Salt reduction policy for out of home sectors: a supplementary document for the salt reduction strategy to prevent and control non-communicable diseases (NCDS) in Malaysia 2021-2025.

Cardiovascular diseases (CVDs) are the major cause of death among Malaysians. Reduction of salt intake in populations is one of the most cost-effective strategies in the prevention of CVDs. It is very feasible as it requires low cost for implementation and yet could produce a positive impact on health. Thus, salt reduction initiatives have been initiated since 2010, and two series of strategies have been launched. However, there are issues on its delivery and outreach to the target audience. Further, strategies targeting out of home sectors are yet to be emphasized. Our recent findings on the perceptions, barriers and enablers towards salt reduction among various stakeholders including policy-makers, food industries, food operators, consumers and schools showed that eating outside of the home contributed to high salt intake. Foods sold outside the home generally contain a high amount of salt. Thus, this supplementary document is being proposed to strengthen the Salt Reduction Strategy to Prevent and Control Non-communicable Diseases (NCDs) for Malaysia 2021-2025 by focussing on the strategy for the out-of-home sectors. In this supplementary document, the Monitoring, Awareness and Product (M-A-P) strategies being used by the Ministry of Health (MOH) are adopted with a defined outline of the plan of action and indicators to ensure that targets could be achieved. The strategies will involve inter-sectoral and multi-disciplinary approaches, including monitoring of salt intake and educating consumers, strengthening the current enforcement of legislation on salt/sodium labelling and promoting research on reformulation. Other strategies included in this supplementary document included reformulation through proposing maximum salt targets for 14 food categories. It is hoped that this supplementary document could strengthen the current the Salt Reduction Strategy to Prevent and Control NCDs for Malaysia 2021-2025 particularly, for the out-of-home sector, to achieve a reduction in mean salt intake of the population to 6.0 g per day by 2025.

Individual and total sugar contents of street foods in Malaysia - Should we be concerned?

Street foods are often of poor nutritional quality with high sugar content, in which the overconsumption of sugar is associated with obesity. However, sugar content information on local street foods is scarce. Thus, the individual and total sugar contents of 94 types of street foods in Malaysia were analysed. Compared to snacks and main meals, desserts contained the highest amounts of sugar, sucrose, fructose, glucose, and maltose. Sucrose was predominant in 90% desserts, 79.3% snacks, and 68.6% main meals. Most desserts (93.3%) contained medium to high sugar content (≥5 g to >15 g/100 g), while 82.9% main meals and 65.5% snacks had low sugar content. When comparing the sugar contents of 39 foods with other local databases, 58.3% main meals, 55.6% desserts, and 33.3% snacks contained either significantly (p < 0.05) higher or lower sugar contents. Consumers can identify low and high-sugar foods, and policymakers can review health priorities to combat obesity.

Perceptions, barriers and enablers on salt reduction in the out-of-home sectors in Malaysia (MySaltOH) from the perspective of street food vendors, caterers and consumers.

OBJECTIVE: To explore the perspectives, barriers and enablers on salt reduction in out-of-home sectors in Malaysia among street food vendors, caterers and consumers. DESIGN: A qualitative study involving twenty-two focus group discussions and six in-depth interviews was conducted, recorded and transcribed verbatim. An inductive thematic analysis approach was employed to analyse the data. SETTING: Two in-depth interviews and twenty-two focus group discussions were conducted face-to-face. Four in-depth interviews were conducted online. PARTICIPANTS: Focus group discussions were conducted among twenty-three street food vendors, twenty-one caterers and seventy-six consumers of various eateries. In-depth interviews were conducted among two street food vendors and four caterers, individually. RESULTS: Consumers and food operators perceived a high-salt intake within Malaysia's out-of-home food sectors. Food operators emphasised the necessity for a comprehensive salt reduction policy in the out-of-home sector involving all stakeholders. Consumers faced limited awareness and knowledge, counterproductive practices among food operators and challenges in accessing affordable low-Na food products, whereas food operators faced the lack of standardised guidelines and effective enforcement mechanisms and uncooperative consumer practices. Both groups expressed that food quality and price of salt were also the barriers, and they advocated for awareness promotion, enhanced regulation of manufactured food products and stricter enforcement targeting vendors. Consumers also suggested promoting and recognising health-conscious food premises, whereas food operators suggested on knowledge enhancement tailored to them, strategies for gaining consumers acceptance and maintaining food quality. CONCLUSIONS: These findings provide valuable insights that serve as foundational evidence for developing and implementing salt reduction policies within Malaysia's out-of-home sectors.

An Assessment of Knowledge, Attitudes and Practices on Pureed Diet Preparation (KAP DYS-PUREE) among Food Handlers in Malaysian Hospitals for Dysphagia Management.

This study aims to assess the knowledge, attitude, and practice towards pureed diet preparation among food handlers using a newly developed questionnaire for dysphagia management. A descriptive cross-sectional design study with purposive sampling was conducted in three government hospitals in the Klang Valley, Malaysia. A newly developed questionnaire, comprised of 40 quantitative items, was used and distributed to 161 food handlers from three hospitals who were directly involved in preparing pureed diets. The results demonstrated a low to moderate knowledge score among food handlers (57.54 ± 12.33), with scoring at 1.95% (very low), 28.6% (low), and 68.3% (moderate). Only 1.2% scored well in the knowledge section on pureed diet preparation. The attitude among food handlers showed that they were referred to the right source of reference before preparing the pureed diet (3.97 ± 1.35). The findings also clearly showed that the practice of using the right equipment (4.41 ± 1.19) is essential for pureed diet preparation. In conclusion, this study serves as a prognosis for future improvement in knowledge, attitude, and practice among food handlers toward pureed diet preparation. Knowledge among food handlers needs to be enhanced, and a comprehensive guideline and reference module will aid in refining dysphagia management, specifically in food preparation by food handlers.

Fatty Acid Composition of Selected Street Foods Commonly Available in Malaysia.

Despite growing evidence of increased saturated and trans fat contents in street foods, little is known about their fatty acid (FA) compositions. This study aimed to analyse the saturated fatty acids (SFAs), monounsaturated fatty acids (MUFAs), polyunsaturated fatty acids (PUFAs), and trans fatty acids (TFAs) content of 70 selected and most commonly available street foods in Malaysia. The street foods were categorised into main meals, snacks, and desserts. TFAs were not detected in any of the street foods. Descriptively, all three categories mainly contained SFAs, followed by MUFAs, and PUFAs. However, the one-way ANOVA testing showed that the differences between each category were insignificant (p > 0.05), and each FA was not significantly different (p > 0.05) from one to another. Nearly half of the deep-fried street foods contained medium to high SFAs content (1.7 g/100 g-24.3 g/100 g), while the MUFAs were also high (32.0-44.4%). The Chi-square test of association showed that the type of preparation methods (low or high fat) used was significantly associated (p < 0.05) with the number of SFAs. These findings provide valuable information about fat composition in local street foods for the Malaysian Food Composition Database and highlight the urgency to improve nutritional composition.

Perceptions, barriers and enablers of salt reduction in Malaysian out-of-home sectors (MySaltOH): from the point of view of policy-makers and food industries.

BACKGROUND: High salt intake is a major cause of hypertension and cardiovascular diseases. The out-of-home sectors have been identified as one of the contributors of high salt intake in the population. The National Salt Reduction Policy of Malaysia was initiated in 2015; however, out-of-home sectors are yet to be emphasized and perception by policy-makers and the food industries towards salt reduction are yet unknown. This study aimed to determine the perceptions, barriers and enablers towards salt reduction in the out-of-home sector in Malaysia, as well as among policy-makers and the food industries. METHODS: This is a qualitative study via semi-structured in-depth interviews (IDI) and focus group discussions (FGD) involving several stakeholders consisting of policy-makers from five ministries, five nongovernment organizations (NGOs) and food science/food technology researchers from five regions (West, North, East, and South Peninsular and East Malaysia/Borneo), as well as the food industries. The IDI and FGD sessions were recorded, transcribed verbatim and analysed thematically using Nvivo software version 12. RESULTS: All participants agreed that salt intake in Malaysia is high and leads to hypertension and cardiovascular diseases. Lack of awareness, poor eating culture and behaviour and frequent eating out were among the causes of high salt intake. Awareness campaigns and education, sodium content labelling and product reformulation were strategies that have been implemented by the government; whilst for the food industries, some of them have tried to reduce salt and labelled the sodium content on their food products. However, there were several barriers including perceived poor consumer acceptance, lack of knowledge and resources, and challenges in reformulation, as well as unavailability of guidelines and salt targets. Hence, several enablers have been suggested, which include prioritizing the salt reduction strategy, creating more awareness, collaboration and engagement, research and technology particularly for reformulation and shelf-life stability, incentives and salt tax. CONCLUSIONS: Salt reduction efforts of the out-of-home sector in Malaysia could be achieved through several measures or enablers that can overcome the barriers currently faced by stakeholders, especially policy-makers, food industries and the consumers themselves. This study will benefit the policy-makers to improve the salt reduction policy of out-of-home sectors and highlight the concerns among the food industries on the policy.

Interventions for Picky Eaters among Typically Developed Children-A Scoping Review.

Picky eating in children is often a major source of concern for many parents and caregivers. Picky eaters (PEs) consume limited foods, demonstrate food aversion, and have a limited food repertoire, which hinders their growth and health. These behaviours are common in children with special health care needs despite the rise in typically developing children. This leads to less attention being given to intervention programmes for typically developing children. Therefore, this scoping review aims to investigate the key concept of an existing intervention programme for PE among typically developing children, primarily on the types and approaches selected. A thorough literature search was conducted on three primary databases (PubMed, Emerald In-sight, and Web of Science) using predefined keywords. The literature was then appraised using the Joanna Briggs Institute's guidelines and protocols, and the PRISMScR checklist. Inclusion and exclusion criteria were also specified in the screening procedure. Results showed that the majority of the interventions in these studies were single-component interventions, with the sensory approach being the type that was most frequently utilised, followed by the nutrition approach and parenting approach. Single and multiple intervention components improved the assessed outcome, with a note that other components may or may not show a similar outcome, as they were not assessed in the single-component intervention. Given the evidence that picky eating is influenced by various factors, a multi-component intervention can provide a substantial impact on future programmes. In addition, defining picky eaters using standardised tools is also essential for a more inclusive subject selection.

Street Food in Malaysia: What Are the Sodium Levels?

Street food is a major source of food in middle- and low-income countries as it is highly accessible and inexpensive. However, it is usually perceived as unhealthy due to the high levels of sodium, sugar, and fat content. However, there is little analytical data on the sodium levels in the street foods of Malaysia. This study started with a survey to determine the most frequently available street foods in every state in Malaysia, followed by food sampling and the analysis of sodium (reported mg/100 g sample). Street food in the snack category contained the highest amount of sodium (433 mg), followed by main meals (336.5 mg) and desserts (168 mg). Approximately 30% of the local street food in this study was deep-fried. Snacks from processed food (8%) contained high sodium content (500−815 mg). Fried noodles and noodle soup contained the highest amount of sodium (>2000 mg sodium) based on per serving. Most main dishes that use a variety of sauces contained high amounts of sodium. These findings were recorded in the Malaysian Food Composition Database. Moreover, this study could raise awareness and serve as baseline data for future interventions on the sodium content in the street foods of Malaysia.

Current Evidence on the Association of Micronutrient Malnutrition with Mild Cognitive Impairment, Frailty, and Cognitive Frailty among Older Adults: A Scoping Review.

Micronutrient malnutrition is thought to play an important role in the cause of cognitive impairment and physical frailty. The purpose of this scoping review was to map current evidence on the association between micronutrient deficiency in blood and mild cognitive impairment, frailty, and cognitive frailty among older adults. The scoping review was conducted based on the 2005 methodological framework by Arksey and O'Malley. The search strategy for potential literature on micronutrient concentration in blood and cognitive frailty was retrieved based on the keywords using electronic databases (PubMed, Cochrane Library, Google Scholar, Ovid, and Science Direct) from January 2010 to December 2021. Gray literature was also included in the searches. A total of 4310 articles were retrieved and 43 articles were incorporated in the review. Findings revealed a trend of significant association between low levels of B vitamins (folate and vitamin B12), vitamin D, vitamin A, vitamin E, omega 3 fatty acid, and albumin, and high homocysteine levels in blood with an increased risk of mild cognitive impairment among older adults. The results also indicated that low vitamin D levels, albumin, and antioxidants (lutein and zeaxanthin) in blood were significantly associated with frailty among older adults, while ß-cryptoxanthin and zeaxanthin in blood were inversely associated with the risk of cognitive frailty. Vitamin D and antioxidants seemed to be targeted nutrients for the prevention of cognitive frailty. In conclusion, a wide range of micronutrient deficiency was associated with either mild cognitive impairment or frailty; however, little evidence exists on the dual impairment, i.e., cognitive frailty. This scoping review can serve as preliminary evidence for the association between micronutrient deficiency in blood and mild cognitive impairment, frailty, and cognitive frailty among older adults and prove the relevancy of the topic for future systematic reviews.

Umami detection threshold among children of different ethnicities and its correlation with various indices of obesity and blood pressure.

Sensitivity to savory taste has been linked to high consumption of savory foods and increased risks of obesity and hypertension. However, there are limited studies that investigate whether obesity indices are correlated with the differences in umami taste perception, particularly in children. This study aimed to investigate the umami detection threshold among children of different ethnicities and the threshold's correlation with obesity indices and blood pressure. A total of 140 subjects were recruited and consisted of a nearly equal distribution of children from three main ethnicities (37.2% Malays, 31.4% Chinese, 31.4% Indians). Umami detection threshold was measured using the two-alternative, forced-choice staircase procedure. Body weight, height, waist circumference and blood pressure of children were measured. Body composition was assessed using bioelectrical impedance analysis (BIA). Mean umami detection threshold was 1.22 ± 1.04 mM and there were no observable differences attributable to the subjects' ethnicities. Body fat percentage was negatively correlated (r = -0.171, p < 0.05), while lean body mass percentage was positively correlated (r = 0.171, p < 0.05) with umami detection threshold. These findings revealed that umami taste perception correlated with children's body composition, but not other anthropometric indicators and blood pressure. Future studies should explore the correlation between umami taste perception and children's total dietary intake.

The Individual Nutrition Education Needs among Patients with Type 2 Diabetes at the Public Health Centers in Padang, Indonesia: A Cross-Sectional Study.

Background: The Indonesian Public Health Care (PHC) of Management Nutrition Therapy (MNT) guidelines describe that individual nutrition education is aimed to improve quality of MNT services. The guidelines were originally developed for non-communicable diseases (NCDs), not specially for type 2 diabetes mellitus (T2DM) purposes. The reluctance of patients with T2DM to attend individual nutrition education is a common public health care issue in Padang (Indonesia). Methods: The presented cross-sectional study aimed to determine the individual nutrition education needs among people with T2DM. A set questionnaire was distributed to 11 PHC selected from 11 districts in Padang and 179 patients with T2DM were recruited and interviewed. Results: Among the 179 patients with T2DM, 76.5% were females and housewives (49.2%), a slight majority (57.8%) were ≤58 years old and 45.9% had graduated from primary school. The highest numbers of patients with T2DM were in PHC Andalas (20.7%). Some 74.9% (134) of the people with T2DM routinely attended individual nutrition education classes for less than 30 min (60.3%). Patients with T2DM followed individual nutrition education at a PHC every 1-2 months (59.8%), and a majority of the individual nutrition education was given by a medical doctor (57.5%). In contrast, 42.3% of patients with T2DM did not attend individual nutrition education due to a lack of recommendation from a medical doctor and their reluctance (33.3%). Although a majority of patients with T2DM (62.6%) were satisfied with their individual nutrition education, (20.4% of patients with T2DM recommended the availability of booklets during individual nutrition education that can be read at home. Patients with T2DM needed individual nutrition education (88.8%) and the majority (25.1%) requested individual nutrition education topics about diabetes food recommendation. Even though patients with T2DM followed health professionals' advice (78.2%), however, their HbA1c (76.5%) wasnot reduced. Patients with T2DM agreed that individual nutrition education can increase their knowledge (51.9%), unfortunately, they still have difficulty to control their blood glucose (5.6%). Conclusions: According to the patients with the T2DM perspective stated above, it is crucial to develop the tool kits and educate patients with T2DM following the Diabetes Nutrition Education (DNE) curriculum to improve glycemic control.

The effects of polyphenols-rich tropical fruit juice on cognitive function and metabolomics profile - a randomized controlled trial in middle-aged women.

Objectives: Polyphenols, particularly anthocyanins, have received attention in improving health issues during old age, including decline in cognitive function and other health parameters. We aimed to determine the effects of polyphenols-rich tropical fruit TP 3-in-1™ juice towards improving cognitive function, oxidative stress and metabolomics profiles among middle-aged women.Methods: This clinical trial involved 31 subjects with signs of poor cognitive function, as assessed using the Rey Auditory Verbal Learning Test (RAVLT). They were randomized to receive either TP 3-in-1™ juice (n = 16) or placebo (n = 15). Study subjects consumed 500 ml of beverages for three times per day, three days per week, for a period of ten weeks. Juice supplementation provided 9135 mg GAE of total phenolic content and 194.1 mg cyanidin-3-glucoside of total anthocyanin monomer.Results: There was a significant interaction effects on RAVLT immediate recall (p < 0.05) and Comprehensive Trail Making Test (CTMT) Trail 4 (p < 0.05). Metabolomics analysis showed the presence of metabolites related to polyphenols intake and cognitive functions with the intervention group showed increased urinary excretion of thyroxine and 3-methyladenine. Thyroxine and 3-methyladenine give stability to human transthyretin (TTR) and activate autophagy, respectively, which are associated with the pathogenesis of Alzheimer's disease.Conclusion: The result shows the potential of TP 3-in-1™ juice which is rich in anthocyanins in improving cognitive function, particularly learning, memory, processing speed, sequencing, mental flexibility and visual-motor skills domains, among middle-aged women.

Barriers, Enablers, and Perceptions on Dietary Salt Reduction in the Out-of-Home Sectors: A Scoping Review.

In this review, we have investigated the perceptions, barriers, and enabling factors that were responsible for a dietary salt reduction in the out-of-home sectors. For this purpose, we examined different knowledge databases such as Google Scholar, Ebscohost, MEDLINE (PubMed), Ovid, and Cochrane Library for research articles from September to December 2020. The inclusion criteria for the research articles were that they had to be published in English and had to be a qualitative or quantitative study that was conducted after 2010. These studies also had to report the various enablers, barriers, and perceptions regarding salt reduction in the out-of-home sectors. After implementing the inclusion criteria, we successfully screened a total of 440 studies, out of which 65 articles fulfilled all the criteria. The perceived barriers that hindered salt reduction among the out-of-home sectors included lack of menu and food variabilities, loss of sales due to salt reduction, lack of technical skills for implementing the salt reduction processes for cooking or reformulation, and an absence of environmental and systemic support for reducing the salt concentration. Furthermore, the enablers for salt reduction included the intervention programs, easy accessibility to salt substitutes, salt intake measurement, educational availability, and a gradual reduction in the salt levels. With regards to the behavior or perceptions, the effect of organizational and individual characteristics on their salt intake were reported. The majority of the people were not aware of their salt intake or the effect of salt on their health. These people also believed that low salt food was recognized as tasteless. In conclusion, the enablers, barriers, and perceptions regarding salt reduction in the out-of-home sectors were multifaceted. Therefore, for the implementation of the strategies, policies, and initiatives for addressing the barriers, the policymakers need to encourage a multisectoral collaboration for reducing the salt intake in the population.

No effect of monosodium glutamate on subjective appetite and subsequent energy intake in children of different ethnicities.

Studies have shown that monosodium glutamate (MSG) can enhance satiety and reduce appetite among infants and adults. In a multi-ethnic country such as Malaysia, it is also important to consider whether ethnic variations will influence the effects of MSG on appetite regulation. Thus, this crossover study aimed to investigate the effects of MSG on the subjective appetite and subsequent energy intake among Malaysian children from the three major ethnic groups, namely the Malays, Chinese and Indians. A total of 92 participants aged 9-11 years from the three ethnic groups were recruited for this study. A cup of low-energy vegetable preload soup (100g, with MSG or without MSG) was served to each of the participants on the day of the study, followed by an ad libitum meal 45 min later. Appetite ratings of hunger, fullness, desire to eat and desire to snack were recorded using visual analogue scale (VAS) before the preload, after the preload, before the ad libitum meal and after the ad libitum meal. Results showed that the subjective appetite of the children did not differ between preload conditions (MSG+ or MSG-) throughout the study. Malay, Chinese and Indian children had similar total energy intake during the subsequent meal after the consumption of preload soups. In conclusion, the addition of MSG to low energy preload neither influenced the perception of appetite nor total energy intake in a subsequent ad libitum meal among children. No difference attributable to the participants' ethnicity was observed. Future studies should be conducted to examine whether repeated ingestion of MSG-containing protein-rich preload has potential longer-term effects on appetite and subsequent meal intakes among children from different ethnicities.

Developing a policy to reduce the salt content of food consumed outside the home in Malaysia: protocol of a qualitative study.

INTRODUCTION: Current salt intake in Malaysia is high. The existing national salt reduction policy has faced slow progress and does not yet include measures to address the out of home sector. Dishes consumed in the out of home sector are a known leading contributor to daily salt intake. This study aims to develop a salt reduction strategy, tailored to the out of home sector in Malaysia. METHODS AND ANALYSIS: This study is a qualitative analysis of stakeholder views towards salt reduction. Participants will be recruited from five zones of Malaysia (Western, Northern, Eastern and Southern regions and East Malaysia), including policy-makers, non-governmental organisations, food industries, school canteen operators, street food vendors and consumers, to participate in focus group discussions or in-depth interviews. Interviews will be transcribed and analysed using thematic analysis. Barriers will be identified and used to develop a tailored salt reduction strategy. ETHICS AND DISSEMINATION: Ethical approval has been obtained from the Universiti Kebangsaan Malaysia Medical Research Ethics Committee (UKM PPI/1118/JEP-2020-524), the Malaysian National Medical Research Ethics Committee (NMRR-20-1387-55481 (IIR)) and Queen Mary University of London Research Ethics Committee (QMERC2020/37) . Results will be presented orally and in report form and made available to the relevant ministries for example, Ministry of Health, Ministry of Education and Ministry of Trade to encourage adoption of strategy as policy. The findings of this study will be disseminated through conference presentations, peer-reviewed publications and webinars.

Currents Nutritional Practices of Nutritionists in the Management of Type 2 Diabetes Patients at Public Health Centres in Padang, Indonesia.

(1) Background: The interest in nutrition practices and education is slowly gaining traction among Indonesian nutritionists. However, there is a lack of local studies that evaluate nutritional practices, especially in the management of type 2 diabetes (T2DM). This cross-sectional study aimed to determine the nutritional practices among nutritionists and the adequacy of the current practices in the management of Type 2 Diabetes Mellitus (T2DM) patients at the Public Health Clinic in Padang (PHC), Indonesia. (2) Methods: An online survey form was distributed to all the nutritionists (n = 50) involved in the management of T2DM patients in their daily practices at the PHC. Socio-demographic characteristics, the current practice of T2DM, the need for DM nutrition education, and an evaluation questionnaire on the Indonesian Non-Communicable Diseases guideline and the Public Health Centre guideline were captured in the survey. (3) Result: A total of 48 completed survey forms were received, providing a response rate of 96% from the recruited nutritionists. One-third (37.5%) of the respondents counselled between one and ten patients per day. Nearly half (41.7%) conducted a monthly follow-up session for the patients at their respective PHC in the previous three months. Each nutritionist educated five to ten T2DM patients. The most common nutrition education topics delivered included appropriate menus (89.6%) as well as the etiology and symptoms of T2DM (85.5%). Almost all the nutritionists (93.8%) used leaflets and about 35.4% used poster education. Around 70.8% of counseling sessions lasted 30 min and two-thirds (66.7%) of the sessions included nutrition education. Based on the results, about half (52.1%) of them claimed that T2DM patients were reluctant to attend individual nutrition education. One-fifth of them (20.8%) claimed that it was because the T2DM patients were not interested in the tool kits and materials used. (4) Conclusions: T2DM patients are reluctant to attend individual nutrition education due to uninteresting tool kits and materials.

Multidomain Intervention for Reversal of Cognitive Frailty, Towards a Personalized Approach (AGELESS Trial): Study Design.

BACKGROUND: Cognitive frailty (CF) is identified as one of the main precursors of dementia. Multidomain intervention has been found to delay or prevent the onset of CF. OBJECTIVE: The aim of our present study is to determine the effectiveness of a comprehensive, multidomain intervention on CF; to evaluate its cost effectiveness and the factors influencing adherence toward this intensive intervention. METHODS: A total of 1,000 community dwelling older adults, aged 60 years and above will be screened for CF. This randomized controlled trial involves recruitment of 330 older adults with CF from urban, semi-urban, and rural areas in Malaysia. Multidomain intervention comprised of physical, nutritional, cognitive, and psychosocial aspects will be provided to participants in the experimental group (n = 165). The control group (n = 165) will continue their usual care with their physician. Primary outcomes include CF status, physical function, psychosocial and nutritional status as well as cognitive performance. Vascular health and gut microbiome will be assessed using blood and stool samples. A 24-month intensive intervention will be prescribed to the participants and its sustainability will be assessed for the following 12 months. The effective intervention strategies will be integrated as a personalized telerehabilitation package for the reversal of CF for future use. RESULTS: The multidomain intervention developed from this trial is expected to be cost effective compared to usual care as well as able is to reverse CF. CONCLUSION: This project will be part of the World-Wide FINGERS (Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability) Network, of which common identifiable data will be shared and harmonized among the consortia.

Neuroimaging Functional Magnetic Resonance Imaging Task-Based Dorsolateral Prefrontal Cortex Activation Following 12 Weeks of Cosmos caudatus Supplementation Among Older Adults With Mild Cognitive Impairment.

BACKGROUND: Cosmos caudatus (CC) is traditional Asian vegetable, commonly consumed among the Southeast Asian population. It has been reported to be high in flavonoids and might potentially improve brain activity among older adults with mild cognitive impairment (MCI). The effect of CC in brain activation improvement using neuroimaging is yet to be discovered. PURPOSE: To investigate the effects of CC supplement on brain activity using functional magnetic resonance imaging (fMRI) among older adults with MCI. STUDY TYPE: Prospective, randomized, double-blind, placebo-controlled trial. POPULATION/SUBJECTS: Twenty older adults with mild cognitive impairment (60-75 years old), 14 of them (70%) were female subjects. FIELD STRENGTH/SEQUENCE: A 3.0-T, T1-weighted anatomical images, T2*-weighted imaging data, A single shot, gradient echo-echo planar imaging (EPI) sequence. ASSESSMENT: All subjects were asked to consume two 500 mg capsules of either CC supplement or placebo (maltodextrin) daily for 12 weeks. Cognitive function was measured using validated neuropsychological tests (i.e. Mini-mental State Examination and Digit Span) and task-based fMRI (N-back and Stroop Color Word Test) at baseline and 12th week. Brodmann's area 9, 46 and anterior cingulate cortex were selected as the regions of interest to define dorsolateral prefrontal cortex (DLPFC) in fMRI analysis. STATISTICAL TESTS: Normality test was performed with the Shapiro-Wilk test. Two-way repeated ANOVA determined the intervention effects of the CC supplementation on brain activity after adjustments for covariates. Significance level at P < 0.05 for independent-t test and Chi square test; adjusted P < 0.0042 for two-way repeated ANOVA after Bonferroni correction. RESULTS: Findings showed significant improvements in digit span (partial η2  = 0.559), increment in right DLPFC activation while performing 1-back task (partial η2  = 0.586) and left DLPFC activation while performing Stroop Color Word Test (SCWT) (congruent) task (partial η2  = 0.432) at 12th week of CC supplementation. CONCLUSION: CC supplementation might have the ability to improve DLPFC activation, potentially leading to improved working memory among older adults with MCI after 12 weeks of administration. LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY: Stage 4.

Development and double cross-validation of new spot urine sodium equation to predict 24-h urine sodium in the Malaysian population.

BACKGROUND: Monitoring sodium intake through 24-h urine collection sample is recommended, but the implementation of this method can be difficult. The objective of this study was to develop and validate an equation using spot urine concentration to predict 24-h sodium excretion in the Malaysian population. METHODS: This was a Malaysian Community Salt Study (MyCoSS) sub-study, which was conducted from October 2017 to March 2018. Out of 798 participants in the MyCoSS study who completed 24-h urine collection, 768 of them have collected one-time spot urine the following morning. They were randomly assigned into two groups to form separate spot urine equations. The final spot urine equation was derived from the entire data set after confirming the stability of the equation by double cross-validation in both study groups. Newly derived spot urine equation was developed using the coefficients from the multiple linear regression test. A Bland-Altman plot was used to measure the mean bias and limits of agreement between estimated and measured 24-h urine sodium. The estimation of sodium intake using the new equation was compared with other established equations, namely Tanaka and INTERSALT. RESULTS: The new equation showed the least mean bias between measured and predicted sodium, - 0.35 (- 72.26, 71.56) mg/day compared to Tanaka, 629.83 (532.19, 727.47) mg/day and INTERSALT, and 360.82 (284.34, 437.29) mg/day. Predicted sodium measured from the new equation showed greater correlation with measured sodium (r = 0.50) compared to Tanaka (r =0.24) and INTERSALT (r = 0.44), P < 0.05. CONCLUSION: Our newly developed equation from spot urine can predict least mean bias of sodium intake among the Malaysian population when 24-h urine sodium collection is not feasible.

Effects of 12 Weeks Cosmos caudatus Supplement among Older Adults with Mild Cognitive Impairment: A Randomized, Double-Blind and Placebo-Controlled Trial.

Cosmos caudatus (CC) contains high flavonoids and might be beneficial in neuroprotection. It has the potential to prevent neurodegenerative diseases. Therefore, we aimed to investigate the effects of 12 weeks of Cosmos caudatus supplement on cognitive function, mood status, blood biochemical profiles and biomarkers among older adults with mild cognitive impairment (MCI) through a double-blind, placebo-controlled trial. The subjects were randomized into CC supplement (n = 24) and placebo group (n = 24). Each of them consumed one capsule of CC supplement (250 mg of CC/capsule) or placebo (500 mg maltodextrin/capsule) twice daily for 12 weeks. Cognitive function and mood status were assessed at baseline, 6th week, and 12th week using validated neuropsychological tests. Blood biochemical profiles and biomarkers were measured at baseline and 12th week. Two-way mixed analysis of variance (ANOVA) analysis showed significant improvements in mini mental state examination (MMSE) (partial η2 = 0.150, p = 0.049), tension (partial η2 = 0.191, p = 0.018), total mood disturbance (partial η2 = 0.171, p = 0.028) and malondialdehyde (MDA) (partial η2 = 0.097, p = 0.047) following CC supplementation. In conclusion, 12 weeks CC supplementation potentially improved global cognition, tension, total mood disturbance, and oxidative stress among older adults with MCI. Larger sample size and longer period of intervention with incorporation of metabolomic approach should be conducted to further investigate the underlying mechanism of CC supplementation in neuroprotection.