Introduction: This two-phase longitudinal study sought to determine the association between isoflavones intake on cognitive function and comorbidities among older adults from the state of Johor, Malaysia. Methods: Phase I involved baseline data collection to examine the association between isoflavones intake and cognitive function among 400 respondents aged 60-years and above, recruited through multistage random sampling. Phase 2 determined the association between isoflavones intake at the baseline and comorbidities at an 18-month follow-up. The baseline data collected included information on socio-demographics, health status, andunpometric measurements, and dietary intake using a dietary history questionnaire (DHQ). Each participant's cognitive function was evaluated using a mini mental state examination (MMSE), digit span, digit symbol, and geriatric depression scale (GDS). Results: The daily intake of total isoflavones, daidzein, and genistein were 19.1±19.7,11.7±12.3 and 7.6+8.1 mg/day, respectively. There was no significant association between isoflavones intake, and specific cognitive function including global, memory, executive functions, and depression. However, there was a significant association (p<0.05) between isoflavones intake r=0.131 (95% CI: 0.064-0.199), daidzein intake r0.132 (95% CI: 0.064-0.199), and genistein intake ra0.129 (95% CI: 0.062-0.197) with memory (digit span) after adjustment for age, gender, educational level, and body mass index (11M1). No association was found between isoflavones intake and comorbidities (p> 0.05). Conclusion: This study found an association between isoflavones intake and memory function, but not with global cognitive, executive functions, depression, and comorbidities. There is a need to promote adequate isoflavones intake in view of its association with memory function.

Nutrition screening is recommended as a first step of nutrition care to allow early identification and intervention of malnourished patients. The present study determined the validities and reliabilities of two malnutrition screening tools namely, the Malnutrition Universal Screening Tool (MUST) and Malnutrition Screening Tool (MST) among adult patients at the Hospital Kuala Lumpur. Methods: The sensitivity, specificity and predictive value of MUST and MST were conducted against the Subjective Global Assessment (SGA), anthropometric parameters including body mass index (BMI), calf circumference (CC),mid-upper arm circumference (MUAC) and energy intake. Inter-rater reliability was evaluated using kappa value (κ) to determine the level of agreement between raters. Results: A total of 151 subjects with mean age of 45.2 ± 13.7 years participated in this study. Prevalence of malnutrition according to MUST, MST and SGA was 34.4%, 33.8% and 19.9%, respectively. As compared to SGA, MUST and MST had a sensitivity of 96.6% and 93.3% respectively, whereas the specificity was 80.9% for both tools. The sensitivity and specificity of MUST against the anthropometric parameters (BMI, CC and MUAC) were between 53.8% to 88.8% and 67.4% to 69.9%, respectively. The sensitivity values for MST were between 46.1% to 63.6% and specificity values were between 64.4% to 67.6%. The inter-rater reliability of MUST was higher (substantial, mean (κ) = 0.78) than for MST (moderate, mean (κ) = 0.52). Conclusions: In conclusion, MUST was found to have similar validity levels but higher reliability result than MST. Based on our result, MUST is recommended for use in identifying adult patients who are at high risk of malnutrition. It can be used as a malnutrition screening tool but there is a need to evaluate the cost effectiveness of its implementation.

Introduction: The benefits of sufficient fruits and vegetables consumption for health are well known. This study investigated the adequacy of fruit and vegetable intake among older persons and its association with mild cognitive impairment (MCI). The study also identified motivation and barrier factors affecting fruit and vegetables consumption. Methods: A total of 114 respondents aged 60-years and above (25 and 89 respomdents with and without MCI, respectively) from low cost housing areas in Kuala Lumpur participated in the study. Participants were interviewed using a standardised questionnaire with neurocognitive testing scales to determine their cognition level. Results: Of the non-MCI participants, 15.7% met World Health Organisation's (WHO) (2003) recommendations for fruit and vegetable consumption of 400 g/ day compared to 12.0% of the subjects with MCI (p<0.05). Participants without MCI also had a significantly higher intake of fruit and vegetables (281.6 ± 77.2 g/ day) compared to those with MCI (250.4 ± 51.3 g/ day). Total daily intake of vegetables and fruits was significantly correlated with the digit span score of the participants (r=0.214, p<0.02). Total daily intake of leafy green vegetables was correlated with the verbal memory domain score of the total digit span (r=0.254, p<0.01). The main motivating factor for taking fruits, vegetables, and 'ulam' (salad) was their belief in its health benefits. The main barriers to their consumption were dental problems, and a dislike of their taste. Conclusion: Generally, the intake of fruits and vegetables among older persons was inadequate and was associated with poorer cognitive functions. Improvement of oral health status and the provision of more choices of fruits and vegetables for older persons may increase their daily intake.

Loss of appetite, decrease in food intake and changes in body composition appear to be inter-related factors that can influence the well-being of older individuals. Therefore, a study was conducted to determine the level of appetite, food intake and its relation to body composition and functional status among noninstitutionalised elderly Malays in Cheras, Kuala Lumpur. The Council on Nutrition Appetite Questionnaire (CNAQ), Diet History Questionnaire (DHQ), Bio-impedance Analysis (BIA) and Instrumental Activity of Daily Living (IADL) questionnaire and handgrip dynamometer were used to measure appetite, food intake, body composition and functional status respectively. A total of 112 subjects (41.1% men and 58.9% women) participated with mean age being 66.0 ± 5.0 years for men and 66.3 ± 6.2 years for women. Prevalence of poor appetite was higher in elderly women (72.3%) than in men (52.3%) (p<0.05). Pearson’s correlation test showed that CNAQ score correlated significantly with age (r=-0.255, p<0.01), energy intake (r=0.272, p<0.01), IADL score (r=0.408, p<0.01) and handgrip strength (r=0.263, p<0.05). Energy intake correlated significantly with fat free mass (r=0.424, p<0.05), muscle mass (r=0.456, p<0.05) and total body water (r=0.403, p<0.05). Multiple regression analysis showed that 27.0% of poor appetite could be explained by advanced age, low energy intake and decreased functional status. In conclusion, the study showed that poor appetite was prevalent among the subjects, especially women and this was influenced by aging, inadequate energy intake and decreased functional status.

Introduction: Understanding the perceptions of healthcare professionals and patients regarding gestational diabetes mellitus (GDM) is important for optimal pregnancy outcomes. This study aimed to identify the problems faced by healthcare professionals in the management of GDM and the patients' perspectives as well. Methods: Two focus groups consisting of thirteen pregnant women diagnosed with GDM at 20-28 weeks of gestation and sixteen healthcare professionals were interviewed using a semi-structured questionnaire. The subjects were recruited purposively from a public health clinic in Negeri Sembilan, Malaysia. Audio recordings were made of the interview sessions and transcribed verbatim before being assessed independently by two researchers. The NVivo 10.0 programme was used to extract key themes. Results: Five emergent themes consisting of views from both groups of subjects were identified. They were: (1) perceived patients' non-adherence to medical advice versus patients' own negligence; (2) poor appetite control versus patients' poor temptation control; (3) patients' lack of knowledge versus confusing information provided by healthcare staff; (4) patients 'giving up' versus being in a non-supportive environment; and (5) patients being in denial versus the disappointment when required to control diet. Conclusion: This study revealed conflicting perspectives between pregnant mothers with GDM and the healthcare staff in managing these patients. There is a need to promote positive communication between healthcare staff and patients for a better understanding of the needs of GDM patients.

Physical Activity Scale for the Elderly (PASE) is a simple, valid and reliable questionnaire that can be administered to quantify older adults’ physical activity levels during daily living. However, PASE in Malay language for use among older population is not available. The objective of our current study was to evaluate the reliability and validity of the Malay translated Physical Activity Scale for Elderly (PASE-M) for the use among older adults. Objective results of physical activity were obtained by wearing continuously an accelerometer for one week among a population of older adults in Malaysia who speak Malay language. Participants completed PASE-M twice, on day-8 (PASE-M1) and day-15 (PASE-M2). Concurrent validity between PASE-M1 and accelerometer results was assessed using Spearman’s rank correlation coefficient. Test-retest reliability for one week interval of PASE-M was tested using Spearman’s rank correlation coefficient and Intra-class correlation coefficients (ICC). Forty-four community-dwelling older adults (12 men and 32 women; mean age ± SD= 66.95 ± 5.34) participated in this study. However, only 33 participants (8 men and 25 women; mean age ± SD= 66.64 ± 5.51) were able to achieve the minimum accelerometer wearing time and filled up the PASE-M questionnaire for two times with one weeks interval. The results showed the PASE-M score was significantly correlated with vector magnitude (VM) counts (r=0.54, p<0.01), time in moderate-to-vigorous physical activity (MVPA) (r =0.55, p<0.01), energy expenditure (r =0.53, p<0.01) and walking steps (r=0.39, p<0.05). A high reliability (ICC = 0.96) was demonstrated between first and the subsequent administration of PASE-M (p<0.01, 95% CI: 0.92-0.98). The PASE-M is a valid and reliable questionnaire to assess physical activity level for Malaysian community-dwelling older adults.
older adults, physical activity, questionnaire, accelerometer, validity, reliability

A cross-sectional study was carried out to assess the physical activity levels among patients with type 2 diabetes mellitus (DM) at Cheras Health Clinic in Kuala Lumpur. A total of 132 subjects (62 men and 70 women) aged 30 years and above participated in this study. Data was collected using an interview based questionnaire to obtain socio-demographic and health profile information. Physical activity was assessed using a shortened version of the International Physical Activity Questionnaire (IPAQ). Anthropometric measurements and body fat were also taken. Glycaemic status, that is, HbA1c, fasting blood sugar (FBS) and 2 hours post-prandial (2-HPP) were obtained from medical records. Results showed that the mean age of the patients was 51.9 + 5.8 years. The majority of patients had poor glycaemic control based on HbA1c (70.7%), FBS (71.9%) and 2HPP (85.4%). Patients who were unmarried and aged(60 years and above had a lower physical activity level (p<0.05). In the older age group, low physical activity was associated with poor glycaemic control (p<0.05). Patients in the moderate and high physical activity level were motivated to perform physical activity so as to be healthy (68.1%). Low physical activity level among patients was due to lack of time (54.5%) and lack of energy (21.2%). In conclusion, physical activity levels of the patients were unsatisfactory and associated with poor glycaemic control, especially in the elderly. There is a need to encourage diabetic patients to undertake regular physical activity in order to achieve optimal glycaemic control.

The Third National Health and Morbidity Survey (NHMS III) was conducted in 2006 on a nationally representative sample of population in Malaysia. Over 21,000 children aged 0-17.9 years were measured for body weight and stature according to the protocol of the World Health Organization. This article describes the nutritional status of children aged 0-59.9 months. Mean z score for weightfor-age (WAZ), height-for-age (HAZ) and BMI-for-age were compared with the z-scores tables of the WHO standards. The overall prevalence of underweight and stunting of the children were 12.9% and 17.2% respectively. These levels included 2.4% severe underweight and 6.0% severe stunting. In terms of z scores, the age group of 0–5.9 months showed the best nutritional status with mean WAZ of -0.33 (95%CI: -0.52, 0.15) and -0.40 (-0.57, 0.24) for boys and girls respectively, while mean HAZ was 0.64 (0.38, 0.89) for boys and 0.76 (0.54, 0.98) for girls. Mean HAZ and WAZ status was least satisfactory after about 6 months, suggesting a faltering in growth rate at an age that coincides with dependence on complementary feeding. Prevalence of overweight based on BMI-for-age for the sexes combined was 6.4%, while that based on WAZ was 3.4%. The NHMS III results indicate that Malaysian children have better nutritional status compared to children under 5 years in neighbouring countries. In order to meet the targets set in the National Plan of Nutrition (2006-2015), more effective intervention programmes are needed to accelerate the reduction of underweight and stunting, and to arrest the rise of overweight in young children.

Abdominal obesity (AO) is an independent risk factor for cardiovascular disease, hypertension and diabetes mellitus in adults. There is a lack of data on the magnitude and socio-demographic profile of AO among Malaysian adults at the national level. In the Third National Health and Morbidity Survey (NHMS III) conducted in 2006, AO of adults aged 18 years and above was determined based on the waist circumference as part of the nutritional status assessment. This article reports the prevalence of AO in relation to socio-economic factors and demographic characteristics of adult subjects. Out of a total of 33,465 eligible individuals 18 years and above, waist circumference was measured in 32,900 (98.3%) individuals. The prevalence of AO was assessed using the cut-off points recommended by World Health Organization. The mean waist circumference in men and women was 84.0cm [95% confidence interval (95% CI): 83.8, 84.3] and 80.3cm (95% CI: 80.1, 80.6) respectively. The national prevalence of AO was 17.4% (95% CI: 16.9, 17.9). The identified risks of AO were women (OR: 4.2, 95% CI: 3.8, 4.6), aged 50-59 years (OR: 5.6, 95% CI: 4.0, 7.7), Indians (OR: 3.0, 95% CI:2.4, 3.8), housewives (OR: 1.4, 95% CI: 1.1, 1.7), subjects with primary education (OR: 1.3, 95% CI: 1.1, 1.5) and ever married (OR: 1.4, 95% CI: 1.2, 1.6). Being the largest population-based study on AO among Malaysians, these findings have important public health implications. There is an urgent need to revise public health policies and programmes aimed at prevention of abdominal obesity especially in the groups at risk.

The incidence of falls among older adults can be caused by nutritional, health status, physical and environmental factors. The objective of this study was to develop and evaluate the contents in a booklet on nutrition and falls prevention among older adults as a nutritional education material for falls prevention. In Phase I, market survey in bookstore, website search and need assessment among 30 respondents using a questionnaire was conducted. Results from Phase I were used to form a 32-page A5 size booklet that includes information on nutrients related to bone health, recommendations of high protein and calcium menus, ideal exercise and tips to avoid falls in older adults. The content validity of the booklet was conducted among six health professionals to assess the suitability and understanding in Phase II. The content of the booklet (Phase III) was then evaluated among 24 respondents aged 60 years and above. From the need assessment in Phase I, majority of respondents chose 7 to 9 for the score of each questions which indicates the need for all information to be included in the booklet. For Phase II, criteria with highest average score were composition and typography with a score of 60%. For Phase III, most respondents chose “good” for all the criteria stated except for pictures (satisfactory), while 62.5% of respondents stated that they were satisfied with the information contents in the booklet. In conclusion, this booklet can be used as one of the strategies for nutrition education in the prevention of falls among older adults.