Introduction: Awareness of the importance of dietary fibre (DF) in health among adolescents is seldom reported in Malaysia. This study aimed to compare the knowledge, attitude and practice (KAP) of DF intake between Malaysian rural and urban school-going adolescents. Pulau Pangkor in Perak and Damansara in Selangor were randomly selected as rural and urban schools, respectively. Methods: A total of 305 school adolescents with a mean age of 13.5±0.6 years were randomly selected from rural (72 Malay, 85 Chinese) and urban (86 Malay, 62 Chinese) schools completed socio-demographic, validated KAP on DF intake questionnaire, as well as a 24-hour dietary recall. Results: Adolescents from both areas have moderate knowledge (54.4±11.3%), positive attitude (78.7±13.1%) and good practice (65.8±19.9%) scores towards DF intake. Although rural adolescents had significantly (p=0.022) higher DF intake (7.8±3.5 g) compared to urban adolescents (6.9±3.5 g), their DF intake was still lower than the Malaysian recommendation of 20-30 g/day. The attitude of DF intake of rural (r=0.390) and urban (r=0.370) adolescents showed significant positive correlations with practice score of DF intake. While a significant correlation was found between the practice score and DF intake (r=0.191, p=0.017), no significant correlation was found between knowledge and attitude scores with DF intake. Conclusion: Public health authorities and schools should raise awareness on health benefit of consuming DF to promote an increase in DF consumption among school adolescents.
Background: Population-based physical activity (PA) data are lacking in multicultural South East Asia. Malaysian elderly Malays, for example, are occupied daily with religious and community activities. Those living in rural areas also have a distinctively different lifestyle in terms of walking habits and leisure-time activities, compared to people from urban areas.
Methods: A cross-sectional study was conducted with 146 community-dwelling Malay adults aged 60 to 85 years (mean (SD) = 67.6 (6.4) years) living in semi-rural areas in Seberang Perai Utara, Penang, Malaysia. Each participant was interviewed using a questionnaire for their socio-economic background and self-reported PA levels. Then, the participants were invited to wear an accelerometer (ActiGraph GT3X or GT3X+) during their waking hours for seven consecutive days.
Results: Daily activity patterns of the participants were dominated by sedentary time (7.9 (SD 2.1) hours/day; 52% of wear time) and light intensity activity (7.0 (1.9) hours/day; 46% of wear time). The participants spent 24 (SD 30) minutes daily in ‘health enhancing’ (i.e. moderatevigorous intensity) activities. Men spent significantly more time in higher intensity acti-vities than women. Average daily step count was more than 10,000 (mean = 12,542 [4,857]) steps/day.
Conclusion: Based on the accelerometer counts, these elderly Malay participants were assessed to be sedentary for most of the time during the day, though their daily step count exceeded 10,000 on average. Community-living older adults, especially women,should be encouraged to increase their physical activity levels.
Introduction: Older persons are vulnerable to food insecurity. This study
aimed to determine the prevalence of food security and associated factors
among free-living older persons in Petaling District, Selangor. Methods:
A total of 220 free-living older persons aged 60-87 years were selected by
using the cluster sampling method in this cross-sectional study. Faceto-face interviews were conducted to obtain information concerning the
demographic and socioeconomic background, food security, oral health, and
psychosocial status. Chi-square test and binary logistic regression analysis
were used to analyse the studied variables. Results: The median age of the
respondents was 65.5 years, and 19.5% were found as food insecure. There
were significant associations between marital status (χ2=6.818), education
level (χ2=6.242), occupation status (χ2=7.540), monthly income (χ2=9.940,),
and oral health status (χ2=9.627) with food security status. Those with a low
monthly income (AOR=2.449, 95% CI: 1.046-5.732), poor oral health status
(AOR: 3.306, 95% CI: 1.387-7.889) and living in rented accommodation
(AOR=6.218, 95% CI: 1.458-26.518) were more likely to be food insecure.
Conclusion: Respondents with an income lower than the poverty line
income (PLI), living in rented accommodation and poor oral health status
face increased risk of food insecurity. A nutrition assistance programme is
suggested to improve the socioeconomic and food security status of older
persons. Regular oral check-ups are recommended to improve the oral
health status of the elderly.
Introduction: This two-phase longitudinal study sought to determine the association between isoflavones intake on cognitive function and comorbidities among older adults from the state of Johor, Malaysia.
Methods: Phase I involved baseline data collection to examine the association between isoflavones intake and cognitive function among 400 respondents aged 60-years and above, recruited through multistage random sampling. Phase 2 determined the association between isoflavones intake at the baseline and comorbidities at an 18-month follow-up. The baseline data collected included information on socio-demographics, health status, andunpometric measurements, and dietary intake using a dietary history questionnaire (DHQ). Each participant's cognitive function was evaluated using a mini mental state examination (MMSE), digit span, digit symbol, and geriatric depression scale (GDS).
Results: The daily intake of total isoflavones, daidzein, and genistein were 19.1Â±19.7,11.7Â±12.3 and 7.6+8.1 mg/day, respectively. There was no significant association between isoflavones intake, and specific cognitive function including global, memory, executive functions, and depression. However, there was a significant association (p 0.05).
Conclusion: This study found an association between isoflavones intake and memory function, but not with global cognitive, executive functions, depression, and comorbidities. There is a need to promote adequate isoflavones intake in view of its association with memory function.
Introduction: Malnutrition is a common problem associated with increased risk of
morbidity and mortality among haemodialysis (HD) patients.
Methods: This study
determined the correlation between anthropometric measurements, biochemical
indicators, dietary intake and dialysis malnutrition score among HD patients in
Sibu, Sarawak. A total of 55 patients were recruited by purposive sampling and
their biochemical parameters were retrieved from dialysis records. Anthropometric
measurements and dietary intake were determined using standardised protocols
while Dialysis Malnutrition Score (DMS) was computed to determine patients’
Results: Mean age of the patients was 53.0±12.2 years. Mean
DMS was low, indicating low tendency of malnutrition among the patients.
Approximately one-third of the patients had high interdialytic weight gain (IDWG),
indicating a poor adherence on fluid recommendation. Mean intakes of dietary
energy (DEI) and protein (DPI) were low, with only approximately 15% achieving
the recommendations according to Kidney Disease Outcomes Quality Initiative (K/
DOQI). Increase in age (r=0.337, p=0.012) and dialysis vintage (r=0.403, p=0.002)
were associated with poorer nutritional status while higher BMI, MUAC, and
serum albumin were associated with better nutritional status.
study revealed a high proportion of the HD patients with poor adherence on fluid
intake, and the prevalence of inadequate DEI and DPI, indicating the importance
of regular dietary counselling for HD patients. In view of their non-invasive nature
and close relationship with nutritional status, body mass index, mid-upper arm
circumference, and serum albumin should be included as part of the comprehensive
periodic nutrition assessment of HD patients.
Introduction: Adequacy of fruit intake contributes to an individual’s health
including reducing the risk of non-communicable disease. This study aimed to
assess consumption of fruits in various forms and to determine associated factors
and barriers. Methods: In this cross-sectional study, a total of 300 adults aged
20-39 years were purposely recruited from several urban locations in the Klang
Valley. Consumption of fruits in the past 12 months was assessed using a selfadministered food frequency questionnaire (FFQ), assisted with pictures of serving
size of fruits. Anthropometric measurements were taken and body mass index
and waist circumference computed. Results: Fruit intake among young adults
was lower (1.6±1.0 servings/day) than the Malaysian Dietary Guideline 2010 of
≥ 2 servings/day. Only 32.3% consumed fruits as recommended, with women
consuming significantly more fruits than men. Preferred fresh fruits were red apple,
banana and papaya. Consumption of fruit juice was associated with increase in
waist circumference (R2=0.261, p=0.027) after adjustment for age, sex, ethnicity,
education level and marital status. Fruit intake showed no significant association
with other anthropometric measurements. Sensory appeal, perceived health benefit,
easy to prepare and influence of family were the main determinants of fruit intake,
whilst affordability and availability were the major barriers. Conclusion: Fruit
consumption among young adults in this study was lower than the recommendation
for daily fruit intake. Studies with larger sample size are suggested to verify the
finding of significant association between fruit juice consumption and risk of
Introduction: Goats milk provides health benefits due to its unique fatty acid composition that
comprises relatively high amounts of short- and medium-chain fatty acids, which make goats
milk easy to digest.
Methods: A total of 20 powdered goats milk samples were selected based
on ease of availability in shops in Kubang Kerian, Kelantan. Proximate composition and fatty
acids, specifically C6:0, C8:0 and C10:0 were determined using AOAC methods (2000), and
Results were compared with commercial pure goats milk
(CBM®). Results: Wide variations in the proximate composition and fatty acid contents were
found among the samples when compared with the CBM® sample. The mean range values for
energy were 368 to 498 kcal/100 g, moisture: 2.46 to 4.28 g/100 g, ash: 2.04 to 6.61 g/100 g,
protein: 2.80 to 26.24 g/100 g, fat: 1.68 to 25.90 g/100 g and carbohydrates: 44.81 to 87.64
g/100 g. The total short and medium-chain fatty acids contents ranged from 3.22% to 12.97%.
Conclusion: There is a need for standardisation of the proximate composition and fatty acids
contents of goats milk available in Malaysia.
Introduction: Sensitivity of red palm oil (RPO) towards oxidation is known to result
in degradation of nutritional value and organoleptic properties. This study aimed
to determine the stability of microencapsulated RPO during accelerated storage at
65˚C for 24 days. Methods: Microencapsulated was undertaken by co-extrusion
technology using sodium alginate with high methoxyl pectin, and calcium chloride
solution enhanced with chitosan as cross-linking agent in the presence of Tween® 80
as surfactant. The encapsulated beads were freeze dried and the physical properties,
antioxidant activities and total carotenoid content of dried powder were determined.
Microencapsulated red palm oil (MRPO) was then subjected to accelerated storage at
65°C for 24 days. Results: Antioxidant activity of both RPO and MRPO measured by
DPPH (2,2-diphenyl-1-picrylhydrazyl) radical scavenging activity was significantly
decreased, with higher percentage loss in MRPO during accelerated storage.
RPO and MRPO also experienced decreases in percentage inhibition with higher
percentage of loss as measured by Azino-bis (3-ethylbenzothiazoline-6-sulpohnic
acid) (ABTS) radical scavenging activity. Both RPO and MRPO showed decreasing
trends in total carotenoid content, with higher content in MRPO than RPO at end
of storage period. Antioxidant activities of RPO and MRPO correlated well with the
carotenoid content, with best correlation coefficient in RPO between the ABTS assay
and total carotenoid content measured by high performance liquid chromatography
(r=0.952). Very strong association between DPPH and ABTS values (r=0.871) for
the MRPO, and between DPPH and total carotenoid content (r=0.856) were noted.
Conclusion: The study showed that microencapsulation effectively protected the
carotenoid content in MRPO, but not its other natural antioxidants.
Introduction: Nutrient profiling is the science of ranking food based on the nutrient
content that enables an individual to make healthier food choice without exceeding
the daily energy recommendation. This study was aimed at developing and validating
a nutrient profiling model for Malaysian older population. Methods: A total of six
nutrient profiling models comprising different combinations of nutrients were
developed. Each model was tested by scoring 94 food items in terms of 100 kcal and
100 g, and the Recommended Nutrient Intakes for Malaysian (2017) as the reference
value. The scores in each model were correlated with energy density per 100 g of
food. The best model to correctly rank food according to nutrient density was chosen
for validation. Validation was done by comparing the healthiness classification of
174 food items as determined by Towards Useful Aging Food Nutrient Density Index
(TUA FNDI) nutrient profiling model and the Malaysian Dietary Guidelines. Results:
Models with sodium and total fat were better correlated with energy density. All
six models were inversely correlated with energy density. TUA FNDI 9-2 model was
chosen as the best model for validation. Overall, there was substantial agreement
between TUA FNDI 9-2 model and the food-based dietary guidelines (κ=0.644,
p=0.001). Conclusion: The inverse correlation between nutrient profiling models
to energy density shows that foods with higher nutrient density contain lower
energy. The validated TUA FNDI 9-2 model is recommended for older adults to make
healthier food choices.
Introduction: The benefits of breastfeeding for both mothers and infants are
widely recognised. Breastfeeding confirms a woman’s unique ability to care for her
infant in the best way possible and promotes optimum infant and maternal health.
Methods: A qualitative research method involving five focus group discussions
(n=33) was chosen in this study to compare and contrast the breastfeeding practice
in two different locations: the communities of Pos Pulat and the regroupment
scheme settlement at Rancangan Pengumpulan Semula (RPS) Kuala Betis in
Kelantan, Malaysia which represents different lifestyle experiences of indigenous
Temiar population. Results: The benefits of breastfeeding to the infants reported
by some Temiar women (42.4%) were for the infant’s health and growth. Responses
from urban RPS Kuala Betis women include breast milk contains antibodies (3.0%),
delays in the return of regular ovulation (6.1%), thus lengthening birth intervals
and bonding between maternal-baby (6.1%). In general, respondents from Pos
Pulat seemed to have little knowledge regarding this issue, except for a woman who
mentioned that maternal milk contains vitamins. Based on the narrative analysis,
knowledge gap was observed between these two communities. Conclusion: Although
all the women interviewed had the experience of breastfeeding their infants, most
of them lacked the knowledge regarding the benefits of the breastfeeding either
to the infants or to the mothers. The findings from this study are crucial for the
preservation of breastfeeding culture among the Temiar women and can be used to
improve promotion of breastfeeding to other Orang Asli groups in Malaysia.
Introduction: The primary reason that compels working mothers to decrease their
ability to continue to breastfeeding successfully is their return to work. Attempts
to continue breastfeeding at work encounters several difficulties. This study
aims to provide an overview of the workplace environment and how facilities at
the workplace affect breastfeeding in Indonesia. Methods: We used a qualitative
approach to provide a detailed picture of the influence of workplace support for
working mothers to perform breastfeeding. We enrolled working mothers (n=18)
in Jakarta, as participants and obtained the following information from them:
parity, type of family and type of work. Results: The findings provided the general
overview of the workplace environment and identified three factors that affected
breastfeeding: seeking information during pregnancy, expression of breast milk at
office facilities and the problem faced by working mothers. Conclusion: Although
the breastfeeding performance of most working mothers in this study comprised
exclusive breastfeeding, some fed their infants with formula milk. This study
suggests that working mothers who continue to breastfeed after returning to work
need the support of their employers, co-workers and others in the workplace to
ensure the provision of health facilities and the protection and dissemination the
rights of breastfeeding working mothers that might lead them to discontinue their
Introduction: The consumption of processed food is increasing in developing
countries. Nutrition labels on food packaging are important for the education of
consumers, particularly adolescents, to help them make healthier food choices.
However, there is evidence to suggest that adolescents generally do not use nutrition
labels. This study aims to explore the personal factors that influence the practice of
Malaysian adolescents in reading nutrition labels. Methods: The participants were
adolescents, aged 13-16 years, from five public schools in Negeri Sembilan. Five
semi-structured focus group discussions (FGDs) were conducted. The participants
discussed their personal views, knowledge and perceptions regarding the use of
nutrition labels and food selection. Data gathered from the FGDs were coded through
thematic analysis using the NVivo software. Results: While the participants were
familiar with nutrition labels, their usage was relatively low during food selection
due to the lack of interest in nutrition information, past experiences, hunger and
cravings, time constraints and the taste of the food. The main reasons for using
nutrition labels were health consciousness and their curiosity about specific
nutrition information provided on the labels. The majority of participants believed
that information provided on the labels was accurate because it was provided by
reliable institutions. There was also misperception among some participants, mixing
up nutrition labels with list of ingredients and the expiry dates. A few participants
were unconvinced by the labels and stated that the labels provided misleading
information. Conclusion: Personal factors such as knowledge, misperception,
awareness and trust significantly impact how adolescents read nutrition labels.
Introduction: Obesity and excess weight gain in adults are linked to an increased
risk of cardiometabolic abnormalities. The changing lifestyle experienced by the
Orang Asli predisposes the population to the risk of obesity and non-communicable
diseases. This study aimed to describe the prevalence of overweight and obesity as
well as body-weight change over a period of four years among Orang Asli adults.
Methods: Data were collected from Orang Asli adults aged ≥18 years, who were
enrolled in the 2011-2012 and 2015-2016 surveys, and who were residing within
the Krau Wildlife Reserve. Weight and height of the adults (N2011-2012=828; N2015-
2016=662) were measured at both time points. Follow-up data were available for 378
adults (male:113; female:265). Results: The prevalence of overweight and obesity
were 18.8% and 7.4% in 2011-2012 and 26.1% and 9.5% in 2015-2016. In the
follow-up group, significant differences in body weight and body mass index (BMI)
were observed in men and women, respectively. More than one-third (35.5%) of the
adults had weight gain of more than 5.0%. The increasing percentage of body weight
change was associated with being female, younger age, more years of schooling and
reduced household income. Conclusion: Obesity is a growing health problem in
the Orang Asli adult population. Weight gain was associated with socioeconomic
indicators and it was more prominent in women. Effective strategies are needed to
address the increasing prevalence of overweight and obesity in this population to
further reduce adverse health outcomes.
Introduction: In Indonesia, most training modules for health paraprofessionals
have been adapted from existing foreign modules without assessment. In addition,
there have been few studies on training development for this group. We aimed to
develop, using a systematic tool, implement and evaluate a training module to
improve the competencies of voluntary health workers (cadres) in communicating
safe complementary feeding practice to caregivers of young children in Indonesia.
Methods: A mixed methods approach was used. A qualitative study employing
in-depth interviews, focus group discussions, mini-workshops, documentary
reviews and expert validation was used to develop the training module, following a
systematic approach. The module’s effectiveness for improving the health workers’
competencies was evaluated using a quantitative study with a non-equivalent
pre-test and post-test control group design that included 70 (intervention group)
and 68 (comparison group) voluntary health workers from a peri-urban district.
Changes in the workers’ cognitive, affective and psychomotor competencies were
tested before and after attending a 3-day training module (intervention group) or
a half-day event (comparison group). Results: A 24-hour learning session module
on communicating safe complementary feeding was developed and used to train
voluntary health workers. After the training, a significantly higher proportion of
workers in the intervention group than in the comparison group were assessed as
competent in the psychomotor and composite domains (psychomotor: 67.1% vs.
20.6%; composite: 74.3% vs. 36.8%; p
Introduction: Monitoring changes in energy and nutrient intakes of the population
over the course of time is essential to help healthcare providers develop effective
dietary policies. The aim of this study was to assess the changes in the nutrient
intake and Recommended Nutrient Intake (RNI) achievements by using the data
obtained from the Malaysian Adult Nutrition Surveys (MANS) that were carried out
in 2003 and 2014. Mis-reporting of energy intake was taken into account. Methods:
Dietary data were obtained from MANS 2003 and MANS 2014, which involved a
combined total of 4,044 randomly selected respondents, aged 18-59 years, using
a single 24-hour diet recall. Energy and nutrients calculations were based on the
Malaysian Food Composition database using the Nutritionist Pro software. The
results were compared against the RNI for Malaysia to assess dietary adequacy.
Results: The proportions of calories derived from macronutrients were within the
recommendations for a healthy diet. The consumption of protein, fat, calcium, iron
and vitamin A was significantly higher in 2014 than in 2003. The consumption
of protein, iron, vitamin C, and vitamin A was found to exceed the RNIs in 2014.
However, carbohydrate and sodium intakes had significantly decreased. Despite the
decrease, sodium intake still exceeded RNI recommendations. Conclusion: Signs
of changing energy and nutrient intakes were found, including increases in protein
and fat intakes since 2003, and decreased carbohydrates. This could be an alarming
indicator of the tendency to eat energy dense food among the population.
Introduction: Data on water and sugar sweetened beverages (SSB) intake
among young adults in Malaysia is sparse. This study aimed at measuring the
intake of plain water and SSB among undergraduate students in a Malaysian
university and examine its association with body mass index (BMI). Methods:
A total of 376 undergraduate students aged 18-30 years were recruited. A selfadministered questionnaire was used to determine the SSB consumption pattern.
The questionnaire consisted of five sections that included the background of the
participants, knowledge about SSB, SSB preferences, frequency and portion size.
Results: 23.9% of subjects in this study were overweight. Almost all of the subjects
took outside food (93.1%) and drink (74.2%). The highest daily consumption was
plain water (92.3%), with a majority drinking more than two cups at each intake.
Caffeinated drinks (coffee or tea) were the most popular SSB among the students
(18.4%). Most students (79.7%) did not consume SSB on a daily basis. A significant
association was found between the proportion of plain water consumption and BMI
Introduction: The aging population is a matter of global concern. Age-related
physiological, pathological, psychosocial, economic, cultural and environmental
changes are common and may greatly influence the quality of life of the elderly.
The aim of this review was to explore the determinants and motivations that drive
the elderly in making food choices. Methods: The search strategy of this literature
review used the PRISMA protocol. Potential literature that was related to food
choices was identified using two different combinations of keywords and two major
electronic search engines, namely Pubmed and Science Direct. The articles that
were selected for this review had to be in the English language, open-accessed and
published between January 2007 and December 2017. Results: From a search of
1398 articles, 15 articles (seven quantitative and eight qualitative) were identified
that were related to food choices among the elderly. The key factor that determined
food choices among the elderly population was identified to be health. Others
included convenience, sensory appeal, price, early food experience and more. The
limitations of these studies that were reported were the small sample size and the
reliance on self-reporting. The conclusions that were drawn were for specific groups
that were studied in this review should be extrapolated or generalised with caution.
Conclusion: Strategies for intervention programmes should be undertaken in
collaboration with health professionals, researchers, policymakers, and the food
industry. Future research is needed in the elderly who have chronic diseases, are
dependent or who have disabilities.
Introduction: Under-reporting of energy intake is a common cause of bias
in nutritional studies. This study was aimed at examining the extent of underreporting of energy intake and its related characteristics among respondents in
the Malaysian Adult Nutrition Survey (MANS) 2003 and MANS 2014. Methods:
The present study analysed energy intakes of 9,624 adults aged 18-59 years from
the MANS in year 2014 (2,890 respondents) and 2003 (6,734 respondents) using
a single 24-hour diet recall. Basal metabolic rates (BMR) were calculated from the
age- and gender-specific equations of Schofield. Under-reporting was defined as an
energy intake:BMR ratio of
Introduction: Intake of soy isoflavones has been shown to be beneficial in reducing
blood pressure, a known cardiovascular risk factor. This study investigated the
association between intake of soy isoflavones and blood pressure among multiethnic Malaysian adults. Methods: A total of 230 non-institutionalised Malaysians
aged 18-81 years were recruited through multi-stage random sampling from urban
and rural areas in four conveniently selected states. Participants were interviewed
on socio-demographics, medical history, smoking status, and physical activity.
Measurements of height, weight, waist circumference (WC), and blood pressure
(BP) were taken. Information on usual intake of soy foods was obtained using a
validated semi-quantitative food frequency questionnaire. Results: The mean
intake of soy protein of both urban (3.40g/day) and rural participants (3.01g/day)
were lower than the USFDA recommended intake level of soy protein (25.00g/day).
Urban participants had significantly higher intake of isoflavones (9.35±11.31mg/
day) compared to the rural participants (7.88±14.30mg/day). Mean BP levels were
significantly lower among urban (136/81mmHg) than rural adults (142/83mmHg).
After adjusting for age, gender, educational level, household income, smoking status,
physical activity, BMI and WC, soy protein intake was significantly associated with
both SBP (R2=0.205, β=-0.136) and DBP (R2=0.110, β=-0.104), whilst soy isoflavones
intake was significantly associated with SBP (β=-0.131). Intake of 1 mg of isoflavone
is estimated to lower SBP by 7.97 mmHg. Conclusion: Higher consumption of
isoflavones among the urban participants showed an association with lower levels
of SBP. Use of biological markers for estimating isoflavones levels is recommended
to investigate its protective effects on blood pressure.