Sociodemographic factors associated with consumption of high-sodium foods: Evidence from Malaysia

@#Introduction: The objective of the present study was to investigate the influences of sociodemographic factors on consumption of high-sodium foods among adults in Malaysia. Methods: Data were extracted from the Malaysian Community Salt Survey (MyCoSS) (n=1046). A seemingly unrelated regression (SUR) was utilised to assess factors associated with the number of servings of high-sodium foods (nasi lemak, roti canai, fried rice, fried noodles, and fried vermicelli) consumed per week. The independent variables were sociodemographic factors. Results: Younger individuals consumed more high-sodium foods than their older counterparts. Adults with secondary level education consumed more high-sodium foods compared with those with tertiary level education. Consumption of high-sodium foods was higher among males and Malays compared to females and non-Malays. Conclusion: Consumption of high-sodium foods was common in the population. Sociodemographic factors, such as age, education level, gender, and ethnicity, play an important role in influencing the decisions of people to consume high-sodium foods.

Malnutrition and its associated factors among children under 5 years old in Putrajaya: a study protocol

@#Introduction: Prevalence of malnourished children in Putrajaya was unexpectedly high in 2016. This paper describes the study protocol for a case-control study conducted to identify the associated factors of malnutrition among children under 5 years old in Putrajaya. Methods: This study involved two phases. Phase I was ‘screening’ where all children aged 6-59 months in 118 preschools and four government health clinics were measured for their weight and height. The World Health Organization Anthro software was used to determine the nutritional status of these children. Phase II was the ‘interview’ where children from screening were sampled into four pairs of case and control. The optimum sample size for the case of stunted, wasted, underweight, and overweight were 380, 335, 318, and 308, respectively. The same number of controls were recruited. Parents/caregivers of selected children were approached to obtain data on parental factors, children factors, food intake factors, and environmental factors that contributed to malnutrition. Data analysis was performed by multiple logistic regression in SPSS version 26. Results: Screening phase successfully measured 8,261 (50.1%) children from an estimated 16,500 children under 5 years old in Putrajaya. The number of children who were stunted, wasted, underweight, and overweight were 2,105 (25.5%), 512 (6.2%), 1,516 (18.4%), and 248 (3.0%), respectively. As overweight was undersampled, the number of controls for overweight was doubled to increase the power of the study. Parents/caregivers of selected cases and controls were interviewed in their household or any other venues at their convenience. Conclusion: This protocol promises beneficial outputs to stakeholders and policy makers that can be used for combating malnutrition in children.

Calcium and iron intakes of adolescents in Malaysia and their relationships with body mass index (BMI): Findings from the Adolescent Nutrition Survey 2017

@#Introduction: Adolescent health is a priority considering they represent the future generation. Data from the Adolescent Nutrition Survey 2017 were analysed to determine the prevalence of micronutrient inadequacy, particularly calcium and iron, and the relationship with body mass index (BMI) among Malaysian secondary school students. Methods: This cross-sectional study included students aged 13 to 17 years old studying at public and private schools. Twenty-four hours dietary recall via face-to-face interview was conducted by trained nutritionists to obtain data on dietary intake. For nutritional status, BMI-for-age z-score (BAZ) was analysed using WHO Anthroplus software. Results: From 999 respondents, 449 were boys and 550 were girls. Overall findings indicated that both boys and girls had inadequate intakes of calcium and iron in their daily diet. Mean intakes of calcium (695.7±463.2 mg/day) and iron (23.4±21.0 mg/day) were higher among boys aged 16 to 17 years old. Mean intake of iron were higher among the older age groups. Majority of the respondents (boys: 94%; girls: 97%) did not meet the recommended nutrient intake (RNI) for calcium and more than half (boys: 50%; girl: 80%) did not achieve the RNI for iron. Current findings also found significant positive but weak correlations between calcium (r=0.112, p=0.001) and iron (r=0.084, p=0.008) intakes with BMI-for-age. Conclusion: BMI-for-age was related to calcium and iron intakes among secondary school students in Malaysia. Thus, intervention strategies should focus on early screening and nutrition education on food choices of high calcium and high iron contents, including iron supplementation programmes, if needed.

A retrospective study of weight-loss predictors following bariatric surgery in Malaysian patients with obesity

@#Introduction: A retrospective study was conducted with the aim of determining the factors that affect weight loss among post-bariatric surgery patients. Methods: A successful weight loss outcome in this study was defined as achieving at least 50% excess weight loss (EWL). Eligible participants were those who had undergone bariatric surgery at least two years prior to the study. Adherence to lifestyle recommendations post-bariatric surgery, binge eating, depression, and social support were assessed. Results: A total of 51 post-bariatric surgery patients were recruited with a mean post-operative period of 3.2±0.7 years. The mean preoperative weight of 116.6±28.8 kg and body mass index (BMI) 45.2±8.8 kg/m2 were significantly reduced to 86.6±21.0 kg and 33.6±6.7 kg/m2, respectively, during follow-up (p<0.001). A total of 66.7% of participants achieved successful weight loss following bariatric surgery, with a mean EWL of 73.6±21.9% and total weight loss (TWL) of 29.4±8.7%. According to multivariate regression analysis adjusted for age and gender, pre-operative weight (β=-1.580, p<0.05) and BMI (β=-1.398, p<0.05), rate of weight loss (β=1.045, p<0.01), and adherence to eating behaviour recommendations (β=0.177, p<0.05) were significant predictors of weight loss outcomes post-bariatric surgery. Conclusion: The lower pre-operative weight and BMI, the faster rate of weight loss and higher adherence towards eating behaviour advice were potential predictors of greater EWL and thus could increase the chance of successful weight loss maintenance post–bariatric surgery.

Identification of dietary patterns associated with characteristics of successful aging

@# 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.

Limited Health Literacy And Its Associated Factors Among Overweight And Obese Housewives Living In Klang Valley Low Cost Flats: Findings From The My Body Is Fit And Fabulous At Home (Mybff@Home) Study

@#Limited health literacy is highly associated with poor health status. The concept of health literacy in public health relates to the concern that people with lower health literacy were also less likely to engage in health promoting behaviours. This is an analysis on health literacy and its associated factors among housewives and also a sub analysis of the Malaysian My Body is Fit and Fabulous at Home (MyBFF@home) study involving 328 overweight and obese housewives living in low cost flats in Klang Valley, part of a weight loss programme recruited using convenient sampling. Health literacy was measured using the Malay version of Newest Vital Sign (NVS) test with scores ranging from 0 to 6. Total score of ≤2 indicate limited health literacy and total scores of >2 indicate adequate health literacy. Descriptive analysis, chi-square test and multiple logistic regression were used to analyse the data.The mean(SD) NVS score was 1.07(1.19) with most (87.5%) housewives having limited health literacy. Factors that were significantly associated with limited health literacy were older age of 45 to 59 years old (p = 0.040), primary education and below (p = 0.001) and absence of internet connectivity (p = 0.001). In the final model, absence of internet connectivity (OR 2.61; 95%CI 1.31 to 5.22) was associated with limited health literacy. Majority of the housewives have limited health literacy and providing internet connectivity to housewives may increase their health literacy.

Sugar intake and metabolic syndrome among older adults in Peninsular Malaysia

@#Introduction: Sugar is widely consumed and excessive intake has been associated with increased risk of weight gain, diabetes mellitus and cardiovascular diseases, leading to metabolic syndrome (MetSyn). However, the association between sugar intake and MetSyn has seldom been studied among multi-ethnic Malaysian older adults. Methods: A total of 1,057 respondents aged ≥60 years were recruited through multistage random sampling from selected states. Anthropometric parameters, blood pressure, blood test for sugar and lipid profile were determined. Dietary intake was derived using a 7-day dietary history questionnaire (DHQ) and a semi-quantitative food frequency questionnaire (FFQ) for added sugar intake. Results: Prevalence of MetSyn was 39.9%, 30.9% and 42.2% using the harmonised definition, International Diabetes Federation (IDF) and National Cholesterol Education Program’s Adult Treatment Panel III (NCEP-ATPIII) definitions respectively. Mean total sugar intake was 40.5±32.0 g (8 tsp) and added sugar intake was 33.0±31.0 g (6 tsp). Excessive added sugar consumption at 100th percentile increased risks of high total cholesterol by two-fold (p<0.001) and triglyceride by 1.8 fold (p<0.001). Total sugar intake at 50th percentile increased risk of high blood pressure by 0.68 fold (p<0.05) and total sugar intake at 50th, 75th and 100th percentile increased total cholesterol risk by 1.7 fold (p<0.01), 1.5 fold (p<0.05) and 2.3 fold (p<0.001) respectively. Conclusion: Excessive sugar consumption among older adults showed no association with MetSyn but revealed significant associations with blood pressure and lipid profiles. Effects of long term excessive consumption of sugar on health outcomes in older persons should be investigated.

Undiagnosed Type 2 Diabetes Mellitus and Its Risk Factors among Malaysians: Findings of a Nationwide Study

​The prevalence of Type 2 diabetes mellitus (T2DM) is increasing worldwide and many of these affected individuals remain unidentified. Undiagnosed T2DM may impose substantial public health implications because these individuals remain untreated and at risk for complications. The objective of this study was to determine the national prevalence of undiagnosed T2DM and to identify the associated risk factors. A nationwide cross-sectional study was conducted involving 17,783 respondents. Two-stage stratified sampling design was used to select a representative sample of the Malaysian adult population. Structured validated questionnaires with face to face interviews were used to obtain data. Respondents, who claimed that they were not having diabetes, were then asked to perform a fasting blood glucose finger-prick test by Accutrend GC machine. The prevalence of undiagnosed T2DM was 8.9% (n=1587). The highest percentage of undiagnosed T2DM was found among males (10.2%), 55-59 years old (13.4%), highest education attainers of primary school (11.1%), Indians (10.3%), married (10.3%), working (8.9%) and living in the urban areas (9.2%). Multivariate analyses showed that factors associated with undiagnosed T2DM were gender, age group, ethnicity, marital status, obesity and hypertension. This study found an increasing trend of undiagnosed T2DM in Malaysia compared to 2006. This finding is alarming as risk factors associated with undiagnosed diabetes were related to most of the socio-demographic factors studied. Therefore, early diabetic screening is crucial especially among adults aged 30 and above to prevent more serious complications of this disease.​

Reliability and Validity of the Physical Activity Questionnaire for Older Children (PAQ-C) In Malay Language

​An Analysis of a Survey Questionnaire on health care workers’ knowledge and practices regarding of infection control and complains them to apply universal precautions. Health care workers are at substantial risk of acquiring blood borne pathogen infections through exposure to blood or other products of patients. To assess of infection control among health care workers in Sana'a healthcare centers, Yemen. A cross-sectional study was conducted in the health center to assess knowledge and practices regarding of infection control among 237 health workers in Sana,a city. A structured self-administered questionnaires were used and data was analyzed using SPSS version 20 and the associations were tested with chi-square, with p-value of < 0.05. The health care workers in public centers ware (51.1%) and (48.9%) of them works in private centers. One hundred and seventeen (49.4%) respondents had poor infection control knowledge, 113 (43.5%) had fair knowledge, and 17 (7.2%) had good knowledge. The knowledge was significantly associated with type of center (P < 0.018), such that the public center had the highest proportion with poor knowledge. And nurses and midwife having the highest proportion with fair knowledge of infection control. Eight (3.4%) respondents had a poor practice of universal precautions, 93 (39.2%) had fair practice, and 136 (57.4%) good practice. The practice was significantly associated with the profession, level of education and work experience (P < 0.001), (P < 0.006), (P < 0.001) respectively, and nurses and midwives as the profession with the highest proportion with good practice. We conclude that the practices and knowledge of universal precautions were low and that's need for intensive programmes to educate health care workers on various aspects of standard precautions and infection control programmes and policies.

Food Label Reading and Understanding among Obese Adults: A Population Study in Malaysia

Food labeling regulation has been implemented to enable consumers, including those with chronic diseases to make healthy informed choices before purchasing pre-packaged foods. The purpose of this study is to determine the prevalence of obese adults in Malaysia who practice reading food labels. It explored types of labels read and understanding of the information. Findings presented in this study were captured from the secondary analysis of National Health and Morbidity Survey’s (NHMS, 2006) food label study which focused only on obese adults (BMI > 30 kg/m2) aged 18 and above. This nation-wide cross sectional study was conducted from April to August 2006 using an interview-based questionnaire. Complex data analysis was done using Stata version 12.0. There were 4565 obese respondents with the mean age of 33 ± 9.7 (18 – 60 years old). About 54.7% completed high-school and 9.9% were higher degree holders. Prevalence of obese adults who claimed to read label was 80.5% (95%CI: 79.3, 81.6). Findings showed significant results in reading and understanding labels among all age group categories, Malay, Indian and other Bumiputras, all education categories and married respondents. Expiry date was the highest percentage being read (74.5%), followed by fat content (15.3%), vitamin (11.8%) and carbohydrate (10.9%). The obese population in Malaysia claimed to read and understand the food label but did not focus on specific macronutrients related to their health condition. Findings can be used to implement effective education programmes targeting the relevant groups to instill an awareness to read, understand and use the label information as one of the means in combating obesity.