A cross-sectional analysis of the PURE study on minerals intake among Malaysian adult population with hypertension.

Hypertension (HPT) is the leading modifiable risk factor for cardiovascular diseases and premature death worldwide. Currently, attention is given to various dietary approaches with a special focus on the role of micronutrient intake in the regulation of blood pressure. This study aims to measure the dietary intake of selected minerals among Malaysian adults and its association with HPT. This cross-sectional study involved 10,031 participants from the Prospective Urban and Rural Epidemiological study conducted in Malaysia. Participants were grouped into HPT if they reported having been diagnosed with high blood pressure [average systolic blood pressure (SBP)/average diastolic blood pressure (DBP) ≥ 140/90 mm Hg]. A validated food frequency questionnaire (FFQ) was used to measure participants' habitual dietary intake. The dietary mineral intake of calcium, copper, iron, magnesium, manganese, phosphorus, potassium, sodium, and zinc was measured. The chi-square test was used to assess differences in socio-demographic factors between HPT and non-HPT groups, while the Mann-Whitney U test was used to assess differences in dietary mineral intake between the groups. The participants' average dietary intake of calcium, copper, iron, magnesium, manganese, phosphorus, potassium, selenium, sodium, and zinc was 591.0 mg/day, 3.8 mg/day, 27.1 mg/day, 32.4 mg/day, 0.4 mg/day, 1431.1 mg/day, 2.3 g/day, 27.1 µg/day, 4526.7 mg/day and 1.5 mg/day, respectively. The intake was significantly lower among those with HPT than those without HPT except for calcium and manganese. Continuous education and intervention should be focused on decreasing sodium intake and increasing potassium, magnesium, manganese, zinc, and calcium intake for the general Malaysian population, particularly for the HPT patients.

Depressive symptoms among adults: Baseline findings of PURE Malaysia cohort study.

Introduction: In Malaysia, the prevalence of depression has increased from 1.8 % to 2.3 % within a decade. Thus, this study was performed to identify depressive symptoms and its associated factors among Malaysian adults. Methods: A cross-sectional study was conducted among the adult population aged 35-70 residing in rural and urban areas in Malaysia. Depressive symptoms were assessed using the short form Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) Composite International Diagnostic Interview (CIDI) questionnaire. Logistic regression models were fitted to identify the associated factors related to depressive symptoms. Results: About 3.7 % (95 % CI: 2.33-4.83) of the respondents reported having depressive symptoms. Younger adults aged 35-40 years old (AOR: 3.087; 95 % CI: 2.021-4.717), females (AOR: 2.318; 95 % CI: 1.669-3.219), widows and divorcees (AOR: 2.294; 95 % CI: 1.085-4.848), smokers (AOR: 1.843; 95 % CI: 1.334-2.545) and alcohol consumers (AOR: 1.843; 95 % CI: 1.264-2.688) showed a higher odds compared to their other counterparts. Underweight individuals (AOR: 1.899; 95 % CI: 1.177-3.065) and those diagnosed either with hypertension (AOR: 1.442; 95 % CI: 1.11-1.873), diabetes (AOR: 1.554; 95 % CI: 1.133-2.13), angina (AOR: 2.73; 95 % CI: 1.596-4.67), COPD (AOR: 4.187; 95 % CI: 1.528-11.472) or asthma (AOR: 1.906; 95 % CI: 1.309-2.774) were more likely to have depressive symptoms. Additionally, individuals with difficulty trusting people (AOR: 1.477; 95 % CI: 1.024-2.13) and those reported to experience either home or work-related stress (AOR: 2.584; 95 % CI: 2.003-3.331) were more prone to have depressive symptoms. Conclusion: In this broad population-based study, about 3.7 % (95 % CI: 2.33-4.83) of respondents reported having depressive symptoms. Timely and well targeted collaborative intervention on the identified risk factors by the relevant authorities, would mitigate their effect on the quality of life and retard the progression into depression, especially among younger adults.

Validation and the associated factors of the Malay version of systemic lupus erythematosus-specific health-related quality of life questionnaires (SLEQoL and LupusQoL).

OBJECTIVES: To assess the reliability and validity of two disease-specific questionnaires that assess the quality of life (QoL) among patients with Systemic Lupus Erythematosus (SLE); SLEQoL and LupusQoL in Malay language. This study also identified the factors affecting each domain of the questionnaires. METHODS: This cross-sectional study was conducted from June 2021 until April 2022, and SLE patients were recruited to complete the SLEQoL, LupusQoL and Short Form Health Survey (SF-36) in Malay language. Disease activity were recorded using the modified SLE Disease Activity Index (M- SLEDAI) and British Isles Lupus Assessment Group 2004 (BILAG-2004) index. Presence of organ damage was determined using the SLICC Damage index. Cronbach's alpha was calculated to determine internal consistency while exploratory factor analysis was done to determine the construct validity. Concurrent validity was evaluated using correlation with SF-36. Multiple linear regression analysis was deployed to determine the factors affecting each domain of SLEQoL and LupusQoL. RESULTS: A total of 125 subjects were recruited. The Cronbach's α value for the Malay-SLEQoL (M-SLEQoL) and Malay-LupusQOL (M-LupusQoL) was 0.890 and 0.944 respectively. Exploratory factor analysis found formation of similar number of components with the original version of questionnaires and all items have good factor loading of >0.4. Both instruments also had good concurrent validity with SF-36. M-SLEQoL had good correlations with BILAG-2004 and M-SLEDAI scores. Musculoskeletal (MSK) involvement was independently associated with lower M-SLEQoL in physical function, activity and symptom domains. Meanwhile, MSK and NPSLE were associated with fatigue in M-LupusQoL. CONCLUSION: Both M-SLEQoL and M-LupusQoL are reliable and valid as disease -specific QoL instruments for Malaysian patients. The M-Lupus QoL has better discriminative validity compared to the M-SLEQoL. SLE patients with MSK involvement are at risk of poor QoL in multiple domains including physical function, activity, symptoms and fatigue.

Prediction of Lung Function Status Using Handgrip Strength and Anthropometry among the Healthy Malay Population in Malaysia.

Lung function depends primarily on the strength of the intercostal muscles and the diaphragm, which is indirectly related to handgrip strength (HGS). This study aims to determine the predictability of lung functions using HGS among healthy adults of Malay ethnicity in Malaysia. This study also aims to compare the equation using HGS with equations without HGS, such as the Global Lung Initiative (GLI). This study was carried out among adults between 35 to 70 years of age residing in urban and rural Malaysia. A series of standardized questionnaires were used to collect socio-demographic information. Lung functions were measured using a portable spirometer and HGS was measured using a Jamar dynamometer. The predictability of lung function indices (FEV1 and FVC) using HGS, age, and height was determined using multiple linear regression (MLR). Prediction of lung function indices was also generated using models without HGS for comparison with the equation that used HGS from this study. Pearson correlation analysis showed that both dominant (r = 0.49; p < 0.001) and non-dominant (r = 0.58; p < 0.001) HGS had a moderate significant correlation with lung function. In the MLR model, HGS was a significant (p < 0.001) predictor of lung function indices (FEV1 and FVC). The correlation of the predicted and measured lung indices using the equation generated in this study, which includes HGS, was higher compared with other lung function test equations that do not include HGS. The equations from MLR could be used to predict lung function indices among healthy Malay adults. The measurement of HGS may be used as a screening tool for lung function status when spirometry is unavailable.

New insights of minimum requirement on legumes (Fabaceae sp.) daily intake in Malaysia.

BACKGROUND: Despite their low energy density and high nutrient content, legumes may be under-recognised as a beneficial food for the prevention and management of obesity and related diseases, such as cardiovascular disease (CVD). This study aims to analyse the moderation effect of legume intake on the relationship between BMI and the prevalence of CVD among the Malaysian adult population. METHODS: This study addressed communities of urban and rural Malaysia, including adults aged between 35 and 70 years old at the baseline recruitment. A series of standardised questionnaires were used to assess legume intake, history of comorbidities and socio-demographic information. Resting blood pressure measurements and physical examinations were performed to collect blood pressure and anthropometric data. Bivariate analysis was completed to determine the association between legume intake, socio-demographic characteristics and CVD prevalence. Moderation analysis was used to quantify the moderation effect of minimum daily legume intake on the relationship between BMI and CVD prevalence. RESULTS: This study found that those who consume less than 3 servings of legumes per day benefit from protective effects against CVD risk (POR = 0.56, 95% CI = 0.37 - 0.85). Moderation analysis of a minimum of three servings/day for the relationship between BMI and CVD prevalence showed significant effects. The group that benefited the most from this effect was those with a BMI in the range of 26 to 34 kg/m2. CONCLUSIONS: This study provides new insights into the recommendation for legume intake according to the relationship between BMI and the prevalence of CVD in Malaysian adults. This study recommends that those with a BMI of 26 to 34 kg/m2 should consume at least 3 servings of legumes per day to reduce the risk of CVD. Further prospective research is warranted to affirm these findings throughout the Malaysian population.

Normative reference values and predicting factors of handgrip strength for dominant and non-dominant hands among healthy Malay adults in Malaysia.

INTRODUCTION: Handgrip strength (HGS) measures the maximum voluntary force of the hand, which has been used to assess individual health status indirectly. Although several factors related to HGS have been identified, studies among adults in Malaysia are lacking. This study aimed to provide the normative reference HGS values and determine its predictor factors among healthy adults of Malay ethnic in Malaysia. METHODOLOGY: This study was a part of the Prospective Urban Rural Epidemiology (PURE) study carried out among adults aged between 35 to 70 years old residing in urban and rural Malaysian communities. A standardised questionnaire was used to assess the socio-demographic information and physical activity level of respondents who provided written informed consent to participate in this study. HGS was measured using Jamar's dynamometer. A total of 3,446 healthy adults of Malay ethnic were included in this study. Descriptive data were used to derive the normative reference values for HGS using means and standard deviations stratified by age and gender. The predictors of HGS were determined using a general linear model (GLM). RESULTS: Mean HGS ranged from 38.48 (± 9.40) kg for the dominant hand of men aged 35-40 years to 16.53 (± 5.69) kg for the non-dominant hand of women aged 61-70 years. The ANOVA indicated that there was a significant descending trend of HGS as age increased for both genders (p < 0.05). The ANOVA also revealed that participants working in blue- or white-collar jobs had higher HGS than their counterparts who are homemakers (p < 0.05). The GLM shows that, age, occupation type, socio-economic status (SES), physical activity level and BMI significantly predicted dominant HGS among male and meanwhile, only age, SES and BMI significantly predicted dominant HGS among female. CONCLUSION: HGS normative values provided herein can serve as a guide for interpreting HGS measurements obtained from healthy Asian adults especially Malay ethnic. The clinicians and researcher can use the established HGS reference values as comparison in their patients or participants. Furthermore, during a rehabilitation process, the clinicians and researchers could use the normal score ranges to document the progress of HGS and provide feedback to the patients. Further study with prospective study design is needed to determine the causal effect association of the predictors and HGS.

Pattern of macronutrients intake among type-2 diabetes mellitus (T2DM) patients in Malaysia.

BACKGROUND: The incidence of type 2 diabetes mellitus (T2DM) is rising rapidly in Malaysia. Modifying dietary intake is key to both the prevention and treatment of T2DM. This study aims to investigate the pattern of macronutrient intake among T2DM patients in Malaysia. METHODS: This study was carried out on adults aged between 35 and 70 years, residing in urban and rural Malaysian communities. A series of standardised questionnaires was used to assess the sociodemographic information, dietary intake and physical activity level of 15,353 respondents who provided informed consent to participate in this study. Blood sampling (finger prick test) and physical examination were performed to obtain blood glucose and anthropometric data, respectively. The Chi-square test was used to assess differences in the trends of macronutrient intake among T2DM patients. RESULTS: The total number of participants diagnosed with T2DM in this study was 2254. Of these, 453 (20.1%) were newly diagnosed, 1156 (51.3%) were diagnosed for ≤5 years and 645 (28.6%) were diagnosed for > 5 years. Male patients show that there were significant differences among the three groups of T2DM according to the following variables: age, BMI, residency, participant comorbidity of hypertension, family history of T2DM and hypertension, and active smoker. Meanwhile, female patients show significant differences among the three groups of T2DM according to the following variables: age, BMI, marital status, education level, residency, participant comorbidity of hypertension and family history of T2DM. Most of the male patients consumed appropriate proportions of carbohydrate (458, 60.7%) and protein (618, 81.9%). However, female patients did not show any significant differences of the macronutrients intake among the three groups of T2DM patients. CONCLUSIONS: The pattern of dietary intake among T2DM patients in this study showed consumption of carbohydrate and protein within the range of Malaysian RNI, coupled with high fat intake. Compliance with the Recommended Nutrient Intake (RNI) was satisfactory for both carbohydrate and protein but not for fat. The pattern indicated a preference for fat rather than protein when carbohydrate intake was restricted.

Brief Virtual Reality Exposure Therapy and Its Effects on Negative and Positive Emotions Among Healthy Working Adults: A Feasibility Study.

Background: The primary purpose of this study is to examine the feasibility of a short-term virtual reality exposure therapy among healthy working adults sample. The secondary aim is to measure the effect of virtual reality exposure therapy on negative and positive emotions by comparing it to the standard stress management program and the wait-list groups. Methods: We enrolled 67 participants allocated into 3 groups to receive virtual reality exposure therapy, standard stress management, or wait-list group. The virtual reality exposure therapy group received a total of a 30-minute exposure to a virtual reality environment over 2 weeks. The standard stress management group received a stress management program once during the study period. Results: The results showed a heterogeneous sample, whereby a significantly younger, less-working years, and higher anxiety baseline score were found in the virtual reality exposure therapy group compared to standard stress management and wait-list groups. Nonetheless, the virtual reality exposure therapy group showed a reduction in depression, anxiety, and stress score (P < .001). The standard stress management group showed a reduction in anxiety score only (P = .002), whereas no significant changes were observed in the wait-list group. For positive emotion, all 3 groups showed significant improvement. Conclusion: Short-term virtual reality exposure therapy is a feasible intervention for the negative and positive emotions; however, cautious interpretation is needed due to significant heterogeneous sample. Replication of study with comparable groups is recommended.

Assessing Factors Associated with Non-Fatal Injuries from Road Traffic Accidents among Malaysian Adults: A Cross-Sectional Analysis of the PURE Malaysia Study.

Non-fatal injuries (NFIs) due to road traffic accidents (RTAs) are a public health problem worldwide that significantly impacts the population morbidity and healthcare costs. As the demands for vehicles in developing countries, such as Malaysia, is increasing annually, the present study aims to determine the prevalence and factors associated with NFIs due to RTAs among Malaysia's adult population. METHODS: This was a cross-sectional study involving 15,321 participants from the Prospective Urban and Rural Epidemiological (PURE) study conducted in Malaysia. Participants reported whether they had experienced an NFI that limited their normal activities within the past 12 months. Data on risk factors for NFIs were elicited. Multiple logistic regression models were fitted to identify the associated factors. RESULTS: Overall, 863 participants (5.6% of 15,321) reported at least 1 NFI in the past 12 months, with 303 caused by RTAs (35.1%), 270 caused by falls (31.3%) and 290 attributed to other causes (33.6%). The factors associated with higher odds of sustaining an NFI due to an RTA were being male (adjusted odd ratio (AOR) 2.08; 95% CI 1.33-3.26), having a primary (2.52; 1.40-4.55) or secondary (2.64; 1.55-4.49) level of education, being overweight to obese (1.40; 1.01-1.94), being currently employed (2.03; 1.31-3.13) and not practicing a noon nap/siesta (1.38; 1.01-1.89). CONCLUSIONS: The occurrence of NFIs due to RTAs is highly preventable with strategic planning aimed at reducing the risk of RTAs among the Malaysian population. Interventions focusing on protecting road users, especially those who drive two-wheelers, with proactive road safety awareness and literacy campaigns, combined with strict enforcement of the existing traffic laws and behavioural modifications, may reduce the risk of NFIs following RTAs.

Somatic mitochondrial DNA mutations in different grades of glioma.

Aim: Mitochondrial DNA (mtDNA) alterations play an important role in the multistep processes of cancer development. Gliomas are among the most diagnosed brain cancer. The relationship between mtDNA alterations and different grades of gliomas are still elusive. This study aimed to elucidate the profile of somatic mtDNA mutations in different grades of gliomas and correlate it with clinical phenotype. Materials & methods: Forty histopathologically confirmed glioma tissue samples and their matched blood were collected and subjected for mtDNA sequencing. Results & conclusion: About 75% of the gliomas harbored at least one somatic mutation in the mtDNA gene, and 45% of these mutations were pathogenic. Mutations were scattered across the mtDNA genome, and the commonest nonsynonymous mutations were located at complex I and IV of the mitochondrial respiratory chain. These findings may have implication for future research to determine the mitochondrial energetics and its downstream metabolomics on gliomas.

Missed Appointments at a Child Development Centre and Barriers to Access Special Needs Services for Children in Klang Valley, Malaysia: A Mixed Methods Study.

Attending appointments is vital for children with special needs, as such appointments involve long-term interdisciplinary care to ensure continuity of care and improve health and well-being. This study was performed to determine the prevalence of missed clinic appointments and identify the factors among those who have ever missed appointments and barriers of access to children's special needs services at the Child Development Centre (CDC) at the Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Moreover, suggestions for improvement from the caregivers' perspectives were explored. This is an explanatory sequential mixed methods study among caregivers of children with developmental disabilities aged up to 17 years old. Of 197 caregivers, 62 (31.5%) had missed clinic appointments. Forgetfulness was the most frequently cited reason. The bi-variable analysis showed significant differences in missed appointment rates by gender of caregivers and duration of follow-up. The final logistic regression model demonstrated that, when combined with the effect of being a male caregiver as an independent variable, follow-up duration of more than 6 years increased 2.67 times the risk of missing an appointment. Caregivers' perceived barriers were transportation, caregiver, child and healthcare services factors. Policies and strategic plans should be focused on key findings from these factors to improve appointment adherence and accessibility to services for children with special needs.

Prevalence of obstructive sleep apnea in an Asian bariatric population: an underdiagnosed dilemma.

BACKGROUND: Obesity is a growing health problem that has become a global epidemic. Serial population studies have shown the same in Malaysia, where the prevalence of obesity increased rapidly in the last decade. Currently, bariatric surgery is the most effective treatment in patients with morbid obesity. Obstructive sleep apnea (OSA) is the most common type of sleep-related breathing disorder seen in obesity. OBJECTIVES: We aim to ascertain the prevalence and severity of OSA in Asian patients who underwent bariatric surgery and were seen in our center. SETTING: The study was conducted in our university hospital. METHODS: Study approval was obtained from our institutional review board for a retrospective chart review. A total of 226 patients were included in this review. OSA was noted as absent or present and graded from mild to severe. The patient population was stratified by body mass index according to the World Health Organization guidelines for Asian population. RESULTS: The overall sample prevalence of OSA was 80.5%. Of these, 24.3% had mild OSA, 23.9% had moderate OSA, and 32.3% had severe OSA. Only 17.3% have been diagnosed with OSA before bariatric workup. Among men, the prevalence of OSA was 93.7% and 75.5% among women. CONCLUSION: Based on these findings, Asian patients undergoing bariatric workup should be considered for routine polysomnography to enable treatment of OSA.

The effect of weight loss intervention programme on health-related quality of life among low income overweight and obese housewives in the MyBFF@home study.

BACKGROUND: Obesity is an emerging global public health concern as it is related to chronic diseases and its impact to health related quality of life. The aim of this study was to assess the effect of weight reduction on health related quality of life (HRQOL) among obese and overweight housewives. METHODS: Data on 123 obese and overweight housewives in the intervention group from the MyBFF@home study were utilised. A validated Malaysian Malay version of Obesity Weight Loss Quality of Life (OWLQOL) questionnaire was administered at baseline and 6 months after intervention. Descriptive analysis, univariate analysis, paired t-test and multiple logistic regression were performed using SPSS Version 22. RESULTS: Mean body mass index (BMI) was 31.5 kg/m2 (SD:4.13), with 51 participants classified as overweight (41.5%) while 72 were obese (58.5%). About 72% of the housewives experienced weight reduction (62% reduced weight less than 5% and 11% reduced weight more than 5% of their baseline weight). There was a significant improvement in HRQOL with a pre-intervention total mean score of 59.82 (SD: 26.60) and post-intervention of 66.13 (SD: 22.82), p-value < 0.001. By domain, the highest post intervention mean score was self-image 71.46 (SD: 22.85), followed by social stigma 68.77 (SD: 28.70), physical 61.83 (SD: 24.25) and trying to lose weight 61.24 (SD: 27.32). There was no significant association between weight reduction and HRQOL improvement. CONCLUSION: Weight loss intervention programme utilizing behavioural modification has led to a significant improvement in HRQOL among overweight and obese housewives.

Predictors of postpartum weight retention among urban Malaysian mothers: A prospective cohort study.

BACKGROUND: Women of childbearing age are predisposed to becoming overweight or obese. This study determines the mean, prevalence and factors associated with 6 months postpartum weight retention among urban Malaysian mothers. METHODS: A prospective cohort study was conducted at baseline (after delivery), 2, 4 and 6 months postpartum. From 638 eligible mothers initially recruited, 420 completed until 6 months. Dependent variable was weight retention, defined as difference between weight at 6 months postpartum and pre-pregnancy weight, and weight retention ≥5kg was considered excessive. Independent variables included socio-demographic, history of pregnancy and delivery, lifestyle, practices and traditional postpartum practices. RESULTS: Average age was 29.61±4.71years, majority (83.3%) were Malays, 58.8% (low education), 70.0% (employed), 65.2% (middle income family), 33.8% (primiparous) and 66.7% (normal/instrumental delivery). Average gestational weight gain was 12.90±5.18kg. Mean postpartum weight retention was 3.12±4.76kg, 33.8% retaining ≥5kg. Bivariable analysis showed low income, primiparity, gestational weight gain ≥12kg, less active physically, higher energy, protein, carbohydrate and fat intake in diet, never using hot stone compression and not continuing breastfeeding were significantly associated with higher 6 months postpartum weight retention. From multivariable linear regression analysis, less active physically, higher energy intake in diet, gestational weight gain ≥12kg, not continuing breastfeeding 6 months postpartum and never using hot stone compression could explain 55.1% variation in 6 months postpartum weight retention. CONCLUSION: Women need to control gestational weight gain, remain physically active, reduce energy intake, breastfeed for at least 6 months and use hot stone compression to prevent high postpartum weight retention.

Mitochondrial DNA Mutations in Grade II and III Glioma Cell Lines Are Associated with Significant Mitochondrial Dysfunction and Higher Oxidative Stress.

The role of mitochondria in tumorigenesis has regained much attention as it could dysregulate cellular energetics, oxidative stress and apoptosis. However, the role of mitochondria in different grade gliomasis still unknown. This study aimed to identify mitochondrial DNA (mtDNA) sequence variations that could possibly affect the mitochondrial functions and also the oxidative stress status. Three different grades of human glioma cell lines and a normal human astrocyte cell line were cultured in-vitro and tested for oxidative stress biomarkers. Relative oxidative stress level, mitochondria activity, and mitochondrial mass were determined by live cell imaging with confocal laser scanning microscope using CM-H2DCFDA, MitoTracker Green, and MitoTracker Orange stains. The entire mitochondrial genome was sequenced using the AffymetrixGeneChip Human Mitochondrial Resequencing Array 2.0. The mitochondrial sequence variations were subjected to phylogenetic haplogroup assessment and pathogenicity of the mutations were predicted using pMUT and PolyPhen2. The Grade II astrocytoma cells showed increased oxidative stress wherea high level of 8-OHdG and oxidative stress indicator were observed. Simultaneously, Grade II and III glioma cells showed relatively poor mitochondria functions and increased number of mutations in the coding region of the mtDNA which could be due to high levels of oxidative stress in these cells. These non-synonymous mtDNA sequence variations were predicted to be pathogenic and could possibly lead to protein dysfunction, leading to oxidative phosphorylation (OXPHOS) impairment, mitochondria dysfunction and could create a vicious cycle of oxidative stress. The Grade IV cells had no missense mutation but preserved intact mitochondria and excellent antioxidant defense mechanisms thus ensuring better survival. In conclusion, Grade II and III glioma cells demonstrated coding region mtDNA mutations, leading to mitochondrial dysfunction and higher oxidative stress.

A 19-Gene expression signature as a predictor of survival in colorectal cancer.

BACKGROUND: Histopathological assessment has a low potential to predict clinical outcome in patients with the same stage of colorectal cancer. More specific and sensitive biomarkers to determine patients' survival are needed. We aimed to determine gene expression signatures as reliable prognostic marker that could predict survival of colorectal cancer patients with Dukes' B and C. METHODS: We examined microarray gene expression profiles of 78 archived tissues of patients with Dukes' B and C using the Illumina DASL assay. The gene expression data were analyzed using the GeneSpring software and R programming. RESULTS: The outliers were detected and replaced with randomly chosen genes from the 90 % confidence interval of the robust mean for each group. We performed three statistical methods (SAM, LIMMA and t-test) to identify significant genes. There were 19 significant common genes identified from microarray data that have been permutated 100 times namely NOTCH2, ITPRIP, FRMD6, GFRA4, OSBPL9, CPXCR1, SORCS2, PDC, C12orf66, SLC38A9, OR10H5, TRIP13, MRPL52, DUSP21, BRCA1, ELTD1, SPG7, LASS6 and DUOX2. This 19-gene signature was able to significantly predict the survival of patients with colorectal cancer compared to the conventional Dukes' classification in both training and test sets (p < 0.05). The performance of this signature was further validated as a significant independent predictor of survival using patient cohorts from Australia (n = 185), USA (n = 114), Denmark (n = 37) and Norway (n = 95) (p < 0.05). Validation using quantitative PCR confirmed similar expression pattern for the six selected genes. CONCLUSION: Profiling of these 19 genes may provide a more accurate method to predict survival of patients with colorectal cancer and assist in identifying patients who require more intensive treatment.