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  1. Asheila Meramat, Razinah Sharif, Suzana Shahar, Nor Fadilah Rajab
    Jurnal Sains Kesihatan Malaysia, 2018;16(101):213-214.
    MyJurnal
    Nutritional diet plays an important roles in the health of an individual. One of the simplest and suitable approach followed by certain individual especially older adults are Sunnah fasting. Sunnah fasting is reported to have a positive impact in maintaining public health and aids to prolong the life span of older adults. This study aimed to examine the relationship of Sunnah fasting in repairing DNA damage of older adults who suffer from mild cognitive impairment (MCI). The study design was comparative cross sectional study that comparing two phases (baseline and 36 months). A total of 99 subjects of MCI aged ≥ 60 years and have no terminally ill diseases involved in the study. Ten ml of whole blood, socio-demographic and cognitive assessment data was taken. The blood collected is used to determine DNA damage using the Alkaline Comet Assay. MMSE, IADL, ADL and GDS was conducted to determine the cognitive function. The study found that the percentage of DNA in tail (TD) for the subjects who practice Sunnah fasting for both phases is significantly lower than in subjects who did not practice Sunnah fasting (Baseline, TD: 12.49 ± 0.24% vs 17.40 ± 0.43%; 36 months, TD: 8.21 ± 0.43% vs 15.23 ± 1.16%). The percentage of tail moment (TM) for the subjects who practice Sunnah fasting for both phases is significantly lower than in subjects who did not practice Sunnah fasting (Baseline, TM: 0.92 ± 0.05% vs 1.46 ± 0.08%; 36 months, TM: 0.4 ± 0.03% vs 1.32 ± 0.13%). In conclusion, this shows the Sunnah fasting can reduce DNA damage among the older adult of MCI subjects. Thus, further research is warranted to determine the metabolomes in MCI subjects that related with Sunnah fasting to produce a predictive model of healthy diet to be used in the future.
  2. Meramat, A. Rajab, N.F. Shahar S, Sharif R
    Sains Malaysiana, 2017;46:1625-1633.
    Prevalens gangguan kognitif ringan (MCI) di Malaysia mencecah 68% pada tahun 2016. Pelbagai kaedah dijalankan bagi memastikan kelestarian tahap kesihatan warga tua termasuk melalui nutrisi, gaya hidup dan persekitaran. Pengehadan kalori dibuktikan mampu untuk menurunkan kadar mortaliti dan morbiditi warga tua serta memelihara tahap kesihatan warga tua supaya dapat membantu dalam meningkatkan kualiti hidup golongan tersebut. Pengehadan kalori juga merupakan salah satu kaedah yang lebih mudah dan berkesan dalam membantu meningkatkan ingatan dan memelihara kesihatan golongan tersebut. Ia juga membantu mengurangkan kadar inflamasi dan mencantas tindakan radikal bebas yang hadir di dalam sistem tubuh akibat daripada proses penuaan dan faktor persekitaran. Keadaan ini menyediakan tubuh badan yang lebih rentan terhadap kerosakan DNA dan serangan toksin daripada penyakit kronik, pemakanan dan persekitaran. Oleh itu, kajian ini memberikan konsep yang lebih jelas terhadap implikasi pengehadan kalori dalam memelihara fungsi kognitif.
  3. Meramat A, Rajab NF, Shahar S, Sharif RA
    J Nutr Health Aging, 2017;21(5):539-545.
    PMID: 28448084 DOI: 10.1007/s12603-016-0759-1
    BACKGROUND: A cross sectional study was conducted in a group of 317 subjects older than 60 in Malaysia, aimed to determine risk factors associated with cognitive impairment in older adults, focusing on trace elements and DNA damage.

    METHOD: Cognitive decline was determined by Montreal Cognitive Assessment (MoCA). Oxidative stress markers (malondialdehyde-MDA and superoxide dismutase-SOD) were determined and DNA damage was assayed using Alkaline Comet Assay. Toenail samples were taken and analyzed using ICP-MS to determine trace element levels.

    RESULTS: A total of 62.1 % of subjects had cognitive impairment. Subjects with cognitive impairment had significantly higher levels of MDA and DNA damage as compared to the group with normal cognitive function; MDA (2.07 ± 0.05 nmol/L vs 1.85 ± 0.06 nmol/L) (p<0.05) and DNA damage (% Tail Density, 14.52 ± 0.32 vs 10.31 ± 0.42; Tail Moment, 1.79 ± 0.06 vs 1.28 ± 0.06) (p<0.05 for all parameters). However, the level of SOD among subjects with cognitive impairment (6.67 ± 0.33 u.e/min/mg protein) was lower than the level among those with normal cognitive functions (11.36 ± 0.65 u.e/min/mg protein) (p<0.05). Multiple logistic regression revealed the predictors for cognitive impairment among the subjects were DNA damage (Adjusted odd ratio [OR], 1.37; 95% confidence interval [CI], 1.18-1.59), level of trace elements in toenails namely, lead (OR, 2.471; CI, 1.535-3.980) and copper (OR, 1.275; CI, 1.047-1.552) (p<0.05).

    CONCLUSION: High levels of lead and copper can lead to increase in oxidative stress levels and are associated with DNA damage that eventually could be associated with cognitive decline.

  4. Ooi TC, Meramat A, Rajab NF, Shahar S, Sharif R
    J Nutr Health Aging, 2022;26(3):272-281.
    PMID: 35297471 DOI: 10.1007/s12603-022-1757-0
    OBJECTIVES: This study aimed to determine the relationship between oxidative stress, DNA damage, inflammation, and metabolic biomarkers as the mediating factor between Islamic Sunnah intermittent fasting (IF) practice and cognitive function among older adults with mild cognitive impairment (MCI).

    DESIGN: This study was a 36 months prospective cohort study.

    SETTING: Community-dwelling older participants recruited through a stratified random sampling method from four states representing Malaysia's central, north-west, northeast and southern regions.

    PARTICIPANTS: Ninety-nine Malay Muslim older adults (n= 99) aged 60 and above with MCI and no known critical illnesses were included in the current analysis. The participants were divided into regularly practicing IF (r-IF), irregularly practicing IF (i-IF) and not practicing IF (n-IF) groups.

    MEASUREMENTS: Fasting venous blood was collected and used to determine the levels of oxidative stress, DNA damage, inflammatory and metabolic biomarkers. Mini-Mental State Examination, Montreal Cognitive Assessment, Rey Auditory Verbal Learning Test, Digit Span and Digit symbol were used to evaluate the cognitive function. Then, the mediation analysis was conducted using a multistep regression model to determine the mediating role of various biomarkers between IF practice and cognitive function.

    RESULTS: When comparing the r-IF and n-IF groups, higher SOD activity, lower DNA damage (percentage of DNA in tail), lower CRP levels and higher HDL-cholesterol levels established partial mediation while lower insulin levels established complete mediation between IF practice and better cognitive function. Meanwhile, when comparing the r-IF and i-IF groups, higher SOD activity and lower CRP levels completely mediated the effects of IF practice on better cognitive function.

    CONCLUSION: It can be concluded that changes in antioxidant function, DNA damage, inflammation and a limited set of metabolic biomarkers (insulin and HDL cholesterol) may mediate improvements in cognitive function among older participants with MCI who practice Islamic Sunnah IF.

  5. Ooi TC, Meramat A, Rajab NF, Shahar S, Ismail IS, Azam AA, et al.
    Nutrients, 2020 Aug 30;12(9).
    PMID: 32872655 DOI: 10.3390/nu12092644
    Intermittent fasting (IF) refers to various dietary regimens that cycle between a period of non-fasting and a period of total fasting. This study aimed to determine the effects of IF on cognitive function among elderly individuals who practice IF who have mild cognitive impairment (MCI). A total of 99 elderly subjects with MCI of Malay ethnicity without any terminal illness were recruited from a larger cohort study, LRGS TUA. The subjects were divided into three groups, comprising those who were regularly practicing IF (r-IF), irregularly practicing IF (i-IF), and non-fasters (n-IF). Upon 36 months of follow-up, more MCI subjects in the r-IF group reverted to successful aging with no cognitive impairment and diseases (24.3%) compared to those in i-IF (14.2%) and n-IF groups (3.7%). The r-IF group's subjects exhibited significant increment in superoxide dismutase (SOD) activity and reduction in body weight, levels of insulin, fasting blood glucose, malondialdehyde (MDA), C-reactive protein (CRP), and DNA damage. Moreover, metabolomics analysis showed that IF may modulate cognitive function via various metabolite pathways, including the synthesis and degradation of ketone bodies, butanoate metabolism, pyruvate metabolism, and glycolysis and gluconeogenesis pathways. Overall, the MCI-afflicted older adults who practiced IF regularly had better cognitive scores and reverted to better cognitive function at 36 months follow-up.
  6. Shahar S, Omar A, Vanoh D, Hamid TA, Mukari SZ, Din NC, et al.
    Aging Clin Exp Res, 2016 Dec;28(6):1089-1104.
    PMID: 26670602 DOI: 10.1007/s40520-015-0511-4
    A number of longitudinal studies on aging have been designed to determine the predictors of healthy longevity, including the neuroprotective factors, however, relatively few studies included a wide range of factors and highlighted the challenges faced during data collection. Thus, the longitudinal study on neuroprotective model for healthy longevity (LRGS TUA) has been designed to prospectively investigate the magnitude of cognitive decline and its risk factors through a comprehensive multidimensional assessment comprising of biophysical health, auditory and visual function, nutrition and dietary pattern and psychosocial aspects. At baseline, subjects were interviewed for their status on sociodemographic, health, neuropsychological test, psychosocial and dietary intake. Subjects were also measured for anthropometric and physical function and fitness. Biospecimens including blood, buccal swap, hair and toenail were collected, processed and stored. A subsample was assessed for sensory function, i.e., vision and auditory. During follow-up, at 18 and 36 months, most of the measurements, along with morbidity and mortality outcomes will be collected. The description of mild cognitive impairment, successful aging and usual aging process is presented here. A total 2322 respondents were recruited in the data analysis at baseline. Most of the respondents were categorized as experiencing usual aging (73 %), followed by successful aging (11 %) and mild cognitive impairment (16 %). The LRGS TUA study is the most comprehensive longitudinal study on aging in Malaysia, and will contribute to the understanding of the aging process and factors associated with healthy aging and mental well-being of a multiethnic population in Malaysia.
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