Knowledge, Attitudes and Self-reported practices Questionnaire on Pureed Diet Preparation (KAP DYS Puree) among Food Handlers in Malaysian Hospitals for Dysphagia Management: Development, Validity, and Reliability Testing

@#Introduction: This methodological research study aimed to measure content validity and reliability of a newly developed questionnaire of knowledge, attitudes, and self-reported practices towards pureed diet preparation (KAP DYS Puree) among hospital food handlers for dysphagia management. Methods: The study was conducted through face validation, content validation, content reliability and construct validation. A cross-sectional design with convenience sampling was carried out involving 4 panels for face validation, 10 raters for content validity and 161 food handlers participated for Exploratory Factor Analysis (EFA), while 30 food handlers were involved for test-retest reliability. The questionnaire which consisted of 40 items distributed into 3 domains and was assessed and analyzed using modified kappa (k*) for reliability. Results: Content Validity Index revealed the following I-CVI values: knowledge = 0.915, attitudes = 0.922 and self-reported practices = 0.900 and modified kappa values (k*) knowledge = 0.983, attitudes = 0.9214 and self-reported practices = 0.899. The EFA was employed for two dimensions which were self-reported practices and attitudes based on principal axis of factoring with varimax rotation. The factor analysis yielded two factors with a total of 10 items in the attitudes domain and two factors with a total of 9 items in the self-reported practices domain that had satisfactory factor loading (> 0.3). The Kaiser-Meyer-Olkin (KMO) values for attitudes = 0.816 and self-reported practices = 0.776. Bartlett’s test of sphericity was significant at p < 0.0001 for attitudes and self-reported practices indicating the suitability of this data for factor analysis. Interclass Correlation Index (ICC) values for attitudes = 0.739 and self-reported practices = 0.789. Conclusion: This instrument can be used as a need assessment tool in the development of a comprehensive training module for pureed diet preparations in dysphagia management.

Dietary Inflammatory and Its Association with Cognitive Frailty Among Community-Dwelling Older Adults in Klang Valley

@#Introduction: Dietary inflammation is a significant risk factor for age-related cognitive impairments among older adults. However, information related to the relationship between Empirical Dietary Inflammatory Index (eDII) score and cognitive frailty (CF) among Malaysian community-dwelling older adults is still limited. The objective of this study is to determine the association between dietary inflammatory risk and CF among community-dwelling older adults. Method: This is a cross sectional study involving community-dwelling older adults in Klang Valley. The Fried’s Criteria and Clinical Dementia Rating (CDR) were used to determine CF status. Subjects were also interviewed using the Dietary History Questionnaire (DHQ) and eDII food checklist to assess the food intake and dietary inflammatory risk. Data collected was analyzed using SPSS version 26.0. Results: A total of 158 older adults (66.7 ± 5.2 years old) residing in Klang Valley were involved. Energy and macronutrients have a weak positive association with pro-inflammatory score (p<0.05). There is no significant mean difference between CF older adults consumed a more pro-inflammatory diet (mean 2.07 ± 1.10) compared to non CF (mean 2.06 ± 1.14). However, white rice food item significantly consumed by CF people (22.4%) than non CF (8.5%) (p<0.05). Conclusion: CF older adults were more likely to consume a pro-inflammatory diet particularly from the rice food group. There is a need to further assess the risk of consuming a pro-inflammatory diet using larger sample size and appropriate biomarkers.

Gender-Specific Age-Related Changes in Physical Performance, Physical Activity And Anthropometry Status Among Community-Dwelling Older Persons With And Without Mild Cognitive Impairment: A Prospective Study (Perubahan Berkaitan Dengan Usia Berdasarkan Jantina yang Berhubung Dengan Antropometri, Prestasi Fungsi Fizikal dan Aktiviti Fizikal dalam Kalangan Warga Emas di Komuniti dengan dan tanpa Kecelaan Kognitif Ringan) / Jurnal Sains Kesihatan Malaysia

@#In this study, we aimed to determine gender specific age-related decline in anthropometry status, physical performance (PP) and physical activity (PA) in older persons with and without mild cognitive impairment (MCI) prospectively over 3 years. Within-group changes across three time points (baseline-Wave 1, 18 months-Wave 2, 36 months-Wave 3) based on gender and cognitive status were determined. Data was collected at Wave 3 of a longitudinal study: “Neuroprotective Model for Health Longevity among Elderly”. Secondary data from Wave 1 and 2 was obtained for analysis. Older persons with MCI were categorised to have subjective memory problems (answered ‘yes’ on item 10 of Geriatric Depression Scale), scored at least 1.5 SD below mean average on Rey Auditory Verbal Learning Test and Digit Span, no dementia, no problems with activities in daily living, intact global cognition (>19/30: Mini Mental State Examination) and without depression (Geriatric Depression Scale 15-items,≤4). Anthropometry measurements and a battery of PP tests were performed. PA was measured using Physical Activity Scale for the Elderly questionnaire. Data from 779 older persons (67.7 ± 5.3 years) consisting of 372 men (68.0 ± 5.2 years) and 407 women (67.4 ± 5.4) who completed all tests from Wave 1 to Wave 3 were analysed. There was a decline in PP (-0.7% to -14.1% per year), PA levels (-0.7% to -14.1% per year) and anthropometry status (-0.1% to -6.3% per year), except for percentage body fat (+9.9% per year) with advancing age. Within-group changes over the three years showed significant differences (p<0.05) in height and PA in non-MCI and MCI men and lower body flexibility in non-MCI and MCI women. Specifically, tailored physical and nutritional health prevention and promotion strategies for older persons based on gender and cognitive status may be beneficial to support person-centered care.

Association between Diet-related Behaviour and Risk of Colorectal Cancer: A Scoping Review

Individual dietary patterns may be influenced by diet-related behaviours, which may eventually play a significant role in contributing to colorectal cancer risk. As nearly half of colorectal cancer cases can be prevented through diet and lifestyle modification, in this study, we aimed to present an overview of the literature on diet-related behaviour and its effect on colorectal cancer risk among adults. Articles published from 2011 until July 2021 were selected. Out of the 1,198 articles retrieved, 25 were analyzed. There were 16 case-control studies, and nine of them were cohort studies. As a finding, the instruments used in this review were food frequency questionnaires (n = 23), followed by a semi-structured interview (n = 1), and diet records (n = 1). We demonstrated that unhealthy diet-related behaviours are linked to an increased risk of colorectal cancer in adults and those food frequency questionnaires or food records are common instruments used to collect diet-related behaviours. This article imparts the research trends and directions of colorectal cancer risk factors and shows that diet-related behaviour varies and changes over time.

Prevalence and Risk Factors of Sarcopenia Among Community Dwelling Older Adults in Klang Valley

@#Introduction: Sarcopenia is one of the geriatric syndromes affecting the ability of older adults to lead an independent living. However, its risk factors among Malaysian older adults are yet to be determined. This study investigated the prevalence and risk factors of sarcopenia among community-dwelling older adults in Klang Valley. Methods: This cross-sectional study involved 393 Malaysians aged 60 and above, residing in urban areas of Klang Valley recruited through convenience sampling. Socio-demographic and food intake information were obtained using validated questionnaires. Cut-off points for sarcopenia screening were obtained from the Asian Working Group of Sarcopenia(AWGS) while body impedance analysis(BIA) was employed to determine skeletal muscle index. A handgrip dynamometer was used to assess dominant handgrip strength and a 6-meter gait speed test was used to determine walking speed. Binary logistic regression analysis was used to determine the risk factors of sarcopenia. Results: Prevalence of sarcopenia was 33.6% and women(35.9%) were more affected compared to men(30.1%). The mean age of women assessed to have sarcopenia(69.1±6.5 years old) was higher compared to men(68.3±5.8 years old) (p<0.05). After adjusting for confounding factors, older adults with one year increased in age and one mg decreased in habitual dietary iron intake were estimated to be 1.08 times and 0.93 times the chances to have sarcopenia respectively. Conclusion: Approximately one-third of community-dwelling older adults in Klang Valley were assessed to have sarcopenia. Older adults aged 60 years and above and those with low dietary iron intake were at an increased risk of developing sarcopenia.

Factors Associated With Pressure Ulcer Risk Among Spinal Cord Injury Adults in Kuala Lumpur, Malaysia: A Community-based Study

@#Introduction: Pressure ulcers (PUs) are a leading health problem among spinal cord injury(SCI) patients. Therefore, this comprehensive study was aimed at determining the association between potential factors and the occurrence of PUs among SCI adults in community settings. Methods: A cross-sectional study was conducted among adults with SCI aged 18 years and above from five selected locations in Kuala Lumpur, Malaysia. The study was carried out through interviews based on validated questionnaires such as the Dietary History Questionnaire (DHQ), Spinal Nutrition Screening Tool (SNST), Physical Activity Scale for Individuals with Physical Disabilities (PASIPD), Barthel Index for Activities of Daily Living (ADL), and Instrumental Activities of Daily Living (IADL). Estimated weight and height were obtained using recumbent formula. The stages of their PUs were assessed based on National Pressure Ulcer Advisory Panel (NPUAP) grading system. Results: A total of 40 subjects participated in the study, 25% of whom were having PUs. Their nutritional inadequacies were identified, whereby 90%, 70% and 85.5% of them were receiving below their daily requirement of energy, carbohydrate and protein, respectively. The fat and sodium intakes of 55% of them were above the Malaysian Recommended Nutrient Intakes(RNI). It was successfully found that physical activity could decrease the risk of PUs(R2=0.654, OR=0.310, p<0.05). Conclusion: Overall, 25% of the subjects had PUs that were associated with physical inactivity. The majority of the subjects did not meet their nutrient requirements. Therefore, there is a need for increased physical activity and improved nutrient intake in order to reduce the risk of pressure ulcers among SCI adults in communities.

Risk Factors For Undernutrition In Children Under Five Years Of Age In Tenom, Sabah, Malaysia

@#Undernutrition is the result of complex interplay of factors such as household food security, childcare, feeding practices, nutrition and sanitation. Therefore, this study aimed to determine the prevalence of stunting, wasting, underweight based on WHO child growth standards 2006 and undernutrition based on Composite Index Anthropometric Failure (CIAF) and its association with the biological, behavioural, socio-economic and physical environment factors among children under-5 years. This was a cross sectional study involving children aged between 6 and 59 months recruited through stratified random sampling from the Tenom district. Sociodemographic background was obtained from mothers via a questionnaire. Height and weight measurements were measured using standardised instrument. The height-for-age, weight-for-age and BMI-for-age were classified according to the WHO Child Growth Standard 2006. Bivariate analysis and multivariate logistic regression analysis were conducted. The prevalence of undernutrition based on CIAF was 42.3%, underweight 34.7%, stunting 33.3% and wasting 10.0%. After adjusting for all confounders, childhood undernutrition was significantly associated with unimproved sanitation (adjusted OR 2.98, 95% CI: 1.082 to 8.225) and frequent illness (adjusted OR 2.07, 95% CI: 1.015 to 3.274). These findings support the association of biological and physical environmental factors with the nutritional status of children under-5 years old.

A retrospective study of weight-loss predictors following bariatric surgery in Malaysian patients with obesity

@#Introduction: A retrospective study was conducted with the aim of determining the factors that affect weight loss among post-bariatric surgery patients. Methods: A successful weight loss outcome in this study was defined as achieving at least 50% excess weight loss (EWL). Eligible participants were those who had undergone bariatric surgery at least two years prior to the study. Adherence to lifestyle recommendations post-bariatric surgery, binge eating, depression, and social support were assessed. Results: A total of 51 post-bariatric surgery patients were recruited with a mean post-operative period of 3.2±0.7 years. The mean preoperative weight of 116.6±28.8 kg and body mass index (BMI) 45.2±8.8 kg/m2 were significantly reduced to 86.6±21.0 kg and 33.6±6.7 kg/m2, respectively, during follow-up (p<0.001). A total of 66.7% of participants achieved successful weight loss following bariatric surgery, with a mean EWL of 73.6±21.9% and total weight loss (TWL) of 29.4±8.7%. According to multivariate regression analysis adjusted for age and gender, pre-operative weight (β=-1.580, p<0.05) and BMI (β=-1.398, p<0.05), rate of weight loss (β=1.045, p<0.01), and adherence to eating behaviour recommendations (β=0.177, p<0.05) were significant predictors of weight loss outcomes post-bariatric surgery. Conclusion: The lower pre-operative weight and BMI, the faster rate of weight loss and higher adherence towards eating behaviour advice were potential predictors of greater EWL and thus could increase the chance of successful weight loss maintenance post–bariatric surgery.

Identification of dietary patterns associated with characteristics of successful aging

@# Introduction: This study aimed to identify dietary patterns (DPs) and their association with successful aging (SA). Methods: A comparative cross-sectional study was conducted among 579 elderly subjects recruited from four states in Malaysia through a multistage random sampling method. SA was defined as having no chronic illnesses, no functional limitation, normal global function, no depression, a good quality of life and good self-perceived health. Information on dietary intake was obtained using a diet history questionnaire. Cognitive functions were assessed using the Mini Mental State Examination (MMSE), depressive symptoms using Geriatric Depression Score-15 items (GDS-15) and a question regarding their perceived health and quality of life. Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) questionnaires were used to determine functional status. DPs were obtained using the principal component analysis (PCA) approach. An ordinal logistic regression model was used to examine associations between DP scores and SA. Results: Five DPs were identified namely ‘sweet foods-beverages’, ‘meat-vegetablesrice and noodles’, ‘local snacks-fish and seafood-high salt foods’, ‘fruits-legumes’, and ‘tropical fruits-oats’. A higher score for ‘tropical fruits-oats’ DP was associated with SA [Adjusted OR=1.59 (95% CI: 1.08-2.32)]. However, the association diminished when the model was adjusted for education level. Further analysis indicated that this DP increased the chance of SA among those with secondary education and above [Adjusted OR=2.43 (95% CI: 1.09–5.42)]. Conclusion: Tropical fruits-oats’ DP is associated with SA among elderly with secondary education and above. There is a need to investigate DPs among those with lower education.

Dietary Polyphenol Intake Associated with Adiposity Indices among Adults from Low to Medium Socioeconomic Status in a Suburban Area of Kuala Lumpur: A Preliminary Findings

@#Background: Researches on polyphenols have been the interest of few parties due to its possible roles in the prevention of obesity. However, studies regarding this topic are still limited. Therefore, this study was conducted to examine the relationship between the intake of polyphenols with adiposity indices among middle-aged adults. Methods: This cross-sectional study involved 227 adults aged 40 to 59 years at low-cost housing flats in suburban area of Cheras, Kuala Lumpur. Data collection involved food frequency questionnaire (FFQ) for polyphenols and international physical activity questionnaire (IPAQ). Subjects were measured for anthropometric parameters including height, weight, waist and neck circumferences (NC), and body fat percentage. The polyphenol intake from the diet was estimated using local polyphenol database built according to PHENOL-EXPLORER. Results: The average intake of polyphenol of subjects was 1815 (672) mg/day. The main food sources of polyphenol were coffee with milk, followed by chocolate milk and red beans. A higher polyphenol intake according to quartile was significantly associated with a lower neck circumference (χ² = 8.30, P = 0.040), waist circumference (χ² = 8.45, P = 0.038) and body fat percentage (χ² = 8.06, P = 0.045). Binomial logistic regression analysis showed that the association remained significant for the neck circumference (P = 0.032), after controlling for age, household income, energy intake and physical activity level. More subjects with normal NC had higher intake of polyphenols (50th percentile and above). In contrast, subjects with high NC showed lower percentiles of polyphenols intake (50th percentile and below). Conclusion: The result showed that polyphenol intake was associated with neck circumference and thus it can be suggested that polyphenol intake is associated with obesity

Prevalence of Poor Mental Health and Cognitive Status among Middle-Aged Adults and Its Predictors in Relation to Polyphenols Intake

@#Background: Decline in mental health and cognitive status starts to show its sign during middle-age and is affected by dietary factors, namely the polyphenols intake. Polyphenols have received attention in improving health issues related to aging, including decline in mental health and cognitive. The aim of this study is to determine the prevalence of poor mental health and cognitive status among middle-aged adults and its predictors in relation to polyphenols intake. Methods: Subjects’ food intakes were calculated by using dietary history questionnaire and food frequency questionnaire for polyphenols. The subjects’ mental health and cognitive status were measured by general health questionnaire-28 (GHQ-28) and Rey’s auditory verbal learning test (RAVLT). Results: More than 40% of middle-aged adults were identified as having signs of poor mental health. A total of 67.9% of the subjects had poor cognitive status according to RAVLT immediate recall. Hierarchical binary logistic regression indicated that fat intake was associated with somatic symptoms for both men [adjusted odds ratio (AOR) = 1.04; P < 0.05] and women (AOR = 1.06; P < 0.05). Intake of lignan (AOR = 1.071; P < 0.05) was associated with better RAVLT immediate recall among women. Additionally, high cholesterol (AOR = 3.14; P < 0.05) was associated with poor score of RAVLT delayed recall for women. Conclusions: Early detection of poor mental health and cognitive is crucial to prevent Alzheimer’s disease in old age.

Prevalence Of Urinary Incontinence And Its Association With Declined Cognitive And Physical Function Among Community Dwelling Older Adults: A Review

@#n this review weaimed to determine the prevalence of urinary incontinence (UI)and its association with declined cognitive and physical function among community dwelling older adults. Literature review was performed using multiple online databases includingMEDLINE, Science Direct andWiley Online Library from June 2000 to April 2017. Hand searching ofbibliographies of relevant studies was also carried out. The studies included ofthose conducted from within the last 17years; assessed and compared according to population characteristics, definition of urinary incontinence, prevalence and its association with cognitive and physical functionaldecline. Nine studies met the eligibility criteria of this review. Prevalence rates of UI among community dwelling older adults ranged from10% to 53% (median 32%).Physical functionaldecline in termsof mobility, locomotion and activities of daily living interruptions werefound to be correlated with UI. Although limited, the existing evidence also showed an association between declined cognitive function and UI.

Built Environment Characteristics And Its Association Between Physical Performance, Falls Risk And Functional Mobility Among Malaysian Older Adults / Jurnal Sains Kesihatan Malaysia

Older adults who walk in their neighbourhood with greater street connectivity are reported to have lower limb physicalperformance decline. There is limited information regarding the association between built environment characteristicsand physical performance in older adults. The aim of this study was to examine the association between built environmentcharacteristics, physical performance, falls risk and functional mobility among older adults. Sixty four (27 men and 37women) community dwelling older adults aged 60 years and above (mean 67.4 ± 7.1 years) from senior citizen clubs inKuala Lumpur, Malaysia participated in this cross-sectional study. Built environment characteristics were assessed usingan adapted Neighbourhood Environment Walkability Scale (NEWS). Physical performance and falls risk was measuredusing Short Physical Performance Battery (SPPB) and Profile Physiological Profile Assessment (PPA) respectively. TimedUp and Go (TUG) and gait speed tests were used to assess functional mobility. There was a significant correlation betweenbuilt environment and physical performance (r = 0.43, p < 0.001) and functional mobility measured using gait speedtest (r = 0.27, p < 0.05) among older adults. Built environment was identified as a significant determinant of physicalperformance (R2 = 0.19, p < 0.001). Built environment characteristics is an important external factor in preservingphysical performance in older adults. Programmes and policies for a more favourable built environment characteristicsin the neighbourhoods should be encouraged to promote and maintain physical performance among older adults

Validity And Reliability Of Physical Activity Scale For Elderly In Malay Language (PASE-M)

@#Physical Activity Scale for the Elderly (PASE) is a simple, valid and reliable questionnaire that can be administered to quantify older adults’ physical activity levels during daily living. However, PASE in Malay language for use among older population is not available. The objective of our current study was to evaluate the reliability and validity of the Malay translated Physical Activity Scale for Elderly (PASE-M) for the use among older adults. Objective results of physical activity were obtained by wearing continuously an accelerometer for one week among a population of older adults in Malaysia who speak Malay language. Participants completed PASE-M twice, on day-8 (PASE-M1) and day-15 (PASE-M2). Concurrent validity between PASE-M1 and accelerometer results was assessed using Spearman’s rank correlation coefficient. Test-retest reliability for one week interval of PASE-M was tested using Spearman’s rank correlation coefficient and Intra-class correlation coefficients (ICC). Forty-four community-dwelling older adults (12 men and 32 women; mean age ± SD= 66.95 ± 5.34) participated in this study. However, only 33 participants (8 men and 25 women; mean age ± SD= 66.64 ± 5.51) were able to achieve the minimum accelerometer wearing time and filled up the PASE-M questionnaire for two times with one weeks interval. The results showed the PASE-M score was significantly correlated with vector magnitude (VM) counts (r=0.54, p<0.01), time in moderate-to-vigorous physical activity (MVPA) (r =0.55, p<0.01), energy expenditure (r =0.53, p<0.01) and walking steps (r=0.39, p<0.05). A high reliability (ICC = 0.96) was demonstrated between first and the subsequent administration of PASE-M (p<0.01, 95% CI: 0.92-0.98). The PASE-M is a valid and reliable questionnaire to assess physical activity level for Malaysian community-dwelling older adults.

Dietary Patterns of the Metabolic Syndrome Among Older Adults in Malaysia / Jurnal Sains Kesihatan Malaysia

@#The term metabolic syndrome (MetS) describes a clustering of risk factors for cardiovascular disease and type 2 diabetes mellitus which include high blood pressure, low fasting high-density lipoprotein cholesterol (HDL-c), high fasting triglyceride (TG), high fasting blood glucose (BG), and abdominal obesity. The aim of this cross sectional study was to determine the dietary patterns (DPs) associated with MetS among 451 older adults in Malaysia. Food intake was determined using validated Diet History. DP was identified based on 40 food groups by using principal component analysis (PCA), and the factors were rotated by varimax rotation. Fasting venous blood samples were taken to determine HDL-c, TaG and BG level. Blood pressure and anthropometric measurements were also performed. Three major dietary patterns have been identified; 1) bread, spreads and oats, 2) Malaysia traditional pancakes and 3) vegetables and healthy cooked dishes. Three models were built to compare the potential confounder such as age, education years, marital status, calorie intakes, ciggarate smoking and body mass indeks (BMI). Only vegetables and healthy cooked dishes DP was associated with MetS. This DP reflects high consumption of various types of vegetables, noodle in soup, healthy cooked fish or seafood and low consumption of all type of high calorie rice, noodles and fried desserts. For all models, subject in the highest tertile of vegetables and healthy cooked dishes DP had a lower odd ratio (OR) for MetS as compared to lowest tertile. As more potential confounders added in new models, the significant values are increased. After adjustment of body mass index, the association for vegetables and healthy cooked dishes DP was attenuated (OR: 0.67, CI: 0.39-1.16, p: 0.156). In conclusion, high consumption of vegetable and healthy cooked dishes may lower the occurance of MetS among Malaysian elderly.

Sugar intake and metabolic syndrome among older adults in Peninsular Malaysia

@#Introduction: Sugar is widely consumed and excessive intake has been associated with increased risk of weight gain, diabetes mellitus and cardiovascular diseases, leading to metabolic syndrome (MetSyn). However, the association between sugar intake and MetSyn has seldom been studied among multi-ethnic Malaysian older adults. Methods: A total of 1,057 respondents aged ≥60 years were recruited through multistage random sampling from selected states. Anthropometric parameters, blood pressure, blood test for sugar and lipid profile were determined. Dietary intake was derived using a 7-day dietary history questionnaire (DHQ) and a semi-quantitative food frequency questionnaire (FFQ) for added sugar intake. Results: Prevalence of MetSyn was 39.9%, 30.9% and 42.2% using the harmonised definition, International Diabetes Federation (IDF) and National Cholesterol Education Program’s Adult Treatment Panel III (NCEP-ATPIII) definitions respectively. Mean total sugar intake was 40.5±32.0 g (8 tsp) and added sugar intake was 33.0±31.0 g (6 tsp). Excessive added sugar consumption at 100th percentile increased risks of high total cholesterol by two-fold (p<0.001) and triglyceride by 1.8 fold (p<0.001). Total sugar intake at 50th percentile increased risk of high blood pressure by 0.68 fold (p<0.05) and total sugar intake at 50th, 75th and 100th percentile increased total cholesterol risk by 1.7 fold (p<0.01), 1.5 fold (p<0.05) and 2.3 fold (p<0.001) respectively. Conclusion: Excessive sugar consumption among older adults showed no association with MetSyn but revealed significant associations with blood pressure and lipid profiles. Effects of long term excessive consumption of sugar on health outcomes in older persons should be investigated.

Association between intake of soy isoflavones and blood pressure among urban and rural Malaysian adult

@#Introduction: Intake of soy isoflavones has been shown to be beneficial in reducing blood pressure, a known cardiovascular risk factor. This study investigated the association between intake of soy isoflavones and blood pressure among multiethnic Malaysian adults. Methods: A total of 230 non-institutionalised Malaysians aged 18-81 years were recruited through multi-stage random sampling from urban and rural areas in four conveniently selected states. Participants were interviewed on socio-demographics, medical history, smoking status, and physical activity. Measurements of height, weight, waist circumference (WC), and blood pressure (BP) were taken. Information on usual intake of soy foods was obtained using a validated semi-quantitative food frequency questionnaire. Results: The mean intake of soy protein of both urban (3.40g/day) and rural participants (3.01g/day) were lower than the USFDA recommended intake level of soy protein (25.00g/day). Urban participants had significantly higher intake of isoflavones (9.35±11.31mg/ day) compared to the rural participants (7.88±14.30mg/day). Mean BP levels were significantly lower among urban (136/81mmHg) than rural adults (142/83mmHg). After adjusting for age, gender, educational level, household income, smoking status, physical activity, BMI and WC, soy protein intake was significantly associated with both SBP (R2=0.205, β=-0.136) and DBP (R2=0.110, β=-0.104), whilst soy isoflavones intake was significantly associated with SBP (β=-0.131). Intake of 1 mg of isoflavone is estimated to lower SBP by 7.97 mmHg. Conclusion: Higher consumption of isoflavones among the urban participants showed an association with lower levels of SBP. Use of biological markers for estimating isoflavones levels is recommended to investigate its protective effects on blood pressure.

Development and validation of a nutrient profiling model for Malaysian older population

@#Introduction: Nutrient profiling is the science of ranking food based on the nutrient content that enables an individual to make healthier food choice without exceeding the daily energy recommendation. This study was aimed at developing and validating a nutrient profiling model for Malaysian older population. Methods: A total of six nutrient profiling models comprising different combinations of nutrients were developed. Each model was tested by scoring 94 food items in terms of 100 kcal and 100 g, and the Recommended Nutrient Intakes for Malaysian (2017) as the reference value. The scores in each model were correlated with energy density per 100 g of food. The best model to correctly rank food according to nutrient density was chosen for validation. Validation was done by comparing the healthiness classification of 174 food items as determined by Towards Useful Aging Food Nutrient Density Index (TUA FNDI) nutrient profiling model and the Malaysian Dietary Guidelines. Results: Models with sodium and total fat were better correlated with energy density. All six models were inversely correlated with energy density. TUA FNDI 9-2 model was chosen as the best model for validation. Overall, there was substantial agreement between TUA FNDI 9-2 model and the food-based dietary guidelines (κ=0.644, p=0.001). Conclusion: The inverse correlation between nutrient profiling models to energy density shows that foods with higher nutrient density contain lower energy. The validated TUA FNDI 9-2 model is recommended for older adults to make healthier food choices.

Delivery of healthy lunch to worksites: a two weeks pilot study in a sample of working adults in Selangor, Malaysia

@#Introduction: Lack of healthy food choices at the worksite is associated with unhealthy eating habits and poor diet quality. This study aimed to conduct a two weeks pilot study to assess the diet quality of lunch-meals delivered to worksites. Methods: Using a crossover study design, a total of 50 adults were purposely recruited from among university and hospital staffs in Selangor. Participants were randomised into two groups, whereby in week one, Group A was provided with the study’s “healthy lunch-meals” (RD4U©) for 3 work days/week, while Group B consumed their usual lunch. In week two, the groups switched over with Group B receiving RD4U© lunch-meals for three days. Diet quality of the lunch meals was assessed using the Healthy Eating Index for Malaysian (HEI-M). Participant satisfaction for RD4U© service was determined using SERVQUAL. Results: Mean protein consumption was significantly higher (27±4 g/day) while fat consumption was significantly lower (18±5 g/day) for the RD4U© lunch-meals, compared to the respective levels (24±11 g/day; 22±12 g/day) for the usual lunch meals. Total HEI score of the RD4U© meals (61.9±9.2) was higher than that for the usual lunch meals (56.1±11.2). Nonetheless, the overall diet quality scores indicate that both RD4U© and usual lunch meals were in the “need improvement” category. Generally, participants were satisfied with the RD4U© lunch-meal service. Conclusion: The RD4U© lunch-meals showed potential in delivering healthy lunch to worksites, and feasibility studies to expand the RD4U© delivery service is recommended.

Fruit consumption and associated determinants in a sample of young urban Malaysian adults

@#Introduction: Adequacy of fruit intake contributes to an individual’s health including reducing the risk of non-communicable disease. This study aimed to assess consumption of fruits in various forms and to determine associated factors and barriers. Methods: In this cross-sectional study, a total of 300 adults aged 20-39 years were purposely recruited from several urban locations in the Klang Valley. Consumption of fruits in the past 12 months was assessed using a selfadministered food frequency questionnaire (FFQ), assisted with pictures of serving size of fruits. Anthropometric measurements were taken and body mass index and waist circumference computed. Results: Fruit intake among young adults was lower (1.6±1.0 servings/day) than the Malaysian Dietary Guideline 2010 of ≥ 2 servings/day. Only 32.3% consumed fruits as recommended, with women consuming significantly more fruits than men. Preferred fresh fruits were red apple, banana and papaya. Consumption of fruit juice was associated with increase in waist circumference (R2=0.261, p=0.027) after adjustment for age, sex, ethnicity, education level and marital status. Fruit intake showed no significant association with other anthropometric measurements. Sensory appeal, perceived health benefit, easy to prepare and influence of family were the main determinants of fruit intake, whilst affordability and availability were the major barriers. Conclusion: Fruit consumption among young adults in this study was lower than the recommendation for daily fruit intake. Studies with larger sample size are suggested to verify the finding of significant association between fruit juice consumption and risk of abdominal obesity.