/day with 98% of them have under-reported their intake. Almost all patients had inadequate macro and micronutrient intake; energy (97%), protein (97%), carbohydrate (86%), fat (99%), vitamin A (95%), C (86%), D (99%) and E (99%). The meal-related situation reported patients had difficulties with food shopping and preparation and problems during mealtime. Conclusion: COPD elderly reported inadequate intake of macro and micronutrients and had problems during mealtime. This indicates the need for Ma- laysian nutrition guidelines specific to COPD patients and nutrition intervention in the primary setting.
Fulltext Health-related quality of life of elderly with chronic obstructive pulmonary disease from selected government institutions

Noraida Omar, Nor-Farahain Yahya, Siti Nur’ Asyura Adznam, UmmiNadira Daut, Barakatun Nisak Mohd Yusof

Malays J Nutr, 2019;25(1):27-35.
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Introduction: It is widely recognised that health-related quality of life (HRQOL) is
impaired in chronic obstructive pulmonary disease (COPD) patients. Most previous
studies were conducted among the younger adult population and there is limited
information on the elderly population. This study aimed to determine the COPD
assessment test (CAT) score in the elderly with COPD. Methods: This was a crosssectional study involving 140 elderly patients who had been diagnosed with COPD
at two selected government institutions. Data on socio-demographic and health
status were collected by interviewing patients and reviewing their medical records.
The HRQOL was measured using CAT. The independence sample t-test and one-way
ANOVA were conducted to compare the CAT scores with socio-demographic and
health status. Results: The socio-demographic and health characteristics of the
patients were as follows: majority (54%) were aged 60-70 years, male (97%), Malay
(59%), married (75%), ex-smokers (72%), had attained primary education (48%),
had co-morbidities (54%), no history of hospitalisation or visits to the emergency
department due to COPD (57%), and were in moderate stage of airflow obstruction
(53%). The mean of CAT score was 21.87±6.85 and the majority of the patients were
classified as having worst symptoms of COPD (93%) as they had high CAT score
which was ≥ 10. Conclusion: Majority of the patients in this study had high scores
of CAT, which indicated poor HRQOL. Ex-smokers had higher scores compared
to non-smokers. More attention need to be given to these subgroups in order to
increase their quality of life.
Fulltext Validation and reproducibility of a culturally specific food frequency questionnaire (FFQ) for Malaysian Punjabis

Satvinder Kaur, Hip, Seng Yim, Hamid Jan Jan Mohamed, Rohana Abdul Jalil, Barakatun-Nisak Mohd. Yusof

Malays J Nutr, 2016;22(2):245-255.
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Introduction: Validation of a culturally specific FFQ is important in assessing habitual dietary intake of ethnic population groups. This study aimed to assess the validity and reproducibility of a FFQ developed specifically for determining the dietary intake of Malaysian Punjabis.

Methods: Subjects were approached through voluntary participation for the development and validation phase in the Klang Valley. A list of foods consumed by participants (n=100) was documented through a 3-day dietary recall. The validation process was conducted by verifying the developed FFQ against another group of Punjabi adult volunteers (n=101) who kept a 2-day dietary record. Macronutrients, dietary fibre, fatty acids, cholesterol, three types of minerals (calcium, sodium, iron) and four vitamins (B12, folate, C, A) were included in the analysis. Reproducibility was shown with intraclass correlation (ICC) values between FFQ1 vs FFQ2 that were administered 6 months apart among 32 participants.

Results: In the validation study, the FFQ1 was found to have over-estimated almost all nutrients compared to those in the dietary records. The Spearman correlation coefficients for energy, carbohydrate, protein and fat intake based on the FFQ1 and 2-day dietary records were 0.54, 0.38, 0.47, and 0.31, respectively. The classification into the same and adjacent quartiles was between 61- 84% for the nutrients consumed. Bland Altman plots showed relatively good agreement (between ±2 standard deviation) for both the dietary methods used. Reproducibility analysis of ICC (FFQ1 vs FFQ2) was between 0.46-0.76 for macronutrients and 0.20-0.92 for micronutrients.

Conclusion: The developed FFQ could be used as a valid tool for assessing dietary intake of Malaysian Punjabis, as it showed a moderate agreement with dietary record for intake of energy and macronutrients.
Fulltext Saffron extract and crocin reduced biomarkers associated with obesity in rats fed a high-fat diet

Maryam Mashmoul, Azrina Azlan, Barakatun Nisak Mohd Yusof, Norhafizah Mohtarrudin, Huzwah Khaza’ai

Malays J Nutr, 2017;23(1):117-127.
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Introduction: This study aimed to investigate the effect of saffron extract and crocin on blood biomarkers associated with obesity using the rat model.

Methods: Obesity was induced by feeding a high-fat diet to 42 male Sprague-Dawley rats for 12 weeks, after which they were equally distributed into seven groups. Three groups served as controls namely, normal diet (ND), high-fat diet (HFD), and high-fat diet plus orlistat (HFD + ORL), while the remaining four treatment groups consisted of HFD added low or high dose (40 and 80 mg/kg/day) of either saffron extract or crocin in the food. At the end of 8 weeks, blood samples were collected by cardiac puncture for biochemical analysis.

Results: Obese rats treated with a high dose of saffron extract and crocin showed significantly lower plasma glucose levels (5.26 and 5.67 mmol/L respectively) than the HFD rats (6.92 mmol/L). Saffron extract and crocin at a high dose showed significantly lower levels of plasma insulin (3.97 and 3.88 ng/mL respctively) compared to HFD control (5.41 ng/mL). Adiponectin levels significantly increased in obese rats fed saffron extract and crocin at high doses (7.44 and 7.92 µg/mL respectively) compared to HFD control (5.34 µg/mL). Ghrelin level significantly increased from 419.10 to 284.10 pg/mL,while leptin level significantly decreased from 8.08 to 5.68 ng/mL for the high dose crocin groups compared to HFD control. No significant differences in plasma serotonin levels were found among the groups.

Conclusion: Saffron extract and crocin show potential in reducing blood biomarkers associated with obesity as well as anti-inflammatory and regulatory potential of adipocytokines in an animal model.
Fulltext The effect of low glycemic index bread eaten with different fillings on blood glucose response in healthy individuals

Barakatun Nisak Mohd Yusof, Ruzita Abd. Talib, Norimah A. Karim, Nor Azmi Kamarudin, Fatimah Arshad

Jurnal Sains Kesihatan Malaysia, 2008;6(1):1-10.
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White and whole meal breads have been classified as high glycemic index (GI) foods which in turn produce the greatest rise in blood glucose. One of the commercial bread products in Malaysia known as Brown breads (BB) has been recently marketed as a healthy choice for diabetics due to its low GI value. This study was conducted to examine the effect of BB when eaten with different fillings on blood glucose response among healthy individuals and to describe the influences of these fillings in reducing blood glucose response. Five test meals using BB (BB eaten with baked beans, BB eaten with vegetable, BB eaten with apple, BB eaten with roast chicken and BB eaten with seaweeds) had been prepared for this study. Postprandial blood glucose response was determined for each test meal and reference food (glucose) that contained 50 g carbohydrate respectively. A total of 21 healthy subjects were recruited by advertisement to participate. Only 20 subjects (15 males, 5 females, Mean + SD Age : 24.4 + 3.7 years; BMI 23.4 + 3.0 kgm-2) completed this study. After an overnight fast, subjects consumed BB eaten with fillings according to the assigned group given and three repeated tests of reference food (glucose). Fasting capillary blood glucose samples were taken at time 0 and at 15, 30, 45, 60, 90 and 120 min respectively after the meal began. The blood glucose response was obtained by calculating the incremental area under the curve (AUC). Blood glucose response after consuming reference food (251.8 + 12.1 mmol.min/L) was significantly higher than all the test meals (p < 0.05). Among the test meals, BB eaten with baked beans produced the highest rise in blood glucose (97.0 + 16.9 mmol.min/L) whereas BB eaten with seaweeds demonstrated the lowest response in blood glucose (33.3 + 6.5 mmol.min/L) and the difference was statistically significant (p < 0.05). The postprandial blood glucose response after ingestion of BB when eaten with vegetable was 73.3 + 19.1 mmol.min/L followed by BB eaten with apple (58.9 + 12.2 mmol.min/L) and BB eaten with roast chicken (56.5 + 10.1 mmol.min/L). Generally, BB when eaten with fillings produced a slow rise in blood glucose response than the reference food. Combining this BB with fillings had the effect of reducing the postprandial blood glucose further.
Fulltext A systematic review on factors associated with Health-Related Quality of Life among chronic obstructive pulmonary disease patients

Nor Farahain Yahya, Noraida Omar, Ummi Nadira Daut, Siti Nur’Asyura Adznam, Barakatun Nisak Mohd Yusof

Malaysian Journal of Medicine and Health Sciences, 2019;15(201):61-68.
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Health-Related Quality of Life (HRQOL) is an important data in managing Chronic Obstructive Pulmonary Disease (COPD). Therefore, it is essential to determine factors that associated with HRQOL and identify the gaps for future research. A systematic search using PubMed, Science Direct and Scopus was performed to discover factors that could impact HRQOL among COPD patients. Socio-demographic factors like age, gender, educational level, smoking status, income were found associated with HRQOL. Other factors included Body Mass Index (BMI), comorbidities, sleep quality and exercise capability also could influence HRQOL of COPD patients. Other than that, lung function, dyspnea and exacerbation also found closely related with HRQOL. However, future study is needed to explore more factors such as nutritional status. Besides that, the finding only focused on general population and very little infor- mation on elderly population.
Fulltext Nutritional status and self-reported nutrition education exposure in women with gestational diabetes mellitus at primary health clinic

Nurul-Alia Samiun, Barakatun-Nisak Mohd Yusof, Irmi Zarina Ismail, Norfarhana Mohd Anuar, Winnie Chee Siew Swee

Journal of Clinical and Health Sciences, 2019;4(2):66-74.
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Introduction: Optimal nutritional status is of utmost importance not only for foetal
development but also to maintain normoglycemia in women with gestational diabetes mellitus
(GDM). This cross-sectional study described the nutritional status of women with GDM and
explored whether self-reported nutrition education (NEd) exposure before a GDM diagnosis
would be able to promote better nutrition status. Methods: GDM women (n= 60; age= 31.6 ±
5.0 years) diagnosed between 13th and 28th week of gestation participated in the study. We
assessed nutritional status that included anthropometric and blood pressure assessments,
biochemical data, and dietary intake. The respondents self-reported their NEd exposure before
a GDM diagnosis was made. Results: The pre-pregnancy BMI of the participants was 27.9 ±
6.8 kg/m2
, which was categorised as overweight. Total (4.3 ± 5.6 kg) and rate (0.2 ± 0.3
kg/week) of gestational weight gain were within the recommendations. Glycemic parameters
and blood pressure were also within the normal range. Nevertheless, they had high intakes of
fat (35.5%) and sugar (14.4%) proportionate to their energy intake. They did not meet the
recommended nutrient intakes for fibre, calcium, and iron. Only 28.3% of women had prior
NEd exposure. Among them, almost all (94.1%) had recurrent GDM. Those with NEd
exposure had lower pre-prandial blood glucose profiles, systolic blood pressure, and
proportion of protein intake from energy than those without (p< 0.05). Conclusions:
Suboptimal maternal nutritional status and low exposure to NEd are evident in women with
GDM. Those with self-reported NEd exposure had better parameters of nutritional status. The
findings recognised the need of having proper nutrition education for women who are at high
risk of GDM since at early pregnancy.
Fulltext Levels of knowledge about the glycemic index concept among women with gestational diabetes mellitus

Norfarhana Mohd Anuar, Barakatun Nisak Mohd Yusof, Farah Yasmin Hasbullah, Siti Nur’Asyura Adznam, Zuriati Ibrahim, Nor Fadhlina Zakaria, et al.

Malaysian Journal of Medicine and Health Sciences, 2020;16(3):185-191.
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Introduction: Low glycemic index (GI) diet is recommended as part of medical nutrition therapy for the management of gestational diabetes mellitus (GDM). While the clinical benefits are evident, data assessing knowledge of the GI concept among women with GDM are scarce. This was a needs assessment study to determine the level of knowl- edge about the GI concept among women with GDM. Methods: Using a cross-sectional design, we included 85 women with GDM (mean age: 30.6 ± 4.0, pre-pregnancy BMI: 24.8 ± 4.1 kg/m2, gestational age: 34.0 ± 4.0 weeks) from Hospital Serdang, Malaysia. Knowledge about the GI concept was assessed using a developed questionnaire. Additional questions on GDM were assessed using Gestational Diabetes Mellitus Knowledge Questionnaire (GDM- KQ). Subjects with less than 50%, 51-74%, and more than 75% total score were categorized as having poor, fair, and good knowledge levels, respectively. Results: The mean knowledge score obtained by the subjects was 12.8 ± 3.5. More subjects scored correctly for GDM-related knowledge (68.2%). More than half (58.8%) had heard about the GI concept previously and 55.3% understood the definition of GI. The average knowledge score about the GI con- cept was 55.6%; subjects scored highest on the influence of different carbohydrates (teh tarik versus milk) on blood glucose level (87.1%). However, the majority of the subjects had fair knowledge level (62.4%). Conclusion: Women with GDM had moderate knowledge about the GI concept. Results of the needs assessment served as preliminary data for the development of a GI-based nutrition education program in Malaysia.
Fulltext Histopathological changes in the kidney and pancreatic tissues following eight weeks consumption of saffron in high-fat diet induced obese rats

Maryam Mashmoul, Azrina Azlan, Norhafizah Mohtarrudin, Barakatun Nisak Mohd Yusof, Huzwah Khaza’ai, Mehdi Farzadnia, et al.

Malaysian Journal of Microscopy, 2016;12(1):12-19.
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Thirty-six adult male SD rats, weighing 200-250 g were used in this study. Dietary obesity was induced by feeding high-fat diet (HFD) for 12 weeks. One group of animal (n=6) served as normal control which received normal diet from the beginning to the end of the study. The other 30 male obese animals induced by HFD were randomly divided into five experimental groups: The group which received high-fat diet considered as a negative control and the other four groups were treated with saffron extract and crocin in low and high dosages of 40 and 80 mg/kg for 8 weeks. At the end of treatment period, kidney and pancreas were removed and stained with hematoxylin and eosin (H&E). There were significant histopathological changes, such as tubular degenerative, vascular congestion and interstitial inflammation in the kidney and extensive pancreatic adipose tissue infiltration in high-fat diet rats group when compared with normal control. The results showed less significant histopathological changes of the kidney and also moderate pancreatic adipose tissue infiltration in the groups treated with crocin. Interestingly saffron extract dose-independently displayed significant renal protective effect while a significant decrease in pancreatic adipose tissue infiltration was observed in obese rat treated with high dose of saffron extract (80 mg/kg). From these results, it can be concluded that consumption of saffron extract reduced the untoward effects of high-fat diet in kidney and pancreas of high-fat diet induced obese rats.
Fulltext Nutrition-related factors and binge eating behaviour in a sample of Malaysian University students

Barakatun-Nisak Mohd Yusof, Yen, Hui Thu, Chin, Yit Siew, Ellin, Kiung, Rohana Abdul Ghani, Adham Motallib, et al.

Jurnal Sains Kesihatan Malaysia, 2019;17(1):57-65.
MyJurnal

Binge eating (BE) behaviour is associated with obesity and eating disorders. This cross-sectional study investigates BE behaviour and its relationship with nutrition-related factors among university students. A total of 170 (69% females) university students in Malaysia aged 19 to 24 years participated in this study. BE behaviour was assessed with the use of Binge Eating Scale (BES) questionnaire. Socio-demographic background and nutritional status (anthropometric measurements, body mass index (BMI) and dietary intake) were also measured. BE behaviour reported by 10% percent of the participants. BE behaviour was associated with increased energy intake, elevated BMI and sex (Adjusted R2 = 0.116, p < 0.001). Differences in sex-specific factors in predicting the risk of BE behaviour were evident. In male participants, an increased in energy intake, elevated BMI and had a higher waist circumference associated with the risk of BE behaviour (Adjusted R2 = 0.411, p < 0.001). In female participants, only a higher waist circumference associated with BE behaviour (Adjusted R2 = 0.028, p < 0.05). The finding suggests that understanding sex-specific factors are necessary to prevent BE. These are the potential targets for tailored eating behaviour intervention among university students.
Nutrition in Diabetes

Hamdy O, Barakatun-Nisak MY

Endocrinol Metab Clin North Am, 2016 12;45(4):799-817.
PMID: 27823606 DOI: 10.1016/j.ecl.2016.06.010

Medical nutrition therapy (MNT) is a key component of diabetes management. The importance of balancing macronutrients, reducing carbohydrate load, lowering glycemic index, and implementing an overall healthy dietary pattern are emerging as better approaches for MNT in diabetes. Recent research points to improved glycemic control, reduction in body weight, and improvement in many cardiovascular risk factors when these approaches are provided by registered dietitians or health care providers. This review article discusses the current evidence about the role of sensible nutrition in diabetes management. Specific eating plans for weight reduction and for patients with type 1 diabetes are also discussed.
Nutritional status, glycemic control and its associated risk factors among a sample of type 2 diabetic individuals, a pilot study

Firouzi S, Barakatun-Nisak MY, Azmi KN

J Res Med Sci, 2015 Jan;20(1):40-6.
PMID: 25767521

The prevalence of type 2 diabetes is increasing in Malaysia, with most patients poorly controlled. Hence, this study aimed to determine nutritional and metabolic status as well as blood pressure of Malaysian patients with type 2 diabetes mellitus and identify associated risk factors for poor glycemic control.
Enhanced Protein-Energy Provision via the Enteral Route in Critically Ill Patients (PEP uP Protocol): A Review of Evidence

Lee ZY, Barakatun-Nisak MY, Noor Airini I, Heyland DK

Nutr Clin Pract, 2016 Feb;31(1):68-79.
PMID: 26385874 DOI: 10.1177/0884533615601638

Nutrition support is an integral part of care among critically ill patients. However, critically ill patients are commonly underfed, leading to consequences such as increased length of hospital and intensive care unit stay, time on mechanical ventilation, infectious complications, and mortality. Nevertheless, the prevalence of underfeeding has not resolved since the first description of this problem more than 15 years ago. This may be due to the traditional conservative feeding approaches. A novel feeding protocol (the Enhanced Protein-Energy Provision via the Enteral Route Feeding Protocol in Critically Ill Patients [PEP uP] protocol) was proposed and proven to improve feeding adequacy significantly. However, some of the components in the protocol are controversial and subject to debate. This article is a review of the supporting evidences and some of the controversy associated with each component of the PEP uP protocol.
Relationship of energy and protein adequacy with 60-day mortality in mechanically ventilated critically ill patients: A prospective observational study

Lee ZY, Noor Airini I, Barakatun-Nisak MY

Clin Nutr, 2018 08;37(4):1264-1270.
PMID: 28599979 DOI: 10.1016/j.clnu.2017.05.013

BACKGROUND & AIMS: The effect of provision of full feeding or permissive underfeeding on mortality in mechanically ventilated critically ill patients in the intensive care unit (ICU) is still controversial. This study investigated the relationship of energy and protein intakes with 60-day mortality, and the extent to which ICU length of stay and nutritional risk status influenced this relationship.
METHODS: This is a prospective observational study conducted among critically ill patients aged ≥18 years, intubated and mechanically ventilated within 48 h of ICU admission and stayed in the ICU for at least 72 h. Information on baseline characteristics and nutritional risk status (the modified Nutrition Risk in Critically ill [NUTRIC] score) was collected on day 1. Nutritional intake was recorded daily until death, discharge, or until the twelfth evaluable days. Mortality status was assessed on day 60 based on the patient's hospital record. Patients were divided into 3 groups a) received <2/3 of prescribed energy and protein (both <2/3), b) received ≥2/3 of prescribed energy and protein (both ≥2/3) and c) either energy or protein received were ≥2/3 of prescribed (either ≥2/3). The relationship between the three groups with 60-day mortality was examined by using logistic regression with adjustment for potential confounders. Sensitivity analysis was performed to examine the influence of ICU length of stay (≥7 days) and nutritional risk status.
RESULTS: Data were collected from 154 mechanically ventilated patients (age, 51.3 ± 15.7 years; body mass index, 26.5 ± 6.7 kg/m2; 54% male). The mean modified NUTRIC score was 5.7 ± 1.9, with 56% of the patients at high nutritional risk. The patients received 64.5 ± 21.6% of the amount of energy and 56.4 ± 20.6% of the amount of protein prescribed. Provision of energy and protein at ≥2/3 compared with <2/3 of the prescribed amounts was associated with a trend towards increased 60-day mortality (Adjusted odds ratio [Adj OR] 2.23; 95% confidence interval [CI], 0.92-5.38; p = 0.074). No difference in mortality status was found between energy and protein provision at either ≥2/3 compared with <2/3 of the prescribed amounts (Adj OR 1.61, 95% CI, 0.58-4.45; p = 0.357). Nutritional risk status, not ICU length of stay, influenced the relationship between nutritional adequacy and 60-day mortality.
CONCLUSIONS: Energy and protein adequacy of ≥2/3 of the prescribed amounts were associated with a trend towards increased 60-day mortality among mechanically ventilated critically ill patients. However, neither energy nor protein adequacy alone at ≥ or <2/3 adequacy affect 60-day mortality. Increased mortality was associated with provision of energy and protein at ≥2/3 of the prescribed amounts, which only affected patients with low nutritional risk.
Fulltext Potential medicinal benefits of Cosmos caudatus (Ulam Raja): A scoping review

Cheng SH, Barakatun-Nisak MY, Anthony J, Ismail A

J Res Med Sci, 2015 Oct;20(10):1000-6.
PMID: 26929767 DOI: 10.4103/1735-1995.172796

Cosmos caudatus is widely used as a traditional medicine in Southeast Asia. C. caudatus has been reported as a rich source of bioactive compounds such as ascorbic acid, quercetin, and chlorogenic acid. Studies have shown that C. caudatus exhibits high anti-oxidant capacity and various medicinal properties, including anti-diabetic activity, anti-hypertensive properties, anti-inflammatory responses, bone-protective effect, and anti-microbial activity. This review aims to present the potential medicinal benefits of C. caudatus from the available scientific literature. We searched PubMed and ScienceDirect database for articles published from 1995 to January 2015. Overall, 15 articles related to C. caudatus and its medicinal benefits are reviewed. All these studies demonstrated that C. caudatus is effective, having demonstrated its anti-diabetic, anti-hypertensive, anti-inflammatory, bone-protective, anti-microbial, and anti-fungal activity in both in vitro and animal studies. None of the studies showed any negative effect of C. caudatus related to medicinal use. Currently available evidence suggests that C. caudatus has beneficial effects such as reducing blood glucose, reducing blood pressure, promoting healthy bone formation, and demonstrating anti-inflammatory and anti-microbial properties. However, human clinical trial is warranted.
Improvement of dietary quality with the aid of a low glycemic index diet in Asian patients with type 2 diabetes mellitus

Barakatun Nisak MY, Ruzita AT, Norimah AK, Gilbertson H, Nor Azmi K

J Am Coll Nutr, 2010 Jun;29(3):161-70.
PMID: 20833988 DOI: 10.1080/07315724.2010.10719830

OBJECTIVES: This randomized controlled study was conducted to determine the effect of low glycemic index (GI) dietary advice on eating patterns and dietary quality in Asian patients with type 2 diabetes (T2DM).

METHODS: Asian patients with T2DM (N = 104) were randomized into 2 groups that received either low GI or conventional carbohydrate exchange (CCE) dietary advice for 12 weeks. Nutritional prescriptions were based on the medical nutrition therapy for T2DM, with the difference being in the GI component of the carbohydrates. Dietary intake and food choices were assessed with the use of a 3-day food record.

RESULTS: At week 12, both groups achieved the recommendations for carbohydrate (52 ± 4% and 54 ± 4% of energy) and fat (30 ± 4% and 28 ± 5% of energy) intake. There were no significant differences in the reported macronutrient intake in both groups. With the low GI diet, crude fiber and dietary calcium intake increased, while the dietary GI reduced. Subjects in the lowest dietary glycemic index/glycemic load (GI/GL) quartile consumed more parboiled/basmati rice, pasta, milk/dairy products, fruits, and dough, which are foods from the low GI category. There was a significant reduction in the hemoglobin A(1c) level at week 12 for patients in the lowest GI/GL quartile (Δ = -0.7 ± 0.1%) compared with those in the highest GI/GL quartile (Δ = -0.1 ± 0.2%).

CONCLUSIONS: These results demonstrate the ability of low GI dietary advice to improve the dietary quality of Asian patients with T2DM.
Effect of multi-strain probiotics (multi-strain microbial cell preparation) on glycemic control and other diabetes-related outcomes in people with type 2 diabetes: a randomized controlled trial

Firouzi S, Majid HA, Ismail A, Kamaruddin NA, Barakatun-Nisak MY

Eur J Nutr, 2017 Jun;56(4):1535-1550.
PMID: 26988693 DOI: 10.1007/s00394-016-1199-8

AIM: Evidence of a possible connection between gut microbiota and several physiological processes linked to type 2 diabetes is increasing. However, the effect of multi-strain probiotics in people with type 2 diabetes remains unclear. This study investigated the effect of multi-strain microbial cell preparation-also refers to multi-strain probiotics-on glycemic control and other diabetes-related outcomes in people with type 2 diabetes.
DESIGN: A randomized, double-blind, parallel-group, controlled clinical trial.
SETTING: Diabetes clinic of a teaching hospital in Kuala Lumpur, Malaysia.
PARTICIPANTS: A total of 136 participants with type 2 diabetes, aged 30-70 years, were recruited and randomly assigned to receive either probiotics (n = 68) or placebo (n = 68) for 12 weeks.
OUTCOMES: Primary outcomes were glycemic control-related parameters, and secondary outcomes were anthropomorphic variables, lipid profile, blood pressure and high-sensitivity C-reactive protein. The Lactobacillus and Bifidobacterium quantities were measured before and after intervention as an indicator of successful passage of the supplement through gastrointestinal tract.
STATISTICAL ANALYSIS: Intention-to-treat (ITT) analysis was performed on all participants, while per-protocol (PP) analysis was performed on those participants who had successfully completed the trial with good compliance rate.
RESULTS: With respect to primary outcomes, glycated hemoglobin decreased by 0.14 % in the probiotics and increased by 0.02 % in the placebo group in PP analysis (p
Nutritional strategies in managing postmeal glucose for type 2 diabetes: A narrative review

Ch'ng LZ, Barakatun-Nisak MY, Wan Zukiman WZH, Abas F, Wahab NA

Diabetes Metab Syndr, 2019 05 29;13(4):2339-2345.
PMID: 31405640 DOI: 10.1016/j.dsx.2019.05.026

Medical Nutrition Therapy (MNT) plays an essential role in overall glycemic management. Less focus is given on managing postmeal hyperglycemia despite the facts that, it is a common feature of Type 2 Diabetes (T2D). The purpose of this narrative review is to provide a comprehensive understanding of the existing literature on the nutritional approaches to improve postmeal hyperglycemia in patients with T2D. We searched multiple databases for the studies examining the nutritional approaches to manage postmeal glucose in patients with T2D. We included studies that involve human trials that were published in English for the past 10 years. Our review of the current literature indicates that the postmeal hyperglycemia can be improved with four nutritional approaches. These approaches include (i) utilizing the appropriate amount and selecting the right type of carbohydrates, (ii) using specific types of dietary protein, (iii) manipulating the meal timing and orders and (iv) others (promoting postmeal physical activity, incorporating diabetes-specific formula and certain functional foods). The potential mechanisms underlying these approaches are discussed and the identified gaps warranted further research. This array of nutritional strategies provide a set of options for healthcare professionals to facilitate patients with T2D in achieving the optimal level of postmeal glucose.
Fulltext Association of health literacy and nutritional status assessment with glycemic control in adults with type 2 diabetes mellitus

Hashim SA, Barakatun-Nisak MY, Abu Saad H, Ismail S, Hamdy O, Mansour AA

Nutrients, 2020 Oct 15;12(10).
PMID: 33076406 DOI: 10.3390/nu12103152

While the role of medical and nutrition factors on glycemic control among adults with type 2 diabetes mellitus (T2DM) has been well-established, the association between health literacy (H.L.) and glycemic control is inconsistent. This study aims to determine the association of H.L. and nutritional status assessments with glycemic control in adults with type 2 diabetes mellitus. A total of 280 T2DM respondents (mean (SD) age = 49.7 (10.3) years, Glycated hemoglobin (HbA1c) = 9.9 (2.6) %, and Body Mass Index = 32.7 (15.1) kg/m2) were included in this study. A short-form Test of Functional Health Literacy in Adults (S-TOFHLA) assessed the H.L. levels. Nutritional status assessments included client history, glycemic control, anthropometric, and biochemical data. The mean (S.D.) H.L. score was 45.7 (24.6), with 56% of the respondents had inadequate H.L. Inadequate H.L. was more common among those females; housewives, low education, received oral antidiabetic therapy, and shorter diabetes duration. Respondents with inadequate H.L. were significantly older and had higher HbA1c than those with marginal and adequate H.L. Meanwhile, respondents with inadequate and marginal H.L. levels had significantly higher total cholesterol, LDL-cholesterol, and systolic blood pressure than the respondents with adequate H.L. Low H.L. scores, self-employment status, received dual antidiabetic therapy (insulin with oral agents), received insulin alone, and had higher fasting blood glucose explained about 21% of the total variation in HbA1c (adjusted R2 = 0.21; p < 0.001). Respondents with inadequate H.L. had poor glycemic control. The H.L. scores, together with nutritional status assessments, were the factors that predicted poor glycemic control among adults with T2DM.
Study site: Faiha Specialized Diabetes, Endocrine, and Metabolism Centre (FDEMC), Basrah, Iraq

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