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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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Sugar intake and metabolic syndrome among older adults in Peninsular Malaysia

NurZetty Sofia Zainuddin ; Suzana Shahar ; Nik Shanita Safii ; Hasnah Haron ; Mohd Azahadi Omar

Malaysian Journal of Nutrition.2018;24(2):163-174.

Introduction: Sugar is widely consumed and excessive intake has been associated with increased risk of weight gain, diabetes mellitus and cardiovascular diseases, leading to metabolic syndrome (MetSyn). However, the association between sugar intake and MetSyn has seldom been studied among multi-ethnic Malaysian older adults. Methods: A total of 1,057 respondents aged ≥60 years were recruited through multistage random sampling from selected states. Anthropometric parameters, blood pressure, blood test for sugar and lipid profile were determined. Dietary intake was derived using a 7-day dietary history questionnaire (DHQ) and a semi-quantitative food frequency questionnaire (FFQ) for added sugar intake. Results: Prevalence of MetSyn was 39.9%, 30.9% and 42.2% using the harmonised definition, International Diabetes Federation (IDF) and National Cholesterol Education Program’s Adult Treatment Panel III (NCEP-ATPIII) definitions respectively. Mean total sugar intake was 40.5±32.0 g (8 tsp) and added sugar intake was 33.0±31.0 g (6 tsp). Excessive added sugar consumption at 100th percentile increased risks of high total cholesterol by two-fold (p<0.001) and triglyceride by 1.8 fold (p<0.001). Total sugar intake at 50th percentile increased risk of high blood pressure by 0.68 fold (p<0.05) and total sugar intake at 50th, 75th and 100th percentile increased total cholesterol risk by 1.7 fold (p<0.01), 1.5 fold (p<0.05) and 2.3 fold (p<0.001) respectively. Conclusion: Excessive sugar consumption among older adults showed no association with MetSyn but revealed significant associations with blood pressure and lipid profiles. Effects of long term excessive consumption of sugar on health outcomes in older persons should be investigated.

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Association of socio-demographic characteristics, nutritional status, risk of malnutrition and depression with quality of life among elderly haemodialysis patients

Fatin Izzaty Mohd Shahrin ; Lim Zhi Yu ; Noraida Omar ; Nor Fadhlina Zakaria ; Zulfitri' ; Azuan Mat Daud

Malaysian Journal of Nutrition.2019;25(1):1-11.

Introduction: A compromised quality of life (QOL) as a result of haemodialysis (HD) is a rising global issue. Elderly HD patients face more challenges than younger counterparts. This study determined the association of socio-demographic characteristics, nutritional status, risk of malnutrition and depression with QOL, among elderly HD patients. Methods: A cross-sectional study was conducted among 112 HD elderly patients in selected dialysis centres in Selangor, Malaysia. The patients completed interview-based questionnaires on socio-demographic characteristics, risk of malnutrition (Dialysis Malnutrition Score, DMS), depression (Patient Health Questionaire-9, PHQ-9) and QOL (KDQOL-36). Anthropometric measurements, 24-hour dietary recall and food intake information were obtained from them and biochemical data from their medical records. Results: Just over half (50.9%) of the patients had a normal body mass index while 85.7% had optimal albumin levels. The proportion of patients who met the recommended energy and protein intakes were 19.0% and 3.4%, respectively. Patients were at moderate risk of malnutrition, had minimal depression level and perceived better QOL in terms of effects and symptoms of kidney disease. There was a significant positive correlation between protein intake and the physical domain of QOL (p=0.02) and negative correlation between risk of malnutrition with physical and mental composites of QOL (p<0.001). There was significant negative correlation between depression and physical composite, mental composite, burden, effects and the symptoms of kidney disease (p<0.001). Conclusion: The present findings provide better insight on QOL for future screening, preventive measures and intervention. Further investigation regarding factors associated with QOL among elderly patients is recommended.

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Nutrition governance, good governance for nutrition and nutritional status of children under-five year old in Laguna, Philippines

Leah M M Felismino ; Ma Theresa M Talavera ; Normahitta P Gordoncillo ; Nelson Jose B Querijero

Malaysian Journal of Nutrition.2018;24(3):301-313.

ntroduction: Governance affects nutrition improvement. This study aimed to determine the association between nutrition governance (NG), nutritional status (NS) of children under five years (CU5) and good governance for nutrition (GGN) in Laguna, where malnutrition is a chronic problem. Methods: This crosssectional study obtained data from thirty cities and municipalities (C/M) using desk review and face-to-face interviews. A developed scorecard generated NG and GGN data using 3-point scale with "0" as lowest/absence to "1" indicating partial to "2" as highest/full compliance. Total NG scores was 26 while 38 for GGN. NS was determined using Operation Timbang Plus data. Spearman's rank analysis statistically determined the associations between NG, NS, and GGN. Results: Underweight and wasting prevalence were low (6.1% and 3.4%) while stunting was high (17.7%). The median percentage scores of C/M on NG and GGN were 73.0%±14.0% and 82.0%±24.0%, respectively. Rosa City and Kalayaan had the highest NG score and the lowest underweight prevalence in urban and rural areas, respectively. Significant but negative associations were found between NG and underweight (r=-0.729, p<0.001), and stunting (r=-0.753, p<0.001). Likewise, GGN and underweight (r=-0.488, p=0.006), and stunting (r=-0.380, p=0.046) showed negative associations. Conclusion: C/M in Laguna with higher NG and GGN scores have lower CU5 underweight and stunting prevalence. The study recommended to local governments to invest in establishing separate nutrition unit, hiring technical and administrative staffs, formulating vision and mission, and building capacity on nutrition programme management.

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Stunting trends and associated factors among Indonesian children aged 0-23 months: Evidence from Indonesian Family Life Surveys (IFLS) 2000, 2007 and 2014

Laily Hanifah ; Rifda Wulansari ; Rini Meiandayati ; Endang Laksminingsih Achadi

Malaysian Journal of Nutrition.2018;24(3):315-322.

ntroduction: Stunting in childhood affects cognitive development and may increase the risk of non-communicable diseases in adulthood. Indonesia is the fifth largest contributor of stunting in the world, with a prevalence of 32.9% in children aged 0-2 years in 2013. This study aimed to determine the stunting trend and associated factors between 2000 and 2014. Methods: This study used data from Indonesia Family Life Surveys (IFLS) that have been conducted periodically since 1993. This study focused on households with children aged 0-23 months. Trend analysis used the IFLS data collected in 2000, 2007 and 2014, while bivariate analysis for determination of the different factors associated with stunting used IFLS data in 2000 and 2014. Results: Based on data from 1,263 children in 2000, 1,805 children in 2007, and 1,609 children in 2014, stunting prevalence slightly increased from 29.7% in 2000 to 32.6% in 2014. Significant associations between stunting and children's age, birth weight, mother's education, antenatal care, health sanitation and immunisation status were recorded in 2000. In 2014, stunting was significantly associated with children's age, birth weight, prelacteal food intake, ownership of Mother and Child Health Book and health sanitation status. Conclusion: Stunting in children below 2 years in Indonesia remains high, exceeding 30%. This study identified several contributing factors to stunting. Interventions to address these factors should be undertaken toward reducing stunting among young children in Indonesia.

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Wasting and associated factors among infants aged 0-23 months in 13 provinces in Indonesia: Evidence from Indonesia Family Life Surveys (IFLS) 2000, 2007 and 2014

Rini Meiandayati ; Rifda Wulansari ; Laily Hanifah ; Endang Laksminingsih Achadi

Malaysian Journal of Nutrition.2018;24(3):323-331.

Introduction: Wasting is an acute form of under-nutrition. Frequent occurrence and long-term wasting can lead to stunting. Indonesia has one of the world's highest wasting prevalence of 12.1% and ranked the 4th highest for wasting globally in 2012. Methods: Data from Rand Corp Indonesia Family Life Survey for 2000, 2007 and 2014 were used to examine wasting trend, while data for 2000 and 2014 were used to determine the associated factors of wasting in infants aged 0-23 months. Data was analysed using SPSS. Logistic regression was used to predict the variables contributing to wasting. Results: Wasting prevalence in 2000, 2007 and 2014 were 12.0%, 11.2% and 10.1%, respectively. Birth weight correlated significantly with wasting prevalence in 2000 while in 2014, wasting prevalence correlated significantly with birth weight, birth length, poverty, and ownership of "Mother and Child Health Book". Logistic regression showed that birth weight was an important associated factor in 2000 and 2014, while ownership of "Mother and Child Health Book" was the only important associated factor of birth weight in 2014. Conclusion: The prevalence of wasting among young Indonesian children was lower in 2014 compared to 2000, but is still at a high level. Birth weight consistently remains the significant factor affecting wasting. It is important that the nutritional status of women be taken care of before and during pregnancy for optimal birth outcomes.

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Food intake, nutritional and health status of Filipino adults according to occupations based on the 8th National Nutrition Survey 2013

Divorah Vinluan Aguila ; Glenn Melvin Purisima Gironella ; Mario Villasaya Capanzana

Malaysian Journal of Nutrition.2018;24(3):333-348.

Introduction: The health and nutrition of a country's workforce plays an effective role in the social health and economic status of its society. Methods: This study determined the food intake, nutritional and health status of 69,505 Filipino adults and their households according to occupations using the 8th National Nutrition Survey conducted in 2013 by the Food and Nutrition Research Institute. Occupational grouping was based on the 1992 Philippine Standard Occupation Code. Descriptive statistics such as mean and percentages were generated using the survey module (svy) of Stata 12.0. Results: Chronic Energy Deficiency and anaemia were highest among adults with no occupation (12.3% and 14.8% respectively) and lowest among officials (4.3%) and those with special occupations (4.5%). Overweight, hypertension, high fasting blood sugar and high total cholesterol levels were highest among officials and lowest among farmers and professionals. Farmers had the highest percentage of smokers, alcoholic drinkers and with high physical activity level, while adults with no occupation had the lowest physical activity level. Households headed by special occupation groups had the highest energy intake, while farmers had the lowest protein, iron, vitamin A, thiamine, riboflavin, niacin and fat intakes. Crafts and related trade workers had the lowest percentage of households meeting the energy requirement (27.4%). Conclusion: The food intake, nutrition and health status of Filipino workers in certain occupations were poor, in need of improvement. A national policy on addressing the health, nutrition and welfare of workers is recommended.

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Prevalence of food insecurity and associated factors among freeliving older persons in Selangor, Malaysia

Siti Farhana Mesbah ; Norhasmah Sulaiman ; Zalilah Mohd Shariff ; Zuriyati Ibrahim

Malaysian Journal of Nutrition.2018;24(3):349-357.

Introduction: Older persons are vulnerable to food insecurity. This study aimed to determine the prevalence of food security and associated factors among free-living older persons in Petaling District, Selangor. Methods: A total of 220 free-living older persons aged 60-87 years were selected by using the cluster sampling method in this cross-sectional study. Faceto-face interviews were conducted to obtain information concerning the demographic and socioeconomic background, food security, oral health, and psychosocial status. Chi-square test and binary logistic regression analysis were used to analyse the studied variables. Results: The median age of the respondents was 65.5 years, and 19.5% were found as food insecure. There were significant associations between marital status (Ï‡2=6.818), education level (Ï‡2=6.242), occupation status (Ï‡2=7.540), monthly income (Ï‡2=9.940,), and oral health status (Ï‡2=9.627) with food security status. Those with a low monthly income (AOR=2.449, 95% CI: 1.046-5.732), poor oral health status (AOR: 3.306, 95% CI: 1.387-7.889) and living in rented accommodation (AOR=6.218, 95% CI: 1.458-26.518) were more likely to be food insecure. Conclusion: Respondents with an income lower than the poverty line income (PLI), living in rented accommodation and poor oral health status face increased risk of food insecurity. A nutrition assistance programme is suggested to improve the socioeconomic and food security status of older persons. Regular oral check-ups are recommended to improve the oral health status of the elderly.

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Comparison of maternal nutrition literacy, dietary diversity, and food security among households with and without double burden of malnutrition in Surabaya, Indonesia

Trias Mahmudiono ; Triska Susila Nindya ; Dini Ririn Andrias ; Hario Megatsari ; Qonita Rachmah ; Richard R Rosenkranz

Malaysian Journal of Nutrition.2018;24(3):359-370.

Introduction: Double burden of malnutrition in the form of stunted child and overweight/obese mother has been increasing in countries experiencing nutrition transition. This study aimed to compare maternal nutrition, literacy, dietary diversity, and food security of households categorised by nutritional status of mother-child pairs. Methods: This cross-sectional study included a total of 685 children under 5 years of age from 14 community health centres (posyandu) in a poor urban area of Surabaya, Indonesia. The Lemeshow formula was used to compute sample size. The children and their mothers were categorised into motherchild pairs based on maternal body mass index (BMI) and height-for-age z-score for the child: non-overweight mother-non-stunted child (NM), non-overweight mother and stunted child (SC), overweight/obese mother and non-stunted child (OWT), stunted child and overweight/obese mother (SCOWT). Nutrition literacy was determined using questionnaires, dietary diversity was estimated using household dietary diversity scores, and food security was determined using the Household Food Insecurity Access Scale (HFIAS). Results: The prevalence of households with SCOWT double burden of malnutrition was 21.2%, OWT 37.7%, SC 15.3% and 25.8% were normal (NM). There were significant differences in maternal nutrition literacy, dietary diversity and household food security status. Households with NM pairs were shown to be most food secure followed by OWT, SC and lastly, the SCOWT pairs. Conclusion: Households with double burden of malnutrition have relatively lower nutrition literacy, dietary diversity, and food security. This study indicates the importance of developing nutritional strategies to enable low-income households to make healthy food

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Association between waist circumference at two measurement sites and indicators of metabolic syndrome and cardiovascular disease among Thai adults

Nopphanath Chumpathat Chumpathat ; Chanchira Phosat ; Chavit Uttamachai ; Pornpimol Panprathip ; Karunee Kwanbunjan

Malaysian Journal of Nutrition.2018;24(3):371-380.

Introduction: Waist circumference (WC) is a measure of central obesity, which is an established indicator of the risk of chronic disease. The objective of this study was to investigate the applicability of WC and risk of metabolic abnormality at two frequently used measurement sites in Thailand namely, at the umbilicus level (WC-U) and midway between the lowest rib and iliac crest (WC-M). Methods: Healthy adults aged 35-60 years living in Sung Noen District, Nakhon Ratchasima Province, Thailand were recruited by convenience for the study (N=296). WC was measured at two locations (WC-U and WC-M). Socioeconomic, health-habits, and physical-activity data were collected. Six ml blood samples from each participant were taken for analysis of glucose, lipids and C-reactive protein concentrations. Association between WC-U and WC-M was determined statistically. Results: WC measurements taken at WC-U and WC-M correlated strongly with each other in men (r=0.978, p<0.001), and in women (r=0.873, p<0.001). Both WC-U and WC-M correlated significantly with BMI, blood pressure, triglyceride, and cholesterol levels in both men and women. Intraclass correlation analysis confirmed highly significant associations between these two WC-measurement sites in men (ICC=0.960, p<0.001) and women (ICC=0.808, p<0.001). Conclusion: The results confirmed that both WC-U and WC-M can be used to monitor health status in men and women; however, WC-U is a simpler procedure for community health-risk surveillance and for self-monitoring.

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