Aflatoxin Occurrence, Food Regulations, Dietary Exposure, and Risk Assessment: A Mini Review from the Malaysian Perspective

@#Aflatoxins are ubiquitous and occur in food. Exposure to aflatoxins seriously impact the health of human and animal. It is concerning especially when aflatoxins are odourless, colourless, and tasteless that hardly be detected through naked eyes. Ingestion of aflatoxin-contaminated food contributes the major route of exposure. The present review is an update on the aflatoxin occurrence in food, aflatoxin regulations in food, and recent risk assessment of aflatoxin exposure in Malaysia. Peanuts and chili were more prone to aflatoxin contamination in Malaysia. The extreme weather experienced in Malaysia and global climatic change may worsen the aflatoxin contamination in food. The regulatory standards for aflatoxins imposed by Malaysia are less stringent than developed countries. The dietary exposure of aflatoxins among Malaysian was relatively high as compared with other Asia countries, ranging from 0.002 to 34.00 ng/kg body weight/day. Nonetheless, Malaysian population had low risk of aflatoxin-related liver cancer, with an estimated liver cancer risk of <1 cancer case/100,000 population/year.

Factors contributing to urinary aflatoxin M1 occurrence among residents in Hulu Langat district, Malaysia

@#Introduction: Chronic exposure to aflatoxin can lead to complications such as liver failure and cancer. There are many factors that affect aflatoxin occurrence. This study aimed to assess the association between sociodemographic factors and the knowledge, attitude and practice towards aflatoxin with urinary aflatoxin M1 occurrence among residents in Hulu Langat district, Malaysia. Methods: This was a cross-sectional study conducted among healthy Malaysian adults aged 18 to 60 years residing in Hulu Langat district, Malaysia. Socio-demographic background and the knowledge, attitude and practice of respondents towards aflatoxin were assessed through questionnaires. Non-fasting urine sample (15 ml) was collected in the morning and urinary aflatoxin M1 level was quantified. Results: Of the 444 healthy Malaysian adults, 199 urine samples were detected with aflatoxin M1. From 37 positive samples with aflatoxin M1 level above detection limit (0.64 ng/ml), mean value was 1.23±0.91 ng/ml (range = 0.65-5.34 ng/ml). Urinary aflatoxin M1 occurrence was significantly different across ethnicity, age group, monthly household income, attitude and practice towards aflatoxin. Binomial logistic regression confirmed ethnicity and monthly household income as factors contributing to urinary aflatoxin M1 occurrence. Chinese were 3.20 times more likely to have aflatoxin exposure than non-Chinese. Detected urinary aflatoxin M1 was more common among household with a monthly income above RM1,500. Conclusion: The results provided an insight to explain the variation in aflatoxin occurrence among the population.

Development of a tool to measure patients’ satisfaction of hospital foodservice in a government hospital

@#Introduction: Dissatisfaction towards the quality of foodservice can affect several important aspects such as nutritional intake and financial burden. The effect of dissatisfaction towards nutritional aspect can be observed via a decline in dietary intake. Therefore, reliable and valid questionnaires are important to measure patients’ satisfaction with hospital foodservice. The main purpose of this study was to investigate the construct validity and reliability of a developed questionnaire in a local setting. Methods: A questionnaire adapted from previous studies and consisting of 27 statements from four dimensions, was administered to a total of 277 hospitalised patients in a government hospital. Factor analysis and reliability analysis were conducted using SPSS version 25. Results: Principal component of factor analysis revealed that the final questionnaire contained four main foodservice dimensions, namely food properties, staff and meal service reliability, customisation, and physical and social aspects. The reliability analysis revealed that the Cronbach’s alpha value ranged from 0.55 to 0.84 for these foodservice dimensions. The analysis showed that the alpha value differed from one dimension to another such as food properties (α=0.84), staff and meal service reliability (α=0.67), customisation (α=0.69) and physical and social aspects (α=0.55). Conclusion: Twenty-seven questionnaire items were retained because their factor loadings were greater than 0.35. Therefore, the questionnaire on patients’ satisfaction towards hospital foodservice was considered reliable and valid. The classification of the four dimensions provided detailed information of the satisfaction level, relationship and influence on the foodservice dimensions, which contributed to satisfaction towards hospital foodservice.

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.

Management Responsibilities Among Dietitians: What is the Level of Job Satisfaction and Skills Involved? A Scoping Review

@#The role of dietitians involves not solely on clinical responsibilities. Additionally, operation management responsibilities such as managing human labor, financial resources, and problem solver are the tasks that a dietitian look after. It is reported to be challenging and stressful and could affect job satisfaction levels in the working environment. This scoping review aimed to explore the job satisfaction level and skills needed among dietitians to assume management responsibilities at their workplace. This study was completed using PRISMA guidelines. Online databases (Scopus and Science Direct) were used to identify papers published from 2000 to 2019. We selected English publications from the United States, Australia, South Africa, Korea, and the United Kingdom that used job satisfaction as a primary or secondary outcome. Studies were included if they addressed dietitians who were involved in clinical work, food service, and management in their dietetic practices. Findings on existing skills, including managerial skills, communication, teamwork, and time management among dietitians with management responsibilities, have helped to enhance the job satisfaction and work quality of the dietetic profession. The findings would be useful for human resource management in the organisation, preserving the professional identity of a dietitian.

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.

The Prevalence and Symptoms Characteristic of Functional Constipation Using Rome III Diagnostic Criteria among Tertiary Education Students.

BACKGROUND AND AIMS: Functional constipation is very common with heterogeneous symptoms that have substantial impact on patient quality of life as well as medical resources which are rarely reported as life-threatening. The aim of this study is to examine the prevalence and symptoms characteristic of functional constipation (FC) by using Rome III diagnostic criteria among tertiary education students with an intention to introduce treatment in the future. METHODS: Demographic, socio-economics characteristics and symptoms of FC using the Rome III criteria were sought using a questionnaire administered to Malaysian students in a tertiary education setting. Other data obtained were the general health status, lifestyle factors and anthropometric measurements. Using a simple random sampling method, a total of 1662 students were recruited in the study with a response rate of 95.0%. Sampled data are presented as frequency and percentage and stratified accordingly into categories for Chi-square analysis. RESULTS: The prevalence of functional constipation among the students was 16.2%, with a significantly higher prevalence among women (17.4%) than men (12.5%). Hard or lumpy stool, incomplete evacuation, anorectal obstruction and straining were reported as the commonest symptoms experienced. Type 3 was the most frequent stool consistency experienced among the constipated individuals (35.2%). Only 4.4% of individuals reported having less than three defecations per week. Using univariable analysis, FC was significantly associated with sex (odds ratio: 1.48, 95% CI: 1.06-2.06) and age group (odds ratio: 1.34, 95% CI: 1.01-1.79) with P value < 0.05 significance level. In multivariate logistic regression analysis, only sex was found significantly associated with FC (adjusted odds ratio: 1.53, 95% CI: 1.08-2.17, P < 0.05). CONCLUSIONS: Based on the prevalence rate, constipation is a common problem among tertiary education students (16.2%), with significantly more prevalence among the female respondents. Early detection of symptoms and further intervention studies focusing on treatment recommendation in improving the symptoms are essential.

Detection of serum AFB1-lysine adduct in Malaysia and its association with liver and kidney functions.

Aflatoxin is ubiquitously found in many foodstuffs and produced by Aspergillus species of fungi. Of many aflatoxin metabolites, AFB1 is classified by the International Agency for Research on Cancer (IARC) as group one carcinogen and linked to the development of hepatocellular carcinoma (HCC). The study on molecular biomarker of aflatoxin provides a better assessment on the extent of human exposure to aflatoxin. In Malaysia, the occurrences of aflatoxin-contaminated foods have been documented, but there is a lack of data on human exposure to aflatoxin. Hence, this study investigated the occurrence of AFB1-lysine adduct in serum samples and its association with liver and kidney functions. 5ml fasting blood samples were collected from seventy-one subjects (n=71) for the measurement of AFB1-lysine adduct, albumin, total bilirubin, AST (aspartate aminotransferase), ALT (alanine transaminase), ALP (alkaline phosphatase), GGT (gamma-glutamyl transpeptidase), creatinine and BUN (blood urea nitrogen). The AFB1-lysine adduct was detected in all serum samples (100% detection rate) with a mean of 6.85±3.20pg/mg albumin (range: 1.13-18.85pg/mg albumin). Male subjects (mean: 8.03±3.41pg/mg albumin) had significantly higher adduct levels than female subjects (mean: 5.64±2.46pg/mg albumin) (p<0.01). It was noteworthy that subjects with adduct levels greater than average (>6.85pg/mg albumin) had significantly elevated level of total bilirubin (p<0.01), GGT (p<0.05) and creatinine (p<0.01). Nevertheless, only the level of total bilirubin, (r=0.347, p-value=0.003) and creatinine (r=0.318, p-value=0.007) showed significant and positive correlation with the level of AFB1-lysine adduct. This study provides a valuable insight on human exposure to aflatoxin in Malaysia. Given that aflatoxin can pose serious problem to the health, intervention strategies should be implemented to limit/reduce human exposure to aflatoxin. Besides, a study with a big sample size should be warranted in order to assess aflatoxin exposure in the general population of Malaysia.

Association between aflatoxin M1 excreted in human urine samples with the consumption of milk and dairy products.

This study aimed to find the association between urinary aflatoxin M(1) level and milk and dairy products consumption. Of 160 morning urine samples collected, aflatoxin M(1) was detected in 61.3 % samples (n = 98) [mean ± SD = 0.0234 ± 0.0177 ng/mL; range = 0-0.0747 ng/mL]. Of these positive samples, 67.3 % (n = 66) had levels above the limit of detection. Respondents with intake of milk and dairy products above median (67.79 g/day) had significantly high level of AFM(1) compared to those with low intake. A significant and positive association (φ = 0.286) was found between milk and dairy products consumption and urinary aflatoxin M(1) level.