Introduction: Poor appetite is prevalent among older adults and may negatively impact on their overall health. This is especially true for institutionalised residents. Despite this, there is a paucity of research on appetite and its associated factors among institutionalised residents, which signified the present study. Methods: A cross-sectional study was conducted among elderly residents at long-term care facilities in the state of Selangor, Malaysia to ascertain their appetite status and its associated factors. Results: A total of 97 residents with mean age of 74.2±8.4 years old were recruited. They comprised 61.9% females and 38.1% males. More than 50% had poor appetite with early satiety. There were 63.0%, 82.4%, and 94.8% who had poor oral health, poor sleep quality, and depression, respectively. Ethnicity (OR=2.73; 95% CI=1.00-7.44; p=0.049) was the only factor that predicted poor appetite among older adults in long-term care facilities, with Malay residents having poorer appetite than their Chinese and Indian counterparts. Conclusion: The prevalence of poor appetite was high among residents staying at long-term care facilities in Selangor, Malaysia, especially among Malays. This issue deserves further studies to identify the specific underlying factors contributing to poor appetite among older adults from different ethnicities. Acknowledging the high prevalence of poor appetite among older adults and its possible unfavourable outcomes, appropriate nutrition interventions are therefore needed to address this issue among institutionalised elderly.

Introduction: In the recent years, there is remarkable increased in the prevalence of Type 2 Diabetes Mellitus (T2DM) in Middle East countries including Oman. There is good evidence that Mediterranean Diet (MedDiet) is effective over diabetes control and several cardiovascular risk factors in different populations, with little compelling evidence among Omanis. This paper describes the protocol of a wait-list, open labelled, randomized control trial, with its main objective aimed to determine the effectiveness of Mediterranean Diet intervention on glycaemic control and cardiovascular risks among T2DM patients in Oman. Methods: A total of 140 eligible T2DM patients will be recruited. Participants in the intervention group will undergo a six-month MedDiet program comprising of different activities (individual dietary counseling, cooking classes, phone calls and social media messages) while the control group will continue with standard diabetes care. Data collection will be conducted at baseline, after three and six months. The 2 x 3 mixed-design ANOVA will be used to determine the mean changes in outcome variables over the full study period between the two groups. Discussion: Epidemiology studies on nutrition and health had focused on dietary pattern, which provides an opportunity to account for nutrient-nutrient interactions lately. Mediterranean Diet has produced consistent findings on its protective role in diabetes management, with little information on its effectiveness in population outside of Mediterranean basin, including Oman. The outcomes of current study will be used to inform community and health care professionals on the effectiveness and practically of MedDiet on diabetes management.

Introduction: Literatures suggest that insufficient physical activity as one of the contributors to non-communicable chronic diseases; nevertheless, data on the physical activity level is sparsely reported among individuals practising a vegetarian diet in Malaysia. The current study aims to determine the prevalence of insufficient physical activity and its association with socio-demographic factors, lifestyle factors and body weight status among 273 individuals practising a vegetarian diet in Klang Valley, Malaysia. Methods: A set of self-administered questionnaire was distributed to all vegetarians and their data on physical activity was determined using the Global Physical Activity Questionnaire (GPAQ). Results: The average years of practising vegetarianism was 14.2±9.6 years, and most of the vegetarians were practised ovo-vegetarian diet (44.0%). A majority of them were Chinese (54.9%) and female (64.8%), with an average age of 47.5 ± 13.1 years. The prevalence of overweight and obesity were 27.5% and 8.1%, respectively. According to GPAQ, about two in five vegetarians (46.2%) were having insufficient physical activity. Being females, older age, Chinese, married individuals, and those with high total household income level were found to be significantly associated with low physical activity level among Malaysian vegetarians (p<0.05). Conclusion: Since insufficient physical activity is one of the factors contributing to non-communicable chronic diseases, it is crucial to educate the importance of physical activity on overall health status, specifically for those who at risk of physically inactive. In addition, future studies can focus the causal associations based on the currently identified factors and physical activity levels, which can help to develop an effective intervention program among Malaysia vegetarians.

Introduction: Hyperphosphatemia is common among hemodialysis patients, often accompanies with unfavourable clinical outcomes. Several factors affect phosphate compliance among hemodialysis patients, with lack of such information at the local context. Thus, this cross-sectional study aimed to determine the associations of sociodemographic factors, knowledge on optimal control of serum phosphate, perceived social support from family, dietary phosphorus intake and phosphate compliance among hemodialysis patients. Methods: Structured questionnaire was used to obtain information on socioeconomic factors, knowledge, family social support and dietary phosphorus intakes of hemodialysis patients, with serum phosphate level was used as the surrogate marker for phosphate compliance. Results: A total of 76 patients (Mean age of 52 years old) were recruited. Hyperphosphatemia was prevalent with approximately 60% of the patients failed to achieve the target. Approximately 90% of the patients perceived low level of family social support. Young patients had significant higher serum phosphate compared to their older counterparts (r = -0.297, p =0.009). Serum phosphate was positively correlated with dietary intake of phosphorus, dialysis vintage (r = 0.301, p = 0.006) and comorbidity score (r = 0.325, p = 0.008) while negatively correlated with dialysis dose (r = -0.582, p = 0.002) and family social support (r = -0.263, p = 0.024). Conclusion: The promising role of dietary phosphorus intake in managing hyperphosphatemia deserves further attention. Innovative approaches are needed to promote self-adherence on serum phosphate especially the younger patients. It is imperative to promote family social support in the management of hyperphosphatemia among hemodialysis patients.

Introduction: Cognitive decline and cognitive impairment among older adults is a rising public health concern because of its association with increased risk of dementia, disability and mortality. In Malaysia, early identification of cognitive impairment is uncommon due to lack of understanding of risk profile of the elderly population. The objective of this study was to determine factors associated with cognitive impairment among community-dwelling older adults. Methods: This cross-sectional study was conducted among 698 community-dwelling older adults aged 60 years old and above in Klang Valley, Malaysia by using multi-stage sampling to determine the risk factors and predictors of cognitive impairment from a multidimensional approach. Multivariate logistic regression analysis was performed to determine the relationship between socio-demographic characteristics, physical activity, physical functional status and cognitive impairment. Results: Increased of age (OR = 1.056), being female (OR = 2.219) and Indian (OR = 2.722) were the risk factors for cognitive impairment, while years of education (OR = 0.765), physically active (OR = 0.823) and better physical function (OR = 0.843) were significantly associated with decreased risk of cognitive impairment. Marital and nutritional status failed to predict the risk of cognitive impairment. Conclusion: Given the protective effects of physical activity and physical function on the cognitive decline at later age, relevant policymakers should formulate appropriate health education programmes to promote regular physical activity to improve physical and cognitive function among Malaysians across all ages.

Introduction: Poor nutritional status is prevalent among hemodialysis patients, with limited studies available on how it is being influenced by other factors in the local context. The current study aimed to determine the nutritional status and its associated factors among hemodialysis patients. Methods: This was a study undertaken in a total of 455 hemodialysis patients (256 men and 199 women). The main outcome measure was Malnutrition Inflammation Score (MIS), which was utilized to identify nutritional and inflammatory status of the hemodialysis patients. Other evaluation tools included anthropometry and biochemical measurements as well as dietary assessment. Results: A high proportion of hemodialysis patients were malnourished (64.4%) and presented with inflammation (67.5%). Using multiple linear regression analysis, factors contributing to malnutrition were older age, lower lean body mass, higher interdialytic weight gain (IDWG), inadequate intakes of energy and protein, as well as presence of comorbidities and inflammation. Conclusion: The presence of malnutrition and inflammation were prevalent among hemodialysis patients. Several determinants of poor nutritional status of hemodialysis patients were modifiable and should be recognized while formulating and implementing appropriate intervention plans for this vulnerable group.
Hemodialysis

Introduction: The ability to perform daily living activities among the elderly is important, as physical disability may lead to dependency and various public health implications. This study aimed to determine the prevalence of instrumental activities of daily living (IADL) disability and its association with socio-demographic characteristics, dietary intake, social participation, perceived-health-status and risk of falls. Methods: This cross-sectional study was conducted among communitybased elderly in the Gombak District of Selangor. 258 respondents aged 60-88 years old (mean age 66±6.5 years) were recruited through multi-stage proportional sampling. Most of the respondents (88.4%) aged 60-74 years and 11.6% were ≥75 years. IADL disability was determined using an eight-item IADL scale. The presence of IADL disability was defined as needing help in at least one or more of eight-IADL activities. Dietary intake and fall risk were assessed using diet history questionnaire (DHQ) and 21-item fall risk index (FRI-21), respectively. Results: The prevalence of IADL disability among the respondents was 58.1%. A binary logistic regression analyses showed that the following factors predicted IADL disability: advanced age (≥75 years, OR=6.4; 95% CI: 1.3, 30.8), being unmarried (OR=2.5; 95% CI: 1.1, 5.9), unemployed/retired (OR=2.3; 95% CI: 1.2, 4.3), and at risk of falls (OR=2.5; 95% CI: 1.3, 6.1). Conclusion: Predictors such as marriage and employment highlight the importance of social support among elderly. In practical terms, this means that it is incumbent upon caregivers, family members, and the community to provide both physical and emotional support if the functional status of the elderly is to be improved.

Loss of teeth can affect masticatory efficiency in older adults. This may result in avoidance or modifications in foodchoices and lead to lower intake of important nutrients among older individuals. The aim of this study was to determinethe association between tooth loss and body mass index, BMI, among older adults in Kuala Pilah, Negeri Sembilan. Across-sectional study was carried out on 428 older adults aged 50 years and above from selected villages in district ofKuala Pilah. Respondents were interviewed to collect information on their demographic characteristics. Number of toothloss was determined through oral assessment, followed by anthropometric assessment to calculate the BMI of respondents.Findings showed that majority of the respondents were overweight and obese, 40.4% and 19.9% respectively, while onlya small proportion was underweight, 3.9%. The proportion of edentulism (total tooth loss) was 18.3% and majority ofthe older adults had lost more than 12 teeth (77.1%) and less than 4 pairs of occluding posterior teeth (86.0%). Totaland partial tooth loss was found to be not significantly associated with BMI. In relation to the arrangement of teeth,older adults with reduced number of posterior occluding pairs of teeth were more likely to experience unsatisfactoryBMI (OR = 3.61, 95% CI: 1.48, 8.76). This may suggest that functional arrangement of the tooth in the oral cavity is moreimportant than the number of tooth loss alone. Thus, maintaining an optimum number of teeth for chewing is essentialfor maintenance of ideal BMI.

Poor oral conditions among older adults can cause significant impacts to their overall quality of life. Older adults with reduced number of functional teeth and dental diseases may experience difficulty in daily activities like chewing and eating. The aim of this study is to assess the association between oral health and oral health-related quality of life (OHRQoL) among a group of community-dwelling older adults in Negeri Sembilan, Malaysia. A cross-sectional study was carried out on 436 older adults aged 50 years and above from 20 randomly selected villages in the state. Respondents were interviewed using a structured questionnaire to collect information on their demographic characteristics. Clinical oral examination was carried out to determine the oral health conditions of older people. The validated Malay version of Geriatric Oral Health Assessment Index (GOHAI) was used to measure OHRQoL. Total GOHAI score ranged from 12 to 60 with higher scores indicate better OHRQoL. Majority (77.1%) of the older adults had less than 20 teeth and about 18.3% were edentulous (total tooth loss). All dentate respondents had experienced dental caries. The median GOHAI score was 54.5 (IQR 50-57). About 25.5% of the older adults perceived their oral health as good, while 74.5% had poor perception on oral health. Bivariate analysis showed that less than 20 teeth and high dental caries experience were significantly associated with poor OHRQoL. A significantly higher proportion of older adults with less than 20 teeth limit the kinds of food intake, had trouble biting or chewing, and experienced tooth sensitivity. The physical functioning and well-being of the older people may be disrupted due to oral diseases. Measures of OHRQoL are important as to complement the clinical oral findings in identifying treatment needs of the geriatric patients.
elderly ; GOHAI ; oral health ; quality of life

BACKGROUND/OBJECTIVES: Diet plays an important role in growth and development of children. However, dietary intakes of children living in either rural or urban areas can be influenced by household income. This cross-sectional study examined energy, nutrient and food group intakes of 749 urban children (1-10 years old) by household income status. SUBJECTS/METHODS: Children's dietary intakes were obtained using food recall and record for two days. Diet adequacy was assessed based on recommended intakes of energy and nutrients and food group servings. RESULTS: For toddlers, all nutrients except dietary fiber (5.5 g) exceeded recommended intakes. Among older children (preschoolers and school children), calcium (548 mg, 435 mg) and dietary fiber (7.4 g, 9.4 g) did not meet recommendations while percentage of energy from total fat and saturated fats exceeded 30% and 10%, respectively. The mean sodium intakes of preschoolers (1,684 mg) and school children (2,000 mg) were relatively high. Toddlers in all income groups had similar energy and nutrient intakes and percentages meeting the recommended intakes. However, low income older children had lowest intakes of energy (P < 0.05) and most nutrients (P < 0.05) and highest proportions that did not meet recommended energy and nutrient intakes. For all food groups, except milk and dairy products, all age groups had mean intakes below the recommended servings. Compared to middle and high income groups, low income preschoolers had the lowest mean intake of fruits (0.07 serving), meat/poultry (0.78 serving) and milk/dairy products (1.14 serving) while low income toddlers and school children had the least mean intake of fruits (0.09 serving) and milk/dairy products (0.54 serving), respectively. CONCLUSION: Low socioeconomic status, as indicated by low household income, could limit access to adequate diets, particularly for older children. Parents and caregivers may need dietary guidance to ensure adequate quantity and quality of home food supply and foster healthy eating habits in children.
Calcium ; Caregivers ; Child ; Cross-Sectional Studies ; Dairy Products ; Diet ; Dietary Fiber ; Eating ; Family Characteristics* ; Fats ; Food Supply ; Fruit ; Growth and Development ; Humans ; Milk ; Parents ; Social Class ; Sodium