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  1. Adegbusi HS, Ismail A, Mohd Esa N, Mat Daud ZA
    J Sci Food Agric, 2022 Dec;102(15):6961-6973.
    PMID: 35672266 DOI: 10.1002/jsfa.12057
    BACKGROUND: Plant-based complementary foods (CFs) supply insufficient amount of nutrients to meet recommended nutrient intakes for 6-23-month-old children. The present study determined the nutritional quality of CFs formulated from blends of Nigerian yellow maize (Zea mays), soybean (Glycine max) and crayfish (Procambarus clarkii). Three CFs were formulated; namely, maize flour (MF, 100:0% w/w), blends of maize and soybean flour (MSF, 72:28% w/w), and maize, soybean and crayfish flour (MSCF, 80:10:10% w/w). Nutritional quality was evaluated using analyses of chemical composition of CFs and of protein quality of complementary food diets. Data were compared by multivariate analysis of variance and significantly differentiated. Nine selected nutritional criteria were used to decide the CF that had best nutritional characteristics compared to MF and fortified wheat flour (FWMF).

    RESULTS: Total scores obtained from the selected nutritional criteria ranked MSCF, with total score of 15, as the lowest and thus it was considered to have the most desirable nutritional characteristics compared to MF, MSF and FWMF, which had respective total scores of 31, 22 and 20.

    CONCLUSION: Conclusively, MSCF may serve as a better alternative CF for MF, MSC and FWMF. The present study has produced a potential alternative cost-effective and adequate CF, formulated from crayfish (P. clarkii) supplementation of locally available blend of yellow maize (Z. mays) and soybean (G. max), for the poor human population, aiming to encourage the consumption of animal-sourced CF for alleviating the prevalence of childhood undernutrition. © 2022 Society of Chemical Industry.

  2. Sahathevan S, Khor BH, Ng HM, Gafor AHA, Mat Daud ZA, Mafra D, et al.
    Nutrients, 2020 Oct 15;12(10).
    PMID: 33076282 DOI: 10.3390/nu12103147
    Hemodialysis (HD) majorly represents the global treatment option for patients with chronic kidney disease stage 5, and, despite advances in dialysis technology, these patients face a high risk of morbidity and mortality from malnutrition. We aimed to provide a novel view that malnutrition susceptibility in the global HD community is either or both of iatrogenic and of non-iatrogenic origins. This categorization of malnutrition origin clearly describes the role of each factor in contributing to malnutrition. Low dialysis adequacy resulting in uremia and metabolic acidosis and dialysis membranes and techniques, which incur greater amino-acid losses, are identified modifiable iatrogenic factors of malnutrition. Dietary inadequacy as per suboptimal energy and protein intakes due to poor appetite status, low diet quality, high diet monotony index, and/or psychosocial and financial barriers are modifiable non-iatrogenic factors implicated in malnutrition in these patients. These factors should be included in a comprehensive nutritional assessment for malnutrition risk. Leveraging the point of origin of malnutrition in dialysis patients is crucial for healthcare practitioners to enable personalized patient care, as well as determine country-specific malnutrition treatment strategies.
  3. Halib H, Ismail A, Mohd Yusof BN, Osakabe N, Mat Daud ZA
    Nutrients, 2020 Nov 30;12(12).
    PMID: 33266002 DOI: 10.3390/nu12123695
    Obesity remains a major public health problem due to its increasing prevalence. Natural products have become common as adjunct therapeutic agents for treating obesity and preventing metabolic diseases. Cocoa and its products are commonly consumed worldwide. Dark chocolate, a rich source of polyphenols, has received attention lately for its beneficial role in the management of obesity; however, conflicting results are still being reported. This scoping review aims to provide a comprehensive understanding of the existing literature on the relationship and effects of cocoa and dark chocolate intake among obese adults. We searched multiple databases for research investigating the consumption of cocoa and/or dark chocolate in managing obesity among adults. This review includes epidemiological and human studies that were published in English over the last 10 years. Our review of the current literature indicates that epidemiological and human trials with obese adults have shown inconsistent results, which may be due to the different populations of subjects, and different types of cocoa products and doses used for intervention. Studies among obese adults are mainly focusing on obese individuals with comorbidities, as such more studies are needed to elucidate the role of cocoa polyphenols in weight control and preventing the risk of chronic diseases among obese individuals without comorbidities as well as healthy individuals. Careful adjustment of confounding factors would be required. The effects of cocoa and dark chocolate intake on obese adults were discussed, and further research is warranted to identify the gaps.
  4. Nguyen TH, Mat Daud ZA, Abd Talib R, Mohd R, Poh BK
    Transplant Proc, 2023 Nov;55(9):2176-2182.
    PMID: 37743189 DOI: 10.1016/j.transproceed.2023.08.008
    BACKGROUND: Although metabolic syndrome (MetS) is a significant risk factor, and dietary intake may affect the quality of life (QoL) of kidney transplant recipients (KTRs), the association between them are unclear. This study identified MetS and nutritional factors associated with the QoL of KTRs.

    METHODS: This study reports baseline data from a longitudinal study that was conducted at a hospital in Vietnam. KTRs aged ≥18 years and >3 months post-transplantation were recruited. Assessments included sociodemographic and blood biomarkers. Dietary intake was estimated from 24-hour recalls. A Short Form-36 Health Survey, comprising physical (PCS) and mental component summaries (MCS), was administered to assess QoL. Multivariate linear regression models were performed.

    RESULTS: The study included 106 patients (79 men) with a mean age of 43.2 years (± 11.9). Mean duration after kidney transplantation was 28.5 months (± 14.9). Patients with MetS had 6.43 lower PCS score (P < .05) and 3.20 lower MCS score (P < .05) than their counterparts without MetS. Calcium intake (β = -0.01; 95% CI, -0.03 to 0.00) and inadequate protein (β = -14.8; 95% CI, -23 to -6.65) were negatively associated with PCS score. MCS score was negatively associated with calcium intake (β = -0.02; 95% CI, -0.04 to -0.01) and inadequate protein intake (β = -15.1; 95% CI, -24.3 to -5.86), and positively associated with fat intake (β = 0.43, 95% CI, 0.02-0.85).

    CONCLUSIONS: MetS and poor dietary intake are independently associated with the QoL of KTRs. Nutritional intervention plans developed specifically for the recipients will improve dietary intake, reduce the incidence of MetS, and help enhance QoL.

  5. Sualeheen A, Khor BH, Balasubramanian GV, Sahathevan S, Chinna K, Mat Daud ZA, et al.
    J Ren Nutr, 2022 Nov;32(6):726-738.
    PMID: 35182714 DOI: 10.1053/j.jrn.2022.02.002
    OBJECTIVES: This study modified Healthy Eating Index (HEI) based on hemodialysis (HD)-specific nutritional guidelines and investigated associations between the diet quality (DQ) and nutritional risk in HD patients.

    METHODS: The HD-HEI tool adapted the Malaysian Dietary Guidelines 2010 framework according to HD-specific nutrition guidelines. This HD-HEI was applied to 3-day dietary records of 382 HD patients. Relationships between HD-HEI scores and nutritional parameters were tested by partial correlations. Binary logistic regression models adjusted with confounders were used to determine adjusted odds ratio (adjOR) with 95% confidence interval (CI) for nutritional risk based on HD-HEI scores categorization.

    RESULTS: The total HD-HEI score (51.3 ± 10.2) for this HD patient population was affected by ethnicity (Ptrend < .001) and sex (P = .003). No patient achieved "good" DQ (score: 81-100), while DQ of 54.5% patients were classified as "needs improvement" (score: 51-80) and remaining as "poor" (score: 0-51). Total HD-HEI scores were positively associated with dietary energy intake (DEI), dietary protein intake (DPI), dry weight, and handgrip strength, but inversely associated with Dietary Monotony Index (DMI) (all P 

  6. Tallman DA, Latifi E, Kaur D, Sulaheen A, Ikizler TA, Chinna K, et al.
    Nutrients, 2020 Mar 18;12(3).
    PMID: 32197373 DOI: 10.3390/nu12030797
    The association between dietary patterns and health outcomes, such as quality of life (QOL), in maintenance hemodialysis (MHD) patients with certain racial backgrounds has not been studied in detail. QOL is a powerful outcome measure in which dietary patterns could be a modifying factor. This study is a secondary analysis examining the association between dietary patterns and health outcomes in 101 African American (AA) maintenance hemodialysis (MHD) patients participating in the Palm Tocotrienols in Chronic Hemodialysis (PATCH) study. Quality of life (QOL) was assessed using the Kidney Disease Quality of Life 36-item survey (KDQOL-36™). Blood samples were analyzed for lipids, lipoprotein subfractions, and inflammatory markers. Food intake was measured using six non-consecutive 24-h dietary recalls over 15 months. Implausible energy intake reports were screened out by comparing reported energy intake (rEI) with predicted total energy expenditure (pTEE). Cluster analysis, using the k-means algorithm, identified two distinct dietary patterns in the study population: a high "sugar sweetened beverage" pattern (hiSSB) and a low "sugar sweetened beverage pattern" (loSSB). In the hiSSB group, consumption of SSB accounted for ~28% of energy intake, while SSB represented only 9% of energy intake in the loSSB group. The hiSSB group was characterized by a higher intake of total calories, sugar and percentage of kilocalories from carbohydrates, whereas the percentage of kilocalories from protein and fat was lower. While additional micronutrient intakes differed between groups (vitamin C, zinc, chromium), these were significantly lower than recommended values in the entire cohort. Patients in the hiSSB group presented with lower high-density lipoprotein cholesterol (HDL-C), lower large HDL particles and smaller low density lipoprotein (LDL) particle diameters. Antidepressant usage was significantly higher in the hiSSB group. Patients in the hiSSB group scored lower across all five KDQOL domains and scored significantly lower in the mental composite domain. MHD patients following a hiSSB dietary pattern had smaller dense LDL particles, lower HDL-C, and a lower QOL. Suboptimal intakes of fruits, vegetables, and grains as well as key micronutrients were evident in both patterns.
  7. Karupaiah T, Mat Daud ZA, Khosla P, Khor BH, Sahathevan S, Kaur D, et al.
    J Ren Nutr, 2023 Nov;33(6S):S73-S79.
    PMID: 37597574 DOI: 10.1053/j.jrn.2023.08.003
    BACKGROUND: Recent surveys highlight gross workforce shortage of dietitians in global kidney health and significant gaps in renal nutrition care, with disparities greater in low/low-middle income countries.

    OBJECTIVE: This paper narrates ground experiences gained through the Palm Tocotrienols in Chronic Hemodialysis (PaTCH) project on kidney nutrition care scenarios and some Asian low-to-middle-income countries namely Bangladesh, India, and Malaysia.

    METHOD: Core PaTCH investigators from 3 universities (USA and Malaysia) were supported by their postgraduate students (n = 17) with capacity skills in kidney nutrition care methodology and processes. This core team, in turn, built capacity for partnering hospitals as countries differed in their ability to deliver dietitian-related activities for dialysis patients.

    RESULTS: We performed a structural component analyses of PaTCH affiliated and nonaffiliated (Myanmar and Indonesia) countries to identify challenges to kidney nutrition care. Deficits in patient-centered care, empowerment processes and moderating factors to nutrition care optimization characterized country comparisons. Underscoring these factors were some countries lacked trained dietitians whilst for others generalist dietitians or nonclinical nutritionists were providing patient care. Resolution of some challenges in low-to-middle-income countries through coalition networking to facilitate interprofessional collaboration and task sharing is described.

    CONCLUSIONS: We perceive interprofessional collaboration is the way forward to fill gaps in essential dietitian services and regional-based institutional coalitions will facilitate culture-sensitive capacity in building skills. For the long-term an advanced renal nutrition course such as the Global Renal Internet Course for Dietitians is vital to facilitate sustainable kidney nutrition care.

  8. Sahathevan S, Khor BH, Yeong CH, Tan TH, Meera Mohaideen AK, Ng HM, et al.
    JPEN J Parenter Enteral Nutr, 2021 07;45(5):872-873.
    PMID: 34165200 DOI: 10.1002/jpen.2206
  9. Sahathevan S, Karupaiah T, Khor BH, Sadu Singh BK, Mat Daud ZA, Fiaccadori E, et al.
    Front Nutr, 2021;8:743324.
    PMID: 34977109 DOI: 10.3389/fnut.2021.743324
    Background: Muscle wasting, observed in patients with end-stage kidney disease and protein energy wasting (PEW), is associated with increased mortality for those on hemodialysis (HD). Oral nutritional supplementation (ONS) and nutrition counseling (NC) are treatment options for PEW but research targeting muscle status, as an outcome metric, is limited. Aim: We compared the effects of combined treatment (ONS + NC) vs. NC alone on muscle status and nutritional parameters in HD patients with PEW. Methods: This multi-center randomized, open label-controlled trial, registered under ClinicalTrials.gov (Identifier no. NCT04789031), recruited 56 HD patients identified with PEW using the International Society of Renal Nutrition and Metabolism criteria. Patients were randomly allocated to intervention (ONS + NC, n = 29) and control (NC, n = 27) groups. The ONS + NC received commercial renal-specific ONS providing 475 kcal and 21.7 g of protein daily for 6 months. Both groups also received standard NC during the study period. Differences in quadriceps muscle status assessed using ultrasound (US) imaging, arm muscle area and circumference, bio-impedance spectroscopy (BIS), and handgrip strength (HGS) methods were analyzed using the generalized linear model for repeated measures. Results: Muscle indices as per US metrics indicated significance (p < 0.001) for group × time interaction only in the ONS + NC group, with increases by 8.3 and 7.7% for quadriceps muscle thickness and 4.5% for cross-sectional area (all p < 0.05). This effect was not observed for arm muscle area and circumference, BIS metrics and HGS in both the groups. ONS + NC compared to NC demonstrated increased dry weight (p = 0.039), mid-thigh girth (p = 0.004), serum prealbumin (p = 0.005), normalized protein catabolic rate (p = 0.025), and dietary intakes (p < 0.001), along with lower malnutrition-inflammation score (MIS) (p = 0.041). At the end of the study, lesser patients in the ONS + NC group were diagnosed with PEW (24.1%, p = 0.008) as they had achieved dietary adequacy with ONS provision. Conclusion: Combination of ONS with NC was effective in treating PEW and contributed to a gain in the muscle status as assessed by the US, suggesting that the treatment for PEW requires nutritional optimization via ONS.
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