Urinary Concentrations of Metals and Metalloids in Malaysian Adults.

Exposure to environmental pollutants in humans can be conducted through direct measurement of biological media such as blood, urine or hair. Assessment studies of metals and metalloids in Malaysia is very scarce although cross-sectional nationwide human biomonitoring surveys have been established by the USA, Canada, Germany, Spain, France, and Korea. This study aims to assess urinary metal levels namely cadmium (Cd), nickel (Ni), lead (Pb) and arsenic (As) among Malaysian adults. This was a cross-sectional study involving 1440 adults between the age of 18 and 88 years old. After excluding those with 24 h urine samples of less than 500 ml, urine creatinine levels < 0.3 or > 3.0 g/L and those who refuse to participate in the study, a total of 817 respondents were included for analysis. A questionnaire with socio-demographic information such as age, gender, occupation, ethnic, academic qualification and medical history was administered to the respondents. Twenty-four-hour urine samples were collected in a container before being transported at 4 °C to the laboratory. Samples were then aliquoted into 15 ml tubes and kept at - 80 °C until further analysis. Urine was diluted ten-fold with ultrapure water, filtered and analysed for metals and metalloids using Inductively Coupled Plasma-Mass Spectrometry (ICP-MS). The geometric mean of urinary As, Ni, Cd and Pb concentrations among adults in Malaysia was 48.21, 4.37, 0.32, and 0.80 µg/L, respectively. Males showed significantly higher urinary metal concentrations compared to females for As, Cd and Pb except for Ni. Those who resided in rural areas exhibited significantly higher As, Cd and Pb urinary concentrations than those who resided in urban areas. As there are no nationwide data on urinary metals, findings from this study could be used to identify high exposure groups, thus enabling policy makers to improve public health strategically.

Salt intake was higher among males and those with high BMI and waist circumference: introduction to the Malaysian Community Salt Survey (MyCoSS), a population-based salt intake survey in Malaysia.

BACKGROUND: Recognising that excessive dietary salt intake is associated with high blood pressure and adverse cardiovascular health, the Ministry of Health Malaysia conducted the Malaysian Community Salt Survey (MyCoSS) among Malaysian adults. This paper introduced MyCoSS projects and presented findings on the salt intake of the Malaysian adult population. METHODS: MyCoSS was a nationally representative survey, designed to provide valuable data on dietary salt intake, sources of salt in the diet, and knowledge, perception, and practice about salt among Malaysian adults. It was a cross-sectional household survey, covering Malaysian citizens of 18 years old and above. Multi-stage-stratified sampling was used to warrant national representativeness. Sample size was calculated on all objectives studied, and the biggest sample size was derived from the knowledge on the effect of high salt on health (1300 participants). Salt intake was estimated using a single 24-h urine collection and its sources from a food frequency questionnaire. Knowledge, attitude, and practice were determined from a pre-tested questionnaire. All questionnaires were fully administered by trained interviewers using mobile devices. Anthropometric indices (weight, height, and waist circumference) and blood pressure were measured using a standardised protocol. Ethical approvals were obtained from the Medical Research Ethics Committee, Ministry of Health Malaysia, and Queen Mary University of London prior to conducting the survey. RESULTS: Findings showed that the average sodium intake of Malaysian adults (3167 mg/day) was higher than the WHO recommendation of 2000 mg/day. Daily intake was significantly higher among males and individuals with higher BMI and higher waist circumference. CONCLUSION: Salt intake in the Malaysian population was higher than the WHO recommendation. MyCoSS's findings will be used for the development and implementation of national salt reduction policy. A successful implementation of a national salt reduction programme in Malaysia will benefit the whole population.

Risk factors related with high sodium intake among Malaysian adults: findings from the Malaysian Community Salt Survey (MyCoSS) 2017-2018.

BACKGROUND: High sodium intake was an established risk factor for stroke and cardiovascular diseases. The objective of this study was to investigate factors associated with high sodium intake based on 24-h urinary sodium excretion from the MyCoSS study. METHODS: The cross-sectional survey was conducted among adults aged 18 years and above in Malaysia. A multi-stage stratified sampling was used to represent nationally. Twenty-four-hour urine was collected from a total of 900 respondents. Indirect ion-selective electrode (ISE) method was used to measure sodium intake. Descriptive and logistic regression analysis was applied to determine factors associated with high sodium intake based on 24-h urinary sodium excretion. RESULTS: A total of 798 respondents (76% response rate) completed the 24-h urine collection process. Logistic regression revealed that high sodium intake associated with obese [aOR 2.611 (95% CI 1.519, 4.488)], male [aOR 2.436 (95% CI 1.473, 4.030)], having a waist circumference of > 90cm for adult males [aOR 2.260 ( 95% CI 1.020, 5.009) and >80cm for adult females [aOR 1.210 (95% CI 0.556, 2.631)], being a young adult [aOR 1.977 (95% CI 1.094, 3.574)], and living in urban areas [aOR 1.701 (95% CI 1.094, 2.645)]. CONCLUSION: Adults who are obese, have a large waist circumference, of male gender, living in urban areas, and belonging to the young adult age group were found to have higher sodium intake than other demographic groups. Hence, reduction of salt consumption among these high-risk groups should be emphasised to reduce the risk of cardiovascular diseases.

Development and double cross-validation of new spot urine sodium equation to predict 24-h urine sodium in the Malaysian population.

BACKGROUND: Monitoring sodium intake through 24-h urine collection sample is recommended, but the implementation of this method can be difficult. The objective of this study was to develop and validate an equation using spot urine concentration to predict 24-h sodium excretion in the Malaysian population. METHODS: This was a Malaysian Community Salt Study (MyCoSS) sub-study, which was conducted from October 2017 to March 2018. Out of 798 participants in the MyCoSS study who completed 24-h urine collection, 768 of them have collected one-time spot urine the following morning. They were randomly assigned into two groups to form separate spot urine equations. The final spot urine equation was derived from the entire data set after confirming the stability of the equation by double cross-validation in both study groups. Newly derived spot urine equation was developed using the coefficients from the multiple linear regression test. A Bland-Altman plot was used to measure the mean bias and limits of agreement between estimated and measured 24-h urine sodium. The estimation of sodium intake using the new equation was compared with other established equations, namely Tanaka and INTERSALT. RESULTS: The new equation showed the least mean bias between measured and predicted sodium, - 0.35 (- 72.26, 71.56) mg/day compared to Tanaka, 629.83 (532.19, 727.47) mg/day and INTERSALT, and 360.82 (284.34, 437.29) mg/day. Predicted sodium measured from the new equation showed greater correlation with measured sodium (r = 0.50) compared to Tanaka (r =0.24) and INTERSALT (r = 0.44), P < 0.05. CONCLUSION: Our newly developed equation from spot urine can predict least mean bias of sodium intake among the Malaysian population when 24-h urine sodium collection is not feasible.

Sodium intake assessed by 24-h urine excretion and its relationship with anthropometric measurements in Malaysian adults.

BACKGROUND: Sodium intake is associated with anthropometric measurement including weight, waist circumference (WC), and body mass index (BMI). Higher intake of sodium is usually linked to higher risk of obesity among adults globally, especially in developing countries. This study aims to explore the probable relationship between sodium intake by 24-h urine excretion assessment and anthropometric measurement of adults in Malaysia. METHODS: A cross-sectional study was conducted from October 2017 to March 2018 using a multi-stage stratified sampling method among Malaysian adults aged 18 years old and above. Sodium intake was determined by 24-h urinary sodium excretion, estimated from the respondents' 24-h urinary sample. Height was obtained based on standard protocol. Weight and WC were measured twice using validated anthropometric equipment and BMI was calculated according to World Health Organization (WHO) 1998 classification. Descriptive analysis was done to describe socio-demographic characteristics. A simple linear regression and multiple linear regression tests were done to assess the relationship of 24-h urinary excretion and anthropometric measurement. All statistical analysis was done using SPSS version 22.0. RESULTS: Of 1047 interviewed respondents, 798 respondents had done the 24-h urine collection (76.0% response rate). Majority was between 40 and 59 years old (43.5%) and married (77.7%). Simple linear regression showed a significant positive linear association between 24-h urinary excretion and household income, WC, and obese group. In the multivariate analysis, it was indicated that, an increase of 1 unit of BMI will significantly increase the sodium intake by 129.20 mg/dl and an increase of 1 cm of WC will significantly increase the sodium intake by 376.45 mg/dl. CONCLUSION: Our study showed a positive significant relationship between sodium intake estimated by 24-h urinary sodium excretion and BMI of Malaysian adults. More research is suggested on how sodium control can potentially contribute to obesity prevention.

Knowledge, attitude and behaviour on salt intake and its association with hypertension in the Malaysian population: findings from MyCoSS (Malaysian Community Salt Survey).

BACKGROUND: High blood pressure or hypertension has become one of the main health problems, worldwide. A number of studies have proven that an increased intake of salt was related to an increased prevalence of cardiovascular diseases. Of late, its relationship with high salt intake has received a lot of attention. Studies in Malaysia have shown both rising hypertension over time as well as high salt consumption. Actions to reduce salt intake are essential to reduce hypertension and its disease burden. As such, we carried out a study to determine associations between knowledge, attitude and behaviour towards salt intake and hypertension among the Malaysian population. METHODS: Data obtained from the Malaysian Community Salt Survey (MyCoSS) was used partially for this study. The survey used a cross-sectional two-stage sampling design to select a nationally representative sample of Malaysian adults aged 18 years and above living in non-institutional living quarters (LQ). Face-to-face interviews were done by trained research assistants (RA) to obtain information on sociodemography, medical report, as well as knowledge, attitude and behaviour of the respondents towards salt intake and blood pressure. RESULTS: Majority of the respondents have been diagnosed with hypertension (61.4%) as well as knowledge of the effects of high salt intake on blood pressure (58.8%). More than half of the respondents (53.3%) said they controlled their salt intake on a regular basis. Those who knew that a high salt diet could contribute to a serious health problem (OR=0.23) as well as those who controlled their salt intake (OR=0.44) were significantly less likely to have hypertension. CONCLUSION: Awareness of the effects of sodium on human health, as well as the behaviour of controlling salt intake, is essential towards lowering the prevalence of hypertension among Malaysians.

Low potassium intake and its association with blood pressure among adults in Malaysia: findings from the MyCoSS (Malaysian Community Salt Survey).

BACKGROUND: High blood pressure or hypertension is well recognized as an important modifiable risk factor for cardiovascular diseases. Several studies had indicated potassium intake has a blood pressure lowering effect. This study aimed to estimate potassium intake via 24-h urinary potassium excretion and to determine the association between potassium intake and blood pressure among adults in Malaysia. METHODS: Data for 424 respondents in this study were drawn from MyCoSS, a nationwide cross- sectional study conducted among Malaysians who were 18 years and above. Respondents were recruited using stratified cluster sampling, covering urban and rural areas in each state in Malaysia. Data collection was undertaken from October 2017 until March 2018. A single urine sample was collected over 24 h for quantification of potassium excreted. Information on socio-demography and medical history of the respondents were collected by interviewer-administered questionnaires. Anthropometric measurements were measured using validated equipment. BMI was estimated using measured body weight and height. Digital blood pressure monitor (Omron HBP-1300) was used to measure blood pressure. Descriptive statistics, analysis of variance (ANOVA), and multivariable linear regression were used to analyze the data in SPSS Version 21. RESULTS: Mean 24-h urinary potassium excretion for the 424 respondents was 37 mmol (95% CI 36, 38). Gender and ethnicity showed statistically significant associations with 24-h urinary potassium excretion. However, potassium excretion was not significantly associated with blood pressure in this study. CONCLUSION: Potassium intake is very low among the adults in Malaysia. Therefore, further education and promotional campaigns regarding daily consumption of potassium-rich diet and its benefits to health need to be tailored for the Malaysian adult population.

Knowledge, perception, and practice related to sodium intake among Malaysian adults: findings from the Malaysian Community Salt Study (MyCoSS).

BACKGROUND: Excessive intake of sodium is a major public health concern. Information on knowledge, perception, and practice (KPP) related to sodium intake in Malaysia is important for the development of an effective salt reduction strategy. This study aimed to investigate the KPP related to sodium intake among Malaysian adults and to determine associations between KPP and dietary sodium intake. METHODS: Data were obtained from Malaysian Community Salt Survey (MyCoSS) which is a nationally representative survey with proportionate stratified cluster sampling design. A pre-tested face-to-face questionnaire was used to collect information on socio-demographic background, and questions from the World Health Organization/Pan American Health Organization were adapted to assess the KPP related to sodium intake. Dietary sodium intake was determined using single 24-h urinary sodium excretion. Respondents were categorized into two categories: normal dietary sodium intake (< 2000 mg) and excessive dietary sodium intake (≥ 2000 mg). Out of 1440 respondents that were selected to participate, 1047 respondents completed the questionnaire and 798 of them provided valid urine samples. Factors associated with excessive dietary sodium intake were analyzed using complex sample logistic regression analysis. RESULTS: Majority of the respondents knew that excessive sodium intake could cause health problems (86.2%) and more than half of them (61.8%) perceived that they consume just the right amount of sodium. Overall, complex sample logistic regression analysis revealed that excessive dietary sodium intake was not significantly associated with KPP related to sodium intake among respondents (P > 0.05). CONCLUSION: The absence of significant associations between KPP and excessive dietary sodium intake suggests that salt reduction strategies should focus on sodium reduction education includes measuring actual dietary sodium intake and educating the public about the source of sodium. In addition, the relationship between the authority and food industry in food reformulation needs to be strengthened for effective dietary sodium reduction in Malaysia.

The prevalence of hypertension among Malaysian adults and its associated risk factors: data from Malaysian Community Salt Study (MyCoSS).

BACKGROUND: Hypertension is one of the most common risk factors for cardiovascular disease and leading cause of mortality globally. The aims of this study were to assess the prevalence of hypertension and its associated risk factors among Malaysian population using data from the Malaysian Community Salt Study (MyCoSS). METHODS: This study was a cross-sectional study using multi-stage stratified sampling method. Data collection was carried out via face-to-face interview at the respondent's home from October 2017 until March 2018. A total of 1047 respondents aged 18 years and above completed the questionnaires and blood pressure measurement. A person who reported diagnosis of hypertension by a physician and had systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg on three readings was categorised as hypertensive. Risk factors of hypertension were analysed using multiple logistic regression. RESULTS: The prevalence of hypertension in the present study was 49.39% (95% CI 44.27-54.51). There was no statistically significant difference in gender. Age, household income, BMI, and diabetes were significantly associated with hypertension. Hypertension found had inverse association with the level of education. Age was the strongest predictor of hypertension (35-44 years old; OR=2.39, 95% CI=1.39-4.09, 45-54 years old; OR=5.50, 95% CI=3.23-9.38, 55-64 years old OR=13.56, 95% CI=7.77-23.64 and 65 years old and above; OR=25.28, 95% CI=13.33-48.66). Those who had higher BMI more likely to be hypertensive as compared to respondents with normal weight (overweight, OR=1.84; 95% CI=1.18-2.86; obese, OR=4.29% CI=2.56-7.29). CONCLUSION: The findings showed that hypertension is prevalent among adults in Malaysia. Those with older age, higher BMI, and diabetes are more likely to have hypertension. Efforts regarding lifestyle modification and education could be important in hypertension management and prevention.

Is socio-demographic status, body mass index, and consumption of food away from home associated with high sodium intake among adults in Malaysia?: findings from the Malaysian Community Salt Survey (MyCoSS).

BACKGROUND: Studies have shown that having away from home meals contributes to high sodium intake among young people and those who lived in urban areas. This study aimed to determine the association between dietary sodium intake, body mass index, and away from home meal consumption behaviour among Malaysian adults. METHODS: MyCoSS was a cross-sectional household survey involving 1440 adults age 18 years and above. This study utilized stratified cluster sampling to obtain a nationally representative sample. Data was collected between October 2017 and March 2018. Socio-demographic information, dietary assessment using food frequency questionnaire (FFQ), and away from home meal consumption were assessed through a face-to-face interview by trained health personnel. Descriptive analysis and logistic regression were applied to identify the association of socioeconomic status and away from home meal consumption with dietary sodium intake. RESULTS: A total of 1032 participants completed the FFQ, with a mean age of 48.8 + 15.6 years. Based on the FFQ, slightly over half of the participants (52.1%) had high sodium intake. Results showed that 43.6% of participants consumed at least one to two away from home meals per day, while 20.8% of them had their three main meals away from home. Participants aged less than 30 years old were the strongest predictor to consume more sodium (adjusted OR: 3.83; 95%CI: 2.23, 6.58) while those of Indian ethnicity had significantly lower sodium intake. Surprisingly, having three away from home meals per day was not associated with high dietary sodium intake, although a significant association (crude OR; 1.67, 95% CI: 1.19, 2.35) was found in the simple logistic regression. Obese participants were less likely to have high dietary sodium intake compared with the normal BMI participants in the final model. CONCLUSION: Over half of the participants consumed sodium more than the recommended daily intake, especially those who consumed three away from home meals. However, there was no significant association between high sodium intake and having three away from home meals per day. The promotion of healthy cooking methods among the public must continue to be emphasized to reduce the dietary sodium intake among Malaysian adults.

Prevalence of chronic kidney disease and its associated factors in Malaysia; findings from a nationwide population-based cross-sectional study.

BACKGROUND: The prevalence of chronic kidney disease (CKD) in Malaysia was 9.07% in 2011. We aim to determine the current CKD prevalence in Malaysia and its associated risk factors. METHODS: A population-based study was conducted on a total of 890 respondents who were representative of the adult population in Malaysia, i.e., aged ≥18 years old. Respondents were randomly selected using a stratified cluster method. The estimated glomerular filtration rate (eGFR) was estimated from calibrated serum creatinine using the CKD-EPI equation. CKD was defined as eGFR < 60 ml/min/1.73m2 or the presence of persistent albuminuria if eGFR ≥60 ml/min/1.73m2. RESULTS: Our study shows that the prevalence of CKD in Malaysia was 15.48% (95% CI: 12.30, 19.31) in 2018, an increase compared to the year 2011 when the prevalence of CKD was 9.07%. An estimated 3.85% had stage 1 CKD, 4.82% had stage 2 CKD, and 6.48% had stage 3 CKD, while 0.33% had stage 4-5 CKD. Hypertension (aOR 3.72), diabetes mellitus (aOR 3.32), increasing BMI (aOR 1.06), and increasing age (aOR 1.06) were significantly associated with CKD. CONCLUSION: Our study has shown that CKD has become one of the leading public health issues in Malaysia. Thus, there is an urgent need to screen for CKD and prevent its progression, associated morbidity, and mortality at the national level.

Weight Change and Its Association with Cardiometabolic Risk Markers in Overweight and Obese Women.

Objectives: To examine the association of weight loss magnitude with changes in cardiometabolic risk markers in overweight and obese women from low socioeconomic areas engaged in a lifestyle intervention. Methods: Analyses were performed on 243 women (mean body mass index 31.27 ± 4.14 kg/m2) who completed a 12-month lifestyle intervention in low socioeconomic communities in Klang Valley, Malaysia. Analysis of covariance (ANCOVA) was used to compare changes of cardiometabolic risk factors across weight change categories (2% gain, ±2% maintain, >2 to <5% loss, and 5 to 20% loss) within intervention and control group. Results: A graded association for changes in waist circumference, fasting insulin, and total cholesterol (p=0.002, for all variables) across the weight change categories were observed within the intervention group at six months postintervention. Participants who lost 5 to 20% of weight had the greatest improvements in those risk markers (-5.67 cm CI: -7.98 to -3.36, -4.27 µU/mL CI: -7.35, -1.19, and -0.59 mmol/L CI: -.99, -0.19, respectively) compared to those who did not. Those who lost >2% to <5% weight reduced more waist circumference (-4.24 cm CI: -5.44 to -3.04) and fasting insulin (-0.36 µU/mL CI: -1.95 to 1.24) than those who maintained or gained weight. No significant association was detected in changes of risk markers across the weight change categories within the control group except for waist circumference and adiponectin. Conclusion: Weight loss of >2 to <5% obtained through lifestyle intervention may represent a reasonable initial weight loss target for women in the low socioeconomic community as it led to improvements in selected risk markers, particularly of diabetes risk.

A Survey on Salt Content Labeling of the Processed Food Available in Malaysia.

Salt content in processed foods is high, and it is usually used as preservatives, stabilizers, and color enhancers in the products. Increased consumption of processed foods in the modern world has contributed to a high salt intake and thus increased the prevalence of hypertension among Malaysian populations. Therefore, this study aimed to identify and compare salt content in processed food products available in supermarkets and determine the percentage of processed food products exceeding the reference value stated in International Product Criteria (2016). The percentage of processed food products without salt and sodium labeling was determined in this study, in which 76.5% of unlabeled processed food products were made in Malaysia, while 23.5% were imported products. The food group with the highest average salt content was gravy and sauce (3.97 g/100 g), followed by soup (2.95 g/100 g), cheese (2.14 g/100 g), meat (1.37 g/100 g), fish (1.25 g/100 g), chicken (1.20 g/100 g), vegetables (1.18 g/100 g), butter and margarine (1.13 g/100 g), breakfast cereal (0.94 g/100 g), savory snacks (0.90 g/100 g), flatbread (0.86 g/100 g), sweet snacks (0.30 g/100 g), and potato (0.29 g/100 g). In addition, 79.5% of butter and margarine products had an average salt content above the reference value stated in the International Product Criteria, followed by gravy and sauce (79.3%), vegetables (72%), soup (50%), fish (49.2%), breakfast cereal (41%), cheese (36.6%), potato (36%), savory and sweet snacks (29.1), meat (12.5%) and chicken products (2.3%). Most processed food products available in local supermarkets were high in salt content.

Association between dietary patterns and overweight risk among Malaysian adults: evidence from nationally representative surveys.

OBJECTIVE: To investigate the association between dietary patterns (DP) and overweight risk in the Malaysian Adult Nutrition Surveys (MANS) of 2003 and 2014. DESIGN: DP were derived from the MANS FFQ using principal component analysis. The cross-sectional association of the derived DP with prevalence of overweight was analysed. SETTING: Malaysia. PARTICIPANTS: Nationally representative sample of Malaysian adults from MANS (2003, n 6928; 2014, n 3000). RESULTS: Three major DP were identified for both years. These were 'Traditional' (fish, eggs, local cakes), 'Western' (fast foods, meat, carbonated beverages) and 'Mixed' (ready-to-eat cereals, bread, vegetables). A fourth DP was generated in 2003, 'Flatbread & Beverages' (flatbread, creamer, malted beverages), and 2014, 'Noodles & Meat' (noodles, meat, eggs). These DP accounted for 25·6 and 26·6 % of DP variations in 2003 and 2014, respectively. For both years, Traditional DP was significantly associated with rural households, lower income, men and Malay ethnicity, while Western DP was associated with younger age and higher income. Mixed DP was positively associated with women and higher income. None of the DP showed positive association with overweight risk, except for reduced adjusted odds of overweight with adherence to Traditional DP in 2003. CONCLUSIONS: Overweight could not be attributed to adherence to a single dietary pattern among Malaysian adults. This may be due to the constantly morphing dietary landscape in Malaysia, especially in urban areas, given the ease of availability and relative affordability of multi-ethnic and international foods. Timely surveys are recommended to monitor implications of these changes.

Factors Associated with High Sodium Intake Assessed from 24-hour Urinary Excretion and the Potential Effect of Energy Intake.

Dietary consumption and other environmental factors are known factors associated with sodium intake. However, little is known about the influence of energy intake on this relationship. The aim of this study was to determine the risk factors associated with high sodium intake assessed from urine sodium excretion and the influence of energy intake. A nationwide, cross-sectional study was conducted from 2015 to 2016 among Malaysian health staff (MySalt 2015). A total of 1027 participants from 1568 targeted participants aged 18 years and older that were randomly selected were included in this study. Sodium intake was determined by measuring sodium excretion in the 24 hr urine test. Dietary, sociodemography, and anthropometry variables as associated risk factors were assessed. Multiple logistic regression models were used to determine the association between high sodium intake (≥2000 mg/day urinary sodium) and potential risk factors. The prevalence of high sodium intake in this study was 70.1% (n=733). High sodium intake was associated with male (OR 1.93, 95% confidence interval (CI) 1.41, 2.64), Bumiputera Sarawak ethnicity (OR 0.24, 95% CI 0.09, 0.62), and energy-adjusted sodium intake (mg/d) (OR 1.19, 95% CI 1.03-1.39). Our results suggested that sex, ethnicity, and energy-adjusted sodium consumption were strong risk factors associated with high sodium intake independent from energy and other potential confounding factors.

Sodium content in sauces-a major contributor of sodium intake in Malaysia: a cross-sectional survey.

OBJECTIVE: To investigate the sodium content in sauces sold in Malaysian supermarkets. METHODS: A cross-sectional market survey was conducted in 2017 of 233 sauces sold in Malaysian supermarkets. Information on the sodium content was collected from the product packaging and nutrient information panels of the sauces sold in the seven top supermarkets in the capital of Malaysia. RESULTS: Of the 233 sauces surveyed, 116 did not include sodium content information on the nutrient information panel (49.8%). Soy sauce (particularly sweet soy sauce) and ketchup (particularly chilli sauce) were found to be the highest number of products surveyed in the analysis (N=54 and N=48, respectively). The highest sodium content information was displayed by fish/prawn sauce (budu/cencalok) (5192±3228 mg/100 g) which was followed by the light/thin soy sauce (5116±2084 mg/100 g), and followed by salty soy sauce (4780±988 mg/100 g). The sodium content information of the imported sauces was higher compared with local products produced in Malaysia. However, for sweet soy sauce, the sodium content information of the local products was higher compared with the imported products. Of the 116 sauces which displayed information regarding their sodium content, only 18.2% of the salty soy sauce and 25% of the light/thin soy sauce were found to be below the 2017 Malaysian sodium guidelines. Furthermore, only 21.7% of chilli ketchup and no tomato ketchup were below the 2017 UK salt guidelines. CONCLUSIONS: Almost half of the sauces surveyed did not include sodium content information on the nutrient information panel. It is recommended that sodium content information is provided on all sauces sold in Malaysia. Also, manufacturers should be urged to reduce the sodium content level of their sauces to a minimum of 5%.

Effectiveness of a community-based intervention for weight loss on cardiometabolic risk factors among overweight and obese women in a low socio-economic urban community: findings of the MyBFF@home.

BACKGROUND: The effectiveness of lifestyle intervention for weight loss on cardiometabolic risk factors among overweight and obese individuals in the community setting remains inconclusive. This study aimed to evaluate the effect of a 6-month weight loss lifestyle intervention on cardiometabolic risk factors among overweight and obese women and the sustainability of the changes in those markers at 12-month follow-up, comparing an intervention group with a control group. METHODS: A total of 243 participants from MyBFF@home were included in this study. Fasting blood samples at baseline, 6- and 12-month were assessed for fasting plasma glucose (FPG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides. The effect of the intervention on cardiometabolic risk markers were investigated within and between study groups using t-test and general linear model (GLM) repeated measure ANOVA. RESULTS: Results from repeated measures ANOVA showed intervention effect only in TC where significant reduction was found in the intervention group (- 0.26 mmol/L [95% CI: - 0.47 to - 0.06], p < 0.01) compared to the control group (- 0.06 mmol/L [95% CI: - 0.28 to 0.17]) at 12 months. At 6 months, TC was reduced significantly in both groups but only intervention group retained the reduction in maintenance phase while, the level increased significantly in the control group (0.22 mmol/L [95% CI: 0.06 to 0.38]). This attributed to significant increase in TC/HDL-C ratio in the control group during maintenance phase (0.32 [95% CI: 0.15 to 0.50], p < 0.001). The intervention group also showed trend of reduction in FPG at 6 months and further decreased during maintenance phase (- 0.19 mmol/L [95% CI: - 0.32 to - 0.06], p < 0.01). At 6 months HDL-C was maintained in the intervention group but reduced significantly in the control group (- 0.05 mmol/L [95% CI: - 0.10 to - 0.01], p < 0.05). No significant difference was detected in both markers when compared between groups. CONCLUSIONS: In the context of low socio-economic communities, this study supports that weight loss related lifestyle modifications over a 6-month period could improve selected cardiometabolic risk factors, particularly fasting glucose, TC and HDL-C in overweight and obese women with favourable sustainability over a 12-month period.

Influence of co-morbidity on body composition changes after weight loss intervention among overweight housewives: a follow-up study of the MyBFF@home.

BACKGROUND: Obesity is a risk factor for co-morbidities such as diabetes, hypertension, osteoarthritis and cardiovascular diseases. However, it is unclear if the presence of co-morbidities has any effect on the magnitude of body composition changes following weight reduction programmes. Thus, this study aimed to determine changes in body composition among obese housewives with and without co-morbidities after they participated in a weight loss intervention. METHODS: This is a follow-up study among 84 obese housewives without co-morbidities aged 18 to 59 years old who previously participated as a control group (delayed intervention, G1) in the My Body is Fit and Fabulous at Home (MyBFF@home) Phase II. Baseline data were obtained from 12 month data collection for this group. A new group of 42 obese housewives with co-morbidities (G2) were also recruited. Both groups received a 6 month intervention (July-December 2015) consisting of dietary counselling, physical activity (PA) and self-monitoring tools (PA diary, food diary and pedometer). Study parameters included weight, height, waist circumference, blood pressure and body compositions. Body compositions were measured using a bioelectrical impedance analysis device, Inbody 720. Descriptive and repeated measures ANOVA analyses were performed using SPSS 21. RESULTS: There were reductions in mean body fat, fat mass and visceral fat area, particularly among obese women without co-morbidities. There were also decreases fat and skeletal muscle from baseline to month six with mean difference - 0.12 (95% CI: -0.38, 0.14) and visceral fat area from month three to month six with mean difference - 9.22 (- 17.87, - 0.56) for G1. G2 showed a decreasing pattern of skeletal muscle from baseline to month six with mean difference - 0.01(95% CI: -0.38, 0.37). There was a significant difference for group effect of visceral fat area (p < 0.05) with mean difference of - 11.49(95% CI: -20.07, 2.91). It showed that the intervention programs was effective to reduce visceral fat area compared to other part of body composition. CONCLUSION: Obese participants without co-morbidities showed more desirable changes in body composition. Visceral fat area was reduced regardless of morbidity status. Weight management efforts are therefore not as straightforward in those with co-morbidities compared to those without, and require thorough and tailor-made strategies for a better chance of success.

Prediction of body fat loss in relation to change in nutrient intake among housewives participating in the MyBFF@home study.

BACKGROUND: Diet compositions are likely to be one of the influential factors for body fat deposition. The aim of this paper was to determine the nutrient changes and its association to body fat loss among the overweight and obese housewives in the MyBFF@home study. METHODS: Data of participants in the MyBFF@home study (intervention and control groups) were analysed. Participants in the intervention group received personalised dietary counselling consisted of reduced calorie diet 1200-1500 kcal/day, while the control group was assigned to receive women's health seminars. The dietary assessment was done during the intervention phase at baseline, 1 month (m), 2 m, 3 m and 6 m using a 3-day food diary. Body fat was measured using a bioelectrical impedance analyser (In-body 720) at baseline and at the end of the intervention phase. The mean differences of nutrient intake and body compositions during the intervention phase were measured with paired t-test. The changes in body fat and nutrients intake were calculated by subtracting baseline measurements from those taken at 6 months. Multiple linear regression analysis was conducted to determine the extent to which the changes in each gram of nutrients per 1000 kcal were predictive of changes in body fat mass. RESULTS: There were significant reductions in energy, all macronutrients, dietary fibre, calcium and iron intake in both study groups after the intervention phase (p <  0.05). In the intervention group, body fat loss increased with the reduction of each gram of carbohydrate, protein and fat per 1000 kcal, (p <  0.05), and decreased with the reduction of each gram of calcium and fibre intake per 1000 kcal (p <  0.05). In the control group, body fat loss increased with the reduction of each gram fat per 1000 kcal (p <  0.05) and decreased with the reduction of each gram iron per 1000 kcal. CONCLUSION: Changes in the intake of various nutrients have different effects on body fat loss between the intervention and control group.

An introduction to the My Body is Fit and Fabulous at home (MyBFF@home): a community-based weight loss intervention study among Malaysian housewives.

BACKGROUND: The national prevalence of overweight and obesity in Malaysia has been increasing in the past 10 years and many efforts have been implemented by the Malaysian government to combat obesity problem among the Malaysian population. The aim of this paper was to describe the background of the My Body is Fit and Fabulous at home (MyBFF@home) study (Phase II). DISCUSSION: The MyBFF@home (Phase II) was a quasi-experimental study and it was conducted among overweight and obese housewives living in the urban areas in Malaysia. In this phase, the study involved a weight loss intervention phase (6 months) and a weight loss maintenance phase (6 months). The intervention group received a standard weight loss intervention package and the control group received group seminars related to women's health. Measurements of weight, height, waist circumference, body composition, fasting blood lipids, dietary intake, physical activity, health literacy, body pain and quality of life were conducted during the study. Overweight and obese housewives from 14 People's Housing/Home Project (PHP) in Federal Territory of Kuala Lumpur (Klang Valley) were selected as control and intervention group (N = 328). Majority of the participants (76.1%) were from the low socioeconomic group. Data were analysed and presented according to the specific objectives and the needs for the particular topic in the present supplement report. CONCLUSION: MyBFF@home is the first and the largest community-based weight loss intervention study which was conducted among overweight and obese housewives in Malaysia. Findings of the study could be used by the policy makers and the researchers to enhance the obesity intervention programme among female adults in Malaysia.