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Insulin resistance, inflammation and metabolic syndrome in normal weight and overweight/obese primary school children in Kuala Lumpur

Malaysian Journal of Nutrition.2018;24(2):153-161.

Introduction: Studies on metabolic syndrome (MetS) of children are important in view of rising prevalence of childhood obesity worldwide. This study compares the risks of insulin resistance, inflammation and metabolic syndrome between overweight/obese (OW/OB) and normal weight (NW) children in Kuala Lumpur. Methods: A cross-sectional study was conducted in 12 primary schools selected using multi-stage stratified random sampling. Height and weight were taken of a total of 1971 children aged 10-11 years. Based on BMI-for-age, 235 OW/OB children matched for age, sex and ethnicity with 226 NW children were selected for the study. Overnight fasting blood samples were collected to determine insulin, high-sensitivity C-reactive protein (hsCRP), glucose and lipid profiles. Logistic regression analysis was conducted to estimate associations between weight status and metabolic risk factors. Results: Prevalence of MetS among OW/OB children was 3.8% compared to 0% in the NW. Prevalence of insulin resistance among OW/OB was 45.5% compared to 18.6% among NW children. High risk of inflammation was found in 28.1% of the OW/OB children compared to 12.4% in the NW. The odds ratio of having insulin resistance, inflammation and metabolic risk factors among OW/OB were 3.66 (95% CI: 2.40-5.59), 2.76 (95% CI: 1.69-4.50), 4.93 (95% CI: 3.42-7.10), respectively compared to the NW. Conclusion: The OW/OB children in this study showed higher risks of developing insulin resistance, inflammation and MetS compared to the NW counterparts. Further studies are suggested to better understand the relationships between insulin resistance, inflammation and MetS in children.

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Validation of the 28-day mortality prognostic performance of the modified Nutrition Risk in Critically Ill (mNUTRIC) score in a Malaysian intensive care unit

Wan Fadzlina Wan Muhd Shukeri ; Samiullah Saeed ; Azrina Md Ralib ; Mohd Basri Mat-Nor

Malaysian Journal of Nutrition.2019;25(3):413-421. doi:10.31246/mjn-2019-0074

Introduction: The mNUTRIC score is a nutritional assessment tool to identify critically ill patients with high nutritional risk who could benefit from nutritional interventions. This study was conducted to validate the 28-day mortality prognostic performance of the mNUTRIC score in a Malaysian intensive care unit (ICU). Methods: This was a retrospective cohort study of adult patients who were consecutively admitted to the ICU from January 2017 to December 2018 for >24 hours. Data were collected on variables required to calculate the mNUTRIC score. Patients with mNUTRIC score ≥5 points were considered to be at high nutritional risk. Main outcome was 28- day mortality from all causes; ICU length of stay (LOS) and prolonged mechanical ventilation (MV) (>2 days) were secondary outcomes. Results: From a total of 432 admissions, 382 (88.4%) patients fulfilled the study criteria. Seventy-seven (20.2%) of these patients were at high nutritional risk. They had longer mean ICU LOS (7.1±7.5 days versus 4.2±4.0 days, p=0.001), greater proportion of prolonged MV (57.1% versus 14.4%, p<0.001) and higher 28-day mortality (44.2% versus 10.2%, p<0.001) compared to patients with low mNUTRIC score (≤4 points). High mNUTRIC score predicted 28-day mortality with area under the curve (AUC) of 0.797 (95% confidence interval: 0.738-0.856). Conclusion: High mNUTRIC score was associated with a higher 28-day mortality. The prognostic performance for 28-day mortality of the mNUTRIC score is clinically valid as indicated by AUC >0.7 and is comparable to the results of other validation studies. In addition, patients with high mNUTRIC score had increased ICU LOS and prolonged MV.

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A retrospective study of weight-loss predictors following bariatric surgery in Malaysian patients with obesity

Fatin Hanani Mazri ; Suzana Shahar ; Nik Ritza Kosai ; Mohd Azahadi Omar ; Nilsiswati Ramilis ; Reynu Rajan

Malaysian Journal of Nutrition.2019;25(3):423-433. doi:10.31246/mjn-2018-0115

Introduction: A retrospective study was conducted with the aim of determining the factors that affect weight loss among post-bariatric surgery patients. Methods: A successful weight loss outcome in this study was defined as achieving at least 50% excess weight loss (EWL). Eligible participants were those who had undergone bariatric surgery at least two years prior to the study. Adherence to lifestyle recommendations post-bariatric surgery, binge eating, depression, and social support were assessed. Results: A total of 51 post-bariatric surgery patients were recruited with a mean post-operative period of 3.2±0.7 years. The mean preoperative weight of 116.6±28.8 kg and body mass index (BMI) 45.2±8.8 kg/m2 were significantly reduced to 86.6±21.0 kg and 33.6±6.7 kg/m2, respectively, during follow-up (p<0.001). A total of 66.7% of participants achieved successful weight loss following bariatric surgery, with a mean EWL of 73.6±21.9% and total weight loss (TWL) of 29.4±8.7%. According to multivariate regression analysis adjusted for age and gender, pre-operative weight (β=-1.580, p<0.05) and BMI (β=-1.398, p<0.05), rate of weight loss (β=1.045, p<0.01), and adherence to eating behaviour recommendations (β=0.177, p<0.05) were significant predictors of weight loss outcomes post-bariatric surgery. Conclusion: The lower pre-operative weight and BMI, the faster rate of weight loss and higher adherence towards eating behaviour advice were potential predictors of greater EWL and thus could increase the chance of successful weight loss maintenance post–bariatric surgery.

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Diabetes literacy and knowledge among patients with type 2 diabetes mellitus attending a primary care clinic in Seremban, Malaysia

Lee Ching Li ; Winnie Chee Siew Swee ; Kanimolli Arasu ; Kwa Siew Kim ; Siti Zubaidah Mohd Ali

Malaysian Journal of Nutrition.2019;25(3):435-444. doi:10.31246/mjn-2019-0031

Introduction: Good health literacy and knowledge are associated with improved outcomes in diabetes. The purpose of this study was to determine diabetes-specific literacy and knowledge levels, and its associated socio-demographic factors, among adults with type 2 diabetes mellitus (T2DM). Methods: This cross-sectional study was conducted among 196 adults from the Indian, Chinese, and Malay ethnic groups with T2DM who attended a primary care clinic in Seremban, Malaysia. The Literacy Assessment for Diabetes and Diabetes Knowledge Test 2 were used to assess diabetes-specific literacy and knowledge, respectively. Results: The majority of participants (75.0%) had literacy scores that corresponded to Ninth Grade Level but only 3.6% of participants had a good knowledge of diabetes. Literacy scores explained up to 19.8% of the variance in knowledge scores (r=0.445, p<0.01). Indian participants had the lowest literacy and knowledge scores when compared to Chinese and Malays (p<0.05). Participants with higher education had better literacy and knowledge scores (p<0.05). Educational level was more likely than ethnicity to predict both literacy and knowledge scores (p<0.001), while gender and age did not significantly predict either score. The majority of participants could answer general questions about physical activity, diabetes-related complications and healthy eating. Knowledge of diabetes and its relation to specific foods and the effect of diet on glucose control were limited among the participants. Conclusion: Education and ethnicity were associated with literacy and knowledge on diabetes. There existed a deficit of diabetes-related nutrition knowledge among the participants. These findings may help healthcare providers tailor individualised patient educational interventions.

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Existence of double burden of malnutrition among Filipino children in the same age-groups and comparison of their usual nutrient intake

Imelda Angeles-Agdeppa ; Patricia Isabel Gayya-Amita ; Wargin P. Longalong

Malaysian Journal of Nutrition.2019;25(3):445-461. doi:10.31246/mjn-2019-0079

Introduction: This study aimed to determine the prevalence of underweight and overweight children in the same age-groups and if differences existed in their usual nutrients intake. Methods: Data were obtained from 8992 children aged 3-12 years who participated in 2013 National Nutrition Survey. Dietary intake information was collected using two days non-consecutive dietary recall. Usual intakes and distributions of energy and nutrients were estimated in pre-schoolers (3-5 years, n=2427), younger (6-9 years, n=3594) and older schoolchildren (10-12 years, n=2971) using PC Software for Intake Distribution Estimation (PC-SIDE) from Iowa State University. Energy inadequacy was assessed by the Estimated Energy Requirements (EER) method calculated using the equation of Institute of Medicine. The prevalence of nutrient inadequacy was estimated as the proportion of individuals with usual food intakes below the estimated average requirement (EAR). Results: The prevalence of underweight among preschool, younger and older schoolchildren was 22%, 30% and 16%, respectively, and 4%, 9% and 10%, respectively, among overweight. The average usual energy and nutrient intake of underweight was significantly lower than overweight. The major source of energy of underweight and overweight was from carbohydrates. However, contribution of fats to total energy was higher among overweight. Most nutrients were below EAR in underweight while only folate (50-79%) and calcium (58-84%) in overweight. Conclusion: The double burden of malnutrition co-exists in children of the same age-groups with higher prevalence nutrient inadequacies in underweight children. Percentage of fat contribution to energy intake was higher among overweight than the underweight.

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Malaysian Food Barometer (MFB): a study of the impact of compressed modernisation on food habits

Jean-Pierre Poulain ; Cyrille Laporte ; Laurence Tibè ; re ; Elise Mognard ; Neethianhantan Ari Ragavan ; Anis Ashraf Zadeh ; Ismail Mohd Noor

Malaysian Journal of Nutrition.2020;26(No.1):1-18. doi:https://doi.org/10.31246/mjn-2019-0042

Introduction: The Malaysian society is undergoing rapid modernisation. The emerging middle class in Malaysia is influencing the lifestyles and traditional food habits of the main three ethnics (i.e. Malays, Chinese, and Indians). This article studied the impact of compressed modernisation on food in a multicultural context. The Malaysian Food Barometer (MFB), published in the year 2014, focuses on the socio-cultural determinants of food habits in Malaysia. Methods: The methods applied in the study were qualitative and quantitative surveys of the food barometers developed at the national level to study the transformation of eating habits. The surveys studied the socio-economic, demographic, and cultural determinants of food consumption, as well as identifying their possible influences on health issues. Results: The results showed two major distinguishing characteristics of Malaysian food patterns, i.e. linking with Malaysia’s multi-ethnicity background and the high frequency of foods consumed outside of home by the urban population. Conclusion: The article concluded that like many societies in transition, Malaysia has to face a rise in the prevalence of overweight. However, with its multicultural characteristics, it becomes a privileged empirical field of observation for the analysis of modernisation modalities of diet models among different ethnic groups.

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Understanding barriers towards the use of food labels among Saudi female college students

Al-Barqi R ; Al-Salem Y ; Mahrous L ; Abu Abat E ; Al-Quraishi R ; Benajiba N

Malaysian Journal of Nutrition.2020;26(No.1):19-30. doi:https://doi.org/10.31246/mjn-2019-0117

Introduction: A food label is an important tool that provides nutritional information which influences consumers by promoting awareness on their diet and improving health status. This study aimed to assess nutrition knowledge level, food label usage, and the barriers that hinder the use of food labels among students in Health Colleges at the Princess Nourah Bint Abdulrahman University (PNU). Methods: A cross-sectional study was conducted among Health College students at PNU in Riyadh (Saudi Arabia). A total of 572 participants were interviewed through a validated questionnaire on social demographic characteristics, nutrition knowledge level, food label use, and barriers that hinder food label use. Statistical analysis was performed using SPSS (version 21), with statistical significance set at p-value <0.05. Results: Only 27.4% of the participants stated that they always or usually use food labels when purchasing food products. Majority of the participants (59.4%) had moderate nutrition knowledge. Factors significantly associated to food label use were nutrition knowledge (R2=0.21), attitude towards health value of the products (R2=0.35), and taste (R2=-0.22). About 41.0% of the participants indicated that time constraint was the main barrier for not using food labels, followed by no interest (31.3%), no need (27.8%), and difficult to use (24.8%). Conclusion: This study found that food label use was low among the participants. Nutrition knowledge supported food label use while time constraint was the main barrier that hindered the use of food label among them. Raising students’ nutrition knowledge level through nutrition education programmes could promote food label use.

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The role of public health dietary messages and guidelines in tackling overweight and obesity issues

Yi Yi Lee ; David Tan ; José ; Siri ; Barry Newell ; Yi Gong ; Katrina Proust ; Terry Marsden

Malaysian Journal of Nutrition.2020;26(No.1):31-50. doi:https://doi.org/10.31246/mjn-2019-0084

Overweight and obesity in Malaysia pose serious threats to health. Prevalence has escalated to alarming levels in recent decades despite a multitude of public health dietary messages geared towards obesity prevention and health promotion. Gaps between health messages, messengers, and the public must be identified and closed to effectively combat obesity and overweight. This review article aims to examine public health dietary messages, guidelines, and programmes for the prevention of obesity in Malaysia, and explore potential reasons for the continued rise in its prevalence. Public health dietary communication in Malaysia has progressed and improved substantially over the years. However, most messages have been designed for the general audience, with little consideration of differences in physical, social, cultural, and environmental backgrounds, and varying levels of comprehension. We offer several recommendations to increase the effectiveness of public health dietary messages in fighting the obesity epidemic, based on a cross-sectoral, place-based approach that recognise the complexity of the underlying causes of obesity.

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Development of a new questionnaire to assess childcare providers’ KAP regarding infant and young child feeding

Najihah Mahfuzah Zakria ; Tengku Alina Tengku Ismail ; Wan Nor Arifin Wan Mansor ; Zaharah Sulaiman ; Tengku Fatimatul Tengku Hassim

Malaysian Journal of Nutrition.2020;26(No.1):51-63. doi:https://doi.org/10.31246/mjn-2019-0113

Introduction: The integration of infant and young child feeding into childcare settings is important to the overall wellbeing of a community. To our knowledge, there is no questionnaire at the national context specifically on the knowledge, attitude and practice (KAP) of infant and young child feeding among childcare providers. Preexisting questionnaires are unsatisfactory due to different target populations and validation approaches. This study aims to develop a new questionnaire for assessing the KAP regarding infant and young child feeding among childcare providers in Malaysia. Methods: A new questionnaire on childcare providers’ KAP was developed using literature review, expert opinions, and a theoretical framework. It was developed using a modified Delphi technique in five phases: 1. Identification of the domains, 2. Verification of the identified domains, 3. Definition of the domains, 4. Identification of relevant and representative items for each domain, and 5. Final verification of the domains and items, followed by a pre-survey evaluation. Results: The final items were verified by experts with references to relevant literatures, other questionnaires, and experts’ experiences. A total of 236 items were selected after consideration of their relevancy and representativeness: 104, 90, 42 items addressing knowledge, attitude, and practice, respectively. The questionnaire was named Borang Kaji Selidik Pemakanan Bayi dan Kanak-kanak dalam kalangan Pengasuh, or IYCFCCPQ. Conclusion: The IYCF-CCPQ is a newly developed questionnaire to measure childcare providers’ KAP regarding infant and young child feeding.

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Determination of glycaemic response of a novel cane sugar product incorporated with Phyllanthus emblica and Zingiber officinale extracts

Chathuranga Hasithi Samarasinghe ; Madhura Arunoda Jayasinghe ; Senadheera Pathirannehelage Anuruddhika Subhashinie Senadheera ; Isuru Wijesekara ; Binosha Fernando ; Kamburawala Kankanamge Don Somathilaka Ranaweera ; Nirodha Heshan Bandara Wilamune

Malaysian Journal of Nutrition.2020;26(No.1):65-76. doi:https://doi.org/10.31246/mjn-2019-0063

Introduction: The use of natural plant extracts to reduce blood glucose response has been practised from ancient times, although their industrial applications are rare. For the convenience of typical cane sugar consumers, selected tropical plant extracts were incorporated with cane sugar to make a low glycaemic sugar product. Methods: This study compared the glycaemic responses of a commercially available product (Product 1) containing seven herbal extracts; fenugreek (Trigonella foenumgraecum), turmeric (Curcuma longa), black pepper (Piper nigrum), ginger (Zingiber officinale), cinnamon (Cinnamomum verum), gooseberry (Phyllanthus emblica) and pomegranate (Punica granatum) against a novel product (Product 2) that was made by incorporating only two plant extracts that were cheaper and readily available in the local market - gooseberry (Phyllanthus emblica) and ginger (Zingiber officinale). Extracts were incorporated with cane sugar to make a series of crystallised solid sugar products and the formulae with the best sensory attributes was selected (Product 2). The glycaemic indices of both products were determined by standardised methodology using 12 healthy volunteers in a randomised crossover study. Results: The mean glycaemic index (GI) value for sugar in Product 1 was 49±9 and in Product 2 was 38±9. Both results elicited significantly (p<0.05) lower GI values than normal cane sugar (GI=65). The novel cane sugar product (Product 2) was far more superior compared to the commercially available product (Product 1) in reducing blood glucose response. Conclusion: Incorporation of suitable herbal extracts to cane sugar and foods like rice and wheat flour may be a suitable option to reduce their glycaemic impact.

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