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.

Prevalence and Factors Associated with Geriatric Malnutrition in Healthcare Institutions: A Systematic Review

@#Aim and Design: The world’s population is ageing. Not only it changes the body composition, but ageing also causes psychological, pathological and economic alterations. These may impact an individual’s quality of life and nutritional status. Thus, this systematic review article aims to review the prevalence of geriatric malnutrition in healthcare institutions and its associated factors. Data Sources: The articles are screened and reviewed based on their titles, abstracts and keywords. English written articles, open-accessed and published between January 2009 and December 2019 are then selected. Review Methods: The PRISMA method is used for this study. Potential studies related to geriatric malnutrition in healthcare institutions were identified using two different combinations and two major electronic search engines, namely Pubmed and Science Direct. Results: From a search of 1011 articles, 22 articles were identified related to geriatric malnutrition in healthcare institutions. Globally, it is found that the prevalence of malnourished elderly patients ranged between 6% – 74.5%. The factors associated with malnutrition among the elderly in the healthcare institutions were recognised, namely socio-demography, medical background, anthropometry data, biochemical data, nutrition-focus physical findings, and dietary inadequacy. Conclusion and Impact: Despite the studies done, geriatric malnutrition is still a matter of concern. Hence, future strategies for interventions need to be taken to aid in overcoming this issue otherwise affecting the health status and life expectancy of the elderly.

Effectiveness of an integrated-Weight Management Programme (i-WMP) in Reducing Body Weight among Noncommunicable Disease Patients in Malaysian Government Primary Care Clinics: A Randomised Controlled Trial

@#Introduction: Obesity is a global issue called as “globesity”. Overweight and obesity may lead to many noncommunicable diseases (NCDs). Primary care is the first centre to monitor and follow-up the progress of NCD patients. Therefore, the objective of this study was to determine the effectiveness of an integrated-Weight Management Programme (i-WMP) to reduce body weight among NCD patients from two Government primary care clinics from Hulu Langat District. Methods: This study was single-blinded randomised controlled trial by design. There were 244 eligible patients were randomised into intervention (n = 122) or wait-list control group (n = 122). The i-WMP was developed based on the behaviour change wheel through the operationalization of behaviour change techniques. The duration of this intervention programme was four weeks. Data collected at week 0, week 4, and week 12. The software IBM SPSS was used to analyse the data. Generalized linear mixed model analysis with intention-to-treat principle was applied. Results: The retention rate was 74.2%. Findings showed that the i-WMP was significantly effective in reducing not only body weight as primary outcome but also secondary outcomes such as waist-to-height ratio, waist circumference, body mass index, and total sitting time. It also improved effectively other secondary outcomes such as participants’ knowledge, attitude, and practice towards dietary and towards physical activity. However, no significant changes were reported for body fat percentage and total physical activity metabolic equivalent of task-minutes/week. Conclusion: Implications surrounding the implementation of i-WMP in the primary care clinics 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.

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.

Factors associated with malnutrition among head and neck cancer in-patients before radiotherapy in National Cancer Institute, Putrajaya

@#Introduction: Head and neck cancer (HNC) patients are often malnourished during diagnosis and before treatment. This study determined the prevalence of malnutrition and factors associated with malnutrition among HNC patients. Methods: A crosssectional study among HNC in-patients before radiotherapy was conducted. Malnutrition status of the patients was determined using scored Patient GeneratedSubjective Global Assessment (PG-SGA). Nutritional parameters of muscle mass, fat mass, albumin, energy and protein intakes were collected. Nutrition impact symptoms (NIS) of the patients were assessed using a validated Head and Neck Symptoms Checklist© (HNSC©). Results: Fifty HNC patients were recruited in this study and the age range of patients was 21 to 78 years old, with gender distribution of 78% males and 22% females. More than half of the patients were malnourished, with 20% severely malnourished before radiotherapy. The lack of dietitian referral before treatment was found to significantly affect nutritional status (p=0.027). There was a significant negative relationship between energy intake (r=0.342, p=0.015) and protein intake (r=0.386, p=0.006) with PG-SGA, indicating lower energy and protein intakes related with poor nutritional status. The result showed a significant positive relationship between NIS score (r=0.731, p<0.001) and PG-SGA, indicating the lower the NIS, the better the nutritional status among HNC patients. More than half of the HNC patients had difficulty chewing. Conclusion: A strong association between nutritional status and NIS showed the importance of dietary management in HNC patients. Early identification of the nutritional status of HNC patients can ensure optimal nutritional status to improve treatment outcomes.

Association between quality of life and handgrip strength among malnourished gynaecological cancer outpatients, National Cancer Institute

@#Introduction: Malnutrition is common among cancer patients and it is reported in a significant proportion of patients with gynaecological cancer (GC). The aim of this study was to determine the association between quality of life (QOL) and hand grip strength (HGS) among malnourished GC outpatients in the National Cancer Institute (NCI). Methods: This study was carried out in a Multidisciplinary Clinic of NCI. HGS was measured using Jamar Hand Dynamometer. Nutritional status was assessed using the scored Patient-Generated Subjective Global Assessment (PGSGA). QOL was measured using the validated European Organisation for Research and Treatment of Cancer Questionnaire (EORTC-QLQ C30). Results: A total of 69 patients were selected for the study. Fifty eight (84.1%) were classified as moderately malnourished or at risk of malnutrition (PG-SGA B) and 11 (15.9%) were classified as severely malnourished (PG-SGA C). There was a moderate, significant positive relationship between HGS and functional status (rs=0.275, p=0.022) observed in this study. Besides, in malnourished GC patients with low HGS, results indicated that they had problems with social functioning as well (r=0.255, p=0.035). Appetite was suggested as a predicting factor for low HGS among malnourished GC patients (F=12.253, p=0.001). Conclusion: HGS is a simple objective indicator of functionality and is, therefore, a valid item to be measured when assessing QOL of malnourished GC outpatients.

Impact of Dietitian Delivered Intensive Nutrition Intervention on Dietary Intake and Weight Outcome Among Gynecology Cancer Outpatient Prior to Surgery

@#Introduction: This is open label randomised control trial, aimed to identify whether an early (commenced at the time of diagnosis) and intensive nutrition intervention (INI) (individualised dietary counselling, oral nutritional supplements [ONS], telephone, and home visit) can improve weight and dietary intake of gynaecological cancer (GC) patients preoperatively. Methods: Selected GC patients planned for surgery were randomly grouped into control group (CG) (n = 35) and intervention group (IG) (n = 34). Malnutrition screening tool (MST) was used as a screening tool, while Patient-Generated Subjective Global Assessment (PG-SGA) was used as a nutrition assessment tool. IG received an intensive individualised dietary counselling with the supply of ONS at baseline (Day 1). This continued with telephone and home visit follow-up by research dietitian (Day 3 and Day 6). Meanwhile, CG only received general nutritional counselling without supply of ONS. Final assessment was conducted on Day 14. The primary outcomes included weight changes measured using TANITA and dietary intake assessment using 24-hour diet recall. Results: Mean duration of INI was 14 days. At the end of the treatment period, there was a significant weight change between groups (p < 0.001), with 0.14% weight gain in IG and 1.3% weight reduction in CG. Mean energy and protein intake of IG were higher compared to CG by +329 kcal/day and +12.2 g/day, respectively. Conclusion: This study showed that INI that incorporated individualised dietary counselling, ONS, telephone counselling, and home visit can increase energy and protein intake of GC patients, resulting in weight gain.

Associations of Sociodemographic Factors and Body Image With Body Weight Status Among Yemeni Adolescents in Selangor and Putrajaya, Malaysia

@#Introduction: Despite the high prevalence of malnutrition in Yemen, little is known on malnourished Yemeni adolescents in Malaysia. This study aimed to assess the body weight status among Yemeni adolescents in Malaysia and its association with sociodemographic factors and body image. Methods: A cross-sectional study involving 364 Yemeni adolescents aged between 12 to 18 years were recruited from four schools in Selangor and Putrajaya, Malaysia. Sociodemographic factors and body image data were collected through face to face interview. Height and body weight were measured and body mass index (BMI) was calculated. Results: The prevalence of overweight and obesity was 23.6%, with 5.2% of thinness. Multivariable logistic regression revealed that a family income greater than RM5,001 (OR = 3.77, p = 0.004), body shape dissatisfaction (OR = 3.54, p = 0.001) and perception of overweight/obesity (OR = 5.75, p = 0.001) were associated with an increased risk of being overweight and obese. Whereas a positive perception of underweight (OR = 0.23, p = 0.009) was found to be a significant protective factor against overweight and obesity. Conclusion: Overweight and obesity are prevalent among Yemeni adolescents in Malaysia. These findings highlight the need for regular weight status assessments amongst adolescents. Additionally, an obesity intervention program that incorporates body image perception may improve the children’s body weight status.

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.