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Nutritional Quality of Meals, Food Intake, Physical Activity and Length of Stay Predict Nutritional Status of Institutionalised Elderly Filipinos

De Guzman AB ; Lago BMM ; Nieves RAA ; Parungao Ma NCC ; Tin CKS ; Urquiza KCJO

Malaysian Journal of Nutrition.2017;23(3):319-327.

Introduction: Increasingly, the threat of malnutrition in geriatric institutions is affected by several factors such as cognition, immobility, oral problems, and psychological status. Low food intake is seen to be the primary cause of geriatric malnutrition. Further, greater length of stay and higher physical activity were significantly associated with reduced body weight and good health status, respectively. This study aimed to identify how nutritional quality of meals, food intake, physical activity and length of stay affect the nutritional status of institutionalised elderly in the Philippines. Methods: Data for this study were obtained using food weighing records, 24-hour food recall, Physical Activity Scale for Elderly (PASE), and Mini Nutritional Assessment (MNA) among 100 purposively recruited institutionalised elderly. Macronutrients were computed based on the Philippine Food Composition Table (FCT) while adequacy was evaluated based on the Philippine Dietary Reference Intake (PDRI). Results: The use of Partial Least Square (PLS) regression analysis revealed that of the variables, only food intake (ÃŸ=0.17; p=0.04), physical activity (ÃŸ=0.16; p=0.04) and length of stay of elderly in the institution (ÃŸ=0.18; p<.01) had a weak positive effect on the nutritional status of the institutionalised elderly. Conclusion: This study showed the role of food intake, physical activity and length of stay in the nutritional status of elderly in home care settings. This implies that assessment of the nutritional status and its associated factors remains vital in the development of nutrition intervention and the provision of quality food planning and service in institutionalised settings.

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Effect of Probiotic Microbial Cell Preparation (MCP) on Fasting Blood Glucose, Body Weight, Waist Circumference, and Faecal Short Chain Fatty Acids among Overweight Malaysian Adults: A Pilot Randomised Controlled Trial of 4 Weeks

Mahadzir MDA ; Shyam S ; Barua A ; Krishnappa P ; Ramamurthy S

Malaysian Journal of Nutrition.2017;23(3):329-341.

Introduction: Probiotic microbial cell preparation (MCP) supplementation is one of the approaches to modulate alterations in gut microbiota (GM). This double-blind randomised controlled trial investigated the effect of 4 weeks of MCP supplementation on fasting blood glucose levels (FBG), body weight (BW), waist circumference (WC), and faecal short chain fatty acids (SCFA) among 24 healthy and overweight (with BMI = 23 kg/m2) Malaysian adults. Methods: Twenty-six subjects were randomised to receive either MCP (n= 12) or placebo (n=14), twice daily, for 4 weeks. The probiotic powder contained a mix of six strains namely, Lactobacillus acidophilus, Lactobacillus lactis, Lactobacillus casei,Bifidobacterium longum, Bifidobacterium bifidum and Bifidobacterium infantis (3.0 x 1010 cfu). FBG, BW, WC, WHR, faecal SCFA, physical activity levels and dietary intake were measured and changes were determined using repeated measures ANOVA. Results: Twenty-four subjects successfully completed the 4-week study period. Changes in FBG, BW, WC and SCFA were not significantly different between the groups. Only subjects in the MCP group significantly reduced their energy intake compared to baseline (1671?±476 vs 1386?±447 kcal, P=0.045). Conclusion: A 4-week supplementation of the MCP mix powder did not have significant effects on the variables studied. However, the significant reduction in dietary energy intake in the MCP group suggests the potential of probiotics as an adjuvant to dietary therapy for weight los

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Effects of Consuming Yellowstripe Scad versus Salmon on Lipid Profile, Fasting Glucose, Body Weight Status and Blood Pressure among Healthy Overweight Malaysian Adults

Chang WL ; Azrina A ; Sabariah MN ; Irmi Zarina I ; Loh SP

Malaysian Journal of Nutrition.2017;23(3):343-352.

Introduction: This is a preliminary result of an on-going randomised cross-over trial to compare the effects of consuming yellowstripe scad (YSS) and salmon, both rich in omega-3 fatty acids, on lipid profile, fasting glucose, body weight status, and blood pressure among healthy overweight adults. Methods: Fifty healthy overweight Malaysians aged 21-55 years were recruited voluntarily through advertisements. During the first period of intervention, subjects were randomised equally to receive eight weeks of either steamed whole YSS fish (YSS group) or salmon fillet (salmon group), three days per week, obtaining approximately 7000 mg EPA+DHA per week. The diets were switched after an eight-week washout period. Lipid profile, fasting glucose, body mass index, and blood pressure were evaluated before and after each intervention period. Results: The mean ages of YSS group (n=25) and salmon (n=25) group were 30.6?±9.1 and 27.9?±7.1 years respectively. Both groups had no statistically significant differences on socio-demographic characteristics (p>0.05). After the first intervention period, there was a significant increase in total cholesterol within the YSS group (p<0.05) but not within the salmon group (p>0.05). Both YSS and salmon groups had significantly higher HDL-cholesterol levels after 8 weeks compared to baseline (p<0.05). There was no significant between-group difference in all the variables after eight weeks (time x group interaction, p>0.05). However, there was a significant effect of time on diastolic blood pressure (p<0.05). Conclusion: These preliminary findings indicate that YSS and salmon may have similar beneficial effects on HDL-cholesterol level among healthy overweight adults. The second intervention period is on-going to confirm these finding

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Nutritional Status and Quality of Life of Oncology Patients Prior to Pelvic Radiotherapy

Dzairudzee ROSLI ; Suzana SHAHAR ; Zahara Abdul MANAF ; Hazreen Abd MAJID ; Mohd Roslan HARON

Malaysian Journal of Nutrition.2017;23(3):361-373.

Introduction: Malnutrition among cancer patients is associated with a higher risk of gastrointestinal toxicity which develops during treatment and may affect quality of life (QOL). Thus, this cross-sectional study aimed to determine the nutritional status and QOL of 30 oncology patients (mean age 50.0+10.7 years) prior to pelvic radiotherapy at Hospital Sultan Ismail, Johor Bahru. Methods: Patients were assessed for anthropometry measurements, 24-h diet recall and nutritional status using Scored Patient-Generated Subjective Global Assessment (PG-SGA) questionnaire while the European Organization for Research and Treatment of Cancer Care Quality of Life Questionnaire (EORTC QLQ-C30) was used to assess QOL two weeks prior to the initiation of pelvic radiotherapy. Results: Mean Body Mass Index (BMI) of patients was 23.3+3.3kg/m2 and 33% of patients experienced weight loss prior to pelvic radiotherapy. The PG-SGA rating indicated that 63% of patients were at Stage A (well-nourished) and 37% were in Stage B (moderate malnutrition). The PG-SGA numerical score was a significant predictor of QOL, after adjusting for socio-demographic factors (R2=0.861, p<0.05). Conclusion: In general, the low nutritional status of the patients indicates the need for early nutritional assessment, education and intervention in ensuring optimal nutritional status throughout the pelvic radiotherapy treatment.

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Relationship between Quality of Life and Nutritional Status in Colorectal Cancer Patients Undergoing Chemotherapy

Zalina Abu ZAIDI ; Kathryn JACKSON ; Lynne COBIAC ; Mirnalini KANDIAH

Malaysian Journal of Nutrition.2017;23(3):375-384.

Introduction: Malnutrition is associated with poorer outcomes following treatment for colorectal cancer (CRC). This study evaluates the relationship between nutritional status using scored Patient Generated-Subjective Global Assessment (PG-SGA) with the validated European Organisation for Research and Treatment of Cancer questionnaire (EORTC-QLQ C30) which consists of five functional scales, three symptoms scales and one item of global health/quality of life (QOL). Methods: A total of 42 CRC patients at oncology outpatient clinics from two hospitals in Malaysia participated in the study from March 2011 to March 2012. The participants were classified as either well-nourished (PG-SGA A) or malnourished (PG-SGA B and C). Results: The majority of patients were Chinese, male, with a mean age of 57.1 ?± 9.8 years and had been diagnosed with stage 2 CRC. Well-nourished patients had statistically significantly better QOL scores on symptom scales: fatigue (p<0.001), nausea and vomiting (p<0.05), and pain (p<0.001) compared to malnourished patients. PG-SGA was strongly correlated with the main domains of the QOL: global health status (r = -0.395, p<0.05), fatigue (r = 0.816, p<0.001), nausea and vomiting (r = 0.730, p<0.001) and pain (r= 0.629, p<0.001). The better the nutritional status (lower total mean score of PG-SGA), the higher the QOL (high mean score of global health status). Conclusion: The scored PG-SGA is suitable for use as a nutrition assessment tool to identify malnutrition and it is associated with QOL among this population

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Quality Coding of Malnutrition under the Casemix System in Hospital Universiti Sains Malaysia

Nur Fazimah S ; Rosminah M ; Sakinah H

Malaysian Journal of Nutrition.2017;23(3):385-396.

Introduction: Detailed clinical information is important for the Casemix System to generate valuable Case Based Group (CBG) for malnourished geriatric patients. Clinical coding for malnutrition provides useful information on the nutritional health of patients for treatment purposes. Methods: This cross-sectional study with purposive sampling involved a total of 130 geriatric patients (>60 years) at Hospital Universiti Sains Malaysia (USM). Nutritional assessments were performed such as anthropometrics measurement, Subjective Global Assessment (SGA), and biochemical assessment. The patientsâ€™ medical records and coded data were systematically reviewed to observe the documentation of nutritional information and coding criteria based on the International Classification for Diseases (ICD-10). Results: The prevalence of malnutrition among the geriatric patients was 35.4%. Proper documentation of required nutritional information was found in less than 50% of the cases. None of the malnourished patients were documented and coded with malnutrition diagnosis, despite being given nutritional interventions. The reasons given for this omission were related to the lack of awareness (50%) and incomplete medical documentation (50%). Further analysis revealed that uncoded diagnosis, miscoding, missing, and unavailable codes for nutritional counselling and oral nutritional supplementation were the main contributors to the incomplete records. Conclusion: The quality of clinical coding for malnourished geriatric patients in the hospital should be improved. A structured assessment and standard documentation is recommended to improve the quality of healthcare provision for malnourished geriatric patients.

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Accelerometer-Measured Physical Activity and its Relationship with Body Mass Index (BMI) and Waist Circumference (WC) Measurements: A Cross-Sectional Study on Malaysian Adults

Lee Yi YI ; Narimah SAMAT ; Wan Manan Wan Muda

Malaysian Journal of Nutrition.2017;23(3):397-408.

Introduction: Physical activity has been shown to be beneficial for the prevention of obesity and non-communicable diseases. Our contemporary way of life that is technology dependent has significantly reduced physical activity. This study aimed to determine accelerometer-measured physical activity (moderate-to-vigorous physical activity (MVPA)) among adults in high and low walkability neighbourhoods in Penang and Kota Bharu, Malaysia. Methods: Participants (n=490) were sampled using multistage sampling method from neighbourhoods with varied levels of walkability using Geographical Information System (GIS). Physical activity was measured objectively using Actigraph GT3X+ accelerometers, worn by the participants on their waists for a period of 5 to 7 days. Results: The participants had a mean of 13.5 min/day of MVPA. Total MVPA was significantly higher among participants in high walkability neighbourhoods (19.7 min/day vs. 9.1 min/ day). Results from t-test showed that the time spent on MVPA per day was significantly lower among participants residing in low walkability neighbourhoods. The final model of the MIXED model statistical tests showed that total MVPA was significantly associated with BMI, but not with WC measurements, after adjusting for covariates. Conclusion: Most of the participants had very low MVPA and did not achieve the current physical activity recommendations, implying that Malaysian adults residing in these two cities were not physically active to achieve health benefits. Results are suggestive of the importance of the walkability concept in neighbourhoods in encouraging physical activity and healthy body weight among Malaysians.

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Knowledge and Attitude Related to Nutritional Supplements and Risk of Doping among National Elite Athletes in Malaysia

Balaravi Chin MQ ; Karppaya H ; Chai WJ ; Samantha Quah LW ; Ramadas A

Malaysian Journal of Nutrition.2017;23(3):409-423.

Introduction: Often considered a legitimate strategy to enhance health and performance, the consumption of nutritional supplements (NS) has become a common practice which frequently results in unintentional doping among athletes. Despite a probable association between NS and doping, there are limited studies on this topic in developing countries such as Malaysia. Thus, this study aimed to identify the prevalence of NS usage among national elite athletes and assess their knowledge and attitude regarding its use and doping. Methods: This was a cross-sectional study conducted at the Malaysian National Sports Institute among national elite athletes (n=50) recruited via convenience sampling. The athletes completed a self-administered questionnaire documenting their demographic characteristics, training information, NS consumption, knowledge and attitude related to supplement-doping. The total knowledge and attitude scores were compared according to demography, training information, and NS consumption. Results: The prevalence of NS use among the athletes was 72%. NS usage was significantly associated with training duration (p=0.029), source of nutrition information (p=0.047) and self-exploration on supplements (p=0.045). Supplement-doping knowledge was significantly higher among athletes with tertiary level education (p=0.027), NS users (p=0.044), those obtaining information from nutritionists (p=0.048) and those who had attended nutrition workshops (p<0.001). The attitude score was significantly higher among males (p=0.021), professional athletes (p=0.041), athletes with lower training hours (p=0.010), those obtaining information from nutritionists (p=0.035) and those who had attended nutrition workshops (p=0.005). Conclusion: A demographic- and training-specific education on NS should be provided by qualified nutritionists to reduce the risk of doping amongst athletes.

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Assessment of Dietary Diversity Score, Nutritional Status and Socio-demographic Characteristics of Under-5 Children in Some Rural Areas of Imo State, Nigeria

Ukegbu Patricia OGECHI ; Ogu Victoria CHILEZIE

Malaysian Journal of Nutrition.2017;23(3):425-435.

Introduction: The study assessed dietary diversity score (DDS) of rural under-five children and the relationship with their nutritional status and socio-demographic characteristics of their mothers/caregivers. Methods: The study was a descriptive cross-sectional survey involving 226 mothers and their under-five children selected at random from rural communities in Imo state, Nigeria. A pre-tested questionnaire was used to obtain information on socio-demographics. Qualitative recall of the childâ€™s food consumption during the previous 24-h was used to calculate individual dietary diversity score (DDS=representing the number of food groups, based on a scale of 12 groups) and the scores were divided into terciles low= =4, medium=5 - 8, and high= 9 - 12). Weight-for-age (WAZ), height-for-age (HAZ) and weight-for-height (WHZ) Z-scores were used to determine nutritional status of the children. Descriptive statistics, Chi square and linear regression analyses were performed. Results: Average age of the children was 4.2Â±0.7years, with 51.8% being males, and 48.2% females. Stunting, wasting and underweight were 11.5%, 5.4% and 2.7%, respectively. Mean DDS for all food groups was 6.04Â±4.18. Cereals and vegetables had higher mean values (0.78Â±0.29 and 0.78Â±0.30, respectively), while eggs had the least value (0.15Â±0.25). The prevalence of low, medium and high DDS (in terciles) was 73.5%, 25.2% and 1.3%, respectively. DDS was significantly associated with HAZ (?2 =10.63;p=0.03), while total family income remained significantly and positively associated with dietary diversity score (p<0.05) in the linear regression model. Conclusion: Children with low DDS were more likely to be stunted. Therefore, efforts aimed at increasing diversity in meals, both at home and in schools, are likely to benefit children at nutritional risk.

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Potential Hypocholesterolemic Activity of Flour from Leaves of Moringa (Moringa oleifera L.)

Indah ASRIFAH ; Teti ESTIASIH ; Hidayat SUJUTI

Malaysian Journal of Nutrition.2017;23(3):449-460.

Introduction: Moringa (Moringa oleifera L.) leaves contain phytosterols and dietary fibres which may be beneficial in controlling blood cholesterol levels. This study was aimed at assessing the hypocholesterolemic effect of flour from leaves of M. oleifera L. (MLF) with white and red stalk in rats. Methods: Thirty male rats were divided into 6 groups, comprising a normal group (negative control), a hypercholestrolemic group (positive control) both of which were without MLF feeding, and 4 hypercholesterolemic groups fed MLF for 4 weeks in the following manner: (i) 0.822 mg/g bw/d white stalk (WM); (ii) 0.822 mg/g bw/d red stalk (RM); (iii) 0.02 ml/g bw/d commercial plant stanol ester (FS); and (iv) 0.001 mg/g bw/d ezetimibe (ET). At the end, serum total cholesterol (TC) and low density lipoprotein cholesterol LDL-c), viscosity and pH of digesta, faecal cholesterol, and short chain fatty acids (SCFAs) were analysed. Results: TC levels in the WM, RM, FS and ET groups decreased by 42.0, 48.8, 48.4 and 52.8% respectively, compared to initial levels. The four groups also showed decreases in serum LDL-c levels by 30.3, 39.2, 37.9 and 46.7% respectively, over the feeding period. Faecal cholesterol levels of WM and RM were higher (63.93?±1.87 and 90.11?±1.77 mg/100 g faeces, respectively) than that of the positive control (51.30?±4.03 mg/100 g) after 4 weeks. Conclusion: Flour from moringa leaves of white and red stalk trees showed potential hypocholesterolemic activity in ra

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