1.Dietary Patterns of the Metabolic Syndrome Among Older Adults in Malaysia
Malaysian Journal of Health Sciences 2018;16(Special Issue (Abstract)):237-
The term metabolic syndrome (MetS) describes a clustering of risk factors for cardiovascular disease and type 2 diabetes mellitus which include high blood pressure, low fasting high-density lipoprotein cholesterol (HDL-c), high fasting triglyceride (TG), high fasting blood glucose (BG), and abdominal obesity. The aim of this cross sectional study was to determine the dietary patterns (DPs) associated with MetS among 451 older adults in Malaysia. Food intake was determined using validated Diet History. DP was identified based on 40 food groups by using principal component analysis (PCA), and the factors were rotated by varimax rotation. Fasting venous blood samples were taken to determine HDL-c, TaG and BG level. Blood pressure and anthropometric measurements were also performed. Three major dietary patterns have been identified; 1) bread, spreads and oats, 2) Malaysia traditional pancakes and 3) vegetables and healthy cooked dishes. Three models were built to compare the potential confounder such as age, education years, marital status, calorie intakes, ciggarate smoking and body mass indeks (BMI). Only vegetables and healthy cooked dishes DP was associated with MetS. This DP reflects high consumption of various types of vegetables, noodle in soup, healthy cooked fish or seafood and low consumption of all type of high calorie rice, noodles and fried desserts. For all models, subject in the highest tertile of vegetables and healthy cooked dishes DP had a lower odd ratio (OR) for MetS as compared to lowest tertile. As more potential confounders added in new models, the significant values are increased. After adjustment of body mass index, the association for vegetables and healthy cooked dishes DP was attenuated (OR: 0.67, CI: 0.39-1.16, p: 0.156). In conclusion, high consumption of vegetable and healthy cooked dishes may lower the occurance of MetS among Malaysian elderly.
2.Validation of nutritional screening tools against anthropometric and functional assessments among elderly people in Selangor.
Suzana Shahar ; Siti Saifa Hussain
Malaysian Journal of Nutrition 2007;13(1):29-44
This cross sectional study was conducted to determine the validity of three screening tools, Mini Nutritional Assessment Short Form (MNA-SF), Malnutrition Risk Screening Tool for Community (MRST-C) and Malnutrition Risk Screening Tool for Hospital (MRST-H) among elderly people at health clinics. The screening tools were validated against anthropometric and functional assessments. The anthropometric assessments that were carried out included body weight, height, arm span, body mass index (BMI), calf circumference (CC) and mid upper arm circumference (MUAC). A set of questionnaire on manual dexterity, muscular strength, instrumental activities daily living (IADL) and cognitive status was used to assess functional abilities. A total of 156 subjects were recruited from rural (38 subjects) and urban (118 subjects) health clinics at Sabak Bernam and Cheras respectively. Subjects’ age ranged from 60 to 83 years old, with 44.2% were men and 55.8% women. The prevalence of muscle wasting among the subjects assessed from MUAC and CC were both 7.0%. MNA-SF had the highest correlation with BMI (r = 0.497, p<0.001), followed by MUAC (r = 0.398, p<0.001), CC (r = 0.473, p<0.001), cognitive assessment (r = 0.229, p<0.001) and handgrip strength (r = 0.209, p<0.001). Whilst MRST-C had the highest correlation with IADL score (r = -0.320, p<0.001) and MRST-H had the highest correlation with the lock and key test (r = -0.325, p<0.01). Sensitivity was the highest for MNA-SF (93.2%), followed by MRST-H (52.5%) and MRST-C (25.8%). Specificity was the highest for MRST-H (97.3%), followed by MRST-C (90.8%) and MNA-SF (79.4%). Positive predictive value (PPV) for MRST-H, MNA-SF and MRST-C was 55.5%, 18.2% and 14.1%, respectively. In conclusion, among the screening tools being validated, MNA-SF is considered the most appropriate tool to be used in health clinics for identification of elderly individuals who are at high risk of malnutrition.
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SF Brand of Topical Fluoride
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3.Factors Influencing Appetite and Depression among Institutionalised Chinese Elderly in Penang
Suzana Shahar ; Yow, Bee Charn.
Malaysian Journal of Health Sciences 2009;7(2):73-88
Poor appetite and inadequate food intake together with depression are associated with malnutrition, that will increase risk of morbidity and mortality
among elderly people. Identifying factors associated with these conditions are essential for formulation of preventive strategies. Therefore, a study was
conducted to identify factors associated with poor appetite and depression among institutionalised Chinese elderly people in Butterworth, Penang. A
total of 100 Chinese elderly (49 men and 51 women) aged 60 years and above, (mean age ± SD of 74.7 ± 9.2 years), with no known terminal and mental illnesses from two nursing homes participated in this study. Subjects
were interviewed to gather information on appetite using Council of Nutrition Appetite Questionnaire (CNAQ), depression using Geriatric Depression Scale
(GDS) and also socio demographic and health status. Food intake was assessed using a combination of one-day food weighing and 24 hour diet recall. Body
weight and height were measured. Results showed that the mean energy and nutrients intake did not achieve the Recommended Nutrient Intake of Malaysia
(RNI), with the exception for vitamin C. Only 4% of the subjects were underweight and obese, 65% normal and 31% overweight. A total of 70% and 73% of subjects had poor appetite and depression, respectively. Subjects
who had depression (adjusted OR = 2.78, 95% CI = 0.95-8.03), energy intake below RNI (adjusted OR = 2.34, 95% CI = 0.68-6.95) and difficulty to fall
asleep at night (insomnia) (adjusted OR = 2.22, 95% CI = 0.72-6.82) were more likely to have poor appetite. Subjects who had poor appetite (adjusted
OR = 3.36, 95% CI = 1.19-9.47) and insomnia (adjusted OR = 2.58, 95% CI = 0.83-7.98) were more likely to have depression. In conclusion, although the
majority of subjects had normal body weight but the nutrient intake was inadequate. Poor appetite and depression were prevalent and interrelated
and also strongly associated with insomnia.
4.Nutritional Management in Enterocutaneous Fistula. What is the evidence?
Manal Badrasawi ; Suzana Shahar ; Ismail Sagap
Malaysian Journal of Medical Sciences 2015;22(4):6-16
The management of Enterocutaneous fistula (ECF) is challenging. It remains associated with morbidity and mortality, despite advancements in medical and surgical therapies. Early nutritional support using parenteral, enteral or fystuloclysis routs is essential to reverse catabolism and replace nutrients, fluid and electrolyte losses. This study aims to review the current literature on the management of ECF. Fistulae classifications have an impact on the calories and protein requirements. Early nutritional support with parenteral, enteral nutrition or fistuloclysis played a significant role in the management outcome. Published literature on the nutritional management of ECF is mostly retrospective and lacks experimental design. Prospective studies do not investigate nutritional assessment or management experimentally. Individualising the nutritional management protocol was recommended due to the absence of management guidelines for ECF patients.
5.Development and Validation of Food Frequency Questionnaire (FFQ) Among Elderly Individuals in Klang Valley
Suzana Shahar ; Chiah Hui Lin ; Hasnah Haron
Malaysian Journal of Health Sciences 2014;12(2):33-40
Polyphenol is a non-nutrient phytochemical compound existed abundantly in plant-based diet which has the properties
to prevent age related oxidative damage induced diseases. However, there are diffi culties in quantifying its intake and
local food frequency questionnaire (FFQ) for the assessment is not available. Therefore, this study aimed to develop and
validate FFQ for estimation of dietary polyphenol intake among 93 individuals aged 60 years and above recruited from
several senior citizen clubs in Klang Valley. Phase I of the study involved the development of FFQ consisted of 117 items
under 9 categories and formation of the database extracted from PHENOL-EXPLORER. In Phase II, the intake of polyphenol
estimated using FFQ was compared with reference method consisted of 2-day diet records and diet history questionnaire
(DHQ). The mean dietary polyphenol intake estimated from FFQ and the reference method was 2770.7 ± 1552.4 mg/d and
2171.4 ± 898.8 mg/d, respectively. Spearman’s rho and Kendall’s tau-b analysis indicated that there was a signifi cant
positive correlation between polyphenol intake estimated from FFQ and reference method (r = 0.41, p < 0.001; r = 0.28,
p < 0.001). For Bland-Altman plot, 95.7% of scattered plot fell within ± 1.96 SD limits of agreement revealed that there
was good agreement between the two methods used. Cross-classifi cation analysis showed that 36.6% was categorized
in the same quartile, 78.5% in identical and contiguous quartiles, with only 3.2% in the opposite quartiles. Regression
analysis showed that all categories in FFQ signifi cantly account for the inter-variance for dietary polyphenol intake after
controlling for the other variables (R2 = 1.000, p < 0.001). In conclusion, the newly developed FFQ is considered valid
and has the potential to be used as a tool to estimate polyphenol intake among elderly individuals in Malaysia
6.Falls Prevalence And Its Risk Assessment Tools Among Malaysian Community-Dwelling Older Adults: A Review
Muhammad Iqbal Shaharudin ; Devinder Kaur Ajit Singh ; Suzana Shahar
Malaysian Journal of Public Health Medicine 2018;18(2):35-38
Falls in older adults is a major health issue globally. Falls prevalence reports vary based on the study settings. The importance of a fast, easy self-assessment tool to identify falls risk has been emphasised in numerous studies. The aim of our study was to pool information on the prevalence of falls and its risk assessment tools based on a scoping review. This information will be beneficial to inform current falls prevalence and to decide on the best falls risk assessment tool to be used among Malaysian community-dwelling older adults. Articles referred were based on the following electronic databases (MEDLINE Complete, CINAHL, Rehabilitation & Sports Medicine Source and SPORTDiscus) via EBSCOHOST, Science Direct, PubMed, Cochrane Library, Embase® and Google Scholar. Twelve studies were identified to meet the inclusion and exclusion criteria. Our review findings showed that current falls prevalence (between 4.2% and 61%) among Malaysian community dwelling older adults was consistent with the findings in Asia. Falls risk assessment tools used were similar to the ones used in other countries, taking the multiple falls risk factors in consideration.
7.Prevalence Of Urinary Incontinence And Its Association With Declined Cognitive And Physical Function Among Community Dwelling Older Adults: A Review
Resshaya Roobini Murukesu ; Devinder Kaur Ajit Singh ; Suzana Shahar
Malaysian Journal of Public Health Medicine 2019;19(1):31-40
n this review weaimed to determine the prevalence of urinary incontinence (UI)and its association with declined cognitive and physical function among community dwelling older adults. Literature review was performed using multiple online databases includingMEDLINE, Science Direct andWiley Online Library from June 2000 to April 2017. Hand searching ofbibliographies of relevant studies was also carried out. The studies included ofthose conducted from within the last 17years; assessed and compared according to population characteristics, definition of urinary incontinence, prevalence and its association with cognitive and physical functionaldecline. Nine studies met the eligibility criteria of this review. Prevalence rates of UI among community dwelling older adults ranged from10% to 53% (median 32%).Physical functionaldecline in termsof mobility, locomotion and activities of daily living interruptions werefound to be correlated with UI. Although limited, the existing evidence also showed an association between declined cognitive function and UI.
8.Dietary and Lifestyle Factors and its Risk to Kidney Stone Disease: A Case Control Study at UKM Medical Centre
Nurul Nurliana Baharudin ; Suzana Shahar ; Zulkifli Md. Zainuddin
Malaysian Journal of Health Sciences 2017;15(1):113-130
Nutrition has been widely recognized to have certain levels of influence on the risk of kidney stone formation. Thus, this case-control study was conducted to determine the association of dietary intake and lifestyles factors with kidney stone disease. Sociodemographic data, dietary intake, supplements intake, smoking and alcohol habit, medical history, physical activity and anthropometric data were obtained using interviewer-administered pre-tested questionnaires among 81 patients who had been diagnosed with kidney stone disease and 81 patients without kidney stone disease at Universiti Kebangsaan Malaysia Medical Centre. The results indicated that body mass index and hip circumference were higher among cases as compared to controls in both men and women (p < 0.05). Energy, macronutrients and micronutrients intake were higher for case subjects compared to control subjects for all significant parameters (p < 0.05). Results showed positive association of kidney stone with consumption of nuts (≥1 time/week) for men and women while consumption of eggs (1-3 times/month) and beans (1-6 times/week) showed positive association for women. Analysis of multivariate found the risk factor among women was diabetes mellitus [Adjusted OR = 27.6 (95% CI = 1.43-53.3)]
(p < 0.05). Whilst, plain water intake of at least 6 glasses [Adjusted OR = 0.001 (95% CI = 0.000-0.08)] (p < 0.05) and 8 glasses per day [Adjusted OR = 0.001 (95% CI = 0.000-0.02)] (p < 0.05) reduced the risk among women. The risk factors for men were smoking habits [Adjusted OR = 16.2 (95% CI = 1.29-203)] (p < 0.05), consumption of carbonated drink 1-3 times per month [Adjusted OR = 6.25 (95% CI = 1.04-40.7)] (p < 0.05) and 1-6 times per week [Adjusted OR = 12.5 (95% CI = 1.41-111)] (p < 0.05). Unhealthy dietary and lifestyles factors increased the risk of kidney stone disease and various risk factors were found for different sexes.
Kidney Calculi
9.Assessing the Nutritional Status of Children with Leukemia from Hospitals in Kuala Lumpur
Zalina AZ ; Suzana Shahar ; A Rahman A Jamal ; Noor Aini MY
Malaysian Journal of Nutrition 2009;15(1):45-51
A cross-sectional study was carried out to evaluate the nutritional status of 51 subjects
with leukemia aged 4 to 12 years from the Haematology & Oncology Paediatric Ward,
Universiti Kebangsaan Malaysia Medical Centre (PPUKM) and the Paediatric Institute of Kuala Lumpur. Nutritional status was assessed using anthropometric measurements,
biochemical and haematological parameters. Subjects comprised 32 (62.7%) males and
19 (27.3%) females. Most of the subjects (41.2%) were in the age group of 4 to 6 years.
More than half of the children were Malays (70.6%) followed by Indians (15.7%) and
Chinese (13.7%). The subjects were diagnosed as acute lymphoblastic leukemia (ALL)
(84.3%) followed by acute myelogenous leukemia (AML) (13.7%) and chronic myelogenous leukemia (CML) (2.0%) respectively. Most of the children were in
remission status (54.9%). Underweight (<-2 SD for weight-for-age) was observed in
37.3% of the children while 17.6% of them were stunted (<-2 SD for height-for-age), and
sign(s) of malnutrition (<-2 SD) for mid upper arm circumference (MUAC)-for-age was
observed in 15.7% of the subjects. Approximately 20.0% of the subjects were in the
severe malnutrition category with respect to low serum albumin levels (<3.5g/dl). All
subjects had hemoglobin levels of less than the normal range. While the results indicated
no significant differences in the nutritional status of subjects with leukemia at different
stages of treatment, it was observed that the prevalence of malnutrition was higher in
children with newly diagnosed leukemia. Thus, the nutritional status of children with
leukemia should be monitored closely as there is a likelihood of deterioration owing to the disease.
10.Development and Acceptance of a Nutrition and Lifestyle Education Booklet to Improve Mild Cognitive Impairment among Elderly
Sa'ida Munira Johari ; Suzana Shahar ; Roslee Rajikan ; Safiyyah A.Aziz
Malaysian Journal of Health Sciences 2011;9(2):45-50
Mild cognitive impairment (MCI) is a common disorder among elderly and may worsen to dementia. The aim of this study
is to develop a nutrition and lifestyle booklet to implement better lifestyle modification, as an effort to delay cognitive decline. A series of discussions with a research group comprising of dieticians, nutritionists, a geriatrician and a public health physician were conducted to ascertain the content of the booklet. There were seven guidelines in the booklet including; eat more fish, eat more foods rich in folic acid, eat more fruits and vegetables, exercise regularly, do activities
to stimulate memory, stop smoking and alcohol drinking and stay cheerful and positive. Evaluation of acceptance for the booklet was carried out which comprised of assessment on content, graphic and design among elderly and health staff at health clinic in Cheras. The assessment involved 15 Malay elderly subjects aged 60 to 81 years (mean age 66.1 ± 6.6 years), with 60.0% men and 40.0% women and 10 health staff aged 36.6 ± 12.0 years, with range of 27 to 58 years, consists of 20.0% men and 80.0% women also participated. Most of elderly subjects (80.0%, n = 12) indicated they understood information in the booklet. Meanwhile, 20.0% (n = 3) of elderly expressed they did not fully understand the content of the booklet in particular on sentence and terminology. All health staff (100.0%) understood the information in the booklet. This booklet was well accepted by elderly subjects and health staff, however adding more graphics, simplifying sentence structures and minimizing scientific terminologies to improve understanding were suggested. The
booklet has the potential to increase the nutritional and health knowledge of elderly specifically with MCI. This would motivate them to adopt healthy eating and lifestyle, thus reducing cognitive decline and prevent dementia.