Development of a Valid and Reliable Scale to Assess Knowledge, Attitude and Practice (KAP) on Frailty, Nutrition and Exercise among Malaysian Elderly

@#Introduction: “Frailty Intervention through Nutrition Education and Exercise (FINE)” program is an educational program, an initiative to ameliorate frailty status among elderly due to the alarming number of frailty cases in Malaysia. The current study aims to develop and determine the validity and reliability of the KAP questionnaire on frailty, nutrition and exercise to assess the effectiveness of the “FINE” program among the Malaysian elderly. Methods: The KAP questionnaire was created based on the developed frailty module and education materials. Content and face validity were conducted before the reliability study among five health professionals and 20 elderly, while 79 elderly were involved in a reliability study in three different Projek Perumahan Rakyat (PPR) flats in the Kuala Lumpur area. Data were analysed to determine its internal consistency reliability. Results: Six items were removed during content and face validity, two from each domain. All items in the knowledge section were within an acceptable range of difficulty and discrimination following the item analysis. Yet, item-to-total correlation removes one item for attitude and four items for the practice domain. The analysis found that the internal consistency reliability was 0.852, 0.732 and 0.600 for the KAP section, respectively. Conclusion: The final version of the KAP questionnaire consisted of (11) knowledge, nine (9) attitudes and six (6) practice items proven to be valid and reliable. Thus, it could be used to assess the effectiveness of the “FINE” program among the Malaysian elderly.

Determination of the prevalence of hypertension and factors associated with blood pressure among hospitalised elderly in Hospital Serdang, Selangor, Malaysia

@#Introduction: Increasing trends of hypertension has been recognised as a common disease among the elderly. This study aimed to determine the prevalence of hypertension and factors associated with blood pressure among hospitalised elderly. Methods: This was a cross-sectional study involving 124 patients in Hospital Serdang, Selangor, Malaysia. Data on socio-demography, medical background, anthropometry, blood biochemistry and lifestyle were collected through face-to-face interviews and medical records. Dietary intake was obtained through two days of food history. Malnutrition risks and stress level were determined using the Mini Nutritional Assessment Short-Form (MNA-SF) and the Geriatric Depression Scale (GDS). Results: There were 59.7% males and 40.3% females with mean age of 66.81±5.35 years. Majority were found to have hypertension (72.6%). Approximately 38.7% had normal body mass index (BMI). Most of them reported insufficient dietary intakes except for trans fats, sodium, and caffeine. Nearly 62.1% were engaged with physical activity, 23.4% were smoking, and 4.8% were taking alcohol. Approximately 66.1% and 86.3% were classified as having normal nutritional status and normal stress levels. In this study, the prevalence of hypertension among elderly patients warded in Hospital Serdang, Selangor was 72.6% and factors such as length of stay, number of co-morbidities, number of medications, having co-morbidities of hypertension, dyslipidaemia and diabetes mellitus, polypharmacy, height, BMI, fibre, polyunsaturated fat, dietary cholesterol, caffeine, and duration of physical activity were found to be associated with blood pressure. Conclusion: The present study found that majority of patients (72.6%) had hypertension. Future studies regarding factors associated with blood pressure are recommended.

Sleep quality and body weight status of Malaysian university students

@#Introduction: Inadequate sleep duration is a modifiable behaviour linked with body weight, yet limited is known on the role of sleep quality with body weight status among university students. The study aimed to determine sleep quality and its association with body weight status among university students. Methods: A crosssectional study was conducted among 240 university students (24.6% males, 75.4% females) with a mean age of 21.22±1.24 years. Subjects were recruited from four faculties of University Putra Malaysia (UPM). Information on socio-demographic, sleep quality and anthropometric measurements were collected. Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality, whereby a summation score from seven components yielded a global score on sleep quality, with higher scores indicating poor sleep quality. Results: Majority of subjects were Malay (79.2%) with a mean body mass index of 22.6kg/m2. A majority (61.3%) had normal body weight, with the prevalences of underweight (UW), overweight (OW), and obesity (OB) at 12.9%, 19.6% and 6.3%, respectively. The mean global PSQI score was 5.76±2.64, with half of the respondents (50.4%) experiencing poor sleep quality. OW-OB experienced poorer sleep quality (6.53±2.79, p=0.004) and longer sleep latency (1.34±0.10, p=0.008) relative to UW-NW. OB subjects had substantially more frequent sleep disturbances compared to non-OB subjects (1.53±0.64, p=0.012). Conclusion: Findings suggest that OW-OB students at university are at a greater risk of having reduced sleep quality with longer sleep latency and frequent sleep disturbances. There is a need for a wellness initiative to reduce the incidence of obesity while fostering healthier sleeping habits among university students.

Financial problems associated with food insecurity among public university students in Peninsular Malaysia

@#Introduction: Food is a necessity for students. Yet, students’ food expenditure is anticipated to be restrained by their financial status. This cross-sectional study aims to determine the prevalence of food insecurity and its determinants among university students attending public universities in Peninsular Malaysia. Methods: Multistage random sampling was used to select respondents from public universities in Peninsular Malaysia. A total of 427 undergraduate students completed a selfadministered questionnaire at four randomly selected universities (Universiti Utara Malaysia, Universiti Kebangsaan Malaysia, Universiti Malaysia Pahang and Universiti Teknologi Malaysia). The questionnaire consisted of information concerning demographic and socioeconomic backgrounds, food security status, eating behaviour, financial literacy, and financial problem among university students. Frequency, chi-square, and logistic regression were used to analyse the variables. Results: Mean age of the respondents was 21.6 years, and 60.9% were found to be food insecure. Gender (χ2=5.415), origin (χ2=3.871), number of siblings (χ2=4.521), financial problem (χ2=42.364), and regular breakfast intake (χ2=5.654) were associated with food security status (p<0.05). Male respondents had 1.5 times (AOR=1.547, 95% CI: 1.006-2.380) the risk of having low food security status. Those with higher financial problems (AOR=3.575, 95% CI: 2.332-5.481) were 3.5 times more likely to be food insecure. Conclusion: The prevalence of food insecurity among public university students in Peninsular Malaysia was significantly high. Thus, intervention studies should focus on students with financial problems. Moreover, establishing a better system for an on campus food pantry or food bank is needed to counter the high prevalence of food insecurity among university students.

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.

Anthropometry Measurements to Determine Nutritional Status Among Cerebral Palsy Children: A Scoping Review

@#This article aimed to review the available anthropometry measurements used in the assessment of nutritional status among Cerebral Palsy (CP) children. Searched journals were from Medline, PubMed and Ovid published from 2015 to 2018. The search identified 443 articles, and eight studies met the criteria. Anthropometric measurements included weight, height, recumbent length, knee height, tibia length, Dual-energy X-ray absorptiometry (DXA), Bioelectrical impedance (BIA), Mid arm circumference (MUAC) subscapular skinfold (SFT), Triceps skinfold (TSF) and prediction equations. Body fat composition can be obtained by DXA, BIA, skinfold measurement, and also prediction equation. The predictive equation is the most reported method to determine nutritional status among CP. This review found that TSF and SFT are more accurate to determine body fat percentage when using together with the predictive equation. Besides, predictive equations using segmental length are reliable in estimating the height and can be used to evaluate the nutritional status using the specific CP growth chart.

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.

Diet Quality and its Associated Factors among Community Dwelling Older Adults in Urban District in Kuala Lumpur, Malaysia

@#Introduction: Diet quality is an essential factor in determining the adherence towards dietary guidelines. This study aims to assess the diet quality among community-dwelling older adults and identify the factors associated with the diet quality. Method: This is a cross-sectional study, conducted among 138 community-dwelling older adults living in PPR flats, Kuala Lumpur. Subjects were randomly recruited in this study. Diet Quality Index (DQI) was used to identify diet quality index of elderly. The Chi-square Test of Independence and Pearson’s correlation test were used to determine the association between tested covariates with DQI. Results: Majority of the respondents were reported with good diet quality (74.6%), whereas quarter of them (25.6%) had poor diet quality. Significant difference between the diet quality and the adherence on the food groups were observed for all food groups (p<0.05) except for cereal and cereal products and poultry, meat and egg food group The results revealed that increasing age, Malay ethnicity, low education attainment, low financial income, hypertension, low skeletal muscle, high body fat, high visceral fat, high waist circumference, low MUAC and low handgrip strength were associated with the diet quality of the subjects (p<0.05). Conclusion: The results of this study provide a new insight on the diet quality of the elderly with good and poor diet quality. More inclusion of factors that are related to the diet quality needs to be emphasized in future studies among older adults as it would play a beneficiary component in improving their nutritional status.

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.

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.