Combined Effect of Dietary Acid Load and Cardiometabolic Syndrome on Bone Resorption Marker among Post-Menopausal Women in Malaysia.

Background: This study aimed to investigate factors associated with bone resorption status and determine the independent and interactive effects of dietary acid load (DAL) and cardiometabolic syndrome (CMS) on bone resorption in post-menopausal women. Methods: Overall, 211 community-dwelling post-menopausal women were recruited from the National Council of Senior Citizens Organization, Malaysia. DAL was estimated using the potential renal acid load from the food frequency questionnaire. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) and smoking behaviour was assessed using the Global Adult Tobacco Survey 2011. Serum 25(OH) vitamin D levels were determined using the ADVIA Centaur vitamin D assay and serum C-terminal telopeptides of type I collagen (CTX1) were used as surrogate markers to assess bone resorption. CMS was determined based on the harmonised criteria. Results: Age (ß = -0.145, t = -2.002, P < 0.05) was negatively associated while DAL (ß = 0.142, t = 2.096, P < 0.05) and sleep quality (ß = 0.147, t = 2.162, P < 0.05) were positively associated with CTX1. Height was positively correlated with CTX1 (r = 0.136, P <0.05). Conversely, other variables (CMS traits, CMS, serum 25(OH) vitamin D level, years of menopause, years of education and physical activity) were not significantly associated with CTX1 levels. There was no significant interaction between DAL and CMS on bone resorption. Conclusion: Our findings propose that high DAL, but not CMS, is a potential risk factor for bone resorption. The analysis did not demonstrate the combined effects of DAL and CMS on bone resorption.

Interactions of genetic and macronutrient intake with abdominal obesity among middle-aged vegetarians in Malaysia.

BACKGROUND AND OBJECTIVES: Evidence for gene-diet interactions is lacking among individuals with specific dietary practices including vegetarians. This study aimed to determine the interactions of rs174547 in the fatty acid desaturase 1 (FADS1) gene with macronutrient such as carbohydrate (particularly fibre), protein and fat intakes on abdominal obesity among middle-aged Malaysian vegetarians of Chinese and Indian ethnicity. METHODS AND STUDY DESIGN: The present cross-sectional study was conducted among 163 vegetarians in Kuala Lumpur and Selangor, Malaysia. Dietary intakes of vegetarians were assessed by using a food frequency questionnaire. Waist circumference of vegetarians was measured by using a Lufkin tape W606PM. Genotypes of the rs174547 of vegetarians were determined by using Agena® MassARRAY. A multiple logistic regression model was used to determine the interactions of the rs174547 with macronutrient on abdominal obesity. RESULTS: About 1 in 2 vegetarians (51.5%) had abdominal obesity. Individuals with CT and TT genotype at T3 intake of carbohydrates, protein, fat and fibre as well as individuals with TT genotype at T2 intake of carbohydrates and protein had higher odds of abdominal obesity (pinteration <0.05). The gene-diet interaction remained significant for fibre intake (OR: 4.71, 95% CI: 1.25-17.74, pinteraction=0.022) among vegetarians with TT genotype at T2 intake of fibre after adjusting for age and sex and considering the effects of ethnicity and food groups. CONCLUSIONS: The rs174547 significantly interacted with fibre intake on abdominal obesity. A specific dietary fibre recommendation based on genetics is needed among Chinese and Indian middle-aged vegetarians.

Dietary Factors and Sleep Quality Among Hemodialysis Patients in Malaysia.

OBJECTIVES: Poor sleep quality is a commonly seen problem in hemodialysis patients. This study investigated the associations between dietary factors and sleep quality among hemodialysis patients. DESIGN AND METHODS: This is a cross-sectional study conducted among 184 eligible hemodialysis patients at four dialysis units in Malaysia. Three days dietary recall were used in the analysis of dietary intake and behavior. Sleep quality was assessed through Pittsburgh Sleep Quality Index. RESULTS: More than half of the patients were poor sleepers. Among the sleep components, sleep latency affected patients the most, with the use of sleep medications was relatively low. A majority of the patients had inadequate dietary intake of energy (88%) and protein (75%). Dietary protein, potassium adjusted for body weight, and sodium intake were significantly increased in poor sleepers. Lower percentage of energy from carbohydrates; higher percentage of energy from fats; higher intakes of dietary protein, fat, phosphorus, and sodium were correlated with poorer sleep quality and its components. Skipping dinner on non-dialysis days and having supper on dialysis days were associated with poor sleep quality. CONCLUSION: Poor sleep is prevalent among hemodialysis patients. Sleep quality of hemodialysis patients was highly associated with certain dietary factors. Periodical assessment of sleep quality and dietary intake is necessary to identify poor sleepers with inappropriate dietary intake to allow effective clinical and nutritional interventions to improve the sleep quality and nutritional status of these patients.

Factors predicting health-related quality of life of the Malaysian B40 school-aged children living in urban-poor flats in the central region of Malaysia.

BACKGROUND AND OBJECTIVES: Health-related quality of life (HRQoL) is a multidimensional concept that indicated an individual's holistic health, whereby the urban-poor community are susceptible to low HRQoL due to their high vulnerability. This study aimed to determine factors that predicted the HRQoL among the urban-poor school-aged children. METHODS AND STUDY DESIGN: This is a cross-sectional study and a total of 408 primary school-aged children (male: 72.3%; female: 27.7%), with a mean age of 9.68±1.48 years, were recruited from 10 urban-poor flats through cluster sampling at the central region of Malaysia. Their anthropometry, nutrition knowledge, attitude and practice, physical activity, dietary practices, and HRQoL were assessed. RESULTS: A quarter (24.5%) of the urban-poor children were either overweight or obese in the present study. The HRQoL total score among the urban-poor children was 65.0±18.5. The result of multiple linear regression analysis shown that higher nutrition attitude (B=0.34, p=0.001) and practices (B=0.39, p=0.001), higher physical activity (B=3.73, p=0.004), higher lunch intake (B=1.35, p<0.001), lower supper intake (B=-1.35, p<0.001), and lower fast-food intake (B=-1.61, -1.17, p<0.001) are the significant predictors of better HRQoL among the urban-poor children (R2=0.32, F(8,399)=23.72, p<0.001). CONCLUSIONS: Future studies should focus on these predictors to formulate interventions that could enhance the HRQoL among the Malaysian urban-poor children.

Association of HTRA1 and ARMS2 gene polymorphisms with response to intravitreal ranibizumab among neovascular age-related macular degenerative subjects.

BACKGROUND: The association of HTRA1 rs11200638 and ARMS2 rs10490924 gene polymorphisms with response to intravitreal ranibizumab therapy among neovascular AMD (nAMD) subjects in Malaysia was determined in this study, followed by the expression of HTRA1 and ARMS2 genes. RESULTS: Both single nucleotide polymorphisms (SNPs) recorded a significant association between nAMD and controls with HTRA1 rs11200638 at P = 0.018 (OR = 1.52, 95% CI = 1.07-215) and ARMS2 rs10490924 at P < 0.001 (OR = 2.44, 95% CI = 1.75-3.42). An association was also observed in response to ranibizumab for both SNPs in a logistic regression analysis (P < 0.001). The mRNA levels in the HTRA1 variant between responder and non-responder groups were significantly different for the homozygous non-risk GG genotype (P = 0.032). CONCLUSIONS: The HTRA1 rs11200638 and ARMS2 rs10490924 gene polymorphisms are associated with nAMD among Malaysians. Both gene polymorphisms were also correlated with response to intravitreal ranibizumab therapy based on visual and anatomical outcomes especially the HTRA1 rs11200638 variant.

Effectiveness of a school-based intervention on knowledge, attitude and practice on healthy lifestyle and body composition in Malaysian adolescents.

BACKGROUND: The 'Eat Right, Be Positive About Your Body and Live Actively' (EPaL) intervention programme was developed to prevent overweight and disordered eating in Malaysian adolescents. This study aimed to evaluate the effectiveness of the EPaL programme on knowledge, attitudes and practices on healthy lifestyle and body composition (body mass index z-score [zBMI], waist circumference [WC] and body fat percentage [BF%]) among adolescents. METHODS: All measures were taken at three time points: before intervention (Pre), after intervention (Post I) and 3 months after intervention (Post II). The intervention group (IG) participated in the EPaL programme for 16 weeks, whereas the comparison group (CG) received no intervention. Seventy-six adolescents (IG: n = 34; CG: n = 42) aged 13-14 years were included in the final analysis. Repeated measures analysis of covariance (ANCOVA) was used to assess the impact of the EPaL intervention programme on the measures between groups (IG and CG) at Post I and Post II. RESULTS: The IG reported significantly higher knowledge scores at both Post I (adjusted mean difference = 3.34; 95% confidence interval [CI] = 0.99, 5.69; p = 0.006) and Post II (adjusted mean difference = 2.82; 95% CI = 0.86, 4.78; p = 0.005) compared with the CG. No significant differences between the IG and CG were found at either Post I or Post II in attitudes, practices, zBMI, WC and BF%. The proportion of participants who were overweight or obese was consistent from Pre to Post II in the IG (35.3%) and increased from 26.2% at Pre to 28.5% at Post II in the CG, but the difference was not statistically significant. The proportion of participants who had abdominal obesity in the IG decreased from 17.6% at Pre to 14.7% at Post II and increased from 16.7% at Pre to 21.4% at Post II in the CG, but the differences were not statistically significant. CONCLUSION: Despite no significant reduction of body composition, this programme shows the positive effect on the adolescents' knowledge regarding healthy lifestyle. This study contributes to the evidence on the effectiveness of school-based health interventions in Malaysian adolescents. TRIAL REGISTRATION: UMIN Clinical Trial Registration UMIN000024349. Registered 11 October 2016.

Association between oral health-related quality of life and nutritional status among older adults in district of Kuala Pilah, Malaysia.

BACKGROUND: Poor oral health has an impact on food choices and intake of important nutrients among older population. The use of oral health-related quality of life instruments along with the clinical dental indicators can help to assess the oral problems that lead to nutritional problems in this group. This study aims to determine the association between oral health-related quality of life (OHRQoL) and nutritional status among a group of older adults in Kuala Pilah district, Malaysia. METHODS: A cross-sectional study was carried out on 446 older adults aged 50 years and above from 20 randomly selected villages. Respondents were interviewed to collect information on their demographic characteristics and oral health perception, followed by physical examination to measure height, weight and body mass index (BMI) of respondents. The validated Malay version of General Oral Health Assessment Index (GOHAI) was used to measure OHRQoL. RESULTS: About one-third (35.8%) of the respondents had normal BMI. Majority of the respondents were overweight (40.4%) and obese (19.9%), while only a small proportion was underweight (3.9%). Mean GOHAI score was 53.3 (SD = 4.7), indicating low perception of oral health. About 81.6% respondents had moderate to low perception of oral health. Logistic regression analysis showed a statistically significant association between the GOHAI and BMI scores (OR = 2.3; p < 0.01). CONCLUSIONS: Oral health-related quality of life was significantly associated with nutritional condition of respondents. Older adults with poor perception of their oral health were more likely to have unsatisfactory BMI compared to those who perceived their oral health to be good.

Serum potassium and handgrip strength as predictors of sleep quality among hemodialysis patients in Malaysia.

BACKGROUND AND OBJECTIVES: Poor sleep quality is prevalent among hemodialysis (HD) patients and leads to adverse health outcomes. This study investigated the association of nutritional parameters with sleep quality among Malaysian HD patients. METHODS AND STUDY DESIGN: A cross-sectional study was conducted among 184 Malaysian HD patients. Anthropometric measurements and handgrip strength (HGS) were obtained using standardized protocols. Relevant biochemical indicators were retrieved from patients' medical records. Nutritional status was assessed using the dialysis malnutrition score. The sleep quality of patients was determined using the Pittsburgh Sleep Quality Index questionnaire on both dialysis and non-dialysis days. RESULTS: Slightly more than half of the HD patients were poor sleepers, with approximately two-third of them having a sleep duration of <7 hours per day. Sleep latency (1.5±1.2) had the highest sleep component score, whereas sleep medicine use (0.1±0.6) had the lowest score. Significantly longer sleep latency and shorter sleep duration were observed in the poor sleepers, regardless of whether it was a dialysis day or not (p<0.001). Poor sleep quality was associated with male sex, old age, small triceps skinfold, hypoproteinemia, hyperkalemia, hyperphosphatemia, and poorer nutritional status. In a multivariate analysis model, serum potassium (ß=1.41, p=0.010), male sex (ß=2.15, p=0.003), and HGS (ß=-0.088, p=0.021) were found as independent predictors of sleep quality. CONCLUSIONS: Poor sleep quality was evident among the HD patients in Malaysia. The sleep quality of the HD patients was associated with nutritional parameters. Routine assessment of sleep quality and nutritional parameters indicated that poor sleepers have a risk of malnutrition and may benefit from appropriate interventions.

Calcium and vitamin D fortified milk reduces bone turnover and improves bone density in postmenopausal women over 1 year.

PURPOSE: In Malaysia, hip fracture incidence is higher in Chinese women than other ethnic groups. This study compared the effects of a high-calcium vitamin D fortified milk with added FOS-inulin versus regular milk over 1 year on aspects of bone health in Chinese postmenopausal women in Malaysia. METHODS: One-hundred and twenty-one women (mean age 59 (± 4) years) were randomized into two groups: control (n = 60; regular milk, 428 mg calcium per day) or intervention (n = 61; fortified milk at 1200 mg calcium, 96 mg magnesium, 2.4 mg zinc, 15 µg vitamin D and 4 g FOS-inulin per day). At baseline, weeks 12, 24, 36 and 52, parathyroid hormone (PTH), C-Telopeptide of Type I Collagen (CTx-1), Procollagen I Intact N-Terminal propeptide (PINP) and vitamin D levels were assessed. Bone density (BMD) was measured at baseline and week 52 using a GE Lunar iDXA. RESULTS: Body mass index, lumbar spine and femoral neck BMD did not differ between groups at baseline. Over 52 weeks, mean plasma 25 (OH) D3 levels increased to 74.8 nmol/L (intervention group) or remained at 63.1 nmol/L (control group) (p < 0.001 between groups). PTH levels increased in the control group (p = 0.001). The intervention resulted in a significant suppression of CTx-1 and PINP at p = 0.018 and p = 0.004. Femoral neck BMD remained stable in the intervention group but decreased significantly in the controls, with a borderline treatment effect (p = 0.07). CONCLUSION: Compared with regular milk, the fortified milk suppressed bone turnover markers and tended to increase femoral neck BMD.

Contribution of early nutrition on the development of malnutrition and allergic diseases in the first year of life: a study protocol for the Mother and Infant Cohort Study (MICOS).

BACKGROUND: Nutrition and environmental factors are essential for the education of the neonatal immune system. Epidemiological evidence has shown that malnutrition and allergic diseases that occur during early childhood share similar protective and risk factors. This paper describes the protocol of the Mother and Infant Cohort Study (MICOS), which aims to determine the contribution of early nutrition to the development of malnutrition and allergic diseases in infants' first year of life. METHODS: MICOS is a prospective cohort study conducted at selected government health clinics in two states, namely Selangor and Wilayah Persekutuan Kuala Lumpur, Malaysia. Women in their third trimester of pregnancy are recruited into the study and their infants will be followed-up at 3, 6, and 12 months of age. Information on prenatal factors including socio-demographic characteristics, obstetric history, pre-pregnancy body mass index, gestational weight gain, smoking, family history of allergic diseases, maternal dietary intake and sunlight exposure during pregnancy are obtained through face-to-face interviews. Postnatal factors including dietary intake, sun exposure, and anthropometric measurements of the mothers, as well as feeding practices, dietary intake, anthropometric measurements, and development of allergic diseases of the infants are assessed at each follow-up. Blood samples are collected from the mothers in the third trimester to determine 25-hydroxyvitamin D levels as well as from the infants at age 12 months to determine atopic sensitisation. DISCUSSION: The concept of developmental origins of health and disease (DOHaD) which emphasises on the role of early life environments in shaping future health and disease susceptibility in adulthood has gained a huge interest in recent years. The DOHaD paradigm has influenced many fields of research including malnutrition and allergic diseases. While findings from the developed countries remain controversial, such studies are scarce in developing countries including Malaysia. The present study will determine the cause and effect relationship between early nutrition and the development of malnutrition and allergic diseases in infants' first year of life.

Differential effects of calcium- and vitamin D-fortified milk with FOS-inulin compared to regular milk, on bone biomarkers in Chinese pre- and postmenopausal women.

PURPOSE: To compare the effects of a high-calcium vitamin D-fortified milk with added FOS-inulin versus regular milk on serum parathyroid hormone, and bone turnover markers in premenopausal (Pre-M) and postmenopausal (PM) women over 12 weeks. METHODS: Premenopausal women (n = 136, mean age 41 (±5) years) and postmenopausal women [n = 121, mean age 59 (±4) years] were recruited, and each age group randomised into two groups to take two glasses per day of control = regular milk (500 mg calcium per day) or intervention (Int) = fortified milk (1000 mg calcium for pre-M women and 1200 mg calcium for PM women, 96 mg magnesium, 2.4 mg zinc, 15 µg vitamin D, 4 g FOS-inulin per day). At baseline, week 4 and week 12 serum minerals and bone biochemical markers were measured and bone density was measured at baseline. RESULTS: Mean 25-hydroxyvitamin D [25(OH) vitamin D3] levels among groups were between 49 and 65 nmol/L at baseline, and over the 12 weeks of supplementation, the fortified milk improved vitamin D status in both Int groups. CTx-1 and PINP reduced significantly in both Pre-M and PM groups over the 12 weeks, with the changes in CTx-1 being significantly different (P < 0.035) between PM control and PM Int groups at week 12. Parathyroid hormone levels were significantly reduced in all groups over time, except for control PM group where levels increased at 12 weeks. CONCLUSION: The overall pattern of responses indicates that while both regular milk and fortified milk reduce bone resorption in young and older women, fortified milk is measurably more effective.

THE RELATIONSHIP BETWEEN METABOLIC SYNDROME AND ITS COMPONENTS WITH SOCIO-ECONOMIC STATUS AMONG ADOLESCENTS IN SHIRAZ, SOUTHERN IRAN.

The objective of this study was to investigate the relationship between metabolic syndrome and its individual components with socio-economic factors among 14-18 year-old adolescents in Shiraz, Iran. Using a multistage random sampling, a total of 538 (289 males and 249 females) adolescents consented to the study. Socio-economic status was obtained using a self-administered questionnaire while presence of metabolic syndrome and its individual components was ascertained using NCEP-ATP III criteria. The relationships between the participants' socio-economic status and metabolic syndrome and its components were determined using bivariate and multivariate statistical analyses. Approximately 6% of the adolescents had metabolic syndrome, with significantly more males than females (9.3% vs 2.4%, p < 0.001). The most commonly found abnormality was low high-density lipoprotein cholesterol (42.4%), followed by hypertensive (16.3%). The prevalence rates of elevated triglycerides, abdominal obesity and high fasting plasma glucose were 15.6%, 8.6% and 3.1%, respectively. Metabolic syndrome was significantly more prevalent in obese participants (44.4%) than those with normal body weight (2.0%) or overweight (9.3%). There were positive associations between the components of metabolic syndrome and parental education, school location and household monthly income. Having a family history of obesity was associated with metabolic syndrome after controlling for other variables (OR = 2.1; 95% CI: 0.9-5.2, p = 0.042). Overweight and obese subjects were approximately 8 times and 15 times more likely to develop metabolic syndrome, respectively (overweight: OR = 8.2; 95% CI: 3.6-17.2; obese: OR = 15.4; 95% CI: 4.8-43.7). In conclusion, a positive association exists between socio-economic status and metabolic syndrome and its individual components among the studied participants. An intervention program to prevent metabolic syndrome needs to be developed for this young generation, especially among those who are overweight or obese and those with a family history of obesity. Keywords: adolescents, metabolic syndrome, components of metabolic syndrome, socio-economic status, Iran

Factors associated with dietary diversity score among individuals with type 2 diabetes mellitus.

Studies on diet quality among individuals with type 2 diabetes mellitus (T2DM) are scarce. This crosssectional study aimed to assess the diet quality and to determine its associated factors among individuals with T2DM at the Medical Outpatients Department, Serdang Hospital, Selangor, Malaysia, from July 2010 to March 2011. Subjects were interviewed for sociodemographic data. Diabetes history was retrieved from the hospital's e-database. Usual dietary intake was measured using a food frequency questionnaire, from which a dietary diversity score was obtained with two measures: Food Group Score and Serving Score were constructed based on the Malaysian Dietary Guidelines. Food Group Score was computed from the number of food groups consumed from five major food groups (grains, vegetables, fruits, meat, and dairy products) whereas Serving Score was computed from the number of servings consumed from the various food groups. Anthropometric measures, including weight, height, waist- and hip-circumference were examined. For data analyses, descriptive statistics, simple and multiple linear regression were conducted using IBM SPSS Statis- tics 20.0. A total of 113 subjects (50.4% female), with mean?SD age of 54.05 +/- 10.30 years and duration of diabetes of 11.25?9.05 years were studied. The mean Food Group Score and Serving Score were 4.12 +/- 0.79 and 12.75+3.50 respectively. Slightly more than one-third of the subjects achieved five food groups a day while less than 2% consumed a desirable number of servings from all food groups. Among the five food groups, dairy, and fruits were the least-frequently consumed foods. Lower education, lower personal income, working, non-insulin, overweight and obese subjects had significantly lower Food Group Score than their counterparts [F (6,106)=4.924, p<0.0001] whereas lower education, lower waist-to-hip ratio, overweight and obese subjects had significantly lower Serving Score than their counterparts [F (4,108)=7.520, p<0.0001]. There was a high proportion of individuals with T2DM, who failed to adhere to the national dietary guidelines. The importance of taking a well-balanced diet in accordance with the guidelines should be emphasized, especially among those with lower educational level through a simple and easy-to-understand approach.

Energy and macronutrient intakes in older urban and rural Iranian adults.

Adequacy of energy and macronutrient intakes is important for disease prevention, health maintenance and nutrition program development in older adults. The present study was designed to evaluate and compare the adequacy of energy and macronutrient intakes of elderly living in rural and urban areas in the north-west of Iran. A total of 432 older adults (332 urban and 100 rural) were selected through stratified, multistage probability cluster sampling. Dietetic information was obtained through three-day 24-hour dietary recall interviews. A small proportion of the subjects (4% rural and 0.6% urban) were underweight while approximately half was either overweight or obese. Aged subjects from the urban had a significantly higher mean body mass index (BMI) (t=3.46, p<0.05) than their rural counterparts. There was also significant greater proportion of elderly subjects who were overweight or obese (X2=14.42, p<0.05). Older adults from the rural had significant more daily energy (t=3.49, p<0.05), carbohydrates (t=2.96, p<0.05) and fat intakes (t=3.15, p<0.05) than their urban counterparts. Generally, average daily intake of energy was lower than the Recommended Dietary Allowance (RDA) in developing countries. High contribution of carbohydrates and low contribution of proteins to total calory intake were observed in the daily diet of the elderly. There is a need to offer health and nutrition awareness programs for the elderly and their families by health care providers.

Effectiveness of Mediterranean Diet on Daytime Sleepiness among Individuals with Type 2 Diabetes Mellitus in Oman.

Background Sleep disturbance is a major complaint among individuals with diabetes mellitus and may be augmented by dietary interventions. The objective of this randomized controlled trial was to determine the effectiveness of a Mediterranean diet intervention on daytime sleepiness among individuals with type 2 diabetes mellitus (T2DM) in Oman. Methods In total, 134 eligible individuals with T2DM (61 and 73 participants in the intervention and control groups, respectively) were recruited. The intervention participants underwent a 6-month Mediterranean diet intervention consisting of individual dietary counseling, cooking classes, phone calls, and social media messages, while the control group continued with standard diabetes care. Daytime sleepiness was assessed using the Epworth Sleepiness Scale. All data was analyzed using IBM SPSS Statistics for Windows, version 26.0 (IBM Corp., Armonk, NY, USA). Results Daytime sleepiness was evident, with ∼ 30% of the participants experiencing it, with no significant difference between control and intervention participants at baseline. There was a significant reduction in daytime sleepiness in both the intervention and control groups after 6 months, with daytime sleepiness significantly lower in the intervention group, with a modest difference of 42.56% ( p < 0.001). Conclusion Adherence to the Mediterranean diet is effective in reducing daytime sleepiness among individuals with T2DM. Clinical Trial UMIN000041152.

Social and Health Determinants of Quality of Life of Community-Dwelling Older Adults in Malaysia.

Quality of life (QOL) of older adults is a complex issue that requires an understanding of the intersection between socioeconomic and health factors. A poor quality of life (QOL) is frequently reported as sub-optimal among older adults whereby concerted and collective actions are required through an evidence-based approach. Hence, this cross-sectional study aims to determine the social and health predictors of the QOL of a community-dwelling older adult Malaysian population through a quantitative household survey using multi-stage sampling. A total of 698 respondents aged 60 years old and older were recruited and the majority of them had a good quality of life. Risk of depression, disability, living with stroke, low household income, and lack of social network were identified as the predictors of a poor QOL among the community-dwelling older Malaysians. The identified predictors for QOL provided a list of priorities for the development of policies, strategies, programmes, and interventions to enhance the QOL of the community-dwelling older Malaysians. Multisectoral approaches, especially collective efforts from both social and health sectors, are required to address the complexities of the ageing issues.

Effectiveness of acupuncture as adjunctive therapy in type 2 diabetic: Study protocol for a randomized controlled trial.

INTRODUCTION: The incidence of type 2 diabetes mellitus is increasing worldwide. The literature suggests that acupuncture is a possible complementary therapy for type 2 diabetes mellitus. This study aims to determine the effectiveness of acupuncture as an adjunctive therapy on homeostasis model assessment-insulin resistance (HOMA-IR), and health-related quality of life (HRQoL) in patients with type 2 diabetes mellitus. MATERIALS AND METHODS: This randomized, double-blind, placebo controlled, and parallel design trial will be carried out in a public university teaching hospitals in Malaysia. Eligible type 2 diabetes mellitus subjects will be randomly assigned to receive either acupuncture (n = 30) or a placebo (n = 30). The intervention is carried out using press needle or press placebo on abdomen area (10 sessions of treatment). Both groups will continue with their routine diabetes care. Primary outcome of HOMA-IR will be measured at the time of recruitment (-week 0), and after completion of 10 sessions (week 7) of the treatment. Additionally, secondary outcome of HRQoL will be measured at the time of recruitment (-week 0), after completion of 5 sessions (week 3/4), and 10 sessions (week 7) of the treatment. Any adverse event will be recorded at every visit. DISCUSSION: The findings of this study will provide important clinical evidence for the effect of acupuncture as adjunctive therapy on HOMA-IR, adiposity and HRQoL of type 2 diabetes mellitus. TRIAL REGISTRATION NUMBER: NCT04829045.

Effects of tai chi on postural balance and quality of life among the elderly with gait disorders: A systematic review.

BACKGROUND: Tai Chi is good for improving the physical fitness of older adults. But few studies have reported the effects of Tai Chi on the postural balance and quality of life of older adults with gait disorders. OBJECTIVE: This review aimed to assess the influence of tai chi on postural stability and quality of life in older adults with abnormal gait. METHOD: According to the literature retrieval principles, the works published from the inception date to May 2023 were retrieved, including the following databases: PubMed, Scopus, Web of Science, China National Knowledge Infrastructure, EBSCOhost, and Google Scholar. Subsequently, literature screening and quality assessment were performed. RESULTS: A total of 16 randomized controlled trials were included in this study, Tai Chi intervention can affect populations with Parkinson's disease (PD), no exercise, mild cognitive impairment (MCI), chronic stroke, sedentary, fear of falling, or history of falling. Postural instability is associated with balance, gait, the Unified Parkinson's Disease Rating Scale Motor Subscale 3 (UPDRS III), mobility, lower body strength, and falls. Only two articles looked at quality of life. The Yang style is the most commonly used in the intervention. Nonetheless, most studies were performed on female participants, hence, more research on older male populations is needed. CONCLUSION: Tai Chi intervention benefits postural balance in patients with gait disorders. 12 weeks is the most common intervention period for patients with gait disorders. The frequency of intervention is seven articles twice a week, and the intervention time is about 60 minutes. The Tai Chi intervention methods in this study involve Yang Style, Sun Style, Taoist Tai Chi, and Health Qigong Tai Chi, but the Yang Style Tai Chi intervention is the most widely used.

Dietitian-led cluster randomised controlled trial on the effectiveness of mHealth education on health outcomes among pregnant women: a protocol paper.

INTRODUCTION: Nutrition education is the cornerstone to maintain optimal pregnancy outcomes including gestational weight gain (GWG). Nevertheless, default for appointments is common and often lead to suboptimal achievement of GWG, accompanied with unfavourable maternal and child health outcomes. While mobile health (mHealth) usage is increasing and helps minimising barriers to clinic appointments among pregnant mothers, its effectiveness on health outcomes has been inconclusive. Therefore, this study aimed to address the gap between current knowledge and clinical care, by exploring the effectiveness of mHealth on GWG as the primary outcome, hoping to serve as a fundamental work to achieve optimal health outcomes with the improvement of secondary outcomes such as physical activity, psychosocial well-being, dietary intake, quality of life and sleep quality among pregnant mothers. METHODS AND ANALYSIS: A total of 294 eligible participants will be recruited and allocated into 3 groups comprising of mHealth intervention alone, mHealth intervention integrated with personal medical nutrition therapy and a control group. Pretested structured questionnaires are used to obtain the respondents' personal information, anthropometry data, prenatal knowledge, physical activity, psychosocial well-being, dietary intake, quality of life, sleep quality and GWG. There will be at least three time points of data collection, with all participants recruited during their first or second trimester will be followed up prospectively (after 3 months or/and after 6 months) until delivery. Generalised linear mixed models will be used to compare the mean changes of outcome measures over the entire study period between the three groups. ETHICS AND DISSEMINATION: Ethical approvals were obtained from the ethics committee of human subjects research of Universiti Putra Malaysia (JKEUPM-2022-072) and medical research & ethics committee, Ministry of Health Malaysia: NMRR ID-22-00622-EPU(IIR). The results will be disseminated through journals and conferences targeting stakeholders involved in nutrition research. TRIAL REGISTRATION NUMBER: Clinicaltrial.gov ID: NCT05377151.

The impact of Movement Control Order during the COVID-19 pandemic on lifestyle behaviours and body weight changes: Findings from the MyNutriLifeCOVID-19 online survey.

BACKGROUND: The COVID-19 pandemic lockdowns have affected daily lives of the communities worldwide. This study aims to determine the lifestyle behaviours and their associations with body weight changes among Malaysian adults during the Movement Control Order (MCO) due to COVID-19 pandemic. METHODS: A total of 1319 Malaysian adults participated in this cross-sectional online survey. Information on anthropometric data including body weight and height, and lifestyle behaviours including eating pattern, physical activity, and sleep pattern were self-reported by the respondents. A multivariable generalised linear mixed model was used to assess the associations between lifestyle behaviours and body weight changes with adjustment of confounding factors; namely, age, sex, ethnicity, and body weight status before MCO. RESULTS: During MCO, 41.2% of the respondents perceived that their eating patterns were healthier, but 36.3% reduced their physical activities, and 25.7% had a poorer sleep quality. Further, the proportion of adults who reported having lose weight (32.2%) was almost similar to those who reported having gained weight (30.7%). Lifestyle behaviours including less frequent practice of healthy cooking methods and lunch skipping were associated with weight gain, while less frequent consumption of high fat foods, more frequent physical activity, and good sleep latency were associated with lower risk of weight gain. In contrast, practicing healthy eating concept, skipped lunch, and more frequent physical activity were significantly associated with weight loss. CONCLUSION: Lifestyle behaviours were associated with body weight changes during MCO. While the COVID-19 pandemic lockdown is necessary to prevent further spread of the disease, promoting healthy lifestyle practices during lockdown should be implemented for a healthy weight and better health.