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  1. Eshkoor SA, Hamid TA, Nudin SS, Mun CY
    Int J Alzheimers Dis, 2014;2014:769062.
    PMID: 24963440 DOI: 10.1155/2014/769062
    This study aimed to determine the effects of disability, physical activity, and functional status as well as environmental conditions on the risk of falls among the elderly with dementia after adjusting for sociodemographic factors. Data were derived from a group including 1210 Malaysian elderly who were demented and noninstitutionalized. The study was a national cross-sectional survey that was entitled "Determinants of Health Status among Older Malaysians." Approximately 17% of subjects experienced falls. The results showed that ethnic non-Malay (OR = 1.73) and functional decline (OR = 1.67) significantly increased the risk of falls in samples (P < 0.05). The findings indicated that increased environmental quality (OR = 0.64) significantly decreased the risk of falls (P < 0.05). Disability, age, marital status, educational level, sex differences, and physical activity were found irrelevant to the likelihood of falls in subjects (P > 0.05). It was concluded that functional decline and ethnic non-Malay increased the risk of falls but the increased environmental quality reduced falls.
  2. Eshkoor SA, Hamid TA, Nudin SS, Mun CY
    Med Devices (Auckl), 2014;7:225-30.
    PMID: 25018658 DOI: 10.2147/MDER.S63220
    BACKGROUND: Poor oral health, chronic diseases, functional decline, and low cognitive ability can increase the risk of falls in the elderly.
    OBJECTIVES: The current study aimed to show the effects of oral health, diabetes mellitus (DM), hypertension (HT), heart disease, functional status, and sociodemographic factors on the risk of falls in elderly with dementia.
    MATERIALS AND METHODS: The sample comprised 1,210 Malaysian elderly who were demented and noninstitutionalized. This study was a national cross-sectional survey entitled "Determinants of Health Status among Older Malaysians". The effects of age, ethnicity, sex differences, marital status, educational level, oral health, DM, HT, heart disease, and functional status on the risk of falls were evaluated. The multiple logistic regression model was used to estimate the effects of contributing variables on the risk of falls in samples.
    RESULTS: The prevalence of falls was approximately 17% in subjects. It was found that age (odds ratio [OR] 1.02), non-Malay ethnicity (OR 1.66), heart disease (OR 1.92), and functional decline (OR 1.58) significantly increased the risk of falls in respondents (P<0.05). Furthermore, having teeth (OR 0.59) and dentures (OR 0.66) significantly decreased the rate of falls (P<0.05).
    CONCLUSION: It was concluded that age, non-Malay ethnicity, functional decline, heart disease, and oral health significantly affected falls in dementia.
    KEYWORDS: chronic diseases; dementia; fall; functional decline; oral health
  3. Eshkoor SA, Hamid TA, Nudin SS, Mun CY
    PMID: 23883099 DOI: 10.1080/13825585.2013.819067
    This study aimed to predict the risk of falls by focusing on substance abuse in the elderly with dementia. Our national cross-sectional survey included 1210 elderly Malaysian demented subjects. The study identified the effects of age, ethnicity, sex differences, marital status, educational level, and substance abuse on the likelihood of falls in the elderly with dementia. The multivariate logistic regression model was used to analyze data collected from samples. The prevalence of falls was about 17% among subjects and significantly increased with age (p = .006). Furthermore, the results showed that age (OR = 1.03), ethnicity (OR = 1.69), substance abuse (OR = 1.68), and female sex (OR = 1.45) significantly enhanced the risk of falls in respondents (p < .05). Educational level and marital status had no significant effects on the likelihood of falls (p > .05). However, the findings provided evidence of an additional effect of substance abuse on further risk of falls in older adults with dementia.
  4. Eshkoor SA, Hamid TA, Mun CY, Ng CK
    Clin Interv Aging, 2015;10:687-93.
    PMID: 25914527 DOI: 10.2147/CIA.S73922
    Mild cognitive impairment (MCI) is a common condition in the elderly. It is characterized by deterioration of memory, attention, and cognitive function that is beyond what is expected based on age and educational level. MCI does not interfere significantly with individuals' daily activities. It can act as a transitional level of evolving dementia with a range of conversion of 10%-15% per year. Thus, it is crucial to protect older people against MCI and developing dementia. The preventive interventions and appropriate treatments should improve cognitive performance, and retard or prevent progressive deficits. The avoidance of toxins, reduction of stress, prevention of somatic diseases, implementation of mental and physical exercises, as well as the use of dietary compounds like antioxidants and supplements can be protective against MCI. The modification of risk factors such as stopping smoking, as well as the treatment of deficiency in vitamins and hormones by correcting behaviors and lifestyle, can prevent cognitive decline in the elderly. The progressive increase in the growth rate of the elderly population can enhance the rate of MCI all over the world. There is no exact cure for MCI and dementia; therefore, further studies are needed in the future to determine causes of MCI and risk factors of progression from MCI to dementia. This will help to find better ways for prevention and treatment of cognitive impairment worldwide.
  5. Lu Shin KN, Mun CY, Shariff ZM
    Asian Pac J Cancer Prev, 2020 Jul 01;21(7):1939-1950.
    PMID: 32711419 DOI: 10.31557/APJCP.2020.21.7.1939
    OBJECTIVE: This study aimed to investigate how nutrition indicators and physical function may influence Health-related Quality of Life (HRQoL) of breast cancer patients undergoing treatment.

    METHODS: This was a cross sectional study among a total of 163 breast cancer patients. Series of measurements including anthropometry, biochemical, and dietary were employed to assess patients' nutritional status while physical function was assessed by handgrip strength. HRQoL of patients was determined using European Organization for Research and Treatment of Cancer quality of life questionnaire Core 30 (EORTC-QLQ-C30) version 3.0. Multiple linear regression was used to identify factors associated with HRQoL.

    RESULTS: Breast cancer patients perceived moderately their overall quality of life (QoL), with the mean global health status (GHS) score of 69.12. Emotional functioning was the poorest functional scale while fatigue was the most distressing symptom presented by the patients. Approximately 20% of patients had low corrected arm muscle area while more than half had low hemoglobin level. More than 90% of patients did not meet the overall dietary recommendation and had poor handgrip strength. Mid-upper arm circumference (MUAC) was associated with GHS (β: 0.906; 95% CI: 0.22, 1.56) and cognitive functioning (β: -1.543; 95% CI: -3.07, -0.01). Handgrip strength was positively associated with most of HRQoL outcomes.

    CONCLUSIONS: Breast cancer patients reported overall good nutritional status and moderate QoL during treatment. Being well-nourished improved HRQoL and handgrip strength could be a potential proxy for functional outcomes as well as overall QoL.

  6. Eshkoor SA, Hamid TA, Nudin SS, Mun CY
    Am J Alzheimers Dis Other Demen, 2013 Jun;28(4):403-7.
    PMID: 23698600 DOI: 10.1177/1533317513488921
    OBJECTIVES: This study aimed to identify the effects of sleep quality, physical activity, environmental quality, age, ethnicity, sex differences, marital status, and educational level on the risk of falls in the elderly individuals with dementia.

    METHODOLOGY: Data were derived from a group of 1210 Malaysian elderly individuals who were noninstitutionalized and demented. The multiple logistic regression model was applied to estimate the risk of falls in respondents.

    RESULTS: Approximately the prevalence of falls was 17% among the individuals. The results of multiple logistic regression analysis revealed that age (odds ratio [OR] = 1.03), ethnicity (OR = 1.76), sleep quality (OR = 1.46), and environmental quality (OR = 0.62) significantly affected the risk of falls in individuals (P < .05). Furthermore, sex differences, marital status, educational level, and physical activity were not significant predictors of falls in samples (P > .05).

    CONCLUSION: It was found that age, ethnic non-Malay, and sleep disruption increased the risk of falls in respondents, but high environmental quality reduced the risk of falls.

  7. Eshkoor SA, Hamid TA, Nudin SS, Mun CY
    Am J Alzheimers Dis Other Demen, 2013 May;28(3):253-7.
    PMID: 23612908 DOI: 10.1177/1533317513481098
    OBJECTIVES: This study aimed to determine the effects of social support and having a partner on sleep quality in the elderly patients with dementia.

    METHODOLOGY: This research was conducted on 1210 noninstitutionalized elderly Malaysian individuals with dementia. The effects of age, ethnicity, educational level, marital status, sex differences, social support, and having a partner on sleep quality were evaluated in the respondents. The multiple logistic regression analysis was used to predict the risk of sleep disturbances among the participants.

    RESULTS: Approximately, 41% of the participants experienced sleep disruption. Further findings showed that ethnicity (odds ratio [OR] = 0.62), social support (OR = 1.35), marital status (OR = 2.21), educational level (OR = 0.65), and having a partner (OR = 0.45) significantly affected sleep quality (P < .05). Sex differences and age were unrelated predictors of sleep disturbances (P > .05).

    CONCLUSION: It was concluded that social isolation and being single increased sleep disruption among respondents, but having a partner and ethnic non-Malay decreased the rate of sleep problems.

  8. Eshkoor SA, Hamid TA, Shahar S, Mun CY
    J Nutr Health Aging, 2017;21(2):220-226.
    PMID: 28112780 DOI: 10.1007/s12603-016-0779-x
    BACKGROUND: Urinary incontinence is a prevalent condition in the elderly that is the spontaneous leakage of urine. It is an age-related problem and increases especially in people aged above 65 years. It can cause many psychological, behavioral, biological, economic and social effects. The treatment of urinary incontinence can reduce morbidity and mortality. Thus, this study aimed to determine the effects of variables including age, ethnicity, gender, education, marital status, body weight, blood elements and nutritional parameters on urinary incontinence among the Malaysian elderly.

    METHODS: The study was on 2322 non-institutionalized Malaysian elderly. The hierarchy logistic regression analysis was applied to estimate the risk of independent variables for urinary incontinence among respondents.

    RESULTS: The findings indicated that approximately 3.80% of subjects had urinary incontinence. In addition, constipation was found a significant factor that increased the risk of urinary incontinence in samples (p=0.006; OR=3.77). The increase in dietary monounsaturated fat (p=0.038; OR=0.59) and plasma triglyceride levels (p=0.029; OR=0.56) significantly reduced the risk of incontinence in subjects. Many of suspected variables including socio-demographic factors, diseases, nutritional minerals, blood components and body weight were non-relevant factors to urinary incontinence in respondents.

    CONCLUSIONS: Constipation increased the risk of urinary incontinence in subjects, and increase in dietary monounsaturated fat and plasma triglyceride levels decreased the risk.

  9. Eshkoor SA, Hamid TA, Nudin SS, Mun CY
    Am J Alzheimers Dis Other Demen, 2014 Feb;29(1):61-6.
    PMID: 24085252 DOI: 10.1177/1533317513505136
    This study aimed to determine the effects of diabetes mellitus (DM), hypertension (HT), heart disease, social isolation, and sociodemographic factors on sleep in the elderly patients with dementia. Samples included 1210 noninstitutionalized, Malaysian elderly patients with dementia. The multiple logistic regression analysis was applied to estimate the risk of sleep disturbances among respondents. Approximately 41% of the patients experienced sleep problems. The results showed that age (odds ratio [OR] = 1.02), social isolation (OR = 1.33), and HT (OR = 1.53) significantly increased sleep disruption in respondents (P .05). It was concluded that age, social isolation, and HT increased sleep disruption but education and ethnic non-Malay reduced the risk of sleep problems. Moreover, HT was the most important variable to increase sleep disturbances in the elderly patients with dementia.
  10. Soon HK, Saad HA, Taib MN, Rahman HA, Mun CY
    PMID: 23691640
    A twelve-week controlled intervention trial was carried out to evaluate the effects of combined physical activity and dietary intervention on obesity and metabolic risk factors among employees of Universiti Putra Malaysia. Participants consisted of adults aged 25-55 years with no reported chronic diseases but with abdominal obesity. They were assigned to either a combined physical activity and dietary intervention group or a control group. The final sample consisted of 56 participants, with an equal number of 28 for each study group. No significant group effect was observed for any variable except for hip circumference (HC) and fasting plasma glucose (FPG). There was a significant increase in HC (p=0.007) and reduction in FPG (p=0.02) in the intervention group compared to the control group. In the intervention group, HC (p=0.002), triglycerides (TG) (p=0.0001), total cholesterol (TC) (p=0.0001), LDL cholesterol (LDLC) (p=0.0001) and FPG (p=0.005) were significantly reduced, while waist circumference (WC) (p=0.025) and the waist-to-hip ratio (WHR) (p=0.027) were significantly reduced in the control group. No significant change in steps/day or calorie intake'was observed in either group. Taken together, these data indicate that the combined physical activity and dietary intervention was not effective at improving diet or physical activity level. However, the intervention was effective in improving FPG among participants with abdominal obesity. The significant increase in HC in the interventions group warrants further study. These findings will be useful to further improve group-based intervention for the prevention and management of obesity.
  11. Albelbeisi A, Shariff ZM, Mun CY, Abdul-Rahman H, Abed Y
    East Mediterr Health J, 2018 Jun 10;24(3):302-310.
    PMID: 29908026 DOI: 10.26719/2018.24.3.302
    Background: Growth faltering in early life can adversely affect health in later childhood and adulthood. Growth monitoring of children can provide evidence to help formulate effective strategies to address growth problems but such information on Palestinian children is lacking.

    Objectives: This study aimed to determine the growth patterns of children under 2 years in Gaza, Palestine.

    Methods: This retrospective cohort study was conducted in 2014 in 10 randomly selected primary health care clinics in 5 governorates of Gaza. Weight and length data were obtained from the health cards of children born in 2012, and z-scores were calculated and compared with the WHO Growth Standard (2006).

    Results: A total of 2 632 children's cards were included at the beginning of the study. Weight-for-age and weight-forlength decreased from birth to 6 months to about -0.40 SD but increased afterwards to -0.11 SD and 0.34 SD at 24 months respectively. Length-for-age declined after 6 months, reaching -0.85 SD at 24 months. At 6 months, the prevalence of underweight and stunting were 5% and 9% but at 24 months, the prevalence was 4% and 20% respectively. Wasting was highest at 6 months (10%) but decreased to 3% at 24 months. Significantly more girls were stunted at 9, 12 and 18 months (P < 0.001), underweight at 24 months (P < 0.05) and wasted at 12 months (P < 0.05). Early life faltering in length was more pronounced than weight, with stunting occurring in one fifth of boys and girls by 2 years of age.

    Conclusions: Preventive strategies are urgently needed to address early life causes of undernutrition, particularly stunting, in Palestinian children in Gaza.

  12. Albelbeisi A, Shariff ZM, Mun CY, Rahman HA, Abed Y
    Nutr J, 2020 12 05;19(1):133.
    PMID: 33278899 DOI: 10.1186/s12937-020-00652-7
    BACKGROUND: Infants and young children 6-24 months of age are the most nutritionally vulnerable groups, as their needs for vitamins and minerals are high relative to the amount of food they consume. This study determines the effect of Micronutrient Powder Supplementation (MNP) on growth and hemoglobin of infants in Gaza Strip, Palestine.

    METHOD: This was a two-arm parallel-group randomized controlled trial conducted in two health care clinics of the United Nations Relief and Work Agency (UNRWA) at the Middle Area governorate of Gaza Strip, Palestine. A total of 200 healthy infants aged 6-month-old were recruited and randomized to receive 3 sachets/week of MNP for 12 months alongside with the National Micronutrient Supplement (NMS) (n = 100) or NMS alone (n = 100). Weight, length, blood hemoglobin, and dietary intakes were measured at 6, 9, 12, 15, 18, and 21 (3 months after the end of intervention) months of age. Analysis was by intention to treat.

    RESULTS: The experimental group had a higher concentration of hemoglobin at 12 and 15 months than did the control group, and a significant difference (p 

  13. Ebrahimi F, Shariff ZM, Tabatabaei SZ, Fathollahi MS, Mun CY, Nazari M
    J Health Popul Nutr, 2015 Mar;33(1):168-76.
    PMID: 25995733
    Gestational weight gain (GWG) is a determinant of health and nutrition of mothers and offspring. However, many factors associated with GWG are not completely understood. The present study assessed the relationship between sociodemographics, dietary intake, and physical activity with GWG in 308 Iranian pregnant women attending government healthcare centres in Rafsanjan city, Iran. Women gained an average of 12.87±3.57 kg during pregnancy while 54% did not gain weight within the Institute of Medicine (IOM)-recommended range. Univariate logistic models showed that gestaional weight gain was related to age, pre-pregnancy body mass index (BMI), energy intake, and sitting time. Cumulative logit model showed positive relationship between age (p=0.0137) and pre-pregnancy BMI (p<0.0001) with GWG. All pregnant women should be counselled on achieving the reccomended GWG to prevent adverse maternal and prenatal outcomes. Pre-pregnancy and gestational nutritional status and physical activity should be emphasized in antenatal care.
  14. Yaw YH, Shariff ZM, Kandiah M, Mun CY, Yusof RM, Othman Z, et al.
    BMC Public Health, 2011;11:309.
    PMID: 21569467 DOI: 10.1186/1471-2458-11-309
    Weight gain rather than weight loss often occurs after breast cancer diagnosis despite breast cancer survivors frequently reported making healthful lifestyle changes. This study describes the prevalence and magnitude of changes in weight before and after breast cancer diagnosis and examines lifestyle behaviors of breast cancer survivors with stable weight, weight gain or weight loss.
  15. Yaw YH, Kandiah M, Shariff ZM, Mun CY, Hashim Z, Yusof RM, et al.
    Asian Pac J Cancer Prev, 2010;11(6):1535-40.
    PMID: 21338193
    This study describes weight changes experienced by Malaysian women with breast cancer. Women with breast cancer (n=368) were recruited from eight hospitals and four breast cancer support groups in Peninsular Malaysia. Current weight was measured and weight at the time of diagnosis and a year preceding diagnosis were based on self-reports. Change in weight was determined from the year preceding breast cancer diagnosis to study entry (time 1), at the time of diagnosis to study entry (time 2) and from a year preceding breast cancer diagnosis to the time of diagnosis (time 3). Current body mass index, at a year preceding diagnosis and at the time of diagnosis were determined. Waist circumference was also measured. The sample comprised 57% Malay, 34% Chinese and 9.8% Indian women. The mean age of the women was 54 ∓ 9.04 years and over 80% were post-menopausal. Majority of the women were in stage I and stage II breast cancer at the time of diagnosis. The most common treatments received by these women were chemotherapy followed by radiotherapy and mastectomy. Overweight and obesity were prevalent in over 40% of the survivors at all three periods. Significant weight changes were observed during time 1 (-0.74 ∓ 4.78kg, p< 0.001), time 2 (2.73 ∓ 8.06kg, p< 0.001) and time 3 (3.47 ∓ 7.53kg, p< 0.001). At time 1, almost 50% showed no changes in their weight. At time 2, nearly two-thirds had gained weight and at time 3, 69% had gained weight, abdominal obesity was observed in nearly two-thirds of the women at study entry. A significant difference in weight change among age groups was observed in time 2 and time 3. All ethnic groups had significant weight change in time 1 and time 2. Significant weight gain was observed in relation to body mass index prior to diagnosis, at diagnosis and at study entry. However, no significant difference in weight change by educational level, family history of cancer and cancer stages were observed in all 3 periods. In conclusion, significant weight gain was evident in this sample of women after diagnosis of breast cancer and treatment. Women with breast cancer should be encouraged to maintain normal body mass index and waist circumference through appropriate diet and regular physical activity which may help to reduce their risk of recurrence, secondary cancer and metastasis.
  16. Shariff ZM, Lin KG, Sariman S, Siew CY, Yusof BN, Mun CY, et al.
    Ecol Food Nutr, 2016 Jul-Aug;55(4):378-89.
    PMID: 27231732 DOI: 10.1080/03670244.2016.1181065
    Although diets with high energy density are associated with increased risk of overweight and obesity, it is not known whether such diets are associated with undernutrition. This study assessed the relationship between dietary energy density (ED) and nutritional status of 745 urban 1- to 10-year-old children. Dietary intakes were obtained using food recall and record for two days. Dietary energy density was based on food and caloric beverages. Higher dietary ED was associated with lower intakes of carbohydrate, sugar, vitamins C and D, and calcium but higher fat, fiber, iron, and folate intakes. While intakes of fruits and milk/dairy products decreased, meat, fish, and legume intakes increased with higher dietary ED. Stunting, but not other growth problems, was associated with higher dietary ED. Future studies should confirm the cause-and-effect relationship between higher dietary ED and stunting.
  17. Samrot AV, Saigeetha S, Mun CY, Abirami S, Purohit K, Cypriyana PJJ, et al.
    Sci Rep, 2021 12 31;11(1):24511.
    PMID: 34972829 DOI: 10.1038/s41598-021-03328-2
    Latex, a milky substance found in a variety of plants which is a natural source of biologically active compounds. In this study, Latex was collected from raw Carica papaya and was characterized using UV-Vis, FTIR and GC-MS analyses. Super Paramagnetic Iron Oxide Nanoparticles (SPIONs) were synthesized, coated with C. papaya latex (PL-Sp) and characterized using UV-Vis, FT-IR, SEM-EDX, XRD, VSM and Zeta potential analyses. SPIONs and latex coated SPIONs (PL-Sp) were used in batch adsorption study for effective removal of Methylene blue (MB) dye, where (PL-Sp) removed MB dye effectively. Further the PL-Sp was used to produce a nanoconjugate loaded with curcumin and it was characterized using UV-Vis spectrophotometer, FT-IR, SEM-EDX, XRD, VSM and Zeta potential. It showed a sustained drug release pattern and also found to have good antibacterial and anticancer activity.
  18. Mohd Shariff Z, Lin KG, Sariman S, Lee HS, Siew CY, Mohd Yusof BN, et al.
    Nutr Res Pract, 2015 Jun;9(3):278-87.
    PMID: 26060540 DOI: 10.4162/nrp.2015.9.3.278
    Diet plays an important role in growth and development of children. However, dietary intakes of children living in either rural or urban areas can be influenced by household income. This cross-sectional study examined energy, nutrient and food group intakes of 749 urban children (1-10 years old) by household income status.
  19. Ong S, Woo J, Parikh P, Chan R, Sun J, Mun CY, et al.
    Asia Pac J Clin Nutr, 2019;28(2):204-213.
    PMID: 31192548 DOI: 10.6133/apjcn.201906_28(2).0001
    The number of older persons in Asia is expected to triple by 2050. Ageing is associated with non-communicable chronic diseases, malnutrition, and geriatric syndromes, which influences the burden on the cost related to healthcare, health outcomes, and the quality of life. Experts in the field of older adult nutrition from Asia, Australia, and Europe were invited to participate in a two-day workshop to review the available data, current policies and programs for the ageing population in different countries of Asia to identify the gaps in knowledge and to develop recommendations for action. In Asia, most of the data pertaining to health status, nutritional status, and nutrient intake of the older persons were mainly obtained by conducting studies in nursing homes or hospitals and small cohort studies. There were limited country-specific data on this population. Moreover, the available data pertaining to different countries were difficult to compare due to differences in the reporting format and reference values used. Although nutrition initiatives and policies were realized and public education was conducted to support the older persons, most of these efforts targeted the general population rather than the older persons population segment. In healthcare management, a higher amount of education is required pertaining to the knowledge of nutritional requirements and appropriate feeding of the older persons to reduce underfeeding and its consequences. The expert group recommended the use of a systematic approach for reviewing data pertaining to different countries, initiatives, and programs to further evaluate the available data to underpin future research.
  20. Bakri NM, Ramachandran V, Kee HF, Subrayan V, Isa H, Ngah NF, et al.
    Kaohsiung J. Med. Sci., 2017 Dec;33(12):602-608.
    PMID: 29132549 DOI: 10.1016/j.kjms.2017.08.003
    Age-related macular degeneration (AMD) is the most widely recognised cause of irreversible vision loss and previous studies have suggested that the advancement of wet AMD is influenced by both modifiable and non-modifiable elements. Single nucleotide polymorphism (SNPs) and copy number of variations (CNVs) have been associated with AMD in various populations, however the results are conflicting. Our aim is to determine the CNVs of Complement Factor H-Related genes among Malaysian subjects with wet AMD. 130 patients with wet AMD and 120 healthy controls were included in this research. DNA was extracted from all subjects and CNVs of CFH, CFHR1 and CFHR3 genes; determined using quantitative real-time PCR and were compared between the two groups. A consistent association was observed between CFH gene and wet AMD susceptibility (P 
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