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: Access to accurate and timely dietary information is of paramount importance in evaluating and developing well-targeted public health nutrition interventions. However, nationwide nutrition surveys are conducted infrequently because they are very costly to design, conduct and analyse. Dietary assessment tools, which are quick and cost- effective, are needed for population research and regular monitoring of Malaysians’ dietary habits. This paper describes the rationale and methodology of the Malaysian Healthy Diet Online Survey (MHDOS) project, which aims to bridge this knowledge gap on dietary intake of Malaysian adults. The main objective of the two-year project is to develop MHDOS as a valid tool to measure compliance with the Malaysian Dietary Guidelines 2020. Methods: The MHDOS project has three study phases, namely (i) adaptation of an online survey and established diet quality scoring system for Malaysia, (ii) usability, validity and reliability testing of the online survey; and (iii) online survey administration in a nationwide study. The survey will be administered to approximately 10,000 Malaysian adults aged 18-59 years. Discussion: MHDOS consists of 38 questions that measures the quantity, quality and variety of foods consumed. Individuals will receive a diet quality score that reflects their overall compliance with the Malaysian Dietary Guidelines and feedback on how to improve their scores. The findings of the online survey, which serve to complement information between larger surveys, will be useful to measure compliance of Malaysians to national dietary guidelines and inform public health interventions.

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: A cross-sectional study was conducted to determine the associations of socio-demographic factors, eating behaviours, fast food purchasing by parents for family meals, and availability of neighbourhood fast-food outlets with BMI-for-age z-score (BAZ) among adolescents. Methods: Through multi-stage stratified cluster sampling method, a total of 420 adolescents from five selected public secondary schools participated in the current study. Data on socio-demographic factors, eating behaviours, and parent’s purchases of fast food were obtained through selfadministered questionnaires. The availability of fast-food outlets was assessed using Geographic Information System (GIS). Body weight and height of the adolescents were measured. Results: The prevalence of overweight, obesity, thinness and severe thinness among adolescents in the present study were 17.6%, 15.5%, 3.1% and 0.7%, respectively. The current findings showed that a higher monthly household income (rs =0.12, p=0.02) and less purchases of fast food by parents for family meals (rs =-0.11, p=0.03) were significantly associated with higher BAZ of the adolescents. However, there were no significant associations between eating outside of home, eating at fast-food restaurants, buying delivery fast food, and availability of neighbourhood fast-food outlets with BAZ. Multiple linear regression showed that less purchases of fast food by parents for family meals significantly contributed towards higher BAZ (β=−0.25, p=0.02). Conclusion: A higher household income and less fast food purchasing by parents were associated with higher BAZ. Fast food purchasing of adolescents were not associated with BAZ. Therefore, an appropriate obesity intervention programme should focus on adolescents and their parents from middle- and high-income households in Labuan.

BACKGROUND/OBJECTIVES: A cross-sectional study was undertaken to evaluate fluid intake and hydration status in association with cognitive function among 230 adolescents (10–14 years of age) in Petaling Perdana, Selangor, Malaysia. SUBJECTS/METHODS: Urine color was used to measure hydration status, while fluid intake was assessed using the 15-item beverage intake questionnaire. Cognitive function was assessed using the Wechsler Intelligence Scale for Children, Fourth Edition. RESULTS: More than half of the adolescents were mildly or moderately dehydrated (59.6%) and only one-third (33.0%) were well hydrated. Among the daily fluid types, intakes of soft drinks (r = −0.180; P = 0.006), sweetened tea (r = −0.184; P= 0.005) and total sugarsweetened beverages (SSBs) (r = −0.199; P= 0.002) were negatively correlated with cognitive function. In terms of hydration status, cognitive function score was significantly higher (F-ratio = 4.102; P= 0.018) among hydrated adolescents (100.38 ± 12.01) than in dehydrated (92.00 ± 13.63) counterparts. Hierarchical multiple linear regression analysis, after adjusting for socio-demographic factors, showed that soft drinks (β = −0.009; P< 0.05) and sweetened tea (β = −0.019; P< 0.05) negatively predicted cognitive function (ΔR 2 = 0.044). When further control for sources of fluid, hydration status (β = −2.839; P< 0.05) was shown to negatively predict cognitive function (ΔR2 = 0.021). The above variables contributed 20.1% of the variance in cognitive function. CONCLUSIONS The results highlight the links between fluid intake (soft drinks, sweetened tea, total SSBs) and hydration status with cognitive function in adolescents. Interventions aimed at decreasing the consumption of SSBs and increasing hydration status through healthy fluid choices, such as water, could improve cognitive performance in adolescents.

Introduction: This paper discussed the effectiveness of “Healthy Kids Programme (HKP)”, specifically in improving the body weight status as well as knowledge, attitude and practice (KAP) of the children. Methods: In this longitudinal intervention study, a total of 12 primary schools in Klang Valley were randomly selected and divided into intervention and control groups. There were 386 standard three children participated at baseline. All children in the intervention group participated in the HKP that was conducted by nutritionists. The evaluations included the pre- and post-Immediate Impact survey (IIS) (every topic), and changes in nutrition KAP survey and anthropometric assessment of the children at the beginning and end of every year for three years. Results: School children in intervention group reported with an increased in the IIS score for each topic and achieved a significantly higher mean nutrition knowledge score than those in the control group over time. There were no significant differences in mean attitude and practice scores between two groups after the intervention. Children in the intervention group had lower rates of overweight and obesity (pre-test: 27.3%; post-test: 32.5%) than their counterpart (pre-test: 26.6%; post-test: 44.0%). Conclusions: The HKP is effective in improving nutrition knowledge of the children. A lower rate of overweight and obesity was observed in intervention group than control group. This approach will contribute towards inculcating healthy eating and active lifestyle habits among Malaysian children that bring about long-term health benefits.

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: Recognising the limitations of present dietary assessments method, recent attention had been drawn to image-based food record (IBFR) to assess dietary intake of the population. Thus, the present study aimed to compare nutrient intake assessed using IBFR with 24-hour diet recall (24DR) among nutrition and dietetics student. Method: There were 46 nutrition and dietetic undergraduates participated in the study, and information on the socio-demographic background and acceptability toward IBFR were obtained. Respondents were trained to complete one-day IBFR, and they were interviewed by researchers on the following day for their 24DR. Result: The mean age of respondents was 21.4±1.7 years old. The present study revealed that there were significantly higher protein and beta-carotene, but lower vitamin C reported by IBFR compared to 24DR. Medium to strong correlations were found between IBFR and 24DR for energy and nutrients intakes. The Bland-Altman analysis demonstrated a good level of agreement between IBFR and 24DR for energy and macronutrients (carbohydrates, protein and fat), respectively. The mean differences between IBFR and 24DR were -36 kcal for total daily energy intake, while mean differences of -12.24g, 0.79g, and 1.52g were reported for carbohydrates protein, and fat, respectively. Moderate level of agreement toward acceptability was demonstrated, and most of them (67.4%) preferred IBFR method. Conclusion: The present study revealed that IBFR showed a good level of agreement with 24DR in assessing nutrient intake. However, more extensive works should be considered to improve IBFR in assessing the energy and nutrients intake for the general population.

BACKGROUND/OBJECTIVES: A large number of studies on anemia have focused mostly on pregnant women or children. The vegetarian population, which is another potential risk group for anemia, remains largely unexplored. Therefore, this cross-sectional study examined the associations of the sociodemographic, lifestyle, nutritional, and psychological factors with the anemia status among female adult vegetarians. SUBJECTS/METHODS: A total of 177 female vegetarians were recruited from a Buddhist and Hindu organization in Selangor, Malaysia. The participants completed a self-administered questionnaire, which analyzed their sociodemographic characteristics, physical activity level, sleep quality, depression, anxiety, and stress. The body weight, height, waist circumference, and body fat percentage of the participants were also measured. A 3-day dietary recall was conducted to assess their dietary intake. Blood samples (3 ml) were withdrawn by a nurse from each participant to determine the hemoglobin (Hb) level. RESULTS: The findings revealed 28.2% of the participants to be anemic. The age group (AOR = 2.46, 95% CI = 1.19–5.05), marital status (AOR = 2.69, 95% CI = 1.27–5.71), and percentage of energy from protein (AOR = 5.52, 95% CI = 1.41–21.65) were the significant predictors of anemia. CONCLUSIONS: Anemia is a public health problem among female vegetarians in this study. Health promotion programs that target female adult vegetarians should be conducted to manage and prevent anemia, particularly among those who are married, aged 50 and below, and with an inadequate protein intake.
Adipose Tissue ; Adult ; Anemia ; Anxiety ; Body Weight ; Child ; Cross-Sectional Studies ; Depression ; Female ; Health Promotion ; Humans ; Life Style ; Malaysia ; Marital Status ; Motor Activity ; Obesity ; Pregnant Women ; Psychology ; Public Health ; Vegetarians ; Waist Circumference