Association Between Anthropometric Status, Dietary Intake and Physical Activity with Bone Health Status among Premenopausal Chinese Women in the Klang Valley, Malaysia

Introduction: There is a lack of information on bone health status of premenopausal women in Malaysia. This study investigated the bone health status of premenopausal women and its associations with anthropometric, dietary and physical activity. Methods: Bone mineral density (BMD) was measured using dual X-ray absorptiometry (DEXA) at the lumbar spine, femoral neck, total hip and total body. Serum osteocalcin, parathyroid hormone (PTH), beta-crosslaps were also determined. Results: A total of 73 Chinese premenopausal women were recruited in the study with a mean age of 39.3 � 5.0 years. Average BMI, body fat percentage and lean body mass were 22.2 � 3.4 kg/m2, 33.9 � 4.6% and 34.5 � 4.4 kg, respectively. Mean BMD at the spine, total hip, femoral neck, and total body were 1.025 � 0.118 g/cm2, 0.876 � 0.109 g/cm2, 0.739 � 0.110 g/cm2, and 1.061 � 0.755 g/cm2, respectively. Their serum beta-crosslaps and PTH were within normal range, but serum osteocalcin (8.5 � 4.2 ng/ml) was low. On average, calorie intake (1506 � 427 kcal/day) was below the Malaysian Recommended Nutrient Intake (RNI) while their calcium intake achieved only 67% of RNI. Their mean metabolic equivalent score (MET) was 771.4 � 926.1 mm/week. Body weight and related indices (BMI, lean mass, fat mass) were significantly positively correlated with BMD at all skeletal sites. Conclusion: The study revealed that Chinese premenopausal women in the Klang Valley have low calcium intake and low level of physical activity.

Gender Differences in the Attitude and Strategy towards Weight Control among Government Employees in Penang, Malaysia.

BACKGROUND: This was a cross-sectional study on the gender differences in weight-control behavior. The strategies used, weight status, weight satisfaction, and proportion of individuals attempting to lose weight among 233 government employees (104 men and 129 women) working in the Federal Government Building in Penang, Malaysia, were assessed. METHODS: Anthropometric indicators such as body mass index, waist-to-hip ratio, and body fat percentage were measured to determine the subjects' body weight status. A questionnaire covering the following items was used to assess weight-control behavior: social support, self-monitoring, self-efficacy, outcome expectations, planning, preparation/buying, portion control, social interactions, and cognitive behavioral strategies. RESULTS: About 50% of the subjects were classified as overweight. Based on percent body fat percentage, 70% of them were classified as having unhealthy levels of body fat. Women were found to be more dissatisfied with their current weight, and were more likely to attempt weight reduction compared to men. Women reported higher levels of social support for dieting and had better expectations for diet and exercise (P < 0.05). They also reported higher use of weight control strategies. For self-monitoring, although no gender-dependent differences (P > 0.05) were observed, women reported more frequent self-monitoring of diet, whereas men reported more frequent self-monitoring of exercise. CONCLUSION: Health care professionals and researchers should be aware of the different strategies used by men and women in order to plan and/or implement community-wide weight management programmes.

Accelerometer-determined physical activity level among government employees in Penang, Malaysia.

INTRODUCTION: A cross-sectional study was carried out to investigate accelerometer-determined physical activity level of 233 Malay government employees (104 men, 129 women) working in the Federal Government Building Penang, Malaysia. METHODS: Body weight, height, waist and hip circumference, body fat percentage and blood pressure were measured for each respondent. All the respondents were asked to wear an accelerometer for 3 days. Body mass index (BMI) and waist-hip ratio (WHR) were calculated using a standard formulas. Fasting blood sample was obtained to determine the lipid profile and glucose levels of the respondents. RESULTS: Based on the accelerometer-determined physical activity level, almost 65% of the respondents were categorised as sedentary. Approximately 50.2% of the respondents were overweight or obese. There were negative but significant relationships between body mass index (BMI) (r = -0.353, p < 0.05), body fat percentage (r = -0.394, p < 0.05), waist circumference (WC) (r = -0.198, p < 0.05) and physical activity level. Sedentary individuals had a higher risk than moderate to active individuals of having a BMI more than or equal to 25 kg/m2 (OR = 2.80, 95% CI 1.55-5.05), an-risk classified WC (OR = 1.79, 95% CI 1.01-3.20), and a body fat percentage classified as unhealthy (OR = 3.01, 95% CI 1.41-6.44). CONCLUSION: The results of this study suggest that accelerometer-determined physical activity level is a significant factor associated with obesity in this study. The high prevalence of physical inactivity and obesity found among respondents of this study indicate a need for implementing intervention programmes among this population.

Accelerometer-Determined Physical Activity Level among Government Employees in Penang, Malaysia

Introduction: A cross-sectional study was carried out to investigate accelerometerdetermined physical activity level of 233 Malay government employees (104 men, 129 women) working in the Federal Government Building Penang,Malaysia. Methods: Body weight, height, waist and hip circumference, body fat percentage and blood pressure were measured for each respondent. All the respondents were asked to wear an accelerometer for 3 days. Body mass index (BMI) and waist-hip ratio (WHR) were calculated using a standard formulas. Fasting blood sample was obtained to determine the lipid profile and glucose levels of the respondents. Results: Based on the accelerometer-determined physical activity level, almost 65% of the respondents were categorised as sedentary. Approximately 50.2% of the respondents were overweight or obese. There were negative but significant relationships between body mass index (BMI) (r=-0.353, p<0.05), body fat percentage (r=-0.394, p<0.05), waist circumference (WC) (r=-0.198, p<0.05) and physical activity level. Sedentary individuals had a higher risk than moderate to active individuals of having a BMI more than or equal to 25 kg/m2 (OR= 2.80, 95% CI 1.55-5.05), an-risk classified WC (OR= 1.79, 95% CI 1.01-3.20), and a body fat percentage classified as unhealthy (OR= 3.01, 95% CI 1.41-6.44). Conclusion: The results of this study suggest that accelerometer-determined physical activity level is a significant factor associated with obesity in this study. The high prevalence of physical inactivity and obesity found among respondents of this study indicate a need for implementing intervention programmes among this population.

Cross-sectional study of older adults with type 2 diabetes mellitus in two rural public primary healthcare facilities in Malaysia.

Knowledge of the characteristics of older adults with type 2 diabetes mellitus (T2DM) is indispensible for improvement of their care. A cross-sectional study in two rural public primary healthcare centres in Malaysia identified 170 actively engaged older patients with T2DM, with suboptimal glycaemic control and frequent hypoglycaemia. The prevalence of multiple co-morbidities, complications of T2DM, high cardiovascular risk, neurological, musculoskeletal and visual deficits suggested high risk of disabilities and dependency but not yet disabled. This short window for interventions presents as an opportunity for development of a more comprehensive approach extending beyond glycaemia control to risk management, preventing functional loss and continuity of social participation.

A follow-up study on the effects of a milk supplement on bone mineral density of postmenopausal Chinese women in Malaysia.

BACKGROUND: A previous study on a randomized controlled trial in 173 postmenopausal Chinese women in Kuala Lumpur showed that milk supplementation was effective to reduce bone loss at the total body, lumbar spine, femoral neck and total hip compared to the control group on a usual diet (Chee et al. 2003). OBJECTIVE: The objective was to determine whether the results were sustained after the conclusion of the study. DESIGN: A follow-up study, 18 months after a randomized controlled trial of milk supplementation was concluded. A total of 139 participants were followed up 21 months after the study ended. Bone mineral density (BMD) was measured at the total body, lumbar spine, femoral neck and total hip by dual energy X-ray absorptiometry, and anthropometric measurements as well as changes in dietary habits were measured. RESULTS: At the follow-up, the milk supplement group did not show significant bone loss from baseline at most sites (mean differences +/- SE) (total body 0.42 +/- 0.25%, femoral neck 0.44 +/- 0.58%, total hip -0.06 +/- 0.46%), unlike the control group (total body -1.07 +/- 0.28% p < 0.005, femoral neck -1.49 +/- 0.56% p < 0.05, total hip -0.89 +/- 0.57% p < 0.05). However, both the milk and control groups showed bone loss from baseline at the lumbar spine (milk -2.01%, control -3.29%, p superior 0.05). The calcium intake of the milk group remained significantly higher than the control group (milk 710 mg/day, control 466 mg/day, p < 0.005) despite discontinuation of the milk supplement. CONCLUSIONS: The results showed that some of the beneficial effects of a milk supplement were still evident at follow-up and it was possible to motivate subjects to adopt a positive change in dietary calcium intake after intervention.

The effect of milk supplementation on bone mineral density in postmenopausal Chinese women in Malaysia.

Dietary studies often report low calcium intake amongst post-menopausal Malaysian women and calcium deficiency has been implicated as part of the etiology of age-related bone loss leading to osteoporosis. Therefore, the objective of this study was to examine the effectiveness of high calcium skimmed milk (Anlene Gold, New Zealand Milk, Wellington, New Zealand) to reduce bone loss in Chinese postmenopausal women. Two hundred subjects aged 55-65 years and who were more than 5 years postmenopausal were randomized to a milk group and control group. The milk group consumed 50 g of high calcium skimmed milk powder daily, which contained 1200 mg calcium (taken as two glasses of milk a day). The control group continued with their usual diet. Using repeated measures ANCOVA, the milk supplement was found to significantly reduce the percentage of bone loss at the total body compared to the control group at 24 months (control -1.04%, milk -0.13%; P<0.001). At the lumbar spine, the percentage of bone loss in the control group was significantly higher (-0.90%) when compared to the milk (-0.13%) supplemented group at 24 months (P<0.05). Similarly, milk supplementation reduced the percentage of bone loss at the femoral neck (control -1.21%, milk 0.51%) (P<0.01) and total hip (control -2.17%, milk -0.50%) (P<0.01). The supplemented group did not experience any significant weight gain over the 24 months. The serum 25-hydroxy vitamin D level improved significantly (P<0.01) from 69.1 +/- 16.1 nmol/l at baseline to 86.4 +/- 22.0 nmol/l at 24 months in the milk group. In conclusion, ingestion of high calcium skimmed milk was effective in reducing the rate of bone loss at clinically important lumbar spine and hip sites in postmenopausal Chinese women in Malaysia. Supplementing with milk had additional benefits of improving the serum 25-hydroxy vitamin D status of the subjects.

Dietary calcium intake in postmenopausal Malaysian women: comparison between the food frequency questionnaire and three-day food records.

The objective of this study was to compare the dietary calcium intakes assessed by a quantitative food frequency questionnaire (FFQ) and the three-day food record method in 230 Chinese postmenopausal women aged 50-65 years in Kuala Lumpur. The results showed that the mean calcium intake from the dietary records was 447+/-168 mg/day and 499+/-211 mg/day from the FFQ. The mean difference in intake by the two methods was 51.3 mg (95% CI = -30.8-77.9; SD = 181.2, P>0.05), which did not differ significantly from zero. Pearson's correlation coefficient of 0.56 was obtained between the two methods. Ninety-five percent of the individuals classified by food records fell into the same or within-one-quartile category when classified by FFQ. Forty-eight percent were classified into the same quartile by both methods. No subjects were grossly misclassified by the FFQ. The FFQ correctly identified subjects with calcium intakes below the Malaysian recommended daily allowance (450 mg/day) with 60% specificity and with 92% specificity for women consuming less than 800 mg calcium/day. In conclusion, the FFQ developed was a useful, rapid clinical tool for assessing calcium intake and identifying postmenopausal Chinese women with low calcium intakes in Malaysia.