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An intervention based on the stages of change, health profiles and physical activity levels of overweight and obese adults in Sarawak, Malaysia - a feasibility study

Cheah WL, Chang CT, Helmy H, Wan Manan WM

Malays Fam Physician, 2019;14(3):46-54.
PMID: 32175040

Introduction: Physical inactivity is the one of the leading causes of major non-communicable diseases in the world. The aim of this study is to assess the feasibility of an intervention program based on the stages of change, physical activity levels and health profiles of selected overweight and obese adults in Sarawak.
Methods: This intervention study was carried out using selected overweight and obese adults in Sarawak. A total of 75 participants were placed in the intervention group, and 80 respondents were placed in the control group participated. Respondent-determined weekly aerobic exercise sessions were conducted for six months. The Malay version of the long-form International Physical Activity Questionnaire (IPAQ) and Transtheoretical model of change (TTM) questionnaire were used, together with anthropometric measurements and the collection of venous fasting blood profiles. Data was entered and analyzed using SPSS Version 20.
Results: The intervention group had significant better stage transitions compared to the control group (p<0.01). They also had significantly lower total cholesterol, although both groups showed significant results (difference= 0.53, p<0.01; difference= 0.38, p=0.01). The respondent-determined intervention program was effective in improving stage transition; however, an intervention of longer duration could provide more conclusive health outcomes.
Conclusion: Physical activity plays a role in assisting overweight and obese adults to be more active and healthier.
The Bahasa Melayu version of the Global Physical Activity Questionnaire: reliability and validity study in Malaysia

Soo KL, Wan Abdul Manan WM, Wan Suriati WN

Asia Pac J Public Health, 2015 Mar;27(2):NP184-93.
PMID: 22234832 DOI: 10.1177/1010539511433462

This study aimed to assess the reliability and concurrent validity of the Bahasa Melayu version of the Global Physical Activity Questionnaire (GPAQ-M) by comparing it with the short form of the International Physical Activity Questionnaire (IPAQ-S) and objectively measuring physical activity using a Yamax DigiWalker (Yamax, Tokyo, Japan) pedometer. A total of 100 adults aged between 20 and 58 years from Kelantan in Malaysia voluntarily participated in this study. The Wilcoxon signed-rank analysis showed no significant differences in 2-week test-retest scores for total metabolic equivalent∙minutes∙per week and 4 domains of the GPAQ-M. There was a low but significant relationship between time spent on total physical activity measured by the GPAQ-M and average steps per day recorded using the pedometer (r s = .265, P = .013). Significant correlations were also found between GPAQ-M and the IPAQ-S for varying levels of intensity during physical activities (r s = .309-.466, P < .01).
Fulltext Body mass index and body fat status of men involved in sports, exercise, and sedentary activites

Wan Nudri WD, Wan Abdul Manan WM, Mohamed Rusli A

Malays J Med Sci, 2009 Apr;16(2):21-6.
PMID: 22589654 MyJurnal

A cross-sectional study was carried out in Kota Bharu on three groups of men with ages ranging from 18 to 44 years. The study groups included 83 athletes representing various types of sports and levels of participation (athlete group), 80 active men who exercised a minimum of 30 minutes per day at least 3 times per week (exercise group), and 80 inactive men (sedentary group). The objectives of the study were to compare the body mass indices (BMIs) and body fat statuses among the three groups with different physical activity levels. The height and weight of respondents were measured using the Seca weighing balance with height attachment. Skinfold thickness of biceps, triceps, subscapular regions, and suprailiac regions of each respondent were measured using Harpenden skinfold calipers. Percentage body fat was calculated as the sum of the four measurements of skinfold thickness. The results showed that the mean (± SD) BMIs in the athlete, exercise, and sedentary groups were 22.6 ± 2.9, 23.4 ± 3.5, and 24.3 ± 4.6 kg/m(2), respectively. The combined prevalence of pre-obese (BMI 25.029.9) and obese (BMI ³ 30.0) subjects was 21.7% in the athlete group, 29.9% in the exercise group, and 47.5% in the sedentary group. The mean (± SD) percentage of body fat in athletes was 15.7 ± 5.4%, which was lower than in the exercise (18.9 ± 5.5%) and sedentary (20.6 ± 5.8%) groups. The study revealed that individuals who are actively involved in physical activity, particularly in sport activities, have lower BMIs and percentage body fat values compared to sedentary people. Therefore, to prevent obesity, all individuals are encouraged to perform regular physical activity, particularly sports activities.
The coexistence of dual form of malnutrition in a sample of rural malaysia

Ihab AN, Rohana AJ, Manan WM, Suriati WN, Zalilah MS, Rusli AM

Int J Prev Med, 2013 Jun;4(6):690-9.
PMID: 23930187

The coexistence of under and over nutrition might be influenced by a marked shift in dietary and lifestyle practices of people in developing countries. This study aims to identify factors associated with the occurrence of dual form of malnutrition in the same households in a rural district in Peninsular Malaysia.
Fulltext A qualitative study on malnutrition in children from the perspectives of health workers in Tumpat, Kelantan

Cheah WL, Wan Manan WM, Zabidi-Hussin ZM, Chang KH

Malays J Nutr, 2007 Mar;13(1):19-28.
PMID: 22692186 MyJurnal

Underlying causes of most nutrition related problems are diverse, including biological, social, cultural, and economic factors. Qualitative approaches complement quantitative methods in identifying the underlying meanings and patterns of relationships involved in managing malnutrition. This study examined perceptions regarding malnutrition among health workers from 7 clinics (community and health clinics) in Tumpat, Kelantan. A total of 18 nurses and 2 doctors, who were involved in monitoring child health and nutrition, were included in the study. These health workers were interviewed using a semi-structured questionnaire adapted from Sastry's framework on malnutrition (Sastry, 1996). The questionnaire included biological, behavioral and environmental factors that influence child health and nutrition. All the health workers perceived that mothers/caregivers play the main role in improving the health of malnourished children. The quality of childcare was rated as moderately satisfactory by the health workers. Most of the affected families who were given the Food Baskets did not fully use all the items for the malnourished child. Child feeding practice was based on the needs of the whole family rather than according to the target child's needs. Most of the mothers preferred processed cereals than rice porridge because the former is easier to prepare for the child. Although they were from a low socioeconomic background, most of the mothers were not earning additional income for the family. The qualitative methodology provided information that can be used as a basis for the designing of quantitative questionnaires to assess malnutrition among children. The induction characteristic of qualitative methods was used to gain an understanding of the underlying reasons or phenomena such as behaviours that are directly observable.
Study site: Klinik kesihatan, Tumpat, Kelantan, Malaysia
Fulltext A study on the nutritional status of physically "active men in Kota Bharu"

Wan Nudri WD, Mohamed Rusli A, Wan Abdul Manan W, Mohd Rafi M, Naing L, Kamarul Imran M, et al.

Malays J Nutr, 2003 Sep;9(2):95-103.
PMID: 22691731

A cross-sectional comparative study was conducted to determine the nutritional status among physically active groups in Kota Bharu. The study population comprised 83 adult male athletes from 8 different types of sports (athlete group), 80 active men who exercised a minimum of 30 min per day for at least 3 times per week (exercise group), and 80 inactive men (sedentary group). All the respondents were aged between 18 to 44 years. Measurements taken from the respondents were anthropometric measurements, systolic (SBP) and diastolic (DBP) blood pressure, and serum total cholesterol (TC). The results showed that the combined prevalence of pre-obese (BMI 25.0-29.9) and obese (BMI ≥30.0) was 21.7% in athletes, 29.9% in exercise group, and 47.5% in sedentary group. The mean (± SD) percentage of body fat in athletes was 15.7 ± 5.4%, which was lower compared to the exercise (18.9 ± 5.5%) and sedentary (20.6 ± 5.8%) groups. The incidence of waist-to-hip ratio above 0.9 in athlete, exercise and sedentary groups was 9.6%, 18.7% and 31.3%, respectively. The incidence of hypertension (SBP ≥140 and/or DBP ≥90 mmHg) was 13.2% in athletes, 17.5% in exercise group and 42.5% in the sedentary group. The TC values showed that the prevalence of "high risk" individuals (TC ≥6.20 mmol/l) was also lower in athletes (20.5%), compared to the exercise (36.2%) and sedentary (47.5%) groups. The study revealed that individuals who are actively involved in physical activity, particularly in sport activities have better nutritional status compared to sedentary people. However, the nutritional status in the athlete and exercise groups was still unsatisfactory. The incidence of poor health status related to over nutrition in the active groups was rather high and needs attention from health professionals. Further studies are needed to determine nutritional practices among physically active groups.
Nutritional outcomes related to household food insecurity among mothers in rural Malaysia

Ihabi AN, Rohana AJ, Wan Manan WM, Wan Suriati WN, Zalilah MS, Rusli AM

J Health Popul Nutr, 2013 Dec;31(4):480-9.
PMID: 24592589

During the past two decades, the rates of food insecurity and obesity have risen. Although a relationship between these two seemingly-paradoxical states has not been repeatedly seen in men, research suggests that a correlation between them exists in women. This study examines nutritional outcomes of household food insecurity among mothers in rural Malaysia. A cross-sectional survey of low-income households was conducted, and 223 households with mothers aged 18-55 years, who were non-lactating, non-pregnant, and had at least one child aged 2-12 years, were purposively selected. A questionnaire was administered that included the Radimer/Cornell Scale, items about sociodemographic characteristics, and anthropometric measurements. Of the households, 16.1% were food-secure whereas 83.9% experienced some kind of food insecurity: 29.6% of households were food-insecure, 19.3% contained individuals who were food-insecure, and 35.0% fell into the 'child hunger' category. The result reported that household-size, total monthly income, income per capita, and food expenditure were significant risk factors of household food insecurity. Although there was a high prevalence of overweight and obese mothers (52%) and 47.1% had at-risk waist-circumference (> or = 80 cm), no significant association was found between food insecurity, body mass index, and waist-circumference. In conclusion, the rates of household food insecurity and overweight and obesity were high in the study population, although they are looking paradoxical. Longitudinal studies with larger sample-sizes are recommended to further examine the relationship between food insecurity and obesity.
Fulltext Food consumption patterns: Findings from the Malaysian Adult Nutrition Survey (MANS)

Norimah AK, Safiah M, Jamal K, Haslinda S, Zuhaida H, Rohida S, et al.

Malays J Nutr, 2008 Mar;14(1):25-39.
PMID: 22691762 MyJurnal

This study reports the food consumption patterns of adults aged 18 to 59 years in the Malaysian Adults Nutrition Survey (MANS) carried out between October 2002 and December 2003. A total of 6,742 subjects comprising 3,274 men and 3,468 women representing the northern, central , southern and east coast of Peninsular Malaysia as well as Sabah and Sarawak were interviewed. A semiquantitative food frequency questionnaire (FFQ) which consisted of 126 food items was used to evaluate the food consumption pattern (habitual food intake) of the respondents during the previous one- year period. The results demonstrate that nasi putih (cooked rice) was consumed by 97% of the population twice daily (average 2½ plates per day). Other food items consumed daily were marine fish, (one medium fish per day), green leafy vegetables (one cup per day) and sweetened condensed milk (three teaspoons per day. The mean frequencies for daily intake of rice, leafy vegetables, marine fish, local kuih, anchovy (ikan bilis) and biscuits were significantly higher among the rural compared to the urban adults. In contrast, more urban dwellers consumed chicken and eggs more frequently than their rural counterparts. More men than women consumed chicken and eggs more frequently. Malaysian adults showed a satisfactory habit of drinking plain water, with 99% drinking at least six glasses of plain water daily. Other beverages such as tea (47%), coffee (28%), chocolate-based drinks (23%) and cordial syrup (11%) were also consumed on daily basis, however, in a smaller proportion of the population. There were differences in the prevalence of daily consumption of foods when comparing urban and rural population, and also between men and women. The prevalence of daily consumption of marine fish among rural and urban adults was 51% and 34% respectively. For sweetened condensed milk, men and women consumed 43% and 28% respectively; however, more women drank full cream milk than men. Between the age groups, 21% of adults below 20 years old consumed chicken at least once a day, while this pattern of intake was not shown in the older age groups. Our findings show that adults, aged 50 to 59 years old, had the highest prevalence of daily consumption of full cream milk with 24% while those aged 18 to 19 years old had the lowest prevalence of daily consumption at 15%. The food consumption pattern of Malaysian adults appears to be satisfactory. However, some changes in food habits are recommended especially in substituting the less wholesome sweetened condensed milk with the more nutritious full cream or skimmed milk.
Study name: Malaysian Adult Nutrition Survey (MANS-2003)
Fulltext Body mass index (BMI) of adults: Findings of the Malaysian Adult Nutrition Survey (MANS)

Azmi MY, Junidah R, Siti Mariam A, Safiah MY, Fatimah S, Norimah AK, et al.

Malays J Nutr, 2009 Sep;15(2):97-119.
PMID: 22691810 MyJurnal

The Malaysian Adults Nutrition Survey (MANS) was carried out between October 2002 and July 2003, involving 6,775 men and 3,441 women aged 18 - 59 years. Anthropometric assessment showed that the overall mean body weight and BMI were 62.65 kg (CI: 62.20, 63.09) and 24.37 kg/m2 (CI: 24.21, 24.53) respectively. Based on the WHO (1998) classification of BMI, 12.15% (CI: 11.26, 13.10) were obese (BMI > 30 kg/m2), and 26.71% (CI: 25.50, 27.96) overweight (BMI > 25 - 29.9 kg/m2). Significantly, more women were obese [14.66% (CI: 13.37, 16.04)] while significantly more men were overweight [28.55% (CI: 26.77, 30.40)]. Ethnicitywise, prevalence of obesity was highest among the Malays [15.28% (CI: 13.91, 16.77)] while overweight was highest for the Indians [31.01% (CI: 26.64, 35.76)]. Both obesity and overweight were highest among those aged 40 - 49 years. Obesity was highest for those whose household income was between RM1,500 - 3,500 while overweight was more prevalent for those whose household income exceeded RM3,500. The prevalence of overweight was highest for those with primary education [31.90% (CI: 29.21, 34.72)]. There was no significant urban rural differential in both obesity and overweight. The study found 9.02% (CI:8.82, 10.61) with chronic energy deficiency (CED) (BMI < 18.5 kg/m2). The prevalence of CED was relatively higher in the indigenous population (Orang Asli) [14.53% (CI: 5.14, 34.77)], subjects aged 18-19 years [26.24% (CI: 21.12, 32.09)], and with monthly household income of < RM1,500 [10.85% (CI: 9.63, 12.20)]. The prevalence of CED was not significantly different among the geographical zones and educational levels, and between urban/rural areas and sexes. The results call for priority action to address the serious problem of overweight and obesity among Malaysian adults as it poses a grave burden to the country's resources and development.
Study name: Malaysian Adult Nutrition Survey (MANS-2003)
Fulltext Meal patterns of Malaysian adults: findings from the Malaysian adults nutrition survey (MANS)

Wan Abdul Manan WM, Nur Firdaus I, Safiah MY, Siti Haslinda MD, Poh BK, Norimah AK, et al.

Malays J Nutr, 2012 Aug;18(2):221-30.
PMID: 24575668 MyJurnal

INTRODUCTION: Meal patterns have received little attention in nutrition studies. The aim of this study is to present the findings on general meal patterns of Malaysian adults.
METHODS: The Malaysian Adults Nutrition Survey (MANS), carried out in 2002 and 2003, involved 6,928 adults selected by stratified random sampling from all households by zone in Peninsular Malaysia, Sabah and Sarawak.
RESULTS: In general, the results showed that most respondents (74.16%) ate three meals per day; 89.20% of the respondents consumed breakfast, while 88.57% consumed lunch and 91.97% consumed dinner with no significant difference in terms of sex. In Peninsular Malaysia, the Northern Zone had the highest number of people consuming breakfast compared to other zones. Meanwhile, the population in Sarawak had the largest proportion of people consuming lunch and dinner, but the smallest proportion of people consuming breakfast. A significantly higher number of the rural population consumed breakfast and lunch than urbanites; however there was no significant difference in dinner consumption. Generally, breakfast consumption increased with age whereby significant difference existed between the 18 to 19 years age group and the age group of 30 years and older. Lunch intake among the age groups showed no significant difference. In contrast, dinner consumption was significantly lower among the 18 to 19 years age group compared to all other age groups. Comparison among the ethnic groups showed that the Indian population had the lowest percentage of having breakfast and lunch while the Orang Asli had the lowest percentage of consuming dinner. However, the Orang Asli recorded the highest percentage for taking breakfast and lunch while the Chinese had the highest percentage of taking dinner.
CONCLUSION: Considering that Malaysian adults consumed their conventional breakfast, lunch and dinner, these findings indicatethat Malaysians are maintaining their traditional meal patterns.
Study name: Malaysian Adult Nutrition Survey (MANS-2003)

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