RESUMO
BACKGROUND AND OBJECTIVES: This narrative review aims to provide recent understanding of the implications of maternal diet on fatty acid composition of breast milk, with focus on the docosahexaenoic acid (22:6n-3 (DHA) and arachidonic acid 20:4n-6 (AA) contents, for fetal growth and development. Breast milk n6/n3 polyunsaturated fatty acids (PUFA) ratio will also be highlighted in relations to maternal lipid intake. METHODS AND STUDY DESIGN: PubMed and Google Scholar were searched for relevant publications in English focusing on but not limited to the use of the key words stated below. RESULTS: Studies since the 1950s of different population groups worldwide affirmed the recognition that breastmilk fatty acid compositions are highly sensitive to maternal diet. Colostrum is richer in long-chain PUFA (LC-PUFA) metabolites of both linoleic and linolenic acids than mature milk. Among these LC-PUFA, both DHA and AA are incorporated preferentially and rapidly within the cerebral cortex and the retina during the last trimester of pregnancy and postnatal 18 months. Maternal supply of DHA and AA include maternal fatty acid stores, endogenous synthesis or directly from diet. Decreasing fish intake concomitant with increased intake of meat and vegetable oil leading to decreased intake of DHA and EPA, and an increase in AA intake, have resulted in an imbalanced n-6/n-3 PUFA ratio in breastmilk. CONCLUSIONS: A balanced intake of PUFAs during pregnancy and lactation is recommended for fetal and childhood growth and development.
Assuntos
Ácidos Docosa-Hexaenoicos , Leite Humano , Gravidez , Animais , Feminino , Humanos , Ácido Araquidônico/metabolismo , Dieta , Ácidos Graxos Insaturados , Ácidos GraxosRESUMO
BACKGROUND: Weekly iron-folic acid (IFA) supplements are recommended for all menstruating women in countries where anemia prevalence is ≥20%; however, it is unknown whether the inclusion of folic acid in weekly IFA supplements reduces anemia. OBJECTIVES: We examined whether the inclusion of folic acid in weekly IFA supplements conferred any benefit on hemoglobin (Hb) concentration, anemia reduction, or iron status [ferritin and soluble transferrin receptor (sTfR)], over iron alone. METHODS: In this secondary analysis of a randomized controlled trial in Malaysia, n = 311 nonpregnant women (18-45 y old) received 60 mg Fe with either 0, 0.4, or 2.8 mg folic acid once-weekly for 16 wk. Fasting blood was collected at baseline and 16 wk. A generalized linear model (normal distribution with identity link) was used to assess Hb concentration at 16 wk (primary outcome). RESULTS: At baseline, 84% of women had low folate status (plasma folate < 14 nmol/L). At 16 wk, marginal mean (95% CI) Hb was 131 (130, 133), 131 (129, 132), and 132 (130, 133) g/L; ferritin was 58.2 (53.9, 62.5), 56.5 (52.2, 60.9), and 58.0 (53.7, 62.3) µg/L; and sTfR was 5.8 (5.5, 6.1), 5.8 (5.5, 6.1), and 5.9 (5.6, 6.2) mg/L in the 0, 0.4, and 2.8 mg/wk groups, respectively, with no differences between groups (P > 0.05). Baseline plasma folate concentration did not modify the effect of treatment on Hb concentration at 16 wk. Among all women, the risks of anemia [risk ratio (RR): 0.65; 95% CI: 0.45, 0.96; P = 0.03] and iron deficiency based on ferritin (RR: 0.30; 95% CI: 0.20, 0.44; P < 0.001) were lower at 16 wk than at baseline. CONCLUSIONS: Despite the low folate status among these nonpregnant Malaysian women, the inclusion of folic acid in weekly IFA supplements did not reduce anemia or improve iron status, over iron alone. However, the benefits of folic acid for neural tube defect prevention still warrant its retention in weekly IFA supplements.This trial was registered at www.anzctr.org.au as ACTRN12619000818134.
Assuntos
Anemia Ferropriva , Anemia , Deficiências de Ferro , Anemia Ferropriva/tratamento farmacológico , Anemia Ferropriva/prevenção & controle , Suplementos Nutricionais , Feminino , Ácido Fólico , Hemoglobinas/análise , Humanos , Ferro , MalásiaRESUMO
BACKGROUND: Malaysia has the highest rate of diabetes mellitus (DM) in the Southeast Asian region, and has ongoing air pollution and periodic haze exposure. METHODS: Diabetes data were derived from the Malaysian National Health and Morbidity Surveys conducted in 2006, 2011 and 2015. The air pollution data (NOx, NO2, SO2, O3 and PM10) were obtained from the Department of Environment Malaysia. Using multiple logistic and linear regression models, the association between long-term exposure to these pollutants and prevalence of diabetes among Malaysian adults was evaluated. RESULTS: The PM10 concentration decreased from 2006 to 2014, followed by an increase in 2015. Levels of NOx decreased while O3 increased annually. The air pollutant levels based on individual modelled air pollution exposure as measured by the nearest monitoring station were higher than the annual averages of the five pollutants present in the ambient air. The prevalence of overall diabetes increased from 11.4% in 2006 to 21.2% in 2015. The prevalence of known diabetes, underdiagnosed diabetes, overweight and obesity also increased over these years. There were significant positive effect estimates of known diabetes at 1.125 (95% CI, 1.042, 1.213) for PM10, 1.553 (95% CI, 1.328, 1.816) for O3, 1.271 (95% CI, 1.088, 1.486) for SO2, 1.124 (95% CI, 1.048, 1.207) for NO2, and 1.087 (95% CI, 1.024, 1.153) for NOx for NHMS 2006. The adjusted annual average levels of PM10 [1.187 (95% CI, 1.088, 1.294)], O3 [1.701 (95% CI, 1.387, 2.086)], NO2 [1.120 (95% CI, 1.026, 1.222)] and NOx [1.110 (95% CI, 1.028, 1.199)] increased significantly from NHMS 2006 to NHMS 2011 for overall diabetes. This was followed by a significant decreasing trend from NHMS 2011 to 2015 [0.911 for NO2, and 0.910 for NOx]. CONCLUSION: The findings of this study suggest that long-term exposure to O3 is an important associated factor of underdiagnosed DM risk in Malaysia. PM10, NO2 and NOx may have mixed effect estimates towards the risk of DM, and their roles should be further investigated with other interaction models. Policy and intervention measures should be taken to reduce air pollution in Malaysia.
Assuntos
Poluição do Ar/efeitos adversos , Diabetes Mellitus/epidemiologia , Exposição Ambiental/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Poluentes Atmosféricos/análise , Diabetes Mellitus/etiologia , Feminino , Humanos , Malásia/epidemiologia , Masculino , Pessoa de Meia-Idade , Material Particulado/análise , Prevalência , Adulto JovemRESUMO
OBJECTIVE: To investigate the association between dietary patterns (DP) and overweight risk in the Malaysian Adult Nutrition Surveys (MANS) of 2003 and 2014. DESIGN: DP were derived from the MANS FFQ using principal component analysis. The cross-sectional association of the derived DP with prevalence of overweight was analysed. SETTING: Malaysia. PARTICIPANTS: Nationally representative sample of Malaysian adults from MANS (2003, n 6928; 2014, n 3000). RESULTS: Three major DP were identified for both years. These were 'Traditional' (fish, eggs, local cakes), 'Western' (fast foods, meat, carbonated beverages) and 'Mixed' (ready-to-eat cereals, bread, vegetables). A fourth DP was generated in 2003, 'Flatbread & Beverages' (flatbread, creamer, malted beverages), and 2014, 'Noodles & Meat' (noodles, meat, eggs). These DP accounted for 25·6 and 26·6 % of DP variations in 2003 and 2014, respectively. For both years, Traditional DP was significantly associated with rural households, lower income, men and Malay ethnicity, while Western DP was associated with younger age and higher income. Mixed DP was positively associated with women and higher income. None of the DP showed positive association with overweight risk, except for reduced adjusted odds of overweight with adherence to Traditional DP in 2003. CONCLUSIONS: Overweight could not be attributed to adherence to a single dietary pattern among Malaysian adults. This may be due to the constantly morphing dietary landscape in Malaysia, especially in urban areas, given the ease of availability and relative affordability of multi-ethnic and international foods. Timely surveys are recommended to monitor implications of these changes.
Assuntos
Dieta/estatística & dados numéricos , Comportamento Alimentar , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Adolescente , Adulto , Índice de Massa Corporal , Bebidas Gaseificadas/estatística & dados numéricos , Estudos Transversais , Dieta Ocidental/estatística & dados numéricos , Feminino , Humanos , Renda , Malásia/epidemiologia , Masculino , Carne/estatística & dados numéricos , Pessoa de Meia-Idade , Inquéritos Nutricionais , Fatores de Risco , População Rural , Verduras , Adulto JovemRESUMO
BACKGROUND: Riboflavin is required for several redox reactions. Clinical riboflavin deficiency occurs mainly in low-income countries, where it is associated with anemia. The functional significance of suboptimal riboflavin status in different populations and its role in anemia is not well understood. OBJECTIVES: We assessed the biomarker status of riboflavin and its association with hemoglobin concentration and anemia in women living in Vancouver, Canada, and Kuala Lumpur, Malaysia. METHODS: Healthy nonpregnant, nonbreastfeeding women (19-45 y) were recruited from Canada ( n = 206) and Malaysia (n = 210) via convenience sampling. Fasting blood was collected to assess riboflavin status [erythrocyte glutathione reductase activity coefficient (EGRac)], hematological indicators, soluble transferrin receptor (sTfR), ferritin, vitamin A, folate, and vitamin B-12 concentrations. Linear and logistic regression models were used to assess the association of riboflavin status with hemoglobin concentration and anemia. RESULTS: EGRac (mean ± SD) values were higher, indicating poorer riboflavin status, in Malaysian compared with Canadian women (1.49 ± 0.17 compared with 1.38 ± 0.11). Likewise, riboflavin biomarker deficiency (EGRac ≥1.40) was significantly more prevalent among Malaysians than Canadians (71% compared with 40%). More Malaysian than Canadian women were anemic (hemoglobin <120 g/L; 18% compared with 7%). With use of linear regression (pooled sample; n = 416), EGRac values were negatively associated with hemoglobin concentration (r = -0.18; P < 0.001). This relation remained significant (P = 0.029) after adjusting for age, parity, ethnicity, vitamin B-12, folate, sTfR, ferritin, and vitamin A. Women with riboflavin deficiency (EGRac ≥1.40) were twice as likely to present with anemia (adjusted OR: 2.38; 95% CI: 1.08, 5.27) compared with women with EGRac <1.40. CONCLUSIONS: Biochemical riboflavin deficiency was observed in Canadian and Malaysian women, with higher rates of deficiency among Malaysian women. Deficient biomarker status of riboflavin was a weak but significant predictor of hemoglobin and anemia, suggesting that the correction of riboflavin deficiency may potentially play a small protective role in anemia, but this requires further investigation.
Assuntos
Anemia/sangue , Anemia/complicações , Hemoglobinas/metabolismo , Deficiência de Riboflavina/sangue , Deficiência de Riboflavina/complicações , Riboflavina/sangue , Adulto , Anemia/epidemiologia , Biomarcadores/sangue , Canadá/epidemiologia , Feminino , Ferritinas/sangue , Humanos , Malásia/epidemiologia , Pessoa de Meia-Idade , Estado Nutricional , Prevalência , Receptores da Transferrina/sangue , Deficiência de Riboflavina/epidemiologia , Adulto JovemRESUMO
The purpose of this correspondence is to express our disappointment with the coverage of the BMC Public Health supplement: Vol 19 (4) titled "Health and Nutritional Issues Among Low Income Population in Malaysia", which neglected to include the fundamental health and nutrition issues that are adversely affecting the lives and livelihood of the indigenous peoples. The Supplement comprised 21 papers. Two of these papers included indigenous peoples as study subjects. These two papers addressed peripheral, albeit important health issues, namely visual impairment and quality of life, and not the persistent and rising health concerns impacting this population. We will provide evidence from research and reports to justify our critique that the Supplement missed the opportunity to spotlight on the serious extent of the health and nutritional deprivations of the indigenous peoples of Malaysia. As researchers of the indigenous peoples, we ought to lend our voice to the "silenced minority" by highlighting their plight in the media including scientific journals.
Assuntos
Disparidades nos Níveis de Saúde , Povos Indígenas/estatística & dados numéricos , Distúrbios Nutricionais/epidemiologia , Pobreza/estatística & dados numéricos , Relatório de Pesquisa/normas , Humanos , Malásia/epidemiologiaRESUMO
Background: Folic acid fortification of grains is mandated in many countries to prevent neural tube defects. Concerns regarding excessive intakes of folic acid have been raised. A synthetic analog of the circulating form of folate, l-5-methyltetrahydrofolate (l-5-MTHF), may be a potential alternative. Objective: The objective of this study was to determine the effects of folic acid or l-5-MTHF supplementation on blood folate concentrations, methyl nutrient metabolites, and DNA methylation in women living in Malaysia, where there is no mandatory fortification policy. Methods: In a 12-wk, randomized, placebo-controlled intervention trial, healthy Malaysian women (n = 142, aged 20-45 y) were randomly assigned to receive 1 of the following supplements daily: 1 mg (2.27 µmol) folic acid, 1.13 mg (2.27 µmol) l-5-MTHF, or a placebo. The primary outcomes were plasma and RBC folate and vitamin B-12 concentrations. Secondary outcomes included plasma total homocysteine, total cysteine, methionine, betaine, and choline concentrations and monocyte long interspersed nuclear element-1 (LINE-1) methylation. Results: The folic acid and l-5-MTHF groups had higher (P < 0.001) RBC folate (mean ± SD: 1498 ± 580 and 1951 ± 496 nmol/L, respectively) and plasma folate [median (25th, 75th percentiles): 40.1 nmol/L (24.9, 52.7 nmol/L) and 52.0 nmol/L (42.7, 73.1 nmol/L), respectively] concentrations compared with RBC folate (958 ± 345 nmol/L) and plasma folate [12.6 nmol/L (8.80, 17.0 nmol/L)] concentrations in the placebo group at 12 wk. The l-5-MTHF group had higher RBC folate (1951 ± 496 nmol/L; P = 0.003) and plasma folate [52.0 nmol/L (42.7, 73.1 nmol/L); P = 0.023] at 12 wk than did the folic acid group [RBC folate, 1498 ± 580 nmol/L; plasma folate, 40.1 nmol/L (24.9, 52.7 nmol/L)]. The folic acid and l-5-MTHF groups had 17% and 15%, respectively, lower (P < 0.001) plasma total homocysteine concentrations than did the placebo group at 12 wk; there were no differences between the folic acid and l-5-MTHF groups. No differences in plasma vitamin B-12, total cysteine, methionine, betaine, and choline and monocyte LINE-1 methylation were observed. Conclusion: These findings suggest differential effects of l-5-MTHF compared with folic acid supplementation on blood folate concentrations but no differences on plasma total homocysteine lowering in Malaysian women. This trial was registered at clinicaltrials.gov as NCT01584050.
Assuntos
Ácido Fólico/administração & dosagem , Ácido Fólico/sangue , Tetra-Hidrofolatos/administração & dosagem , Tetra-Hidrofolatos/farmacologia , Adulto , Suplementos Nutricionais , Método Duplo-Cego , Feminino , Ácido Fólico/farmacologia , Humanos , Malásia , Adulto JovemRESUMO
Breast-fed infants are susceptible to vitamin D deficiency rickets. The current vitamin D 'adequate intake' (AI) for 0-6-month-old infants is 10 µg/d, corresponding with a human milk antirachitic activity (ARA) of 513 IU/l. We were particularly interested to see whether milk ARA of mothers with lifetime abundant sunlight exposure reaches the AI. We measured milk ARA of lactating mothers with different cultural backgrounds, living at different latitudes. Mature milk was derived from 181 lactating women in the Netherlands, Curaçao, Vietnam, Malaysia and Tanzania. Milk ARA and plasma 25-hydroxyvitamin D (25(OH)D) were analysed by liquid-chromatography-MS/MS; milk fatty acids were analysed by GC-flame ionisation detector (FID). None of the mothers reached the milk vitamin D AI. Milk ARA (n; median; range) were as follows: Netherlands (n 9; 46 IU/l; 3-51), Curaçao (n 10; 31 IU/l; 5-113), Vietnam: Halong Bay (n 20; 58 IU/l; 23-110), Phu Tho (n 22; 28 IU/l; 1-62), Tien Giang (n 20; 63 IU/l; 26-247), Ho-Chi-Minh-City (n 18; 49 IU/l; 24-116), Hanoi (n 21; 37 IU/l; 11-118), Malaysia-Kuala Lumpur (n 20; 14 IU/l; 1-46) and Tanzania-Ukerewe (n 21; 77 IU/l; 12-232) and Maasai (n 20; 88 IU/l; 43-189). We collected blood samples of these lactating women in Curaçao, Vietnam and from Tanzania-Ukerewe, and found that 33·3 % had plasma 25(OH)D levels between 80 and 249·9 nmol/l, 47·3 % between 50 and 79·9 nmol/l and 19·4 % between 25 and 49·9 nmol/l. Milk ARA correlated positively with maternal plasma 25(OH)D (range 27-132 nmol/l, r 0·40) and milk EPA+DHA (0·1-3·1 g%, r 0·20), and negatively with latitude (2°S-53°N, r -0·21). Milk ARA of mothers with lifetime abundant sunlight exposure is not even close to the vitamin D AI for 0-6-month-old infants. Our data may point at the importance of adequate fetal vitamin D stores.
Assuntos
Aleitamento Materno , Leite Humano/metabolismo , Necessidades Nutricionais , Luz Solar , Deficiência de Vitamina D , Vitamina D/administração & dosagem , Adulto , Curaçao , Dieta , Feminino , Humanos , Lactente , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido , Lactação/metabolismo , Malásia , Masculino , Países Baixos , Política Nutricional , Raquitismo/sangue , Raquitismo/etiologia , Tanzânia , Vietnã , Vitamina D/análogos & derivados , Vitamina D/sangue , Vitamina D/metabolismo , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/epidemiologia , Deficiência de Vitamina D/metabolismo , Vitaminas/administração & dosagem , Vitaminas/metabolismo , Adulto JovemRESUMO
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
Assuntos
Síndrome Metabólica/epidemiologia , Síndrome Metabólica/psicologia , Classe Social , Adolescente , Glicemia/metabolismo , Escolaridade , Feminino , Humanos , Hipertensão/epidemiologia , Renda , Irã (Geográfico)/epidemiologia , Lipoproteínas HDL/sangue , Masculino , Obesidade/epidemiologia , Obesidade/psicologia , Sobrepeso/epidemiologia , Sobrepeso/psicologia , Pais , Prevalência , Distribuição por Sexo , Triglicerídeos/sangueRESUMO
The soya-breast cancer risk relationship remains controversial in Asia due to limited and inconsistent research findings and is exacerbated by difficulties in recruiting and retaining participants in intervention trials. Understanding public perceptions towards soya is important for designing effective intervention trials. Here, we administered a close-ended, quantitative survey to healthy, peri- and post-menopausal Asian women in the Malaysian Soy and Mammographic Density (MiSo) Study to assess perception towards soya and explore motivators and barriers that affect study adherence using the Capability, Opportunity, Motivation and Belief (COM-B) Model and Theoretical Domains Framework (TDF). Of 118 participants, the majority reported the belief that soya promotes good health (Supplement = 85â 7 %, Diet = 90â 0 %, Control = 87â 9 %). Most participants reported obtaining information about soya from the internet (Supplement = 61â 0 %, Diet = 55â 3 %, Control = 35â 9 %), while health professionals were least reported (Supplement = 9â 8 %, Diet = 7â 9 %, Control = 5â 1 %). Stratified analyses by study completion and adherence status yielded comparable findings. By the end of the study, dietary arm participants reported a strong belief that soya has no impact on their health (Supplement = 7â 1 % v. Diet = 20â 0 % v. Control = 0â 0 %, P = 0â 012). Motivation and opportunity strongly facilitated soya consumption, while psychological capability was the most common barrier to consumption though less evident among dietary arm participants. While most Asian women have a positive perception towards soya, theory-based intervention trials are warranted to understand the perception-study adherence relationship and to accurately inform the public of the health effects of soya.
Assuntos
Dieta , Conhecimentos, Atitudes e Prática em Saúde , Alimentos de Soja , Humanos , Feminino , Malásia , Inquéritos e Questionários , Pessoa de Meia-Idade , Suplementos NutricionaisRESUMO
Soy intake is associated with lower breast cancer risk in observational studies concerning Asian women, however, no randomized controlled trials (RCT) have been conducted among Asian women living in Asia. This three-armed RCT assessed the effects of one-year soy isoflavone (ISF) intervention on mammographic density (MD) change among healthy peri- and postmenopausal Malaysian women. This study was registered at ClinicalTrials.gov (NCT03686098). Participants were randomized into the 100 mg/day ISF Supplement, 50 mg/day ISF Diet, or control arm, and assessed for change in absolute and relative dense area from digital mammograms conducted at enrolment and after 12 months, compared over time across study arms using Kruskal-Wallis tests. Out of 118 women enrolled, 91 women completed the intervention, while 27 women (23%) were lost in follow up. The ISF supplement arm participants observed a larger decline in dense area (−1.3 cm2), compared to the ISF diet (−0.5 cm2) and control arm (−0.8 cm2), though it was not statistically significant (p = 0.48). Notably, among women enrolled within 5 years of menopause; dense area declined by 6 cm2 in the ISF supplement arm, compared to <1.0 cm2 in the control arm (p = 0.13). This RCT demonstrates a possible causal association between soy ISF intake and MD, a biomarker of breast cancer risk, among Asian women around the time of menopause, but these findings require confirmation in a larger trial.
Assuntos
Neoplasias da Mama , Isoflavonas , Feminino , Humanos , Densidade da Mama , Isoflavonas/farmacologia , Mama/diagnóstico por imagem , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/prevenção & controle , MamografiaRESUMO
Although maternal and child mortality are on the decline in southeast Asia, there are still major disparities, and greater equity is key to achieve the Millennium Development Goals. We used comparable cross-national data sources to document mortality trends from 1990 to 2008 and to assess major causes of maternal and child deaths. We present inequalities in intervention coverage by two common measures of wealth quintiles and rural or urban status. Case studies of reduction in mortality in Thailand and Indonesia indicate the varying extents of success and point to some factors that accelerate progress. We developed a Lives Saved Tool analysis for the region and for country subgroups to estimate deaths averted by cause and intervention. We identified three major patterns of maternal and child mortality reduction: early, rapid downward trends (Brunei, Singapore, Malaysia, and Thailand); initially high declines (sustained by Vietnam but faltering in the Philippines and Indonesia); and high initial rates with a downward trend (Laos, Cambodia, and Myanmar). Economic development seems to provide an important context that should be coupled with broader health-system interventions. Increasing coverage and consideration of the health-system context is needed, and regional support from the Association of Southeast Asian Nations can provide increased policy support to achieve maternal, neonatal, and child health goals.
Assuntos
Mortalidade da Criança , Proteção da Criança , Mortalidade Materna , Bem-Estar Materno , Sudeste Asiático , Criança , Serviços de Saúde da Criança , Mortalidade da Criança/tendências , Feminino , Pessoal de Saúde/educação , Política de Saúde , Mão de Obra em Saúde , Disparidades em Assistência à Saúde , Humanos , Recém-Nascido , Serviços de Saúde Materna , Mortalidade Materna/tendências , Pobreza , Serviços de Saúde Rural , Cobertura Universal do Seguro de Saúde , Serviços Urbanos de Saúde , VacinaçãoRESUMO
This study determined the intakes of complementary foods (CFs) and milk-based formulas (MFs) by a total of 119 subjects aged 6-23.9 months from urban day care centers. Dietary intakes were assessed using two-day weighed food records. Intake adequacy of energy and nutrients was compared to the Recommended Nutrient Intakes (RNI) for Malaysia. The most commonly consumed CFs were cereals (rice, noodles, bread). The subjects derived approximately half of their energy requirements (kcals) from CFs (57 ± 35%) and MFs (56 ± 31%). Protein intake was in excess of their RNI requirements, from both CFs (145 ± 72%) and MFs (133 ± 88%). Main sources of protein included meat, dairy products, and western fast food. Intake of CFs provided less than the RNI requirements for vitamin A, thiamine, riboflavin, folate, vitamin C, calcium, iron, and zinc. Neither CF nor MF intake met the Adequate Intake (AI) requirements for essential fatty acids. These findings indicate imbalances in the dietary intake of the subjects that may have adverse health implications, including increased risk of rapid weight gain from excess protein intake, and linear growth faltering and intellectual impairment from multiple micronutrient deficiencies. Interventions are needed to improve child feeding knowledge and practices among parents and child care providers.
Assuntos
Proteínas Alimentares/análise , Ácidos Graxos Essenciais/análise , Alimentos Infantis/estatística & dados numéricos , Micronutrientes/análise , População Urbana/estatística & dados numéricos , Animais , Creches , Registros de Dieta , Inquéritos sobre Dietas , Ingestão de Alimentos , Ácidos Graxos Essenciais/deficiência , Feminino , Humanos , Lactente , Alimentos Infantis/análise , Fórmulas Infantis/análise , Fórmulas Infantis/estatística & dados numéricos , Transtornos da Nutrição do Lactente/epidemiologia , Transtornos da Nutrição do Lactente/etiologia , Fenômenos Fisiológicos da Nutrição do Lactente , Malásia/epidemiologia , Masculino , Micronutrientes/deficiência , Leite , Necessidades NutricionaisRESUMO
The composition of human breast milk changes in the first two months of life, adapting itself to the evolving needs of the growing new-born. Lipids in milk are a source of energy, essential fatty acids (FA), fat-soluble vitamins, and vital bioactive components. Information on breast milk FA of Malaysian lactating women is scarce. Based on convenience sampling, a total of 20 Malay breastfeeding women who fulfilled the inclusion criteria were recruited. Breast milk was collected three times from each subject at consecutive intervals of 2-3 weeks apart. A total of 60 breast milk samples were collected and classified into "transitional milk" (n = 8), "early milk" (n = 26) and "mature milk" (n = 26). All milk samples were air freighted to University of Groningen, Netherlands for analysis. The dominant breast milk FA were oleic acid, constituting 33% of total fatty acids, followed by palmitic acid (26%). Both these FA and the essential FA, linoleic acid (10%) and alpha-linolenic acid (0.4%), showed no significant changes from transitional to mature milk. Breast milk ratio of n-6:n-3 polyunsaturated fatty acids (PUFA) was comparatively high, exceeding 10 throughout the lactation period, suggesting a healthier balance of PUFA intake is needed in pregnancy and at postpartum.
Assuntos
Aleitamento Materno , Ácidos Graxos/metabolismo , Lactação/psicologia , Leite Humano/metabolismo , Adulto , Feminino , HumanosRESUMO
INTRODUCTION: Folic acid (0.4 mg) taken prior to and during early pregnancy reduces the risk of neural tube defects (NTDs). Because these birth defects occur early in pregnancy, before women may know they are pregnant, many countries have mandated the addition of folic acid to food staples. In countries where fortification is not possible, and weekly iron folic acid programmes exist to reduce anaemia, the WHO recommends that 2.8 mg (7×0.4 mg) folic acid be given instead of the current weekly practice of 0.4 mg. Currently, there is a lack of evidence to support if the 2.8 mg folic acid per week dose is sufficient to raise erythrocyte folate concentrations to a level associated with a reduced risk of a NTD-affected pregnancy. We aim to conduct a three-arm randomised controlled trial to determine the effect of weekly folic acid with iron on erythrocyte folate, a biomarker of NTD risk. METHODS AND ANALYSIS: We will recruit non-pregnant women (n=300; 18-45 years) from Selangor, Malaysia. Women will be randomised to receive either 2.8, 0.4 or 0.0 (placebo) mg folic acid with 60 mg iron weekly for 16 weeks, followed by a 4-week washout period. The primary outcome will be erythrocyte folate concentration at 16 weeks and the mean concentration will be compared between randomised treatment groups (intention-to-treat) using a linear regression model adjusting for the baseline measure. ETHICS AND DISSEMINATION: Ethical approval was obtained from the University of British Columbia (H18-00768) and Universiti Putra Malaysia (JKEUPM-2018-255). The results of this trial will be presented at scientific conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBERS: ACTRN12619000818134 and NMRR-19-119-45736.
Assuntos
Eritrócitos/química , Ácido Fólico/administração & dosagem , Defeitos do Tubo Neural , Suplementos Nutricionais , Feminino , Humanos , Malásia , Defeitos do Tubo Neural/prevenção & controle , Gravidez , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
INTRODUCTION: Weekly iron-folic acid (IFA) supplements are recommended for all menstruating women in countries where anaemia prevalence is >20%. Anaemia caused by folate deficiency is low worldwide, and the need to include folic acid is in question. Including folic acid might reduce the risk of a neural tube defect (NTD) should a woman become pregnant. Most weekly supplements contain 0.4 mg folic acid; however, WHO recommends 2.8 mg because it is seven times the daily dose effective in reducing NTDs. There is a reluctance to switch to supplements containing 2.8 mg of folic acid because of a lack of evidence that this dose would prevent NTDs. Our aim was to investigate the effect of two doses of folic acid, compared with placebo, on red blood cell (RBC) folate, a biomarker of NTD risk. METHODS: We conducted a three-arm double-blind efficacy trial in Malaysia. Non-pregnant women (n=331) were randomised to receive 60 mg iron and either 0, 0.4, or 2.8 mg folic acid once weekly for 16 weeks. RESULTS: At 16 weeks, women receiving 0.4 mg and 2.8 mg folic acid per week had a higher mean RBC folate than those receiving 0 mg (mean difference (95% CI) 84 (54 to 113) and 355 (316 to 394) nmol/L, respectively). Women receiving 2.8 mg folic acid had a 271 (234 to 309) nmol/L greater mean RBC folate than those receiving 0.4 mg. Moreover, women in the 2.8 mg group were seven times (RR 7.3, 95% CI 3.9 to 13.7; p<0.0001) more likely to achieve an RBC folate >748 nmol/L, a concentration associated with a low risk of NTD, compared with the 0.4 mg group. CONCLUSION: Weekly IFA supplements containing 2.8 mg folic acid increases RBC folate more than those containing 0.4 mg. Increased availability and access to the 2.8 mg formulation is needed. TRAIL REGISTRATION NUMBER: This trial is registered with the Australian New Zealand Clinical Trial Registry (ACTRN12619000818134).
Assuntos
Ácido Fólico , Defeitos do Tubo Neural , Austrália , Feminino , Humanos , Ferro , Malásia/epidemiologia , Defeitos do Tubo Neural/epidemiologia , Defeitos do Tubo Neural/prevenção & controle , GravidezRESUMO
Metabolic syndrome is a cluster of interconnected cardiovascular risk factors. This research determined the prevalence of metabolic syndrome by body mass index, sociodemography, and lifestyle habits of women 30-50 years old in Babol Iran. A systematic random sampling was used to select 984 middle aged women from an urban area in Babol, Mazandaran, Iran. Screening was used to select eligible women who fulfilled selection criteria. The Adult Treatment Panel III (ATP III) criteria were used to classify participants as having metabolic syndrome. The overall prevalence of metabolic syndrome was 31.0%. Abdominal obesity was observed in about 76.6% (n = 273) of subjects. The prevalences of hypertension, high fasting blood glucose, high triglycerides and low HDL-cholesterol were 12.1, 12.1, 41.5 and 48.6%, respectively. Older age (OR = 2.07; CI = 1.56-2.75), higher waist circumference (OR = 6.46; 95% CI = 3.48-11.96), higher systolic (OR = 3.84; 95% CI = 2.37-6.22) and diastolic blood pressure (OR = 1.89; 95% CI =1.17-3.05), low education level (OR = 2.780; CI = 1.80-4.31), housekeeping (OR = 3.92; CI = 1.24-12.44) and farming occupation (OR = 20.54; 95% CI = 3.54-119.06) were associated with increased risk for metabolic syndrome. The odds ratio (OR) showed no significant associations between metabolic syndrome and smoking or exposure to smoking. This study showed high prevalence of metabolic syndrome in Iranian middle aged women. A larger area and population study is needed to enable broader recommendations for the prevention of metabolic syndrome.
Assuntos
Síndrome Metabólica/epidemiologia , Adulto , Estudos Transversais , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Pessoa de Meia-Idade , PrevalênciaRESUMO
PURPOSE: To evaluate the association between preconception care and the risk of adverse birth outcomes. DESIGN: A quasi-experimental study comparing 2 groups: (1) integrated maternal health care (MHC) program (with preconception care) and (2) standard MHC program (without preconception care). SETTING: Maternal health-care clinics in Alvand and Qazvin cities in Qazvin Province, Iran. PARTICIPANTS: A total of 152 and 247 Iranian women aged 16 to 35 years were enrolled in the integrated MHC and standard MHC program, respectively. MEASURES: The birth outcomes measured included low birth weight, preterm birth, maternal and neonatal complications, and mode of delivery (normal vaginal delivery and cesarean delivery). ANALYSIS: Multiple logistic regression was performed to determine the impact of preconception care and risk of adverse birth outcomes with adjusted odds ratios (ORs) as effect sizes. RESULTS: One hundred forty-seven women in integrated MHC and 218 women in standard MHC completed this study. Preconception care was associated with reduced risk of preterm birth (OR = 0.298; 95% confidence interval [CI] = 0.120-0.743; P = .009), low birth weight (OR = 0.406; 95% CI = 0.169-0.971; P = .043), maternal complication (OR = 0.399; 95% CI = 0.241-0.663; P < .001), and neonatal complications (OR = 0.460; 95% CI = 0.275-0.771; P = .003). CONCLUSION: The findings of the present study revealed advantages of preconception care with reduced adverse birth outcomes.
Assuntos
Cuidado Pré-Concepcional/estatística & dados numéricos , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Adolescente , Adulto , Fatores Etários , Peso ao Nascer , Feminino , Humanos , Irã (Geográfico) , Modelos Logísticos , Cuidado Pós-Natal/estatística & dados numéricos , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Fatores Socioeconômicos , Adulto JovemRESUMO
The term 'added sugars' refers to sugars and syrup added to foods during processing or preparation, and sugars and syrups added at the table. Calls to limit the daily intakes of added sugars and its sources arose from evidence analysed by WHO, the American Heart Association and other organizations. The present review examined the best available evidence regarding levels of added sugar consumption among different age and sex groups in Malaysia and sources of added sugars. Information was extracted from food balance sheets, household expenditure surveys, nutrition surveys and published studies. Varying results emerged, as nationwide information on intake of sugar and foods with added sugar were obtained at different times and used different assessment methods. Data from the 2003 Malaysian Adult Nutrition Survey (MANS) using food frequency questionnaires suggested that on average, Malaysian adults consumed 30 grams of sweetened condensed milk (equivalent to 16 grams sugar) and 21 grams of table sugar per day, which together are below the WHO recommendation of 50 grams sugar for every 2000 kcal/day to reduce risk of chronic disease. Published studies suggested that, for both adults and the elderly, frequently consumed sweetened foods were beverages (tea or coffee) with sweetened condensed milk and added sugar. More accurate data should be obtained by conducting population-wide studies using biomarkers of sugar intake (e.g. 24-hour urinary sucrose and fructose excretion or serum abundance of the stable isotope 13C) to determine intake levels, and multiple 24 hour recalls to identify major food sources of added sugar.