Delusional infestation is a psychiatric condition in which a patient belief that they are infested with living organisms in the absence of any objective evidence. The objective of this case report is to highlight a rare case of delusional infestations in a patient with schizophrenia who misusing polysubstance abuse. Methods: We report a case of 36-year-old Malay gentlemen, unemployed, married with three children, known case of schizophrenia since 2013, with history of polysubstance abuse presented to the emergency department with symptoms of itching followed by a sensation of insects crawling, biting and burrowing under the skin on his head causing an ulcerated wound. Results: He was diagnosed to be suffering from schizophrenia and was successfully treated with monthly antipsychotic depot injection in view of his poor adherence to medication On examination, ulcerated scalp wound measuring 4 x 4 cm was noted at the parieto-occipital region of the scalp. Skull X-ray and computerized tomography (CT) scan of the brain were normal. Electroconvulsive therapy (ECT) was introduced in view of slow treatment response and self-inflicted injury. The symptoms were successfully controlled after eight months, and no extrapyramidal side effect was observed. Conclusion: Patients with delusional infestation often poorly adhered to his treatment medication and the usage of depot injection of antipsychotic may benefited some patients to control the psychotic symptoms. ASEAN Journal of Psychiatry, Vol. 17 (2): July – December 2016: XX XX.

Introduction: The consumption of ready-to-eat cereals (RTECs) has been associated with lower anthropometric status as well as a lower risk of childhood obesity. This relationship has not been investigated among school children in Malaysia. This study aimed to determine the association between consumption of RTECs and anthropometric status among primary school children in Kuala Lumpur. Method: In this cross-sectional study, a total of 208 school children aged 10 and 11 years were recruited from Kuala Lumpur, Malaysia. Information on socio-demographics, RTECs consumption and anthropometric measurements (height, weight and waist circumference) were obtained. Results: The overall median body mass index (BMI) and waist circumference (WC) were 17.95(IqR 6.45) kg/ m2 and 57.35 (IqR 13.00) cm, respectively. The majority of the children (73%) consumed RTECs. The prevalence of obesity was 23.1%, with more boys (31%) than girls (17.4%) being obese. Meanwhile, 16.8% of the children were overweight. BMI (U=3335.50, z=-2.278, p=0.023) and WC (U=3273.50, z=-2.440, p=0.015) of those who consumed RTECs were significantly lower than those who did not consume RTECs. Meanwhile, children who did not consume RTECs were significantly more likely to develop abdominal adiposity than those who consumed RTECS, x2(2, N=208) =7.61, p=0.022. Conclusion: Children who consumed RTECs have significantly lower BMI and WC, as well as a lower chance of developing abdominal adiposity. Consumption of RTECs indicates an overall healthy lifestyle with an excellent nutritional profile to promote healthy body weight in children and decreased risk of childhood obesity.

This study was conducted to determine changes in nutrition knowledge, attitude and practice of 8-year-old school children after receiving a nutrition education package. A total of 418 school children from urban and rural areas participated in this study. The intervention group consisted of 237 children while 181 children who did not receive the nutrition education package acted as controls. The nutrition education programme that was conducted for 3 weeks comprised of a video viewing session and a comic reading session followed by exercise questions as reinforcement for each session, and also classroom activities. Knowledge, attitude and practice questionnaires were distributed to the children before (pre-intervention) and after (post intervention) receiving the nutrition education programme. A follow-up visit was conducted six months after the programme had elapsed. The results obtained indicated that the nutrition knowledge score increased significantly in the intervention group from 48.3±13.2 at pre-test to 54.6±16.2 in post-test and 55.0±14.3 in follow-up test (p<0.05). The nutrition attitude score also increased significantly from 68.7±15.5 at pre-intervention to 72.6±15.0 and 74.7±15.8 during post-test and follow-up test respectively (p<0.05). However, the nutrition practice score had no significant improvement in both groups throughout the study period. There were no significant changes in the control group in knowledge, attitude and practice scores at pre, post and follow-up tests. In conclusion, this study showed that a good nutrition education programme had a positive impact whereby better nutrition knowledge, attitude and healthy eating habits in children were seen. It is hoped that the improvements would be sustained throughout their lives.
Child ; Diet education ; Nutritional status ; Attitude ; Schools

This cross-sectional study was conducted to investigate the relationship between the involvements of activities at the residential college with the nutritional status of Universiti Kebangsaan Malaysia (UKM) Kuala Lumpur students and also to identify dietary habit of the students and determine the availability of healthy food around them. A total 106 student of second to fourth year of UKM Kuala Lumpur were involved in this study (20.8% male and 79.2% female). Subject’s food intake data were collected by using three day food diary. The involvement in college activities and the availability of healthy food were determined by specifi c questionnaire, which were developed for this study. Body weight, height, waist circumference, percentage of body fat and body mass index was also measured. The study showed that majority of the subjects (62.3%) is actively involved in residential college activities. Among the subjects that are actively involved in residential college activities, 5.3% of male subjects and 31.9% of female were underweight. 68.4% of male and 55.3% of female had normal body weight. 21% of male and 8.5% of female were pre obese. In addition, 5.3% (n = 1) of male subjects and 4.3% (n = 2) of female subjects were obese. From this study, majority of subjects agree that it is easy to get healthy foods in campus. There was a signifi cant positive correlation between energy intake (r = 0.352, p < 0.05) and fat (r = 0.391, p < 0.05) with Body Mass Index (BMI) for the involvement of college activities that are less than three hours. For the involvement of the college activities that are more than three hours, there was a signifi cant positive correlation between energy intake (r = 0.678, p < 0.01), fat (r = 0.550, p < 0.05), carbohydrate (r = 0.685, p < 0.01), protein (r = 0.465, p < 0.05), calcium (r = 0.357, p < 0.05), iron (r = 0.500, p < 0.05), vitamin A (r = 0.733, p < 0.01) and vitamin E (r = 0.582, p < 0.05) with BMI. Recommended Nutrient Intake (RNI) achievement of energy intake, calcium, ribofl avin, vitamin C and vitamin E were higher among the subjects that involved in college activities less than three hours compared to those who involved in college activities more than three hours. In conclusion, even though there are many subjects who are active, there are still among those who are suffering from being underweight, overweight and obese. Therefore, the involvement in residential college activities does affect the nutritional status of Universiti Kebangsaan Malaysia students

Introduction: Post-prandial hyperglycemia is an important independent risk factor in the development of cardiovascular disease in diabetes. This randomised cross-over study was conducted to compare the post-prandial glycemic and insulin responses to both high and low glycemic index (GI) meals in patients with type 2 diabetes (T2DM). Methods: A total of 41 patients with established T2DM (16 males, 25 males, Age= 55 ± 10 years and BMI = 27 ± 4kg/m²) were randomly given either a High GI or a Low GI meal in a cross-over manner. Both test meals were separated by one week washout periods. The meals contained almost the same amount of energy and macronutrients with the exception of the GI values (High GI=70 vs Low GI= 36). Venous blood was taken through an indwelling catheter periodically at 0, 30, 60, 90, 120, 150 and 180 minutes respectively. The incremental area under the curve (iAUC) was used to calculate the post-prandial glycemia and insulin excursion over the 3-hour period. Results: The low GI meal induced lower glycemic responses at times 30,60,90 and 120 minutes (mean±SE; low GI=8.1±0.4, 9.1±0.4 and 8.9±0.4 and 8.5±0.4mmol/l vs high GI=9.1±0.4, 10.7±0.4, 11.0±0.5 and 9.7±0.5mmol/l) and reduced the insulin levels at time 60,90,120 and 150 minutes (mean±SE; low GI=215.93±15.9mmol.L/minute vs high GI=419.52±32.7mmol.L/minute) and insulin (mean±SE;low GI=1439.76±226 vs high GI=2372.76±317mIU.ml/min) curves were lower after the low GI than high GI meal respectively (p<0.05). Conclusion: The low GI meal has the ability to reduce the post-prandial hyperglycemia as well insulin responses in type 2 diabetes patients.

Introduction: The present study describes a randomised controlled trial (RCT) based on a novel, generalisable intervention for childhood obesity, comparing the intervention with a no-treatment control group. Method: The Malaysian Childhood Obesity Treatment Trial (MASCOT) was a single-blind RCT of a dietetic treatment for childhood obesity in children of primary school age (7 to 11 years old) in Kuala Lumpur, Malaysia. The MASCOT comprising eight sessions, of an 8-hour family-centred group treatment programme is described, based on behavioural change techniques. The study sample was characterised by BMI zscore, health related quality of life reported by participants and their parents (PedsQL questionnaire), objectively measured habitual physical activity and sedentary behaviour (Actigraph accelerometry) Results: The MASCOT sample of 107 children was characterised by a low quality of life, mean total score on PedsQL 67.7 (4.5) as reported by the children, and 66.0 (16.4) as reported by their parents. The children spent, on average, 89% of their waking day on sedentary activity, and 1% of the day in moderate-vigorous intensity physical activity, equivalent to only around 8 minutes/day. Conclusion: Obese children in the MASCOT study had an impaired quality of life, high levels of sedentary behaviour and very low levels of physical activity.

Background: Studies from the West have demonstrated that ready-to-eat cereals (RTECs) are a common form of breakfast and more likely to be consumed by children. This study aimed to investigate the breakfast eating pattern and RTECs consumption among schoolchildren in Kuala Lumpur. Methods: In this cross-sectional study, a total of 382 schoolchildren, aged 10 and 11 years old, were recruited from seven randomly selected primary schools in Kuala Lumpur. Information on socio-demographics, breakfast eating patterns, and perceptions of RTECs and dietary intake (24-hour dietary recalls) were obtained. Results: Among the respondents, only 22% of them consumed breakfast on a regular basis. The most commonly eaten food by children at breakfast was bread (27.2%), followed by biscuits (22.2%) and RTECs (20.5%). The majority of them (93%) reported that they consumed RTECs sometimes during the week. Chocolate RTECs (34.1%), corn flake RTECs (30.3%), and RTECs coated with honey (25.1%) were the most popular RTECs chosen by children. Respondents who consumed RTECs showed a significantly higher intake in calories, carbohydrate, vitamin A, vitamin B1, vitamin B2, vitamin B3, folate, vitamin C, calcium, iron, and fibre (P < 0.05), compared to those who skipped breakfast and those who had breakfast foods other than RTECs. Conclusion: The lower levels of breakfast consumption among schoolchildren in Kuala Lumpur need serious attention. RTEC is a nutritious food which is well accepted by a majority of the schoolchildren in Kuala Lumpur. Nutrition intervention should be conducted in the future to include a well-balanced breakfast with the utilisation of RTECs for schoolchildren.

The Malaysian Dietary Guidelines (MDG) with eight key messages were first published in 1999. An updated version consisting of 14 key messages is being developed. The objective of this study was to evaluate the understanding of five key messages of the updated MDG among adults aged 18-59 years in Kuala Lumpur. A total of 773 adults comprising 330 Malays, 364 Chinese and 79 Indians were included in the study. A self-administrated questionnaire was used to obtain demographic data and to determine the level of understanding of key words and messages to be included in the new MDG. The results showed that 63% of the subjects were not aware of the existence of the MDG published in 1999. Overall, the understanding of the five messages in the updated MDG was moderate with a mean score of 60.0 ± 16.5. Between 52% to 93% of the subjects did not understand such key words as serving size, sedentary habits, blended vegetable oil and shortenings. The mean scores of understanding were significantly higher (p< 0.05) among the Chinese subjects (61.3 + 17.8) than Malays (58.6 + 14.2) and Indians (60.0 + 18.9). The younger subjects (61.2 + 16.0) scored significantly (p< 0.05) higher than the older (58.7 + 17.0) counterparts. There was also a significant association between the level of understanding of MDG with education level (p<0.001) and occupational status (p<0.001), respectively. This study suggests that some key words and messages in the updated MDG should be simplified to ensure that they are understood by Malaysians.

Introduction: Dietitians play an essential role in the management of childhood obesity and consistency in dietetic practices is required to ensure the effectiveness of treatment. This study assessed dietitians’ current practices in the management of childhood obesity, compared the practices with nutrition practice guidelines used by dietitians in other countries and identified practice components for the development of nutrition practice guidelines for the management of childhood obesity in Malaysia. Methods: A cross-sectional study was conducted among 40 dietitians in 16 Ministry of Health hospitals and three teaching hospitals. Information on current dietetic practices in the management of childhood obesity was obtained through a mailed survey questionnaire. The practices included nutritional assessment, determination of energy requirement, dietary prescription and physical activity modification. Emails were sent to 31 dietetic associations in other countries to obtain information on practice guidelines used by dietitians. Results: Frequently used dietary intervention and physical activity modification approaches were high fibre diet (65%), low fat diet (40%), reduction of sedentary pursuits and screen times (67.5%) and an increase in duration of current physical activities (60%). In comparison to other dietetic practice guidelines, the current dietetic practices in Malaysia do not usually include waist circumference, biochemical and blood pressure data. However, similar to other guidelines, the current dietetic practices included low dietary fat, high fibre diet, decreased sedentary activity and increased physical activity level. Conclusions: The dietetic practices in the management of childhood obesity in Malaysia are diverse. A comprehensive nutrition practice guideline for management of childhood obesity is urgently needed for standardisation of dietetic practices in Malaysia.
Dietetics ; Child ; Obesity ; Prevalence

Aim: This prospective, single-group, pre-post design trial was conducted to evaluate the effect of individualised Medical Nutrition Therapy intervention administered by a dietitian in individuals with type 2 diabetes mellitus on glycaemic control, metabolic parameters and dietary intake. Methods: Subjects (n=104; age=56.4 +9.9 years; 37% male; years of diagnosis = 6.3 +4.9 years) treated with diet and on a stabile dose of oral anti-diabetic agents were given dietary advice by a dietitian for a 12 week period. Individualised dietary advice was based on Malaysian Medical Nutrition Therapy for adults with type 2 diabetes mellitus. The primary outcome measure was glycaemic control (fructosamine and HbA1c level) and the secondary outcome included measures of anthropometry, blood pressure, lipid profile, insulin levels dietary intake and knowledge on nutrition. Results: At week 12, 100 subjects completed the study with a dropout rate of 3.8%. The post-Medical Nutrition Therapy results showed a significant reduction of fructosamine (311.5 +50 to 297 +44 umol/L; p< 0.001) and HbA1c (7.6 +1.2 to 7.2 +1.1 %, p<0.001) with pronounced reduction for subjects who had very high HbA1c levels of >9.3% at baseline. Waist circumference (90.7 +10.2 to 89.1 +9.8 cm, p<0.05), HDL-cholesterol (1.1 +0.3 to 1.2 +0.3 mmol/L, p<0.05), dietary intake and nutrition knowledge score (42 +19 vs. 75 +17%; p< 0.001) were significantly improved from the baseline. Conclusions: Individualised Medical Nutrition Therapy administered by a dietitian resulted in favourable diabetes outcomes, which were more apparent for individuals with higher than optimal HbA1c levels at the start of the study.