Prevalence and determinants of Instrumental Activities of Daily Living (IADL) disability among communitydwelling elderly in a semi-urban setting in Peninsular Malaysia

@#Introduction: The ability to perform daily living activities among the elderly is important, as physical disability may lead to dependency and various public health implications. This study aimed to determine the prevalence of instrumental activities of daily living (IADL) disability and its association with socio-demographic characteristics, dietary intake, social participation, perceived-health-status and risk of falls. Methods: This cross-sectional study was conducted among communitybased elderly in the Gombak District of Selangor. 258 respondents aged 60-88 years old (mean age 66±6.5 years) were recruited through multi-stage proportional sampling. Most of the respondents (88.4%) aged 60-74 years and 11.6% were ≥75 years. IADL disability was determined using an eight-item IADL scale. The presence of IADL disability was defined as needing help in at least one or more of eight-IADL activities. Dietary intake and fall risk were assessed using diet history questionnaire (DHQ) and 21-item fall risk index (FRI-21), respectively. Results: The prevalence of IADL disability among the respondents was 58.1%. A binary logistic regression analyses showed that the following factors predicted IADL disability: advanced age (≥75 years, OR=6.4; 95% CI: 1.3, 30.8), being unmarried (OR=2.5; 95% CI: 1.1, 5.9), unemployed/retired (OR=2.3; 95% CI: 1.2, 4.3), and at risk of falls (OR=2.5; 95% CI: 1.3, 6.1). Conclusion: Predictors such as marriage and employment highlight the importance of social support among elderly. In practical terms, this means that it is incumbent upon caregivers, family members, and the community to provide both physical and emotional support if the functional status of the elderly is to be improved.

Oral Status And Its Association With Oral Health-Related Quality Of Life In Community-Dwelling Older Adults

@#Poor oral conditions among older adults can cause significant impacts to their overall quality of life. Older adults with reduced number of functional teeth and dental diseases may experience difficulty in daily activities like chewing and eating. The aim of this study is to assess the association between oral health and oral health-related quality of life (OHRQoL) among a group of community-dwelling older adults in Negeri Sembilan, Malaysia. A cross-sectional study was carried out on 436 older adults aged 50 years and above from 20 randomly selected villages in the state. Respondents were interviewed using a structured questionnaire to collect information on their demographic characteristics. Clinical oral examination was carried out to determine the oral health conditions of older people. The validated Malay version of Geriatric Oral Health Assessment Index (GOHAI) was used to measure OHRQoL. Total GOHAI score ranged from 12 to 60 with higher scores indicate better OHRQoL. Majority (77.1%) of the older adults had less than 20 teeth and about 18.3% were edentulous (total tooth loss). All dentate respondents had experienced dental caries. The median GOHAI score was 54.5 (IQR 50-57). About 25.5% of the older adults perceived their oral health as good, while 74.5% had poor perception on oral health. Bivariate analysis showed that less than 20 teeth and high dental caries experience were significantly associated with poor OHRQoL. A significantly higher proportion of older adults with less than 20 teeth limit the kinds of food intake, had trouble biting or chewing, and experienced tooth sensitivity. The physical functioning and well-being of the older people may be disrupted due to oral diseases. Measures of OHRQoL are important as to complement the clinical oral findings in identifying treatment needs of the geriatric patients.

Association between Tooth Loss and Body Mass Index Among Older Adults in Kuala Pilah, Negeri Sembilan / Jurnal Sains Kesihatan Malaysia

@#Loss of teeth can affect masticatory efficiency in older adults. This may result in avoidance or modifications in foodchoices and lead to lower intake of important nutrients among older individuals. The aim of this study was to determinethe association between tooth loss and body mass index, BMI, among older adults in Kuala Pilah, Negeri Sembilan. Across-sectional study was carried out on 428 older adults aged 50 years and above from selected villages in district ofKuala Pilah. Respondents were interviewed to collect information on their demographic characteristics. Number of toothloss was determined through oral assessment, followed by anthropometric assessment to calculate the BMI of respondents.Findings showed that majority of the respondents were overweight and obese, 40.4% and 19.9% respectively, while onlya small proportion was underweight, 3.9%. The proportion of edentulism (total tooth loss) was 18.3% and majority ofthe older adults had lost more than 12 teeth (77.1%) and less than 4 pairs of occluding posterior teeth (86.0%). Totaland partial tooth loss was found to be not significantly associated with BMI. In relation to the arrangement of teeth,older adults with reduced number of posterior occluding pairs of teeth were more likely to experience unsatisfactoryBMI (OR = 3.61, 95% CI: 1.48, 8.76). This may suggest that functional arrangement of the tooth in the oral cavity is moreimportant than the number of tooth loss alone. Thus, maintaining an optimum number of teeth for chewing is essentialfor maintenance of ideal BMI.

Growth patterns of Palestinian children from birth to 24 months

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

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.

Factors Associated with Dietary Diversity Score among Individuals with Type 2 Diabetes Mellitus.

Studies on diet quality among individuals with type 2 diabetes mellitus (T2DM) are scarce. This crosssectional study aimed to assess the diet quality and to determine its associated factors among individuals with T2DM at the Medical Outpatients Department, Serdang Hospital, Selangor, Malaysia, from July 2010 to March 2011. Subjects were interviewed for sociodemographic data. Diabetes history was retrieved from the hospital’s e-database. Usual dietary intake was measured using a food frequency questionnaire, from which a dietary diversity score was obtained with two measures: Food Group Score and Serving Score were constructed based on the Malaysian Dietary Guidelines. Food Group Score was computed from the number of food groups consumed from five major food groups (grains, vegetables, fruits, meat, and dairy products) whereas Serving Score was computed from the number of servings consumed from the various food groups. Anthropometric measures, including weight, height, waist- and hip-circumference were examined. For data analyses, descriptive statistics, simple and multiple linear regression were conducted using IBM SPSS Statistics 20.0. A total of 113 subjects (50.4% female), with mean±SD age of 54.05±10.30 years and duration of diabetes of 11.25±9.05 years were studied. The mean Food Group Score and Serving Score were 4.12±0.79 and 12.75±3.50 respectively. Slightly more than one-third of the subjects achieved five food groups a day while less than 2% consumed a desirable number of servings from all food groups. Among the five food groups, dairy, and fruits were the least-frequently consumed foods. Lower education, lower personal income, working, non-insulin, overweight and obese subjects had significantly lower Food Group Score than their counterparts [F (6,106)=4.924, p<0.0001] whereas lower education, lower waist-to-hip ratio, overweight and obese subjects had significantly lower Serving Score than their counterparts [F (4,108)=7.520, p<0.0001]. There was a high proportion of individuals with T2DM, who failed to adhere to the national dietary guidelines. The importance of taking a well-balanced diet in accordance with the guidelines should be emphasized, especially among those with lower educational level through a simple and easy-to-understand approach.