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@#Polyunsaturated fatty acids (PUFAs) intake may be beneficial in many aspects during the early phase of life. This scoping review aims to examine the beneficial outcomes and intakes of omega-3 and omega-6 PUFA among children. An electronic database search on academic journals published from 2017 to 2021 was conducted using Science Direct, PubMed, and Google Scholar. A total of 35 studies were identified and included in this scoping review. Majority of the findings found that PUFAs intake has a beneficial impact on the growth development, mental and cognitive health among children whether they are malnourished, sick or healthy individuals. Overall, this review may provide additional information on the benefits and recommended intake of supplementing PUFAs on children. More detailed research on this topic is needed to support these findings since it will contribute to the formation of the dietary intervention.
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@#Introduction: COVID-19 is a disease caused by a new strain of coronavirus spreading rapidly over the globe, and the older population has had a larger impact as the fatality rate increases with age. This pandemic caused them to reduce their physical activity (PA). COVID-19 also resulted in food supply disruption and led to unhealthy dietary changes, which are usually associated with weight gain and affecting the body mass index (BMI). PA and BMI can influence the quality of life (QoL) of the older people. Therefore, this study aimed to determine the association between PA, BMI, and QoL amongst the older people in Malaysia during COVID-19. Methods: A cross-sectional study was conducted amongst community-dwelling older people from all states in Malaysia. An online survey consisting of self-reported anthropometry, Global Physical Activity Questionnaire- Malay version (GPAQ-M) and Short Form-36 Health (SF-36) Survey were collected. Statistical analysis chi-square test was used to identify the association between BMI, PA, and QoL. Results: This study included data from 180 individuals with a median age of 64.0 ± 9.8 years. The results showed that participants aged 60-69 years were significantly associated with better QoL, meanwhile, those who practice low PA levels were significantly associated with poor QoL. Conclusion: The findings revealed that age and PA were associated with QoL. Thus, the healthcare profession must emphasise regular PA to accomplish a better QoL amongst older people in the future.
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@#Introduction: In Malaysia, the undiagnosed diabetes prevalence has increased. Socio-demographic characteristics and nutritional status play a crucial role in prediabetes development. Hence, this cross-sectional study aimed to identify the socio-demographic characteristics and nutritional status of adults at risk of T2DM in Kuala Nerus, Terengganu. Methods: A total of 30 participants at risk of T2DM aged 18 to 59 years old were recruited from Kuala Nerus using a convenience sampling method. Information on socio-demographic, anthropometric, fasting plasma glucose (FPG) level, clinical profile, Finnish Type 2 Diabetes Risk Assessment Tool (FINDRISC) score, dietary intake, and physical activity level were obtained. Results: The participants (mean age: 36.1 ± 8.7 years) were mostly female (76.7%), Malay (96.7%), married (43.3%), had a tertiary degree (60.0%), and were working (83.3%) with a monthly salary of less than RM 1000. Half of the participants were from the obese class I category. Their FPG level was 5.6 ± 0.5 mmol/L and half of them were classified as having optimal blood pressure. Also, they had a mean FINDRISC score of 6.3 ± 1.8. The participants consumed 2073 ± 247 kcal/day, which was comprised of 50.8% carbohydrate, 16.1% protein, and 33.1% fat. Most of them (63.3%) were minimally active. Conclusion: The participants had moderate T2DM risk with normal FPG level, blood pressure, and heart rate. They had excessive energy and fat intake with insufficient dietary fibre intake. It is vital to examine the socio-demographic characteristics and nutritional status, which can provide important information for planning future cost-effective T2DM preventive strategies.
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@#Malnutrition and poor quality of life (QoL) in older adults are becoming a public health concern. Therefore, this review article summarised significant studies which investigated the assessment of malnutrition and QoL and its relation. A literature research on academic journals published from 2011 to 2021 was conducted by using electronic databases, which were Google Scholar, PubMed, Science Direct and SCOPUS. A total of 21 studies with 26,569 participants were identified and included in this review. The prevalence of malnutrition ranged from 1.6% to 26.5%, and poor QoL was significant amongst malnourished older adults. In conclusion, malnutrition is associated with poor QoL amongst older adults. Future studies regarding factors that influence malnutrition and its relation towards the QoL amongst older adults are needed as it will help in assisting the healthcare professions to combat these health problems.
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@#Introduction: Older persons are more susceptible to malnutrition. However, malnutrition identification through nutrition screening is not routinely performed in Malaysia’s health clinics due to no specific nutrition screening guideline and validated tool in this setting. This study aimed to develop a nutrition screening guideline for older patients and assess its feasibility for use by healthcare staff in health clinic setting. Methods: This study was conducted in three phases. In Phase I, needs assessment was conducted amongst healthcare staff. Development of nutrition screening guideline in Phase II involved scoping review and validation amongst six experts and twelve healthcare staff. In Phase III, twenty-two healthcare staff participated in feasibility assessment using in-depth interviews after completing nutrition screening in older patients. Interview data was analysed thematically using NVivo Software 12.0. Results: A Malay language version of nutrition screening guideline in A4-sized with 31 pages was developed and validated. Items with a content validity index ≥0.83 from experts review were retained, while <0.83 were revised accordingly. Validation amongst healthcare staff showed positive responses. The guideline was then assessed for feasibility, where 110 older patients (mean age= 68.7±6.1 years) were screened by healthcare staff using the newly developed nutrition screening guideline. Four themes emerged from in-depth interviews: 1) Ease of use; 2) Identification and management of malnutrition; 3) Acceptability; and 4) Implementation of nutrition screening. Conclusion: The newly developed and validated nutrition screening guideline is well-accepted and feasible for healthcare staff to screen older patients in health clinic setting for timely malnutrition identification and management.
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@#Introduction: Malnutrition, specifically undernutrition, in community-dwelling older adults reduces their well-being and predisposes to diseases. Therefore, timely malnutrition identification through nutrition screening is needed to identify at risk and malnourished patients. This study aimed to develop the content of nutrition screening guideline to facilitate healthcare staffs in health clinics to administer a validated nutrition screening tool specifically for older adults. Methods: A scoping review was conducted electronically using SCOPUS, PubMed, ProQuest Health & Medical Complete, and Cochrane databases. The systematic search was performed up to 31st December 2021. Search terms were created for identification of eligible and related articles. Inclusion and exclusion criteria were determined for the systematic search. The search was limited to English and Malay languages, and full text articles with no limitation of years. All data were extracted and analysed, guided by the PRISMA extension for scoping reviews (PRISMA-ScR). Results: From 728 identified articles, 18 articles were included in the analysis. Identified information for the guideline content were: introduction, aims and objectives, definition of malnutrition, prevalence of malnutrition, implementation of nutrition screening, guidance on administering items in validated tools, and guidance on anthropometric measurements. Meanwhile, format and flow charts from established guidelines served as references for the guideline development process. Conclusion: Appropriate content to develop a nutrition screening guideline has been identified based on this review. Development of a guideline based on this content can facilitate healthcare staffs to perform timely nutrition screening in older adults.
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@#Introduction: The elderly population is highly vulnerable to malnutrition, including those in the community. The use of nutrition education as part of nutrition intervention is able to improve their nutritional status. Hence, provision of a nutrition resource kit addressing the needs of at-risk and malnourished elderly would be advantageous. This research aimed to develop, validate and evaluate the acceptance of a newly developed nutrition resource kit, which served as an educational material among at-risk and malnourished elderly in Malaysian health clinics. Methods: This study was conducted in three phases: Phase I comprised of qualitative needs assessment to identify the types of nutrition resource kit needed; Phase II was the development and validation of the nutrition resource kit; while Phase III was acceptance evaluation, which involved individual in-depth interview and triangulation. Results: An A5-sized booklet with incorporation of an educational video in a QR code was developed. Both printed material and educational video had excellent content and face validity. Suggestions by experts and elderly from validation were considered and revision was done accordingly. Acceptance evaluation revealed four themes: 1) positive acceptance, 2) elderly-friendly, 3) valuable, and 4) individual preference. Triangulation data revealed that all elderly positively evaluated both resources. Additional suggestions given by elderly were considered for improvement. Conclusion: This newly developed nutrition resource kit, both in the printed and electronic format, was well-accepted among the at-risk and malnourished elderly. It could be used as an important reference for the elderly, especially those attending health clinics, in treating and preventing malnutrition.
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@#Introduction: Elderly population is more likely to suffer from malnutrition, thereby requiring appropriate nutrition education as part of nutrition intervention to overcome this issue. This review aims to identify content suitable for developing a nutrition resource kit that provides nutritional guidance to combat malnutrition among malnourished and at-risk elderly in health clinics setting, particularly in Malaysia. Methods: A literature search was conducted up to 15th December 2019 in four databases: PubMed, Scopus, COCHRANE, and ProQuest Health & Medical Collection. Potential literature on nutrition education, suitable dietary guidelines and existing educational materials for elderly in the community, in English and Malay languages, were searched to identify suitable content for the nutrition resource kit. All relevant documents were included based on inclusion and exclusion criteria. Data were extracted and analysed according to the PRISMA-ScR guidelines. Results: A total of 27 documents consisting of articles, printed materials and guidelines were included for analysis. Suitable content included information related to malnutrition such as definition, signs and symptoms, cause-consequences, and nutrition management, which included food plate, serving size, menu suggestion, examples of recipes, tips to increase energy and protein intakes through food or drink, texture modification, a guide to using oral nutritional supplements, tips for maintaining nutrient content in food and drink, tips to encourage to eat, and oral health. Conclusion: A nutrition resource kit tailored for malnourished and at-risk elderly would be a beneficial nutrition intervention. There is a need to incorporate these information in the development of a nutrition resource kit to improve their dietary intake.
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@#Introduction: The elderly population are susceptible to malnutrition due to many factors. Hence, timely malnutrition identification through nutrition screening needs to be performed routinely in health clinics. However, the nutrition screening practice in health clinics need to be improvised for malnutrition identification among the elderly population. This study identifies barriers and opportunities for nutrition screening in elderly patients in health clinic settings. Method: A qualitative study was conducted among healthcare staff from urban and rural health clinics in Kuantan, Pahang, Malaysia. In-depth individual interviews were performed, audio-recorded and transcribed verbatim. Non-participant observations that act as triangulation were conducted among elderly patients (aged ≥60 years) attending the sampled health clinics. Both data from the interviews and observations were analysed thematically using NVivo software. Results: Twenty healthcare staff participated in the interviews were medical officers (n=6), medical assistants (n=8), staff nurses (n=4), and community nurses (n=2) with a mean age of 33.7±6.3 years. Twenty- one elderly patients were involved in non-participant observations. The four themes that emerged as barriers and opportunities were: time, patient factors, organisation factors and nutrition screening knowledge. Time constituted the main barrier, whilst incorporating a validated nutrition screening tool into current health screening practices was identified as the most practical approach to performing nutrition screening. Staff also highlighted the need for appropriate guidelines for implementing nutrition screening. Conclusion: This study identified appropriate approaches to implementing nutrition screening among elderly patients in health clinics. Developing a comprehensive nutrition screening guideline may facilitate healthcare staff in performing nutrition screening.
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@#Introduction: Elderly population is at high-risk to suffer from malnutrition and nutritional inadequacy. The use of nutrition resource kit which provides nutritional guidance could be helpful to improve their dietary intake. There is no study performed previously on the type of nutrition resource kit that can be used to overcome and prevent malnutrition among Malaysian elderly. Therefore, this study aimed to identify the types of nutrition resource kit needed by community living elderly in Malaysian health clinic setting. Methods: Qualitative study was conducted to explore the types of nutrition resource kit needed by community living elderly in health clinics. Recruitment for in-depth individual interview targeted elderly aged ≥60 years old who met the inclusion and exclusion criteria and received primary healthcare services in four health clinics in Kuantan, Pahang. Interview questions addressed the knowledge on existing nutrition educational materials, preference for types of nutrition resource kit and opinion on technology-based materials. Data were audiotaped, transcribed verbatim and thematically analyzed using NVivo software version 12. Results: 21 participants involved in this study (mean age=67.24 ±6.98 years). Five key themes identified from the data: provision of nutrition resource kit; preference for printed version; eye-friendly; facilitate understanding with diagram; and support for technology-based materials. This study also found that majority of elderly preferred for A5-sized booklet for nutrition resource kit. Conclusion: Future development of nutrition resource kit tailored to the need of elderly is needed to deliver nutritional guidance effectively and served as an important reference for them to overcome malnutrition.
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@#Introduction: This study explored stroke survivors’ understanding regarding stroke, the perceived facilitators and barriers of healthy lifestyle changes, and provision of secondary prevention education. Methods: Semi-structured interviews were conducted with 22 stroke patients (13 males and nine females; aged 34-80 years) who were attending rehabilitation clinics in three Malaysian hospitals. Each interview was audiotaped, transcribed, and analysed using the framework approach. Results: Six themes were reported: understanding of stroke; facilitators of healthy lifestyle changes; barriers of healthy lifestyle changes; food taboos; recovery; and provision of secondary stroke prevention. A third of them were uncertain about the cause of stroke and the perception towards risk of recurrent stroke varied widely. The lack of secondary prevention education was obvious although many had received general verbal advices. Several personal, social, and environmental factors were identified as the facilitators or barriers in healthy lifestyle participation. Food taboos were common and had become one of the barriers in practising healthy eating practices. Families had a strong influence on the patient’s belief and behaviour changes, both in positive and negative ways. Besides, patients tended to have a problem in information recall, while some faced confusion during the early stages of stroke recovery. Conclusion: More efforts to improve knowledge regarding cause of stroke and secondary prevention strategies are needed. Use of appropriate behavioural changes strategies, family-centred approach and continuous health education are necessary to facilitate patients’ efforts at making successful lifestyle modification after stroke event.
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@#Treatment effectiveness depends on the knowledge, attitude, and practice (KAP) of osteoarthritis (OA) patients towards their assigned treatment. This study aimed to explore the KAP towards non-surgical intervention among OA patients. A methodological framework proposed by Arksey and O’Malley (2005) was implemented. An electronic database search of English-language academic articles was conducted using PubMed and ScienceDirect databases encompassing 1998 to 2018 period of time, resulting in a total of 26 studies. OA patients were knowledgeable about the disease and exercise management. However, they were lack of knowledge on drug therapy and complementary strategies. The attitude towards non-surgical interventions was ambivalence. Lastly, the practice section mainly focused on patients’ compliance and behaviour towards different conservative managements, namely physiotherapy, medications, and complementary and alternative medicines (CAMs) which influenced by both knowledge level and attitudes. In conclusion, a higher knowledge level and positive attitude will result in good practice.
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@# 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.
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Introduction: In most Asian countries, stroke is one of themajor causes of mortality. A stroke event is life-changing forstroke survivors, which results in either mortality ordisability. Therefore, this study comprehensively focuses onprevalence, risk factors, and secondary prevention forstroke recurrence identified in South, East, and SoutheastAsian countries. Methods: This scoping review uses themethodological framework of Arksey and O’Malley. Acomprehensive search of academic journals (English) onthis topic published from 2007 to 2017 was conducted. Atotal of 22 studies were selected from 585 studies screenedfrom the electronic databases.Results: First-year stroke recurrence rates are in the rangeof 2.2% to 25.4%. Besides that, modifiable risk factors aresignificantly associated with pathophysiological factors(hypertension, ankle-brachial pressure index, atherogenicdyslipidaemia, diabetes mellitus, metabolic syndrome, andatrial fibrillation) and lifestyle factors (obesity, smoking,physical inactivity, and high salt intake). Furthermore, age,previous history of cerebrovascular events, and strokesubtype are also significant influence risk factors forrecurrence. A strategic secondary prevention method forrecurrent stroke is health education along with managingrisk factors through a combination of appropriate lifestyleintervention and pharmacological therapy.Conclusion: To prevent recurrent stroke, health interventionshould be geared towards changing lifestyle to embody ahealthier approach to life. This is of great importance topublic health and stroke survivors’ quality of life.
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The main objective of the study was to determine the factors associated with blood cholesterol level among staff in Universiti Sains Malaysia (USM). The study was a cross-sectional. One-hundred staff between 23 and 59 years of age were recruited in this study using convenient sampling at USM Health Campus. A questionnaire which includes socio-demographic characteristics, medical history, and red meat intake was used in the study. Anthropometric and biochemical assessment were measured. Blood cholesterol level was divided into two categories which were known as healthy range (<5.2mmol/L) and slight risk/high risk range (≥5.2mmol/L). The gender distribution of respondents for this study comprised of 40 male and 60 female. The age group (18 to 39) years and (40 to 59) years had a total of 40.3% and 63.2% of slightly risk or high risk blood cholesterol respectively; with the significant association between age group and blood cholesterol level (χ²=4.916,p=0.027). Besides, normal BMI group had 66.7% of respondents achieved healthy blood cholesterol level whereas underweight, overweight and obese group had 39.7% achieved healthy blood cholesterol with the significant association between BMI and blood cholesterol level (χ²=7.112,p=0.008). Moreover, daily or weekly intake of red meat showed that 65.0% of total respondents had a healthier blood cholesterol level compared to 51.0% of monthly, rarely, or none red meat intake group which achieved healthy blood cholesterol level. The result also showed a significant association between red meat intake and blood cholesterol (χ²=5.229, p=0.022), which indicating less red meat consumption is linked to high level of blood cholesterol level. Therefore, further investigation and future studies are needed to gain a clearer understanding of the association between these variables and blood cholesterol level.
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@#The main objective of the study was to determine the factors associated with blood cholesterol level among staff in Universiti Sains Malaysia (USM). The study was a cross-sectional. One-hundred staff between 23 and 59 years of age were recruited in this study using convenient sampling at USM Health Campus. A questionnaire which includes sociodemographic characteristics, medical history, and red meat intake was used in the study. Anthropometric and biochemical assessment were measured. Blood cholesterol level was divided into two categories which were known as healthy range (<5.2mmol/L) and slight risk/high risk range (≥5.2mmol/L). The gender distribution of respondents for this study comprised of 40 male and 60 female. The age group (18 to 39) years and (40 to 59) years had a total of 40.3% and 63.2% of slightly risk or high risk blood cholesterol respectively; with the significant association between age group and blood cholesterol level (χ²=4.916,p=0.027). Besides, normal BMI group had 66.7% of respondents achieved healthy blood cholesterol level whereas underweight, overweight and obese group had 39.7% achieved healthy blood cholesterol with the significant association between BMI and blood cholesterol level (χ²=7.112,p=0.008). Moreover, daily or weekly intake of red meat showed that 65.0% of total respondents had a healthier blood cholesterol level compared to 51.0% of monthly, rarely, or none red meat intake group which achieved healthy blood cholesterol level. The result also showed a significant association between red meat intake and blood cholesterol (χ²=5.229, p=0.022), which indicating less red meat consumption is linked to high level of blood cholesterol level. Therefore, further investigation and future studies are needed to gain a clearer understanding of the association between these variables and blood cholesterol level.
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Nutritional StatusABSTRACT
Introduction: Identified parameters associated with geriatric malnutrition add greatly to the knowledge of clinical nutrition and facilitate patient-centred nutritional care management. Methods: A six-month cross-sectional study with the aims of deterrninine the prevalence of malnutrition and its associated parameters was conducted among hospitalised geriatrics admitted to Hospital USM. A total of 130 (49 men, 81 women) eligible participants with a mean age of 69.7 (6.99) were recruited for this study. Anthropometric tests, biochemical tests, and subjective global assessments (SGA) were applied in this study to assess the nutritional status of the participants. Meanwhile, socio-demographics, nutritional risk factors, and clinical elements were examined to identify the associated factors of malnutrition. Results: The findings of this study revealed that 35.4% of the participants were malnourished based on SGA ratings of B (26.2%) and C (9.2%), with women having a significantly higher proportion (43.5%) compared to men (22 4%) with p<0.05. Multivariate analysis revealed that loss of appetite (p<0.001), low body mass index (EMI) (p<0.001), albumin (p<0.05), and surgical procedures (p<0.05) were significantly associated with malnutrition. Conclusion: The associated parameters were found to be practicable in facilitating the identification process of malnutrition, and thus enable earlier nutritional intervention to improve the overall disease progress.
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This study was conducted to determine types of educational needs among stroke patients admitted to Hospital Universiti Sains Malaysia. Stroke patients (n = 41) were conveniently recruited from Medical and Surgical Ward between September to December 2012. Data were obtained using semi-guided administered questionnaires and from the medical reports. Patients were given adequate time to complete the lifestyle history and educational needs on stroke with researcher’s assistance. Instrument on the educational needs consisted of fi ve themes including general information on stroke, management of risk factors, treatments of stroke, rehabilitation and post-stroke problems and post-stroke diet management. Findings indicated majority of the stroke patients were female (58.5%), between 56 to 65 years old (39.0%) and diagnosed with ischemic stroke (68.3%). Patients had history of hypertension (85.4%), diabetes (46.3%), hyperlipidemia (29.3%), ischemic heart disease (22.0%) and atrial fi brillation (2.4%). Eleven of them (26.9%) were ex-smokers and many practice unhealthy lifestyle such as lack of exercise (80.5%) and prefer fried foods (68.3%). Most patients were on multiple pharmacotherapies (92.7%) to treat their medical conditions. Educational needs rated highest need to know among stroke patients were on prevention (92.7%), fi rst aid management (85.4%), complications (85.4%) and recurrence (85.4%) of stroke in general. Other concerned were about possibility of cure with drug (92.7%), range of motion exercise (82.9%), fi sh intake (78.0%), fruit and vegetable consumption (78.0%) after stroke. Findings from this study provide a baseline information on types of educational needs among stroke patients. More patient educational intervention on primary and secondary stroke prevention should be structured in hospital and community settings in the future
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Background: No previous study has assessed the impact of childhood disability on parents and family in the context of Malaysia, and no instrument to measure this impact has previously been available. The objective of this cross-sectional study was to determine the reliability of a Malay version of the PedsQL™ Family Impact Module that measures the impact of children with disabilities (CWD) on their parents and family in a Malaysian context. Methods: The study was conducted in 2009. The questionnaire was translated forward and backward before it was administered to 44 caregivers of CWD to determine the internal consistency reliability. The test for Cronbach’s alpha was performed. Results: The internal consistency reliability was good. The Cronbach’s alpha for all domains was above 0.7, ranging from 0.73 to 0.895. Conclusion: The Malay version of the PedsQL™ Family Impact Module showed evidence of good internal consistency reliability. However, future studies with a larger sample size are necessary before the module can be recommended as a tool to measure the impact of disability on Malay-speaking Malaysian families.