Vitamin A, C and E intake has been shown to play a role in the etiology of breast cancer, but the findings have been inconsistent and limited to developed countries with higher cancer incidence. Therefore, the aim of this study is to examine the association of premenopausal and postmenopausal breast cancer risk with vitamin A, C and E intake from dietary sources. This is a population based case-control study conducted in Malaysian population among 382 breast cancer patients and 382 control group. Dietary intake was assessed via an interviewer-administered food frequency questionnaire. Logistic regression was used to compute odds ratios (OR) with 95% confidence intervals (CI) and a broad range of potential confounders were included in analysis. The results of this study shows a significant decreased risk of breast cancer among premenopausal (ORQ4 to Q1=0.38, 95% CI, 0.12 – 0.55, p-trend=0.001) and postmenopausal (ORQ4 to Q1=0.26, 95% CI, 0.03 – 0.75, p-trend=0.017) women was observed in the highest quartile of beta-carotene intake. Meanwhile, a higher intake of vitamin C showed significantly lowered risk only for premenopausal women (ORQ4 to Q1=0.13, 95% CI, 0.03 – 0.32, p-trend=0.001). As a conclusion, beta-carotene intake was independently related to pre- and postmenopausal breast cancer risk, while vitamin C intake was associated with decreased risk among premenopausal women only. However, no association was observed for vitamin A especially retinol and vitamin E intake from dietary sources.

The objective of this study was to compile and analyse existing scientific evidences reporting the effects of objectively measured physical activity on the levels of adiponectin and leptin. Articles related to the effects of objectively measured physical activity on the levels of adiponectin and leptin were searched from the Medline and PubMed databases. The search was limited to ‘objectively measured’ physical activity, and studies that did not objectively measure the physical activity were excluded. Only English articles were included in the search and review. A total of 18 articles encompassing 2,026 respondents met the inclusion criteria. The eligible articles included all forms of evidence (e.g., cross-sectional and intervention). Seventeen and 11 studies showed the effects of objectively measured physical activity on adiponectin and leptin, respectively. Five and four cross-sectional studies showed the effects of objectively measured physical activity on adiponectin and leptin, respectively. Two out of five studies showed a weak to moderate positive association between adiponectin and objectively measured physical activity, while three out of four studies showed a weak to moderate inverse association between leptin and objectively measured physical activity. For intervention studies, six out of 12 studies involving adiponectin and five out of seven studies involving leptin showed a significant effect between the proteins and objectively measured physical activity. However, a definitive conclusion could not be drawn due to several methodological flaws in the existing articles and the acute lack of additional research in this area. In conclusion, the existing evidences are encouraging but yet not compelling. Hence, further well-designed large trials are needed before the effectiveness of objectively measured physical activity in elevating adiponectin levels and in decreasing leptin levels could be strongly confirmed.

University years are a critical period regarding a change in eating behaviour, notably among international students. Body weight and eating behaviour of Nigerian students have never been investigated. Therefore, the aim of this study is to assess the nutritional status and eating behaviour of Nigerian postgraduate students in UniSZA, Malaysia. A total of 82 students (76 male and six females) with a mean age of 28.1 ± 2.0 years old participated in this study. Participants completed a set of a self-administered questionnaire and three days 24-hour dietary record. Weight and height were measured and BMI was calculated to determine the weight status Energy and nutrient intake was described in relation to the Dietary Reference Intake (DRI). Majority of the students had normal weight (69.5%), with minority overweight and obese (11.0%). The mean total caloric intake of the students was 2142 ± 434kcal/day. More than half of the students ate carbohydrate less than the recommended range while ate fat above the recommended range. However, more than half of the students consumed protein within the recommended range. Majority of the students skipped at least one meal daily with breakfast was the most frequently skipped meal (51.2%). Most students consume fruits frequently (37.8%) and 39% consume vegetables sometimes. It is about 40.2% of students never/less than once a month consumes fast food. Present study suggests that the need of further study to monitor any changes in body weight, eating behaviours of the students after living few months in Malaysia. These might help to provide a better understanding of adaptation to new culture.

Increasing physical activity level during and after treatment is recommended by the American Cancer Society because of the many benefits namely reducing fatigue and improves psychological distress which leads to an improvement in the quality of life. This study is aimed to compare physical activity level and body composition between oncology patients who are still undergoing treatment and those on medical follow-up. Patients were recruited based on convenience sampling from the Oncology Outpatient Clinics of Universiti Kebangsaan Malaysia Medical Center (UKMMC). Anthropometric measurements and body compositions were measured using calibrated tools while physical activity level were assessed using Global Physical Activity Questionnaire (GPAQ). Medical treatment history was obtained from patients medical records. A total of 53 patients (n=38 were undergoing treatment and n=15 was on follow-up) consisting of Malays (54.7%) and Chinese (45.3%) and with mean age of 55.3 ± 9.3 years. Most patients were previously diagnosed with ovarian cancer (39.6%) and colon cancer (18.9%) patients and they were at cancer stage III (18.8%). Body mass index (BMI) and percent fat mass were significantly different (p<0.05) between patients undergoing treatment (22.8 ± 2.7 kg/m2, 28.7 ± 7.2%) and on follow-up (26.2 ± 5.5 kg/m2, 37.1 ± 11.9%). Majority of the patients undergoing treatment were categorized under low physical activity compared to those on follow-up (p<0.05). Physical activity level measured as METS-minutes/week is also found to be significantly different (p<0.05) between patients on treatment and follow-up. As a conclusion, cancer patients undergoing treatment have low physical activity, with lower BMI and fat mass compared to those on follow-up. This is consistent with their nature of living where during treatment the patients will resting while coping with side effects of treatments.

Despite being effective in promoting healthy dietary behaviour, smartphone apps are scarcely available for our local communities and the majority of nutritional-related information is based on western food selections. Our new innovation aims to provide specific educational advice about recommended food intake, types, nutritional qualities and weight issues for cancer patients and survivors who suffer appetite problems and nutritional deficits. The Cancer Dietary (CanDiTM) app was developed as a convenient, flexible and attractively engaging smartphone app containing healthy tips which are uniquely tailored to the local food choices, preferences and ingredients. This helps customise users’ dietary needs besides permitting constant information up-dating. Features are broadly categorised into Healthy Eating Guide (advice from healthy eating to eating problems, weight loss prevention and increasing proteins and calories intake) and Malaysian Recipes For Cancer Patients (focusing on common Malaysian dishes, ingredients, treatment-based recipes and special diets). An additional Symptom Diary allows user’s personal profile to be recorded and stored virtually online. Its feasibility and acceptability were further tested among 30 cancer patients, family caregivers and dieticians recruited from a public hospital in Terengganu, Malaysia. Very good feasibility (> 80%) and excellent acceptability (> 90%) were reported regarding its ease of operation, suitability of language used, attractiveness, knowledge enhancement and perceived usefulness. With this scientific yet creative innovation, routine dietary habits related to cancer conditions could be easily facilitated for both patients/survivors as well as family caregivers for their independent and healthy living.
Cancer dietary app ; Smartphone app ; Malaysian dishes

Food frequency questionnaire (FFQ) is a practical tool for the measurement of usual food intake in large surveys because it gives a quick approximation to ‘true’ dietary intake. This study was carried out to compare the semiquantitative FFQ with three day 24-hour diet recalls (24-hr DR) in assessing intake of energy, total fat, fatty acids and vitamin A, C and E among Malaysian women. This semi-quantitative FFQ which was developed specifically for the Malay and Indian ethnicities has 200 food items and categorized according to three mealtimes namely breakfast, lunch or dinner and morning or afternoon snacks. A total of 51 Malay and 28 Indian women aged between 30 to 60 years were selected as study subjects. The result of the study shows that majority of study subjects were within the normal EI/BMR ratio when their energy intake was assessed by semi-quantitative FFQ (70%) and 24-hr DR (74%). However, 10% of study subjects became over-reporters when their intakes were assessed using the semi-quantitative FFQ. Analysis of t-test shows there is no significant difference (p > 0.05) on the mean intake of energy, total fats, saturated, monounsaturated and polyunsaturated fatty acids and vitamin A, C and E between semi-quantitative FFQ and 24-hr DR. Percent mean differences were also less than 10% for all nutrients included in this study. This indicates that the semi-quantitative FFQ can produce comparable results with 24-hr DR. Energy adjusted correlation coefficient values for all studied nutrients were total fat (r = 0.64, p = 0.02), saturated fatty acids (r = 0.59, p = 0.01), monounsaturated fatty acids (r = 0.52, p = 0.03), polyunsaturated fatty acids (r = 0.57, p = 0.02), vitamin A (r = 0.69, p = 0.01), retinol (r = 0.55, p = 0.01), beta carotene (r = 0.74, p = 0.01), vitamin C (r = 0.64, p = 0.02) and vitamin E (r = 0.69, p = 0.01). Cross-classification for both methods into quartiles of intake resulted in correct classification into the same or adjacent quartile from 82% to 96% of the study subjects. Only 3% of the subjects were grossly misclassified. As a conclusion, this semi-quantitative FFQ gives estimation as good as 24-hr DR for intakes of energy, total fat, fatty acids and vitamin A, C and E among Malaysian women specifically for the Malay and Indian ethnicities. This semi-quantitative FFQ is a useful tool in dietary intake assessment for research use especially for epidemiological study on diet and disease relationship such as cardiovascular, cancer and diabetes.

Objective: The purpose of this study was to evaluate the effectiveness of nutrition education intervention among university students in terms of social, psychological factors and nutrition-related Quality of Life (NQoL) outcomes after receiving a 10-week nutrition education. Longitudinal and randomised study design was adopted for the study. Methods: A total of 417 respondents from four public universities in Terengganu were randomly assigned to either intervention group (IG = 205) or control group (CG = 212). The IG received nutrition education through three tools; 1) conventional lecture, 2) brochures and 3) text messages via short messaging system (SMS) while the CG not received any intervention. Students completed the Malay version of NQoL (6 domains; 49 items; Likert-type responses=1-5) and SF-36 (8 domains; 36 items) at pre-intervention and post-intervention. Data analysis was carried out by using SPSS 16.0 utilising descriptive and parametric statistics. Results: Ninety-one percent of participants (IG = 178; CG = 202) completed the study (age = 19.1±1.1 years; female = 87.6%; Malay = 98.2%). After controlling for possible confounders (eg. weight, waist, hip circumferences and pre-intervention scores for each domain), IG possessed relatively higher NQoL score in Food Impact (p = 0.001), Social / Interpersonal (p = 0.008), Physical Functioning (p = 0.011) and Overall NQoL (p = 0.001). However, Psychological Factors did not show any significant difference for both groups. Conclusion: Although the intervention did not generate significant impact in the psychological component over a period of 10 weeks, significant positive impacts in Social/Interpersonal aspects and NQoL were clearly shown.
Quality of Life ; Text Messaging

Background: University students generally tend to engage in problematic eating behaviours, including unhealthy dieting, skipping meals, and high intake of fast food, although they are aware of the negative consequences. Eating behaviours have been shown to be interestingly related to quality of life (QoL). Our study aimed to 1) assess general nutrition quality of life (NQoL) status and 2) compare NQoL status based on gender, financial resources, study courses, year of study, and body mass index (BMI) profiles. Methods: This study was conducted among undergraduates of health sciences in a local public university in Terengganu. Students completed the Malay version of NQoL (6 domains; 50 items; Likert-type responses 1–5). Data analysis was carried out by using SPSS 16.0, utilising descriptive and parametric statistics. Results: A total of 241 students were enrolled [age = 19.7 (0.1) years; female (83.0%); Malay (96.7%)]. Social/Interpersonal Factors [3.84 (0.43)] emerged as the best component, while Food Impact [3.10 (0.40)] was the worst. Across all variables, only gender and study courses showed significantly different NQoL. Females scored better than males in Self-Efficacy (confidence in food selection ability) (p < 0.05). Nursing students also experienced significantly greater NQoL (mean = 3.58, 95% CI = 3.47, 3.68) than radiography students in Self-Efficacy (p < 0.05). Medical laboratory technology students had a significantly more favourable NQoL rating (mean = 3.62, 95% CI = 3.47, 3.76) than nursing students in Self-Image (p < 0.05). Study courses significantly influenced the NQoL status of students with Good NQoL, while those with Poor NQoL were mostly influenced by gender and financial resources (p < 0.05). Conclusion: These outcomes indicate that specific demographic characteristics seemed to make a difference in the NQoL of undergraduate students.

School-based health programs implemented by the Malaysian Ministry of Education (MOE) through the National Physical Fitness Standard (SEGAK) assessments provided an important platform in health status monitoring among schoolchildren. However, to date, there is still no reliability study conducted on this method. Therefore, this study aimed to determine the reliability of the anthropometric data collected by physical education (PE) teachers in the SEGAK assessments. Anthropometry measurements of standard six school adolescents involved in the Health of Adolescents in Terengganu study were taken by trained researchers using a standardised protocol. The anthropometrics data were then compared with PE teachers’ measurements from the SEGAK assessments obtained from the specifically developed Health Monitoring System database. Reliability of the anthropometric measurements were analysed using Pearson’s correlation test, Intraclass Correlation Coefficients (ICC), Bland-Altman plot and Cohen’s Kappa statistics. Intraclass correlation coefficient between teacher-measured and researcher-measured values shows good correlation in weight (ICC = 0.93), height (ICC = 0.98) and BMI (ICC = 0.91). The Bland-Altman plot showed a relatively small difference in mean of weight, height, and BMI between teacher-measured and researcher-measured value. The mean difference between teacher-measured and researcher-measured value of weight, height, and BMI were 1.8kg, 0.1cm, and 0.8kg/m2 respectively. Overall, Cohen’s Kappa statistics showed substantial agreement (κ = 0.642) in BMI categorisation between the two measurements. Findings from reliability analysis conducted affirmed that anthropometrics assessments conducted by PE teachers in SEGAK assessments are reliable to be used for identification of body weight status among school children and adolescents particularly in Terengganu, Malaysia.

A balanced dietary intake plays an important role in the prognosis of breast cancer and is one of the modifiable factors in preventing cancer recurrence. This study aims to determine the dietary intake among breast cancer survivors in East Coast of Peninsular Malaysia. A total of 125 breast cancer survivors, aged 37 to 72 years, with mean duration of survivorship of 6.1 ± 3.9 years were recruited from two main referral hospitals in Terengganu and Kelantan. Majority of the respondents were Malay (94.4%) with a mean BMI of 27.7 ± 5.07 kg/m², and were diagnosed with stage II cancer (66.0%). Dietary intake was estimated using a semi-quantitative food frequency questionnaire (FFQ). The results show that the mean daily intake of energy was 1764 ± 378 kcal/day, protein was 72.38 ± 33.6 g/day (16.5% of energy), carbohydrate was 243.0 ± 62.2 g/day (55% of energy) and fat was 55.8 ± 15.6 g/day (28% of energy). Overall, breast cancer survivors in this study had an adequate daily intake of vitamins and minerals according to Malaysian Recommended Nutrient Intakes (RNI) except for dietary fibre (10.6 ± 4.2 g/day), monounsaturated fatty acids (20.7 ± 5.7 g/day), polyunsaturated fatty acids (8.0 ± 2.2 g/day), calcium (561.0 ± 257.1 mg/day), iron (18.3 ± 7.2 mg/day) and potassium (1813.4 ± 531.1 mg/day) which was lower than the recommendation. Meanwhile, intake of sodium (2592 ± 1697 mg/day), protein (80.4 ± 33.6 g/day), saturated fatty acids (26.9 ± 14.2 g/day), vitamin B2 (1.9 ± 1.1 mg/day) and vitamin C (151.1 ± 149.3 mg/day) exceeded the recommendation by 135.0%, 139.0%, 166.9%, 154.6% and 152.0%, respectively. There was no significant difference in dietary intake between cancer survivors who were diagnosed in the past five years and those who were diagnosed more than five years ago (p>0.05) except for fat (p<0.001), saturated fatty acid (p=0.006), monounsaturated fatty acid (p=0.005) and polyunsaturated fatty acid (p=0.003). As a conclusion, breast cancer survivors in East Coast of Peninsular Malaysia had an adequate intake of most nutrients except for dietary fibre, monounsaturated fatty acids, polyunsaturated fatty acids, calcium, iron and potassium which was below the recommendation and sodium, protein, saturated fatty acids, vitamin B2, vitamin C which was above the recommendation. The intakes between long-term and short-term survivors were also comparable showing sustained dietary intake throughout survivorship.