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Fulltext Dietary patterns of the metabolic syndrome among older adults in Malaysia

Suzana Shahar, Nik Nur Izzati

Jurnal Sains Kesihatan Malaysia, 2018;16(101):237-237.
MyJurnal

The term metabolic syndrome (MetS) describes a clustering of risk factors for cardiovascular disease and type 2 diabetes mellitus which include high blood pressure, low fasting high-density lipoprotein cholesterol (HDL-c), high fasting triglyceride (TG), high fasting blood glucose (BG), and abdominal obesity. The aim of this cross sectional study was to determine the dietary patterns (DPs) associated with MetS among 451 older adults in Malaysia. Food intake was determined using validated Diet History. DP was identified based on 40 food groups by using principal component analysis (PCA), and the factors were rotated by varimax rotation. Fasting venous blood samples were taken to determine HDL-c, TaG and BG level. Blood pressure and anthropometric measurements were also performed. Three major dietary patterns have been identified; 1) bread, spreads and oats, 2) Malaysia traditional pancakes and 3) vegetables and healthy cooked dishes. Three models were built to compare the potential confounder such as age, education years, marital status, calorie intakes, ciggarate smoking and body mass indeks (BMI). Only vegetables and healthy cooked dishes DP was associated with MetS. This DP reflects high consumption of various types of vegetables, noodle in soup, healthy cooked fish or seafood and low consumption of all type of high calorie rice, noodles and fried desserts. For all models, subject in the highest tertile of vegetables and healthy cooked dishes DP had a lower odd ratio (OR) for MetS as compared to lowest tertile. As more potential confounders added in new models, the significant values are increased. After adjustment of body mass index, the association for vegetables and healthy cooked dishes DP was attenuated (OR: 0.67, CI: 0.39-1.16, p: 0.156). In conclusion, high consumption of vegetable and healthy cooked dishes may lower the occurance of MetS among Malaysian elderly.
Kemampanan intervensi suplementasi minyak ikan dan pendidikan kesihatan dalam kalangan warga tua yang mengalami kecelaan kognitif ringan

Suzana S, Nik Nur Izzati N, Siti Hajar M, Hasnah H, Kamaruddin M

Sains Malaysiana, 2016;45:1823-1834.

Intervensi pemakanan berpotensi untuk melambatkan penurunan fungsi kognitif dalam kalangan warga tua yang mengalami kecelaan kognitif ringan (MCI). Walau bagaimanapun, kemampanan program sedemikian masih belum dapat dipastikan. Oleh itu, suatu kajian susulan dijalankan bagi menentukan kemampanan suplementasi minyak ikan dan pendidikan kesihatan bagi mengurangkan kemerosotan fungsi kognitif dalam kalangan warga tua yang mengalami MCI selepas setahun kajian intervensi dijalankan. Kajian ini melibatkan 18 orang subjek MCI iaitu 6 orang bagi setiap kumpulan intervensi suplementasi minyak ikan (A) dan pendidikan kesihatan (B) dan kumpulan kawalan (C). Analisis menunjukkan kesan intervensi yang signifikan bagi ujian Span Digit (p<0.05) dan aras serum folat (p<0.05) dengan kumpulan B menunjukkan min yang paling tinggi, diikuti dengan A dan C. Intervensi pendidikan kesihatan dan suplementasi minyak ikan mempunyai kesan kemampanan bagi meningkatkan aras serum folat dan memperbaiki status fungsi kognitif yang dinilai menggunakan Ujian Span Digit. Terdapat keperluan bagi promosi kesihatan dan suplementasi minyak ikan dalam mengekalkan fungsi kognitif individu warga tua yang mengalami MCI
Which aging group prone to have inadequate nutrient intake?: TUA study

Nik Nur Izzati Nik Mohd Fakhruddin, Suzana Shahar, Nurul Atiqah Abd Aziz, Roslee Rajikan, Hanis Mastura Yahya

Sains Malaysiana, 2016;45:1381-1391.

Older adults quite often had an inadequate diet leading to micronutrient deficiencies and impaired immune response with subsequent development of degenerative diseases. This study aimed to determine the adequacy of energy and nutrient intake and its distribution among three aging groups i.e. successful aging (SA), usual aging (UA) and mild cognitive impairment (MCI). This is a cross-sectional study involving a large sample size (n = 2322) of older adults recruited through multistage random sampling from four states of Malaysia. An interview was conducted to measure dietary intake, neurocognitive status and functional status by using the Diet History Questionnaire (DHQ), Mini-Mental State Examination (MMSE), Rey Auditory Learning Test (RAVLT), Geriatric Depression Scale (GDS), Instrumental Activity of Daily Living (IADL) and Quality of Life Questionnaire. For comparison of dietary intake, a sub-sample of 173 respondents from each aging groups were matched and selected using a comparative cross-sectional approach. Women in SA group had the highest mean intake of vitamin A, calcium (p <0.05), vitamin C, riboflavin and iron (p<0.001). The same aging group also achieved the highest RNI percentage for the same nutrients. More than 80% of respondents for all aging groups did not met the recommended nutrient intake (RNI) for vitamin E, thiamin, niacin, folate, calcium and zinc. In women, MCI respondents were more likely to have an inadequate intake of vitamin A, C, riboflavin and iron followed by UA and SA. Inadequate vitamin E, niacin, folate and calcium were prevalent among all gender and aging groups. There is a need to further distinguish specific dietary patterns associated with these three aging groups to promote optimal nutrient intake for cognitive health.
Fulltext Identification of dietary patterns associated with characteristics of successful aging

Nik Nur Izzati Nik Mohd Fakhruddin, Suzana Shahar, Roslee Rajikan, Mohd Azahadi Omar, Normah Che Din, Rosdinom Razali, et al.

Malays J Nutr, 2019;25(1):47-57.
MyJurnal

Introduction: This study aimed to identify dietary patterns (DPs) and their
association with successful aging (SA). Methods: A comparative cross-sectional
study was conducted among 579 elderly subjects recruited from four states in
Malaysia through a multistage random sampling method. SA was defined as having
no chronic illnesses, no functional limitation, normal global function, no depression,
a good quality of life and good self-perceived health. Information on dietary intake was
obtained using a diet history questionnaire. Cognitive functions were assessed using
the Mini Mental State Examination (MMSE), depressive symptoms using Geriatric
Depression Score-15 items (GDS-15) and a question regarding their perceived health
and quality of life. Activities of Daily Living (ADL) and Instrumental Activities of Daily
Living (IADL) questionnaires were used to determine functional status. DPs were
obtained using the principal component analysis (PCA) approach. An ordinal logistic
regression model was used to examine associations between DP scores and SA.
Results: Five DPs were identified namely ‘sweet foods-beverages’, ‘meat-vegetablesrice and noodles’, ‘local snacks-fish and seafood-high salt foods’, ‘fruits-legumes’, and
‘tropical fruits-oats’. A higher score for ‘tropical fruits-oats’ DP was associated with
SA [Adjusted OR=1.59 (95% CI: 1.08-2.32)]. However, the association diminished
when the model was adjusted for education level. Further analysis indicated that
this DP increased the chance of SA among those with secondary education and above
[Adjusted OR=2.43 (95% CI: 1.09–5.42)]. Conclusion: ‘Tropical fruits-oats’ DP is
associated with SA among elderly with secondary education and above. There is a
need to investigate DPs among those with lower education.
Fulltext Urine Untargeted Metabolomic Profiling Is Associated with the Dietary Pattern of Successful Aging among Malaysian Elderly

Nik Mohd Fakhruddin NNI, Shahar S, Ismail IS, Ahmad Azam A, Rajab NF

Nutrients, 2020 Sep 23;12(10).
PMID: 32977370 DOI: 10.3390/nu12102900

Food intake biomarkers (FIBs) can reflect the intake of specific foods or dietary patterns (DP). DP for successful aging (SA) has been widely studied. However, the relationship between SA and DP characterized by FIBs still needs further exploration as the candidate markers are scarce. Thus, 1H-nuclear magnetic resonance (1H-NMR)-based urine metabolomics profiling was conducted to identify potential metabolites which can act as specific markers representing DP for SA. Urine sample of nine subjects from each three aging groups, SA, usual aging (UA), and mild cognitive impairment (MCI), were analyzed using the 1H-NMR metabolomic approach. Principal components analysis (PCA) and partial least-squares discriminant analysis (PLS-DA) were applied. The association between SA urinary metabolites and its DP was assessed using the Pearson's correlation analysis. The urine of SA subjects was characterized by the greater excretion of citrate, taurine, hypotaurine, serotonin, and melatonin as compared to UA and MCI. These urinary metabolites were associated with alteration in "taurine and hypotaurine metabolism" and "tryptophan metabolism" in SA elderly. Urinary serotonin (r = 0.48, p < 0.05) and melatonin (r = 0.47, p < 0.05) were associated with oat intake. These findings demonstrate that a metabolomic approach may be useful for correlating DP with SA urinary metabolites and for further understanding of SA development.
Fulltext The effect of dietary patterns on mild cognitive impairment and dementia incidence among community-dwelling older adults

Malek Rivan NF, Shahar S, Fakhruddin NNINM, You YX, Che Din N, Rajikan R

Front Nutr, 2022;9:901750.
PMID: 36003836 DOI: 10.3389/fnut.2022.901750

Multiple studies have shown that dietary patterns have beneficial health effects on cognitive function. However, information on this relationship is presently limited, particularly among older adults. Thus, this study aimed to determine the effects of dietary patterns on mild cognitive impairment (MCI) and dementia incidence among Malaysian community-dwelling older adults. In this prospective cohort study, a total of 280 participants aged 60 years and above were included in the 5-year follow-up analysis. Participants' sociodemographic, medical history, anthropometry, blood pressure, body composition, biochemical indices, cognitive assessments, psychosocial functions, functional status, and dietary intake were obtained. MCI was classified based on Petersen criteria, whereas dementia status was assessed using clinical dementia rating (CDR). Univariate analysis was performed for all variables, followed by multinomial regression analysis to identify the ability of dietary patterns in predicting the incidence of MCI and dementia. After controlling for confounding factors, the findings indicated that "local snacks-fish and seafood-high salt foods" dietary pattern was associated with an increased risk of MCI incidence, where the T3 [adjusted OR = 3.943 (95% CI: 1.212-12.832), p = 0.032] had the highest OR compared to T2 [adjusted OR = 3.252 (95% CI: 1.108-9.546), p = 0.023]. Meanwhile, a negative association across the tertiles of tropical fruits-oats dietary pattern and dementia incidence was observed [T2: adjusted OR = 0.152 (95% CI: 0.026-0.871), p = 0.034; T3: Adjusted OR = 0.101 (95% CI: 0.011-0.967), p = 0.047]. In conclusion, specific dietary patterns, particularly "local snacks-fish and seafoods-high salt foods," were shown to increase the risk of MCI, while increasing intakes of "tropical fruits-oats" dietary patterns would protect against the dementia incidence among Malaysian older adults.
Fulltext Family support and self-motivation influence dietary compliance and glycaemic control among type 2 diabetes mellitus outpatients

Nik Mohd Fakhruddin NNI, Khor JH, Suhaimi NFS, Zulkepli NYF, Roslan R, Wong ES, et al.

Jurnal Sains Kesihatan Malaysia, 2016;14(2):39-47.
MyJurnal

Diabetes Mellitus is a disease due to reduced insulin sensitivity and secretion in the body which associated with obesity and hypertension. This study aimed to determine the influence of family support and self-motivation towards dietary compliance and glycaemic control among Type 2 Diabetes Mellitus (T2DM) outpatients. This cross-sectional study involved 35 subjects selected from Universiti Kebangsaan Malaysia Medical Centre (UKMMC) in Cheras and Ampangan Health Clinic in Seremban. Anthropometric measurements and fasting blood glucose have been obtained. Face-to-face interview session was done to obtain socio-demographic and diet intake. Further, dietary compliance, social support and self-motivation were assessed using Summary Diabetes Self Care Activities (SDSCA), Diabetes Social Support Questionnaire Family version (DSSQ-Fa) and Treatment Self-Regulation Questionnaire (TSRQ), respectively. Only 8.6% of subjects complied with dietary counselling. Fasting blood glucose for both men (7.93 ± 1.99 mmol/L) and women (8.77 ± 3.08 mmol/L) were higher than normal range. Self-motivation (r = 0.358, p < 0.05) and family support (r = 0.460, p < 0.01) significantly correlated with dietary compliance. Self-motivation and family support are important factors which can increase compliance towards dietary counseling. Further investigation should be carried out to determine factors that may influence dietary compliance and family support towards achieving desirable glycaemic control among T2DM patients.
Study site: Klinik Warga UKMMC, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur; Klinik Kesihatan Ampangan, Seremban, Negeri Sembilan, Malaysia
Fulltext Development of Malaysian-MIND diet scores for prediction of mild cognitive impairment among older adults in Malaysia

M Zapawi MM, You YX, Shahar S, Shahril MR, Malek Rivan NF, Nik Mohd Fakhruddin NNI, et al.

BMC Geriatr, 2024 May 01;24(1):387.
PMID: 38693524 DOI: 10.1186/s12877-024-04966-7

BACKGROUND: Mild Cognitive impairment (MCI) is a pre-demented state in the elderly populace. The Mediterranean & Dietary Approaches to Stop Hypertension (DASH) Intervention for Neurodegenerative Delay (MIND) diet has shown promise in reducing the risk of MCI and Alzheimer's disease in older people. Notably, the existing MIND diet is not adapted to the specific needs of older adults in Malaysia, considering distinct food cultures and availability. Consequently, this study aimed to develop the Malaysian version of the MIND diet (MY-MINDD) scores and investigate their association with MCI in the older adult populace of Malaysia.
METHODS: A comprehensive pooled data analysis was conducted on combined data from 810 participants sourced from the longitudinal Long-Term Research Grant Scheme-Towards Useful Aging (LRGS-TUA) and Fundamental Research Grant Scheme (FRGS) studies. The MY-MINDD scores were developed by incorporating existing MIND diet food groups, their corresponding scoring mechanisms, and consideration of common Malaysian foods which are proven to be beneficial and detrimental to cognitive function. To substantiate the MY-MINDD scoring system, its association with MCI was evaluated using a series of validated neuropsychological test batteries.
RESULTS: MY-MINDD consists of seven food groups promote brain health and four food groups exert negative cognitive outcomes. The study participants had an average age of 67.9 ± 4.7 years. The collective MY-MINDD score for all participants was 6.4 ± 0.1 (out of a maximum 11 points), revealing a lower score in individuals with MCI at 6.0 ± 1.7 compared to those without MCI at 6.6 ± 1.6 (p