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.

Prevalence Of Carbonated Soft Drink Consumption And Associated Factors Among Malaysian Adolescents: A Nationwide Cross-Sectional Study 2017

@#Carbonated soft drinks (CSD) consumption is one of the contributing factors to weight gain, dental caries and non-communicable diseases among adolescents. This study aims to determine CSD consumption among Malaysian adolescents and their associated factors. The Adolescent Health Survey 2017, was a nationally representative survey sampled school-going adolescents aged 13 to 17 years. Findings reported that 36.9% of adolescents reported CSD consumption at least once daily in the past 30 days, and the prevalence was higher than a similar study conducted in 2012. Boys, schools in rural areas, lower secondary schoolers, not physically active, consuming fast food, having food insecurity, and truancy problem reported significantly higher odds of consuming CSD compared to their counterparts. By ethnicity, Bumiputera Sarawak adolescents showed the highest odds of consuming CSD and followed by Bumiputera Sabah. Thus, interventions to limit CSD consumption among Malaysian adolescents should consider the factors highlighted in this study.

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.

Association between intake of soy isoflavones and blood pressure among urban and rural Malaysian adult

@#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.

The Association of Knowledge, Attitude and Practice with 24 Hours Urinary Sodium Excretion among Malay Healthcare Staff in Malaysia

The most effective and affordable public health strategy to prevent hypertension, stroke and renal disease is by reducing daily salt consumption. Therefore, this study aims to determine the association of knowledge, attitude and practice on salt diet intake and to identify foods contributing to high sodium intake. Secondary data analysis was performed on MySalt 2016 data. It was conducted from November 2015 until January 2016 which involving Ministry of Health Staff worked at 16 study sites in Malaysia. Salt intake was measured using 24 hours urinary sodium excretion. Food frequency questionnaire was used to determine the sodium sources. Knowledge, attitude and practice of salt intake were assessed using a validated questionnaire adapted from WHO. Demographic data and anthropometric measures also were collected. Sodium levels of more than 2400mg/day was categorised as high sodium intake. Data were analysed using SPSS software version 21. The mean sodium intake estimated by 24 hours urinary sodium excretion was 2853.23 + 1275.8 mg/day. Food groups namely rice/noodles (33.8%), sauces/seasoning (20.6%), meat and poultry (12.6%) and fish/seafoods (9.3%) were the major contributors of dietary sodium. In multiple logistic regression analysis, being a male (aOR=2.83, 95% CI 2.02 – 3.96) and obese (aOR=6.78, 95% CI 1.98 – 23.18) were significantly associated with high urinary sodium excretions. In addition, those who were unsure that high salt intake can cause hypertension (aOR=1.24, 95% CI 0.65 – 2.36), those who think that they consumed too much salt (aOR=2.10, 95% CI 1.13 – 3.87) and those who only use salt rather than other spices for cooking (aOR=2.07, 95% CI 1.29 – 3.30) were significantly associated with high urinary sodium excretion. This study showed that the main sources of sodium among Malay healthcare staff is cooked food. Poor knowledge and practice towards reducing salt consumption among them contributes to the high sodium consumption. The practice of healthy eating among them together with continuous awareness campaign is essential in order to educate them to minimize sodium consumption and to practice healthy eating.​

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.​

Prevalence and Socio-Demographic Determinant of Overweight and Obesity among Malaysian Adult

​Overweight and obesity is a major public health problem in Malaysia. This study aims to determine the prevalence of overweight and obesity among the Malaysian adult population and their association with socio-demographic characteristics (gender, ethnic, and age groups). A total of 17,257 adults aged 18 years and older (8,252 men, 9,005 women) were assessed for BMI status, with a response rate of 97.8%, through a household survey from the National Health and Morbidity Survey (NHMS), conducted in all states of Malaysia in 2011. All socio-demographic factors were consistently associated with higher chance of being overweight (except gender and location) and obesity (except location and household income). The identified risk of overweight were Indian (aOR: 1.8, 95% CI: 1.2-2.8), aged 50-59 years (aOR: 2.8, 95% CI: 2.0-3.9), widower (aOR: 1.6, 95% CI: 1.3-2.0), subject with secondary education (aOR: 1.2, 95% CI: 1.0-1.4), Homemaker/unpaid worker (aOR: 1.3, 95% CI: 1.1-1.4), and with high household income group (aOR: 1.3, 95% CI: 1.2-1.6). The identified risk of obesity were women (aOR: 1.4, 95% CI: 1.2-1.6), Indian (aOR: 1.7, 95% CI: 0.9-3.2), aged 30-39 years (aOR: 3.6, 95% CI: 2.4-5.5), widower (aOR: 1.2, 95% CI: 0.9-1.6), subjects with primary education (aOR: 1.2, 95% CI: 0.9-1.6), Homemaker/unpaid worker (aOR: 1.3, 95% CI: 1.1-1.6), and with middle household income group (aOR: 1.3, 95% CI: 1.2-1.6). Our data indicate a high prevalence of overweight and obesity in the population. Several sociodemographic characteristics are associated with both overweight and obesity. This study highlights the serious problem of overweight and obesity among Malaysia adults. Documentation of these problems may lead to research and policy agendas that will contribute both to our understanding and to the reduction of these problems.

Association of Diet Practice and Glycaemic Control among Type 2 Diabetes Mellitus Patients Attending Primary Care Clinic in Kuala Lumpur

Healthy dietary practice is important in preventing diabetes, managing existing diabetes, and preventing, or at least slowing the rate of diabetes complication development. It is, therefore, important at all levels of diabetes prevention. The objective of this study was to determine the association of dietary practice with glycaemic control among Type 2 diabetes mellitus (T2DM) patients, who received treatment from an urban Health Clinic in Kuala Lumpur. A total of 307 patients with T2DM aged 18 years and above participated in this study. A pre-tested structured questionnaire with guided interview was used to collect information on socio-demographic, clinical and dietary practice. Anthropometric and biological measurements were also taken. Descriptive statistics and Chi-square were used in the data analysis. Good glycaemic control was defined as HbA1c level less than 6.5%. The prevalence of good glycaemic control was only 27% (n=83). The highest percentage of good glycaemic control were among male patients (29.1%), aged 60 and above (33.3%), educational level of primary school (35.4%) and those with monthly income group between RM1001 to RM1500 (32.0%). About three quarter of T2DM patient (n=224) had poor control of HbA1c (≥6.5%). Age (p=0.045) and working status (p=0.039) had significant relationship with the level of HbA1c. Dietary practice showed no significant relationship with the HbA1c level. Effective interventional health education strategies are needed, focussing on modification of dietary behaviour in order to achieve glycaemic control among diabetic patients.​

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.