Introduction: The aim of this study was to develop and validate a semiquantitative food frequency questionnaire (FFQ) for assessing habitual added sugar consumption of adults in the Klang Valley. Methods: In the development phase, a 24-hour dietary recall (24-hr DR) was used to determine food items to be included into the FFQ among adults from three major ethnicities (n=51). In the validation phase, the FFQ was further validated against a reference method which was a multiple-pass 24-hr DR among 125 adults in Klang Valley. The response rate for the latter phase was 96.1%. Results: The semi-quantitative FFQ consisting of 64 food items was categorised into 10 food groups. The mean added sugar intake determined by the reference method was 44.2 ± 20.2 g/day while that from the FFQ was 49.4 ± 21.4 g/day. The difference in mean intake between the two methods was 5.2 g (95% CI = 2.6-7.9; SD = 14.9, p<0.05) or 11.8%. Pearson correlation was r=0.74 (p<0.001) for the two methods while Spearman rank correlations for the various food groups ranged between 0.11 (cake and related foods) to 0.61 (self-prepared drinks), with most groups correlating significantly (p<0.05). Cross-classification of subjects into quintiles of intake showed 47.2% of the subjects correctly classifying into the same quintile, 34.4% into adjacent quintiles while none were grossly misclassified. The Bland-Altman plot was concentrated in the y-axis range (-24.14 g to 34.8 g) with a mean of 5.22 g. Conclusion: This semi-quantitative FFQ provides a validated tool for estimating habitual intake of added sugar in the adult population of the Klang Valley.

Iron deficiency and anaemia affect millions of children worldwide. This study aimed to investigate the effect of iron deficiency with or without anaemia on cognitive functions, specifically with short-term memory, attention and visualmotor coordination in children. A total of 173 primary school children was enrolled. Cognitive functions were assessed using the Wechsler Intelligence Scale for Children. Three sub-tests were selected to assess processing speed (coding test), immediate auditory memory (digit span test) and visual processing and problem solving ability (maze test). The results showed significant correlation between age and coding test (r =0.38, p<0.001), digit span test (r =0.16,p = 0.028), and maze test scores (r =0.28, p<0.001), and the total sub-test scores (r=0.43, p <.001). After age adjustment of the cognitive function tests, iron deficient children without anaemia scored significantly lower than the healthy children (p<0.001) on coding test, while iron deficient children with anaemia and iron deficient children without anaemia scored significantly lower (p<0.001) than the healthy counterparts on maze test. No significant differences were observed on digit-span score among the groups. This study confirms the negative effect of both iron deficiency and iron deficiency anaemia on processing speed and visualmotor coordination in children.

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.

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.

This paper aims to report the physical activity pattern and energy expenditure of adults aged 18 – 59 years in the Malaysian Adults Nutrition Survey (MANS) carried out between October 2002 and December 2003. The survey included 7349 adults representative of Peninsular Malaysia (Northern, Southern, Central and East Coast), as well as Sabah and Sarawak. A total of 6926 adults, comprising 3343 men and 3583 women, completed the physical activity section of the survey. Physical activity data was obtained using a physical activity questionnaire and 24-hour physical activity recall. Basal metabolic rate (BMR) was calculated from Ismail et al. (1998) predictive equations; total energy expenditure (TEE) was then estimated through factorial calculations based on time allocated and energy cost of various activities. Physical activity level (PAL) was calculated as the ratio of TEE to BMR. It was found that almost three-quarters of Malaysian adults travelled by passive modes of transportation. Only a third reported having ever-exercised, and an even smaller proportion of the population (14%) had adequate exercise. The population also spent the majority of their time (74% of the day) in sedentary activities, such as sleeping or lying down; doing light intensity activities (15% of the day), and doing moderate to vigorous intensity activities (10% of the day). Mean BMR and TEE was significantly higher amongst men than women, while mean PAL values were similar for men [1.6 (1.6 – 1.7)] and women [1.6 (1.6 – 1.6)]. More men (16%) were categorised as having active PAL compared to women (10%), while more women (43%) were categorised as having sedentary PAL compared to their male counterparts (37%). The present study provides the first in-depth report of the physical activity pattern, and national estimates of energy expenditure and physical activity levels of Malaysian adults, and concluded that Malaysian adults are generally sedentary. It is thus important that physical activity be further promoted and integrated into the lives of the population, preferably through various health promotion efforts as well as through the commitment of the authorities in providing a suitable environment for an active lifestyle.

Introduction: Meal patterns have received little attention in nutrition studies. The aim of this study is to present the findings on general meal patterns of Malaysian adults. Methods: The Malaysian Adults Nutrition Survey (MANS), carried out in 2002 and 2003, involved 6,928 adults selected by stratified random sampling from all households by zone in Peninsular Malaysia, Sabah and Sarawak. Results: In general, the results showed that most respondents (74.16%) ate three meals per day; 89.20% of the respondents consumed breakfast, while 88.57% consumed lunch and 91.97% consumed dinner with no significant difference in terms of sex. In Peninsular Malaysia, the Northern Zone had the highest number of people consuming breakfast compared to other zones. Meanwhile, the population in Sarawak had the largest proportion of people consuming lunch and dinner, but the smallest proportion of people consuming breakfast. A significantly higher number of the rural population consumed breakfast and lunch than urbanites; however there was no significant difference in dinner consumption. Generally, breakfast consumption increased with age whereby significant difference existed between the 18 to 19 years age group and the age group of 30 years and older. Lunch intake among the age groups showed no significant difference. In contrast, dinner consumption was significantly lower among the 18 to 19 years age group compared to all other age groups. Comparison among the ethnic groups showed that the Indian population had the lowest percentage of having breakfast and lunch while the Orang Asli had the lowest percentage of consuming dinner. However, the Orang Asli recorded the highest percentage for taking breakfast and lunch while the Chinese had the highest percentage of taking dinner. Conclusion: Considering that Malaysian adults consumed their conventional breakfast, lunch and dinner, these findings indicatethat Malaysians are maintaining their traditional meal patterns.

This study reports the food consumption patterns of adults aged 18 to 59 years in the Malaysian Adults Nutrition Survey (MANS) carried out between October 2002 and December 2003. A total of 6,742 subjects comprising 3,274 men and 3,468 women representing the northern, central , southern and east coast of Peninsular Malaysia as well as Sabah and Sarawak were interviewed. A semiquantitative food frequency questionnaire (FFQ) which consisted of 126 food items was used to evaluate the food consumption pattern (habitual food intake) of the respondents during the previous one- year period. The results demonstrate that nasi putih (cooked rice) was consumed by 97% of the population twice daily (average 2½ plates per day). Other food items consumed daily were marine fish, (one medium fish per day), green leafy vegetables (one cup per day) and sweetened condensed milk (three teaspoons per day. The mean frequencies for daily intake of rice, leafy vegetables, marine fish, local kuih, anchovy(ikan bilis) and biscuits were significantly higher among the rural compared to the urban adults. In contrast, more urban dwellers consumed chicken and eggs more frequently than their rural counterparts. More men than women consumed chicken and eggs more frequently. Malaysian adults showed a satisfactory habit of drinking plain water, with 99% drinking at least six glasses of plain water daily. Other beverages such as tea (47%), coffee (28%), chocolate-based drinks (23%) and cordial syrup (11%) were also consumed on daily basis, however, in a smaller proportion of the population. There were differences in the prevalence of daily consumption of foods when comparing urban and rural population, and also between men and women. The prevalence of daily consumption of marine fish among rural and urban adults was 51% and 34% respectively. For sweetened condensed milk, men and women consumed 43% and 28% respectively; however, more women drank full cream milk than men. Between the age groups, 21% of adults below 20 years old consumed chicken at least once a day, while this pattern of intake was not shown in the older age groups. Our findings show that adults, aged 50 to 59 years old, had the highest prevalence of daily consumption of full cream milk with 24% while those aged 18 to 19 years old had the lowest prevalence of daily consumption at 15%. The food consumption pattern of Malaysian adults appears to be satisfactory. However, some changes in food habits are recommended especially in substituting the less wholesome sweetened condensed milk with the more nutritious full cream or skimmed milk.