Changes in health-related lifestyles and food insecurity and its association with quality of life during the COVID-19 lockdown in Malaysia.

BACKGROUND: The pandemic of SARS CoV2 virus has severely impacted the entire world population. The lockdown imposed during the pandemic has created enormous challenges particularly on the health, economic and social life of most individuals. This study aimed to investigate the changes in health-related lifestyle and food security during the lockdown and how they influenced the quality of life (QoL) of Malaysian adults. METHODS: An online survey using a structured questionnaire consisting of sociodemographic, body weight, diet quality, physical activity, sleep quality, food insecurity, and QoL was conducted among adult respondents across Malaysia. Multivariate linear regression analyses were conducted to assess the associations between the changes in each component and QoL based on the total score before and during the lockdown. RESULTS: A total of 759 valid responses were included in the final analysis (75% female and 24.5% male). There was a significant improvement in diet quality during the lockdown while sleep quality and food insecurity worsened significantly. As for physical activity, metabolic equivalents (METs) in moderate activity increased significantly, whilst there was a significant decrease in the METs in walking and total minutes spent on physical activity during the lockdown. Overall, independent of age, gender, ethnicity, and religion, there were significant associations between QoL during lockdown and changes in BMI, METs of moderate activity, sleep quality, and food insecurity. CONCLUSIONS: The unprecedented COVID-19 outbreak and the lockdown measure during the pandemic have caused significant negative changes in health-related lifestyles and affected the QoL of Malaysian adults. Despite the new norms and rules to prevent disease transmission, efforts to maintain a healthy lifestyle and food security among the population must be rolled out to improve the QoL and prevent further adverse mental and physical health outcomes.

Prevalence of metabolic syndrome among breast cancer survivors in East Coast of Peninsular Malaysia.

BACKGROUND: To date, limited data are available on metabolic syndrome prevalence among breast cancer survivors in Malaysia. Therefore, this study was conducted to determine the prevalence of metabolic syndrome and abnormal metabolic syndrome components among breast cancer survivors in East Coast of Peninsular Malaysia. METHODS: This cross-sectional study included 95 breast cancer survivors (age 53.7 ± 7.6 years) who have completed main cancer treatments for ≥6 months. Cancer survivors were recruited from two main government hospitals in Kelantan and Terengganu using a purposive sampling method. RESULTS: According to the Harmonized criteria, the metabolic syndrome prevalence was 50.5%. Among those with metabolic syndrome, the most prevalent abnormal metabolic components were triglycerides (91.2%), fasting blood glucose (79.6%) and HDL-c level (78.4%). Except for total cholesterol and LDL-c, all other metabolic syndrome components were significantly different (p < 0.05) between those with and without metabolic syndrome. Significant differences between metabolic syndrome and non-metabolic syndrome groups were found for weight, BMI, waist circumference, body fat percentage and cancer stages (p < 0.05). However, no significant relationship was reported between sociodemographic, clinical parameters and metabolic syndrome among breast cancer survivors in this study. CONCLUSIONS: Metabolic syndrome was highly prevalent among breast cancer survivors. It is recommended for health care professionals to closely monitor and improve the triglycerides, blood glucose and HDL-c level of the breast cancer survivors under their care to control the detrimental effect of metabolic syndrome.

Obesity determinants among Malaysian 12-year old school adolescents: findings from the HAT study.

BACKGROUND: Childhood obesity has been associated with increased odds of adult obesity and co-morbidities in later life. Finding the key determinants may help in designing the most appropriate and effective interventions to prevent obesity. This study aimed to identify the determinants of obesity among school adolescents in a sub-urban state of Malaysia. METHODS: This cross-sectional study involved 1,404 school adolescents aged 12 years (46% boys and 54% girls). Socio-demographic, dietary and physical activity data were collected using questionnaires whilst body weight and height were measured and body mass index was classified based on WHO BMI-for-age Z-scores cut-off. RESULTS: A multivariable linear regression model showed that BMI z-score was positively associated with parents' BMI (P<0.001), birth weight (P=0.003), and serving size of milk and dairy products (P=0.036) whilst inversely associated with household size (P=0.022). Overall, 13.1% of the variances in BMI Z-scores were explained by parents' BMI, birth weight, servings of milk and dairy products and household size. CONCLUSION: This study found important determinants of body weight status among adolescents mainly associated with family and home environmental factor. This evidence could help to form the effective and tailored strategies at the earliest stage to prevent obesity in this population.

Relationship of objectively measured physical activity and sedentary behaviour with health-related quality of life among breast cancer survivors.

BACKGROUND: Lack of physical activity throughout one's lifetime has been associated with obesity and it is also an important risk factor of breast cancer. This study aimed to determine the relationship between objectively measured physical activity and sedentary behaviour with health-related quality of life (HRQoL) among breast cancer survivors in the East Coast region of Peninsular Malaysia. METHODS: A cross-sectional study involving 83 breast cancer survivors was carried out in two main government referral hospitals in the region. Participants wore the ActivPAL3™ microdevice physical activity monitor for seven consecutive days. The validated European Organization for Research and Treatment of Cancer Quality of Life Questionnaires (EORTC QLQ-C30) and Breast Cancer Supplementary Measure (EORTC QLQ-BR23) were used to measure their HRQoL. Multiple linear regression analysis was conducted to determine the relationship between objectively measured physical activity and sedentary behaviour with HRQoL. RESULTS: Longer time spent on moderate to vigorous physical activity (MVPA) was significantly associated with an improvement of HRQoL (p = 0.039) whereas longer time spent on sedentary behaviour significantly reduced the functioning score (p = 0.005). In addition, prolonged sedentary bouts were also significantly associated with better body image that led to improved HRQoL (p = 0.013). CONCLUSIONS: The study findings suggest that an increase in the time spent on MVPA was associated with improved HRQoL while sedentary behaviour was associated with poorer HRQoL among breast cancer survivors. Thus, it is essential to displace sedentary behaviour with MVPA to improve the quality of life of breast cancer survivors.

Correction to: Relationship of objectively measured physical activity and sedentary behaviour with health-related quality of life among breast cancer survivors.

An amendment to this paper has been published and can be accessed via the original article.

Determination of calorie and protein intake among acute and sub-acute traumatic brain injury patients.

PURPOSE: Malnutrition is a common problem among hospitalized patients, especially among traumatic brain injury (TBI) patients. It is developed from hypermetabolism and the condition may worsen under the circumstance of underfeeding or incompatible dietary management. However, the data of nutrient intake especially calorie and protein among TBI patients were scarce. Hence, this study aimed to determine the calorie and protein intake among acute and sub-acute TBI patients receiving medical nutrition therapy in hospital Sultanah Nur Zahirah, Terengganu. METHODS: This observational study involved 50 patients recruited from the neurosurgical ward. Method of 24 h dietary recall was utilized and combined with self-administered food diaries for 2-8 days. Food consumptions including calorie intake and protein intake were analyzed using Nutritionist PRO™ (Woodinville, USA) and manual calculation based on the Malaysian food composition database (2015). RESULTS: Patients consisted of 56% males and 44% females with the median age of 28.0 (IQR = 22.8-36.5) years, of which 92% were diagnosed as mild TBI and the remaining (8%) as moderate TBI. The Glasgow coma scale (GCS) was adopted to classify TBI severity with the score 13-15 being mild and 9-12 being moderate. The median length of hospital stay was 2 (IQR = 2.0-3.3) days. Calorie and protein intake improved significantly from day 1 to discharge day. However, the intake during discharge day was still considered as suboptimal, i.e. 75% of calorie requirement, whilst the median protein intake was only 61.3% relative to protein requirement. Moreover, the average percentages of calorie and protein intakes throughout hospitalization were remarkably lower, i.e. 52.2% and 41.0%, respectively. CONCLUSION: Although the calorie and protein intakes had increased from baseline, hospitalized TBI patients were still at a risk to develop malnutrition as the average intakes were considerably low as compared to their requirements. Optimum nutrient intakes especially calorie and protein are crucial to ensure optimum recovery process as well as to minimize risks of infection and complications.

Impact of liver fat on the differential partitioning of hepatic triacylglycerol into VLDL subclasses on high and low sugar diets.

Dietary sugars are linked to the development of non-alcoholic fatty liver disease (NAFLD) and dyslipidaemia, but it is unknown if NAFLD itself influences the effects of sugars on plasma lipoproteins. To study this further, men with NAFLD (n = 11) and low liver fat 'controls' (n = 14) were fed two iso-energetic diets, high or low in sugars (26% or 6% total energy) for 12 weeks, in a randomised, cross-over design. Fasting plasma lipid and lipoprotein kinetics were measured after each diet by stable isotope trace-labelling.There were significant differences in the production and catabolic rates of VLDL subclasses between men with NAFLD and controls, in response to the high and low sugar diets. Men with NAFLD had higher plasma concentrations of VLDL1-triacylglycerol (TAG) after the high (P<0.02) and low sugar (P<0.0002) diets, a lower VLDL1-TAG fractional catabolic rate after the high sugar diet (P<0.01), and a higher VLDL1-TAG production rate after the low sugar diet (P<0.01), relative to controls. An effect of the high sugar diet, was to channel hepatic TAG into a higher production of VLDL1-TAG (P<0.02) in the controls, but in contrast, a higher production of VLDL2-TAG (P<0.05) in NAFLD. These dietary effects on VLDL subclass kinetics could be explained, in part, by differences in the contribution of fatty acids from intra-hepatic stores, and de novo lipogenesis. The present study provides new evidence that liver fat accumulation leads to a differential partitioning of hepatic TAG into large and small VLDL subclasses, in response to high and low intakes of sugars.

Body weight status of school adolescents in Terengganu, Malaysia: a population baseline study.

BACKGROUND: Body weight is highly associated with overall health status. Being severely thin or obese may impose the risk of many health problems. Early detection of body mass index (BMI) status may help to reduce the associated comorbidities. Although many studies in the literature have investigated the BMI of school adolescents in Malaysia, the data on status of body weight among school adolescents in suburban states like Terengganu is limited. This study aimed to describe the body weight status of the whole population of school adolescents in all seven districts in Terengganu, Malaysia. METHODS: Using a cross-sectional study design, body weight and height were measured, and BMI was calculated and classified using WHO BMI-for-age Z-score. Data was obtained using the National Fitness Standard (SEGAK) assessment, which was uploaded in a specific Health Monitoring System (HEMS). RESULTS: From a total of 62,567 school adolescents, 50.7% were boys and 49.3% were girls. Girls had significantly higher BMI than boys in age groups of 13 to 15 and 16 to 17 years old. Among boys and girls, there were significant differences in mean BMI of school adolescents between rural and urban school locations in all age groups (p < 0.001). There were also significant differences in BMI between boys and girls in all districts in Terengganu, except Kemaman and Kuala Terengganu, for all age groups (p < 0.001). Overall, the prevalence of thinness, normal, overweight and obesity were 8.4, 64.6, 15.0 and 12.0%, respectively. There were significant differences between BMI categories and genders in total participants, and within rural and urban school locations (p < 0.05). In all districts except Marang and Dungun, significant difference was also found between BMI categories and genders. CONCLUSION: The prevalence of thinness, overweight and obesity in Terengganu were substantial. In this study, BMI category was associated with gender, age, school location and district. However, the actual effects of these factors on the prevalence of thinness and obesity among this population demand further investigation.

Association between physical activity and health-related quality of life in children: a cross-sectional study.

BACKGROUND: Research suggests that physical activity plays a role to improve health related- quality of life (QoL), however studies examining the association between physical activity and HRQOL are limited in the paediatric literature. The aim of this study is to explore the relationship between physical activity and HRQoL among Malaysian children. METHODS: Participants (n = 78 normal weight; 78 obese children) aged 9-11 years completed a validated quality of life (QoL) inventory and wore an accelerometer to objectively measure physical activity for 1 week. RESULTS: Psychosocial Health domain and Total QoL (all p < 0.05) were significantly lower for obese compared to normal weight children. Children who spent more time in sedentary behaviour had significantly lower QoL on Psychosocial Health domain and Total QoL except for the Physical Health domain. There was also a strong positive correlation between QoL and moderate-vigorous physical activity (MVPA) indicating that children who are physically active have a better quality of life. CONCLUSIONS: Physical activity promotion should be emphasised to improve QoL in children.

Effect of diet-induced weight loss on iron status and its markers among young women with overweight/obesity and iron deficiency anemia: a randomized controlled trial.

Introduction: Obesity and iron deficiency are prevalent health problems that affect billions of people all over the world. Obesity is postulated to relate to iron deficiency via reduced intestinal iron absorption due to increased serum hepcidin level, which is mediated by chronic inflammation. Weight loss in individuals with overweight or obesity and iron deficiency anemia is believed to be associated with an improvement in iron status however the evidence from clinical trials is scarce. This study was conducted to evaluate the effect of diet-induced weight loss on iron status and its markers among young women with overweight/obesity and iron deficiency anemia. Methods: The study design was a single-blinded, randomized controlled trial with two parallel arms (weight loss intervention vs control). Study participants were recruited using the convenience sampling method through public advertisements posted and disseminated through social media. Interested and potential participants were asked to visit the Diet Clinic for eligibility screening. A total of 62 women were recruited and randomized into weight loss intervention and control group. The intervention duration was three months. The intervention group received individual consultation sessions with the dietitian and tailored energy-restricted diets. Physical activity levels, dietary intake, anthropometric measurements and clinical markers were measured at baseline and end of the trial. Results: There was a significant decrease (p < 0.001) in body weight of the intervention group (-7.4 ± 2.7 kg) that was associated with significant improvements in iron status and its markers (p < 0.01). The intervention group experienced a significant increase in hemoglobin (0.5 ± 0.6 g/dL), serum ferritin (5.6 ± 5.8 ng/mL), and serum iron (13.0 ± 16.2 µg/dL), and a significant decrease in high-sensitivity C-reactive protein (-5.2 ± 5.6 mg/L), and serum hepcidin level (-1.9 ± 2.2 ng/mL) at the end of the trial. Conclusion: Our findings indicate that diet-induced weight loss among participants was associated with an improvement in iron status and its related clinical markers. Clinical Trial Registration: [https://www.thaiclinicaltrials.org/show/TCTR20221009001], identifier [TCTR20221009001].

A Qualitative Exploration of Weight Loss Experiences through Hypnotherapy.

Hypnotherapy has been gaining recognition as an alternative treatment for excess weight problems. This qualitative study aims to explore individuals' experiences of losing weight through hypnotherapy and their perceived barriers and facilitators for healthy lifestyle changes. Semistructured interviews were conducted with 15 participants (11 women and 4 men; mean age of 23 years) who recorded having lost ≥5% weight after undergoing 3 hypnotherapy sessions previously at a public university in Terengganu, Malaysia. Each interview was audiotaped, transcribed, and analyzed using thematic analysis. The themes that emerged were the usefulness of hypnotherapy, barriers, and facilitators of healthy lifestyle changes. All participants contended that hypnotherapy played a role in their weight-loss journey through increased mindful eating and enhanced motivation to make lifestyle modifications. Barriers to healthy lifestyle changes included high costs of healthy foods and lack of support for healthy food sources in social and family settings. Hypnotherapy is essential as an adjunct tool in assisting weight loss. However, additional efforts are needed to improve support in the weight management journey.

Clinician resistance to broaching the topic of weight in primary care: Digging deeper into weight management using strong structuration theory.

Clinical trials have shown that providing advice and support for people with excess weight can lead to meaningful weight loss. Despite this evidence and guidelines endorsing this approach, provision in real-world clinical settings remains low. We used Strong Structuration Theory (SST) to understand why people are often not offered weight management advice in primary care in England. Data from policy, clinical practice and focus groups were analysed using SST to consider how the interplay between weight stigma and structures of professional responsibilities influenced clinicians to raise (or not) the issue of excess weight with patients. We found that general practitioners (GPs) often accounted for their actions by referring to obesity as a health problem, consistent with policy documents and clinical guidelines. However, they were also aware of weight stigma as a social process that can be internalised by their patients. GPs identified addressing obesity as a priority in their work, but described wanting to care for their patients by avoiding unnecessary suffering, which they were concerned could be caused by talking about weight. We observed tensions between knowledge of clinical guidelines and understanding of the lived experience of their patients. We interpreted that the practice of 'caring by not offering care' produced the outcome of an absence of weight management advice in consultations. There is a risk that this outcome reinforces the external structure of weight stigma as a delicate topic to be avoided, while at the same time denying patients the offer of support to manage their weight.

Trends in weight loss attempts among children in England.

OBJECTIVES: To describe trends in reported weight loss attempts among school-aged children and to investigate its sociodemographic determinants. DESIGN: We analysed data of children who participated in the Health Survey for England from 1997 to 2016 (n=34 235). This repeated cross-sectional survey reported weight loss attempts and sociodemographic characteristics. Body weight and height were measured by trained interviewers, and body mass index for age z-score was calculated. Multivariable logistic regression was used to investigate the sociodemographic determinants. SETTING: England. PARTICIPANTS: Children (8-17 years). MAIN OUTCOME MEASURES: Weight loss attempts by year, age group, gender, BMI for age z-score, ethnicity and household income. RESULTS: The prevalence of reported weight loss attempts increased significantly from 21.4% (1997-1998) to 26.5% (2015-2016). The increase was significant for boys, older children, Asian children, children from lower income households and in all categories of BMI for age z-score. Significant predictors of weight loss attempts included having overweight (8-12 years old, OR 4.01 (%CI 3.47 to 4.64); 13-17 years old, OR 1.96 (%CI 1.58 to 2.42)) or obesity (8-12 years old, OR 13.57 (%CI 11.94 to 15.43); 13-17 years old, OR 4.72 (%CI 3.94 to 5.66)) as well as being older, girls, from ethnic minority groups or low household income. CONCLUSION: The prevalence of reported weight loss attempts among children is increasing at a faster rate than the rise in excess weight and includes an increasing proportion of children with a 'healthy' weight. The increase in the prevalence of reported weight loss attempts among children is greatest among subgroups with lower baseline prevalence.

Differences in Overweight and Obesity Prevalence among Young Men from Twelve Middle Eastern and Asian Countries Living in Saudi Arabia.

OBJECTIVES: This study was conducted to assess differences in the prevalence of overweight and obesity among young men from twelve Middle Eastern and Asian countries who live in Riyadh, Saudi Arabia. METHODS: This study used a cross-sectional design and was conducted in Riyadh, Saudi Arabia. The body weight and height of 3600 young men (aged 20 to 35 years) were measured using standardized methods. The sociodemographic characteristics of the participants were collected using face-to-face interviews. RESULTS: Overweight and obesity was reported in 48.3% of the study sample; 42.2% were overweight, and 6.2% were obese. The overweight and obesity rate was associated with the nationality of the participants. The lowest rate of overweight and obesity was observed among participants from Bangladesh (19.4%), while the highest rate was reported among participants from Egypt (67.5%). Older age and longer residency duration were associated with overweight and obesity risk among the subjects. CONCLUSION: The outcomes revealed a fairly high prevalence of overweight and obesity among participants. The notable disparity in overweight and obesity rates among participants of different nationalities is confirmed. The risk of overweight and obesity among young men in Saudi Arabia is associated with nationality, age, and residency duration.

Does hypnosis result in greater weight loss compared to conventional approach?

Hypnosis has been increasingly used in recent years as an alternative treatment to maintain well-being. Yet, limited evidence is available regarding its role in weight management, especially in Malaysia. Hence, this quasi-experimental study was conducted to evaluate the effectiveness of hypnosis on weight loss and body composition (body mass index, waist circumference and body fat percentage) among staff and students of a public university in Terengganu, Malaysia. Participants with body mass index (BMI) ≥ 25.0 kg/m2 were randomly assigned to either intervention group (IG = 53) or control group (CG = 54), for 12 weeks. All participants received health education (diet + exercise + behavioral recommendations) with those in IG had additional three hypnotherapy sessions, once a month. Body weight was measured at week 1, 7, and 12 while body compositions were measured at weeks 1 and 12. Descriptive, univariate, and repeated-measures analysis of covariance (ANCOVA) were utilized. A total of 104 participants completed the trial (mean age = 26.28 ± 8.01; female = 82.2%; BMI = 31.39 ± 4.89). A significant weight loss was observed in the intervention (-4.61%) and control (-3.04%) groups (mean difference = -1.57; 95%CI: -2.59, -0.54; p = .003) after 12 weeks. Participants that frequently practiced self-hypnosis lost more weight (-6.27%; t(50) = -5.331, p < .001). Body fat percentage and waist circumference did not significantly change from baseline in both groups. Essentially, the positive outcomes indicated the promising potential of hypnosis as an alternative tool in facilitating weight loss efforts for those in need.

Differences in Overweight and Obesity Prevalence in Middle-Aged Men from Twelve Middle Eastern and Asian Countries Living in Saudi Arabia.

Purpose: This study was conducted to determine differences in overweight and obesity prevalence and the associated sociodemographic variables among middle-aged men from twelve Middle Eastern and Asian countries living in Riyadh, Saudi Arabia. Methods: This is a cross-sectional study. The study sample was chosen randomly using a stratified clustered sampling technique. The weight and height of 1800 middle-aged men (36 to 59 years) from twelve Middle Eastern and Asian countries living in Riyadh, Saudi Arabia, were measured using standardized methods. Face-to-face interviews were used to gather sociodemographic information from participants. Results: Overweight and obesity were reported among 51.9% and 14.7% of participants, respectively. Nationality was a predictor of overweight and obesity. Subjects from Bangladesh and Saudi Arabia had the lowest (41.0%) and highest (85.1%) rates of overweight and obesity, respectively. Increasing age, staying in Saudi Arabia for a longer period, being single, and earning a high monthly income were associated with a significantly higher risk of overweight and obesity among the participants. Conclusion: The findings revealed significant differences in the prevalence of overweight and obesity among participants from different countries living in Saudi Arabia. Sociodemographic variables associated with overweight and obesity among participants were identified.

Association between a dietary pattern high in saturated fatty acids, dietary energy density, and sodium with coronary heart disease.

This study aimed to determine the association between dietary pattern (DP) and coronary heart disease (CHD) among high-risk adults as determined by metabolic syndrome (MetS) criteria in Malaysia. This cross-sectional study involved 365 participants with (CHD = 178; non-CHD = 187) who were recruited from selected health clinics. Dietary intake was measured using a 189-item semi-quantitative foods frequency questionnaire (FFQ) whilst anthropometry and clinical data were measured by trained researcher and biochemical data were obtained from medical records. The reduced rank regression (RRR) method was used to derive DPs scores and binary logistic regression was used to assess the associations between identified DPs and CHD. The main DP found in this study was characterised by "high saturated fatty acid (SFA), high dietary energy density (DED), high sodium". This DP, which is attributed to high consumption of coconut-based dishes, fast foods and snacks, rice dishes, fat spread, seasoning sauces, salted and processed foods, and low intake of fruits, green leafy vegetables, white rice and other vegetables were associated with CHD (OR:1.32, 95% CI:1.03, 1.69) p value = 0.026 when, adjusted for age, sex, race, education level, household income, family history of CHD, marital status, smoking status, physical activity, stress level and BMI. This study suggests that individuals with a DP of high SFA, high DED, and high sodium have a significantly increased likelihood of having CHD compared to those who do not practice this DP.

Association between obesity and iron deficiency (Review).

Obesity is a risk factor for several comorbidities and complications, including iron deficiency anemia. Iron deficiency anemia is a serious global public health problem, with a worldwide prevalence. The high prevalence of obesity in combination with iron deficiency incidence observed in different age and sex categories suggests an association between obesity and iron status. Obesity may disrupt iron homeostasis, resulting in iron deficiency anemia. The association between obesity and iron deficiency may be due to increased hepcidin levels mediated by chronic inflammation. Hepcidin is a small peptide hormone that functions as a negative regulator of intestinal iron absorption. Significant body weight loss in overweight and obese individuals decreases chronic inflammation and serum hepcidin levels, resulting in improved iron status due to increased iron absorption. However, further randomized controlled trials are required to confirm this effect.

'Energy-Dense, High-SFA and Low-Fiber' Dietary Pattern Lowered Adiponectin but Not Leptin Concentration of Breast Cancer Survivors.

Dietary pattern (DP) and its relationship with disease biomarkers have received recognition in nutritional epidemiology investigations. However, DP relationships with adipokines (i.e., adiponectin and leptin) among breast cancer survivors remain unclear. Therefore, we assessed relationships between DP and high-molecular weight (HMW) adiponectin and leptin concentration among breast cancer survivors. This cross-sectional study involved 128 breast cancer survivors who attended the oncology outpatient clinic at two main government hospitals in the East Coast of Peninsular Malaysia. The serum concentration of HMW adiponectin and leptin were measured using enzyme-linked immunosorbent assay (ELISA) kits. A reduced rank regression method was used to analyze DP. Relationships between DP with HMW adiponectin and leptin were examined using regression models. The findings show that with every 1-unit increase in the 'energy-dense, high-SFA, low-fiber' DP z-score, there was a reduction by 0.41 µg/mL in HMW adiponectin which was independent of age, BMI, education level, occupation status, cancer stage, and duration since diagnosis. A similar relationship with leptin concentration was not observed. In conclusion, the 'energy-dense, high-saturated fat and low-fiber' DP, which is characterized by high intake levels of sugar-sweetened drinks and fat-based spreads but low intake of fruits and vegetables, is an unhealthy dietary pattern and unfavorable for HMW adiponectin concentration, but not for leptin. These findings could serve as a basis in developing specific preventive strategies that are tailored to the growing population of breast cancer survivors.