Dietary patterns associated with the risk of type 2 diabetes in women with and without a history of gestational diabetes mellitus: A pilot study

@#Introduction: There is limited evidence on dietary patterns and the risk of type 2 diabetes (T2D) in women with a history of gestational diabetes mellitus (GDM) compared to their non-GDM counterparts, especially in the Asian population. The pilot study investigated dietary patterns in women with a history of GDM (HGDM) and without a history of GDM (non-HGDM), and the association with T2D risk. Methods: This comparative cross-sectional study involved 64 women (32 HGDM, 32 non-HGDM). Food intake was assessed using a validated food frequency questionnaire. Principal component analysis derived the dietary patterns. T2D risk score was determined using the Finnish Diabetes Risk Score tool. Results: HGDM group had significantly higher proportion of first-degree family history of diabetes; higher risk of T2D and better diabetes knowledge; lower gestational weight gain and postpartum weight retention; and consumed more fast food than nonHGDM. ‘Rice-noodle-pasta-meat’ dietary pattern was significantly associated with increased T2D risk after adjusting for age (β=0.272, p=0.032). ‘Bread-cereals-fast food-meat’ dietary pattern was positively and significantly associated with T2D risk after adjusting for confounders, including age, education level, family history of diabetes, diabetes knowledge score, gestational weight gain, and postpartum weight retention (β=0.251, p=0.012). Conclusion: Dietary patterns high in bread, cereals and cereal products, fast food and meat, as well as rice, noodle, pasta and meat were associated with an elevated T2D risk. A more extensive study is warranted to establish the association between dietary patterns and risk of T2D, focusing on women with a history of GDM.

Length of Hospital Stay and Its Associated Factors among Surgical Patients in Hospital Serdang

@#Introduction: Hospital length of stay (LOS) is one of the measurable indicators which can be used to evaluate hospital administration, operative performance, and quality of patient care. Prolonged LOS has been associated with poor outcomes in patients and inefficient use of hospital resources. Due to the scarcity of findings in this field in Malaysia, this study aims to identify the factors affecting LOS. Methods: A single health facility-based retrospective cross-sectional study was conducted in Hospital Serdang. Data of patients admitted to the surgical ward from 2017 to 2021 were retrieved. Result: A total of 114 surgical patients’ data were analysed, of which most were adults (72.8%), female (69.3%) and Malay (67.5%). The mean LOS was 5.90 ± 4.35 days. Pearson correlation revealed age (r = 0.309, p = 0.001) and preoperative albumin (r = -0.397, p <0.001) having a significant correlation with LOS. An independent samples T-test showed that males had significantly higher mean LOS than females (t = 2.653, p = 0.009). Surprisingly, having been seen by dietitians and being supplemented by oral nutrition supplements (ONS) had longer stay compared to groups who were not seen by dietitians and given ONS respectively (t = 4.278, p<0.001), (t = 3.111, p = 0.002). Furthermore, those with a moderate and high risk of malnutrition spent approximately 3.27 days longer hospitalized than low-risk patients (t = -2.868, p = 0.007). Conclusion: Factors that influence LOS are age, gender, preoperative albumin, seen by a dietitian, risk of malnutrition and oral nutrition supplementation.

Overcoming Therapeutic Inertia as the Achilles’ Heel for Improving Suboptimal Diabetes Care: An Integrative Review

The ultimate purpose of diabetes care is achieving the outcomes that patients regard as important throughout the life course. Despite advances in pharmaceuticals, nutraceuticals, psychoeducational programs, information technologies, and digital health, the levels of treatment target achievement in people with diabetes mellitus (DM) have remained suboptimal. This clinical care of people with DM is highly challenging, complex, costly, and confounded for patients, physicians, and healthcare systems. One key underlying problem is clinical inertia in general and therapeutic inertia (TI) in particular. TI refers to healthcare providers’ failure to modify therapy appropriately when treatment goals are not met. TI therefore relates to the prescribing decisions made by healthcare professionals, such as doctors, nurses, and pharmacists. The known causes of TI include factors at the level of the physician (50%), patient (30%), and health system (20%). Although TI is often multifactorial, the literature suggests that 28% of strategies are targeted at multiple levels of causes, 38% at the patient level, 26% at the healthcare professional level, and only 8% at the healthcare system level. The most effective interventions against TI are shorter intervals until revisit appointments and empowering nurses, diabetes educators, and pharmacists to review treatments and modify prescriptions.

Effects of White Rice-Based Carbohydrates Diets on Body Weight and Metabolic Parameters in Rats

@#Introduction: We clarified the extent to which white rice (WR)-based carbohydrate diets affect body weight and metabolic parameters in rats. Methods: In this experimental study, a male Sprague Dawley (n=32) rats fed with WRbased CHO diet in two different proportions of total energy intake (TEI 55% moderate-CHO (MCHO, n=8) and 65% High-CHO (HCHO, n=8)) or high-fat diet (HFD, n=8) were compared with rats maintained on standard pellet diet (SD, n=8) for eight weeks period. Carbohydrate sources in the HFD and SD were mainly based on cornstarch (25% of amylose). Outcomes measures include body weight and metabolic parameters. Results: At baseline, body weight and metabolic parameters (fasting plasma glucose, insulin, and triglyceride levels) were comparable in all rats. Despite higher daily caloric intake in rats fed with HFD (103.9±3.0) than the other diets, no significant differences in body weight between groups after 8 weeks of study. However, rats’ feds with WR-based CHO diets (both moderate and high carbohydrates) had higher fasting blood glucose (MCHO=12.8±1.6, HCHO=16.9±2.4) and triglycerides level (MCHO=1.2±0.0, HCHO=1.3±0.0) than rats in cornstarch-based HFD and SD (p<0.05). Both HFD and HCHO had higher fasting insulin than MCHO and SD (p<0.05), but the homeostatic model assessment of insulin resistance (HOMA-IR) was significantly higher in WR-based CHO diets (both moderate and high carbohydrates) than the rats in cornstarch-based HFD and SD (p<0.05). Conclusion: A WR-based CHO diet exhibits higher fasting blood glucose, triglycerides, and insulin resistance state than a high-fat diet without a significant impact on body weight. These findings may explain the growing incidence of diabetes in Asia and worth studying further.

High early pregnancy serum 25-hydroxy vitamin D level, within a sub-optimal range, is associated with gestational diabetes mellitus: a prospective cohort study

BACKGROUND/OBJECTIVES@#Low early pregnancy serum 25-hydroxy vitamin D (25[OH]D) levels can increase gestational diabetes mellitus (GDM) risk, although inconsistent findings related to that association have been reported. This study examined the association of serum vitamin D with GDM and the possible influencers on this association. @*SUBJECTS/METHODS@#This study included 259 pregnant women within the Seremban Cohort Study (SECOST). Blood samples at < 14 weeks of gestation were drawn to determine serum 25(OH)D levels. GDM diagnosis was made at 24 to 32 weeks of gestation using a standard procedure. Association between serum vitamin D and GDM was tested using binary logistic regression. @*RESULTS@#Nearly all women (90%) had mild (68.3%) or severe (32.2%) vitamin D deficiency (VDD). Non-GDM women with mild VDD had a significantly higher mean vitamin D intake than GDM women with mild VDD (t = 2.04, p < 0.05). Women with higher early pregnancy serum vitamin D levels had a greater risk of GDM. However, this significant association was only identified among those with a family history of type 2 diabetes mellitus (T2DM) and in women with a body mass index indicating overweight or obese status. @*CONCLUSIONS@#The high prevalence of VDD in this sample of pregnant women underscores the need for effective preventive public health strategies. Further investigation of this unexpected association between serum vitamin D level and GDM risk in predominantly VDD pregnant women and the potential effects of adiposity and family history of T2DM on that association is warranted.

Effectiveness of Mediterranean Diet on Diabetic Control and Cardiovascular Risk Modification Among Patients With Type 2 Diabetes Mellitus in Oman: A Study Protocol

@#Introduction: In the recent years, there is remarkable increased in the prevalence of Type 2 Diabetes Mellitus (T2DM) in Middle East countries including Oman. There is good evidence that Mediterranean Diet (MedDiet) is effective over diabetes control and several cardiovascular risk factors in different populations, with little compelling evidence among Omanis. This paper describes the protocol of a wait-list, open labelled, randomized control trial, with its main objective aimed to determine the effectiveness of Mediterranean Diet intervention on glycaemic control and cardiovascular risks among T2DM patients in Oman. Methods: A total of 140 eligible T2DM patients will be recruited. Participants in the intervention group will undergo a six-month MedDiet program comprising of different activities (individual dietary counseling, cooking classes, phone calls and social media messages) while the control group will continue with standard diabetes care. Data collection will be conducted at baseline, after three and six months. The 2 x 3 mixed-design ANOVA will be used to determine the mean changes in outcome variables over the full study period between the two groups. Discussion: Epidemiology studies on nutrition and health had focused on dietary pattern, which provides an opportunity to account for nutrient-nutrient interactions lately. Mediterranean Diet has produced consistent findings on its protective role in diabetes management, with little information on its effectiveness in population outside of Mediterranean basin, including Oman. The outcomes of current study will be used to inform community and health care professionals on the effectiveness and practically of MedDiet on diabetes management.

Nutrition Characteristics and Delivery in Relation to 28-day Mortality in Critically Ill Patients

@#Introduction: The limited data regarding nutrition characteristics and the delivery of critically ill patients in South Asia is intriguing. This study was conducted to investigate the nutrition characteristics and delivery in relation to 28- day mortality in mechanically ventilated patients. Methods: This prospective observational study was conducted in the intensive care unit (ICU) of the Maldives government referral hospital. Data about nutrition characteristics and delivery were collected from the ICU charts, and each patient was followed for a maximum of 28 days. Results: We recruited a total of 115 patients (mean age: 61.57±17.26 years, 52% females, mean BMI: 25.5±6.19kg/m2), of which 61 (53%) of them died within 28 days of ICU admission. Mean energy intake was 681.15±395.37 kcal per day, and mean protein intake was 30.32±18.97g per day. In the univariate logistic regression analysis, length of stay in ICU (OR = 0.950, 95% CI: 0.908 – 0.994, p = 0.027), and received intervention by a dietitian (OR = 0.250, 95% CI: 0.066 – 0.940, p = 0.040) were associated with 28-day mortality. None of the factors in the multivariate regression analysis remains significant when adjusted for sex, SOFA total score, daily energy and protein dosage. Conclusion: 28-day mortality was much higher in this study than in similar studies in South Asia, Asia and around the globe. None of the variables was significantly associated with 28-day mortality in the multivariate logistic model. However, there was a trend towards higher mortality for patients with shorter length of stay in the ICU, larger mean gastric residual volume, and no intervention by a dietitian.

Adverse Pregnancy Outcomes Are Associated With Lower Cut-offs for Maternal Hyperglycemia in Malaysian Women: A Retrospective Cohort Study

@#Introduction: This cohort aimed to determine glycemia distribution of pregnant women and maternal glycemia categories and its correlation with adverse pregnancy outcomes among Malaysian women. Methods: A retrospective cohort study of normal glycemia pregnant women. Binary logistic regression was used to examine the associations between maternal glycemia categories and adverse outcomes. Results: Women with elevated fasting plasma glucose (FPG) were at lower risk of having SGA infants (aORFPG 4= 0.64, 95% CI= 0.47 – 0.85; aORFPG 6= 0.68, 95% CI= 0.43–0.98; aORFPG 7= 0.64, 95% CI= 0.42–0.96) than those women in category 1. Women in the higher 2-hour plasma glucose (2hPG) category had a nearly two-fold risk of having LBW and LGA infants. Hyperglycemia less severe than gestational diabetes mellitus (GDM) was associated with LGA (aOR= 1.22, 95% CI= 1.07 – 1.88) and caesarean delivery (aOR= 1.80, 95% CI= 1.20 – 2.69), in the meanwhile GDM was associated with caesarean delivery (aOR= 1.33, 95% CI= 1.02 –1.79). Conclusion: Cut-off points for FPG and 2hPG that relate to adverse pregnancy outcomes started at 4.9 – 5.0 mmol/l and 7.5 – 7.7 mmol/l. These cut-off points were lower than the current recommended criteria of Clinical Practice Guideline (CPG) of Malaysia for GDM diagnosis. Large-scale studies are required to identify the optimal GDM cut-off.

Levels of Knowledge about the Glycemic Index Concept among Women with Gestational Diabetes Mellitus

@#Introduction: Low glycemic index (GI) diet is recommended as part of medical nutrition therapy for the management of gestational diabetes mellitus (GDM). While the clinical benefits are evident, data assessing knowledge of the GI concept among women with GDM are scarce. This was a needs assessment study to determine the level of knowledge about the GI concept among women with GDM. Methods: Using a cross-sectional design, we included 85 women with GDM (mean age: 30.6 ± 4.0, pre-pregnancy BMI: 24.8 ± 4.1 kg/m2, gestational age: 34.0 ± 4.0 weeks) from Hospital Serdang, Malaysia. Knowledge about the GI concept was assessed using a developed questionnaire. Additional questions on GDM were assessed using Gestational Diabetes Mellitus Knowledge Questionnaire (GDMKQ). Subjects with less than 50%, 51-74%, and more than 75% total score were categorized as having poor, fair, and good knowledge levels, respectively. Results: The mean knowledge score obtained by the subjects was 12.8 ± 3.5. More subjects scored correctly for GDM-related knowledge (68.2%). More than half (58.8%) had heard about the GI concept previously and 55.3% understood the definition of GI. The average knowledge score about the GI concept was 55.6%; subjects scored highest on the influence of different carbohydrates (teh tarik versus milk) on blood glucose level (87.1%). However, the majority of the subjects had fair knowledge level (62.4%). Conclusion: Women with GDM had moderate knowledge about the GI concept. Results of the needs assessment served as preliminary data for the development of a GI-based nutrition education program in Malaysia.

Dietary Nutrient Intake and Meal-related Situations among Elderly Outpatients with Chronic Obstructive Pulmonary Disease from Respiratory Clinics, Malaysia

@#Introduction: Chronic obstructive pulmonary disease (COPD) patients usually have dietary problems leading to malnutrition issues. Therefore, this study aimed to determine macro and micronutrient intakes and meal-related situations among outpatients COPD elderly and its adequacy according to their requirements. Methods: 140 patients were included in this cross-sectional study at Respiratory Clinics of Hospital Serdang and Institut Perubatan Respiratori. Socio-demographic and health status data were collected by interviewing patients and reviewing their medical records. A three-day diet history (two-day on weekdays, one day on weekend) was analysed using Nutritionist Pro and compared against their requirements. Meal-related situation was assessed using three open-ended questions that related to food shopping, cooking and eating and analysed using content analysis. Results: Patients were 70±7 years old, 97% male, 59% Malay, 48% had primary education, 75% married, 72% ex-smokers and 54% presented with comorbidities. Majority of them had no episode of exacerbation for the past one year and in moderate stage of the COPD severity. Mean energy intake was 916±221 kcal/day with 98% of them have under-reported their intake. Almost all patients had inadequate macro and micronutrient intake; energy (97%), protein (97%), carbohydrate (86%), fat (99%), vitamin A (95%), C (86%), D (99%) and E (99%). The meal-related situation reported patients had difficulties with food shopping and preparation and problems during mealtime. Conclusion: COPD elderly reported inadequate intake of macro and micronutrients and had problems during mealtime. This indicates the need for Malaysian nutrition guidelines specific to COPD patients and nutrition intervention in the primary setting.

Management of diabetes in pregnancy in primary care

@#Diabetes in pregnancy is associated with risks to the woman and her developing fetus. Management of the condition at the primary care level includes pre-conception care, screening, diagnosis, as well as antenatal and postpartum care. A multidisciplinary approach is essential in ensuring its holistic management.

Associations between the dietary patterns of pregnant Malaysian women and ethnicity, education, and early pregnancy waist circumference: A prospective cohort study

BACKGROUND/OBJECTIVES: Little is known about the dietary patterns (DPs) of women during pregnancy. The present study aimed to identify the DPs of pregnant Malaysian women and their associations with socio-demographic, obstetric, and anthropometric characteristics. SUBJECTS AND METHODS: This prospective cohort study included 737 participants enrolled in Seremban Cohort Study between 2013 and 2015. Food consumption was assessed using a validated 126-food item semi-quantitative food frequency questionnaire (SFFQ) at four time-points, namely, pre-pregnancy and at each trimester (first, second, and third). Principal component analysis (PCA) was used to identify DPs. RESULTS: Three DPs were identified at each time point and designated DP 1–3 (pre-pregnancy), DP 4–6 (first trimester), DP 7–9 (second trimester) and DP 10–12 (third trimester). DP 1, 4, and 7 appeared to be more prudent diets, characterized by higher intakes of nuts, seeds & legumes, green leafy vegetables, other vegetables, eggs, fruits, and milk & dairy products. DP 2, 5, 8, and 11 had greater loadings of condiments & spices, sugar, spreads & creamer, though DP 2 had additional sweet foods, DP 5 and 8 had additional oils & fats, and DP 11 had additional tea & coffee, respectively. DP 3 and 6 were characterized by high protein (poultry, meat, processed, dairy, eggs, and fish), sugars (mainly as beverages and sweet foods), and energy (bread, cereal & cereal products, rice, noodles & pasta) intakes. DP 9 had additional fruits. However, DP 12 had greater loadings of energy foods (bread, cereal & cereal products, rice, noodles & pasta), sugars (mainly as beverages, and sweet foods), and good protein sources (eggs, nuts, seeds & legumes). Malays were more likely to have lower adherence (LA) for DP 1 and 10 than non-Malays. DP 2, 8, and 11 were more prevalent among Malays than non-Malays. Women with a higher education were more likely to have LA for DP 10, and women with a greater waist circumference at first prenatal visit were more likely to show LA for DP 11. CONCLUSIONS: DPs observed in the present study were substantially different from those reported in Western populations. Information concerning associations between ethnicity, waist circumference and education with specific DPs before and throughout pregnancy could facilitate efforts to promote healthy dietary behavior and the overall health and well-being of pregnant women.

Nutrition-Related Factors and Binge Eating Behaviour in a Sample of Malaysian University Students / Jurnal Sains Kesihatan Malaysia

@#Binge eating (BE) behaviour is associated with obesity and eating disorders. This cross-sectional study investigates BE behaviour and its relationship with nutrition-related factors among university students. A total of 170 (69% females) university students in Malaysia aged 19 to 24 years participated in this study. BE behaviour was assessed with the use of Binge Eating Scale (BES) questionnaire. Socio-demographic background and nutritional status (anthropometric measurements, body mass index (BMI) and dietary intake) were also measured. BE behaviour reported by 10% percent of the participants. BE behaviour was associated with increased energy intake, elevated BMI and sex (Adjusted R2 = 0.116, p < 0.001). Differences in sex-specific factors in predicting the risk of BE behaviour were evident. In male participants, an increased in energy intake, elevated BMI and had a higher waist circumference associated with the risk of BE behaviour (Adjusted R2 = 0.411, p < 0.001). In female participants, only a higher waist circumference associated with BE behaviour (Adjusted R2 = 0.028, p < 0.05). The finding suggests that understanding sex-specific factors are necessary to prevent BE. These are the potential targets for tailored eating behaviour intervention among university students.

Health-related quality of life of elderly with chronic obstructive pulmonary disease from selected government institutions

@# Introduction: It is widely recognised that health-related quality of life (HRQOL) is impaired in chronic obstructive pulmonary disease (COPD) patients. Most previous studies were conducted among the younger adult population and there is limited information on the elderly population. This study aimed to determine the COPD assessment test (CAT) score in the elderly with COPD. Methods: This was a crosssectional study involving 140 elderly patients who had been diagnosed with COPD at two selected government institutions. Data on socio-demographic and health status were collected by interviewing patients and reviewing their medical records. The HRQOL was measured using CAT. The independence sample t-test and one-way ANOVA were conducted to compare the CAT scores with socio-demographic and health status. Results: The socio-demographic and health characteristics of the patients were as follows: majority (54%) were aged 60-70 years, male (97%), Malay (59%), married (75%), ex-smokers (72%), had attained primary education (48%), had co-morbidities (54%), no history of hospitalisation or visits to the emergency department due to COPD (57%), and were in moderate stage of airflow obstruction (53%). The mean of CAT score was 21.87±6.85 and the majority of the patients were classified as having worst symptoms of COPD (93%) as they had high CAT score which was ≥ 10. Conclusion: Majority of the patients in this study had high scores of CAT, which indicated poor HRQOL. Ex-smokers had higher scores compared to non-smokers. More attention need to be given to these subgroups in order to increase their quality of life.

Saffron Extract and Crocin Reduced Biomarkers Associated with Obesity in Rats Fed a High-Fat Diet

This study aimed to investigate the effect of saffron extract and crocin on blood biomarkers associated with obesity using the rat model. Methods: Obesity was induced by feeding a high-fat diet to 42 male Sprague-Dawley rats for 12 weeks, after which they were equally distributed into seven groups. Three groups served as controls namely, normal diet (ND), high-fat diet (HFD), and high-fat diet plus orlistat (HFD + ORL), while the remaining four treatment groups consisted of HFD added low or high dose (40 and 80 mg/kg/day) of either saffron extract or crocin in the food. At the end of 8 weeks, blood samples were collected by cardiac puncture for biochemical analysis. Results: Obese rats treated with a high dose of saffron extract and crocin showed significantly lower plasma glucose levels (5.26 and 5.67 mmol/L respectively) than the HFD rats (6.92 mmol/L). Saffron extract and crocin at a high dose showed significantly lower levels of plasma insulin (3.97 and 3.88 ng/mL respctively) compared to HFD control (5.41 ng/mL). Adiponectin levels significantly increased in obese rats fed saffron extract and crocin at high doses (7.44 and 7.92 µg/mL respectively) compared to HFD control (5.34 µg/mL). Ghrelin level significantly increased from 419.10 to 284.10 pg/mL,while leptin level significantly decreased from 8.08 to 5.68 ng/mL for the high dose crocin groups compared to HFD control. No significant differences in plasma serotonin levels were found among the groups. Conclusion: Saffron extract and crocin show potential in reducing blood biomarkers associated with obesity as well as anti-inflammatory and regulatory potential of adipocytokines in an animal model.

The relationship between household income and dietary intakes of 1-10 year old urban Malaysian

BACKGROUND/OBJECTIVES: 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. SUBJECTS/METHODS: Children's dietary intakes were obtained using food recall and record for two days. Diet adequacy was assessed based on recommended intakes of energy and nutrients and food group servings. RESULTS: For toddlers, all nutrients except dietary fiber (5.5 g) exceeded recommended intakes. Among older children (preschoolers and school children), calcium (548 mg, 435 mg) and dietary fiber (7.4 g, 9.4 g) did not meet recommendations while percentage of energy from total fat and saturated fats exceeded 30% and 10%, respectively. The mean sodium intakes of preschoolers (1,684 mg) and school children (2,000 mg) were relatively high. Toddlers in all income groups had similar energy and nutrient intakes and percentages meeting the recommended intakes. However, low income older children had lowest intakes of energy (P < 0.05) and most nutrients (P < 0.05) and highest proportions that did not meet recommended energy and nutrient intakes. For all food groups, except milk and dairy products, all age groups had mean intakes below the recommended servings. Compared to middle and high income groups, low income preschoolers had the lowest mean intake of fruits (0.07 serving), meat/poultry (0.78 serving) and milk/dairy products (1.14 serving) while low income toddlers and school children had the least mean intake of fruits (0.09 serving) and milk/dairy products (0.54 serving), respectively. CONCLUSION: Low socioeconomic status, as indicated by low household income, could limit access to adequate diets, particularly for older children. Parents and caregivers may need dietary guidance to ensure adequate quantity and quality of home food supply and foster healthy eating habits in children.

Evaluation of diet quality and its associated factors among adolescents in Kuala Lumpur, Malaysia

BACKGROUND/OBJECTIVES: This study aims to determine contribution of meal frequency, self-efficacy for healthy eating, and availability of healthy foods towards diet quality of adolescents in Kuala Lumpur, Malaysia. SUBJECTS/METHODS: This study was conducted among 373 adolescents aged from 13 to 16 years old. Diet quality of the respondents was assessed using the Healthy Eating Index for Malaysians. Meal frequency, self-efficacy for healthy eating, and availability of healthy foods were assessed through the Eating Behaviours Questionnaire (EBQ), self-efficacy for healthy eating scale, and availability of healthy foods scale, respectively. RESULTS: The majority of the respondents (80.7%) were at risk of poor diet quality. Males (mean = 34.2 +/- 8.2%) had poorer diet quality than females (mean = 39.9 +/- 9.0%) (t = -5.941, P < 0.05). Malay respondents (mean = 36.9 +/- 8.7%) had poorer diet quality than Indian respondents (mean = 41.3 +/- 10.0%) (F = 2.762, P < 0.05). Age (r = 0.123, P < 0.05), self-efficacy for healthy eating (r = 0.129, P < 0.05), and availability of healthy foods (r = 0.159, P < 0.05) were positively correlated with the diet quality of the respondents. However, meal frequency was not correlated with the diet quality of the respondents. Multiple linear regression analysis showed that being a male, being a Malay, low self-efficacy for healthy eating, and low availability of healthy foods contributed significantly towards poor diet quality among respondents. CONCLUSIONS: In short, sex, ethnicity, self-efficacy for healthy eating, and availability of healthy foods were associated with diet quality among adolescents. Health practitioners should take into consideration of differences in sex and ethnicity during implementation of nutrition-related intervention programs. Self-efficacy for healthy eating and availability of healthy foods should be included as important components in improving diet quality of adolescents.

Obesity-related behaviors of Malaysian adolescents: a sample from Kajang district of Selangor state

This study aims to determine the association between obesity-related behaviors (dietary practices, physical activity and body image) and body weight status among adolescents. A total of 382 adolescents (187 males and 195 females) aged 13 to 15 years in Kajang, Selangor participated in this study. Majority of the respondents were Malays (56.0%), followed by Chinese (30.1%) and Indians (13.9%). Dietary practices, physical activity and body image of the adolescents were assessed through the eating behaviors questionnaire, two-day dietary record, two-day physical activity record and multi-dimensional body image scale (MBIS), respectively. Body weight and height were measured by trained researchers. The prevalence of overweight and obesity (19.5%) was about twice the prevalence of underweight (10.5%). About two-thirds of the respondents (72.3%) skipped at least one meal and half of them (56.2%) snacked between meals with a mean energy intake of 1,641 +/- 452 kcal/day. More than half of the respondents (56.8%) were practicing sedentary lifestyle with a mean energy expenditure of 1,631 +/- 573 kcal per day. Energy intake (r = 0.153, P < 0.05), physical activity (r = 0.463, P < 0.01) and body image (r = 0.424, P < 0.01) were correlated with BMI. However, meal skipping, snacking and energy expenditure per kg body weight were not associated with body weight status. Multiple linear regression analysis showed that body image, physical activity and energy intake contributed significantly in explaining body weight status of the adolescents. In short, overweight and obesity were likely to be associated not only with energy intake and physical activity, but also body image. Hence, promoting healthy eating, active lifestyle and positive body image should be incorporated in future obesity prevention programmes in adolescents.

The Effect of Low Glycemic Index Bread Eaten with Different Fillings on Blood Glucose Response in Healthy Individuals / Jurnal Sains Kesihatan Malaysia

White and whole meal breads have been classified as high glycemic index (GI) foods which in turn produce the greatest rise in blood glucose. One of the commercial bread products in Malaysia known as Brown breads (BB) has been recently marketed as a healthy choice for diabetics due to its low GI value. This study was conducted to examine the effect of BB when eaten with different fillings on blood glucose response among healthy individuals and to describe the influences of these fillings in reducing blood glucose response. Five test meals using BB (BB eaten with baked beans, BB eaten with vegetable, BB eaten with apple, BB eaten with roast chicken and BB eaten with seaweeds) had been prepared for this study. Postprandial blood glucose response was determined for each test meal and reference food (glucose) that contained 50 g carbohydrate respectively. A total of 21 healthy subjects were recruited by advertisement to participate. Only 20 subjects (15 males, 5 females, Mean + SD Age : 24.4 + 3.7 years; BMI 23.4 + 3.0 kgm-2) completed this study. After an overnight fast, subjects consumed BB eaten with fillings according to the assigned group given and three repeated tests of reference food (glucose). Fasting capillary blood glucose samples were taken at time 0 and at 15, 30, 45, 60, 90 and 120 min respectively after the meal began. The blood glucose response was obtained by calculating the incremental area under the curve (AUC). Blood glucose response after consuming reference food (251.8 + 12.1 mmol.min/L) was significantly higher than all the test meals (p < 0.05). Among the test meals, BB eaten with baked beans produced the highest rise in blood glucose (97.0 + 16.9 mmol.min/L) whereas BB eaten with seaweeds demonstrated the lowest response in blood glucose (33.3 + 6.5 mmol.min/L) and the difference was statistically significant (p < 0.05). The postprandial blood glucose response after ingestion of BB when eaten with vegetable was 73.3 + 19.1 mmol.min/L followed by BB eaten with apple (58.9 + 12.2 mmol.min/L) and BB eaten with roast chicken (56.5 + 10.1 mmol.min/ L). Generally, BB when eaten with fillings produced a slow rise in blood glucose response than the reference food. Combining this BB with fillings had the effect of reducing the postprandial blood glucose further.