MJN 2018 Issues

Malaysian Journal of Nutrition

Volume 24 No.1, 2018


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Table of Content

NUTRITIONAL STATUS, DIETRY INTAKE AND BODY COMPOSITION

Vitamin D supplementation decreased body weight and body mass index of Iranian type-2 diabetic patients: A randomised clinical trial study
Esmaeil Yousefi Rad, Somayeh Saboori, Ebrahim Falahi & Mahmoud Djalali

ABSTRACT

Introduction: Vitamin D as a common deficient micronutrient possibly plays an important role in body weight management. The aim of this study was to assess possible effects of vitamin D supplementation on anthropometric parameters of type-2 diabetic patients.
Methods: Participants of this randomised controlled trial were 28 type-2 diabetic patients who received 4000 IU/day vitamin D and 30 patients who received placebo for two months. All patients were selected from the Iranian Diabetes Association (IDA), Tehran, Iran. Weight, height, body mass index, waist circumference, hip circumference and waist to hip ratio (WHR) were determined before and after the intervention. Dietary information was obtained using a 3-day food record.
Results: Results showed a significant decrease in bodyweight (from 75.73±3.09 kg to 74.63±3.04 kg, p = 0.002), BMI (from 27.94±0.92 kg/m2 to 27.544±0.90 kg/m2, p = 0.001); waist circumference (from 92.56±2.33 cm to 91.05±2.27 cm, p = 0.004); and hip circumference (from 104.19±1.88 cm to 102.35±1.88 cm, p = 0.029) in the vitamin D group. Food record analysis showed that the percent of total calorie intake from dietary carbohydrates increased (from 50.40±1.38% to 53.14±1.53%, p = 0.023) and from fat, it decreased (from 38.43±1.30% to 35.22±1.49%, p = 0.011) significantly in the vitamin D group at the end of the intervention.
Conclusion: Supplementation with vitamin D seems to include beneficial effects on bodyweight management in type-2 diabetic patients. However, the percentage of total calorie intake from each macronutrient should be considered.
Key words: Vitamin D, type-2 diabetes, weight, BMI

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Short birth length, low birth weight and maternal short stature are dominant risks of stunting among children aged 0-23 months: Evidence from Bogor longitudinal study on child growth and development, Indonesia
Wan Putri Elena Wan Dali, Hamid Jan JanMohamed & HafzanYusoff

ABSTRACT

Introduction: Stunting remains a predominant global health problem and Indonesia is no exception. This analysis aims to determine the major factors of stunting among children aged 0-23 months, using data from the Bogor Longitudinal Study on Child Growth and Development (BLSCGD).
Methods: The BLSCGD was conducted by the Center for Public Health Research and Development, Ministry of Health, Indonesia. This analysis used part of the BLSCGD data. A total of 320 children aged above 23 months were included. Anthropometric measurements were performed by trained enumerators each month from the first month of birth until 23 months of age. The analyses of survival resilience was conducted using survival statistics test using life table and Kaplan Meier, whereby the case for this survival analysis was the occurrence of stunting. Factors affecting stunting (including children and maternal characteristics) were tested using cox proportional hazards regression.
Results: Determinants of stunting were birth weight with hazards regressions (HR) score=1.847; 95% CI: 1.282-2.662), birth length (HR=1.567; 1.034-2.375), and maternal height (HR=1.436; 1.014–2.030). The probability of children not being stunted decreased with increase in age.
Conclusion: Birth weight and length at birth, and maternal short stature were the dominant risks factors of stunting among the study children aged 0-23 months.
Key words: stunting, survival resilience, children under two years of age, Indonesia

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Association between stunting and obesity among underfive children in urban and rural areas of Oyo State, Nigeria
Olanike Bukola Bamisaye & Oladejo Thomas Adepoju

ABSTRACT

Introduction: Malnutrition contributes to more than one-third of all child deaths worldwide and accounts for over 50 percent of under-five deaths in Nigeria. Both overnutrition and undernutrition exist among under-five children, leading to double burden of malnutrition, a major risk factor for chronic diseases. The study was conducted to assess the association between stunting and obesity among under-five children in urban and rural areas of Oyo State, Nigeria.
Methods: A cross-sectional survey was carried out using a four-stage random sampling technique to select 450 (214 males and 236 females) under-five children from Ibadan North (Urban) and Ido (Rural) Local Government Areas (LGAs) of Oyo State. A pre-tested, interviewer-administered semi-structured questionnaire was used to collect information on socio-demographic characteristics of respondents. Weight and height of the children were measured and categorized according to the WHO Child Growth Standards.
Results: Mean age of children was 29.8±17.0 months (Ibadan North, 29.1±16.8; Ido, 31.9±17.4 months) with 52.6% being female. The prevalence of stunting, overweight and obesity was 32.9%, 14.4% and 20.2%, respectively. A total of 30.7%, 17.2% and 22.1% of children in Ibadan North and 40.6%, 5.0% and 13.9% in Ido LGA were stunted, overweight and obese, respectively. High proportion of obese children (43.5%) was stunted, indicating co-existence of obesity and stunting among the population.
Conclusion: Double burden of overweight and stunting found in urban and rural young children indicate that public policies should emphasise on targeting both malnutrition conditions to prevent the subsequent health risks and complications.
Key words: Stunting, obesity, overweight, preschool children, malnutrition

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Influence of maternal autonomy and socioeconomic factors on birth weight of infants in India
Suparna Shome, Manoranjan Pal & Premananda Bharati

ABSTRACT

Introduction: Child’s birth weight (BW) is an important aspect not only during childhood but also affects morbidity and mortality in adulthood. The focus of this study is to examine the role of different socioeconomic factors, along with women’s decision-making autonomy on the determination of infant BW.
Methods: The dataset was obtained from the National Family Health Survey, India (2005-06). The respondents were women of reproductive age (15-49 years) having at least one living child at least five years old preceding the survey. This study considered only the last single live birth child having a recorded BW at the time of delivery.
Results: The results showed that 19% of the infants were born with low birth weight (LBW) with regional variations ranging from 13% to 27%. The mean BW of infants of mothers from high autonomy category was 2.90±0.645 kg, while that of mothers with low autonomy was 2.75±0.702 kg. The proportion of LBW infants was significantly higher among mothers with low education, short stature, low BMI and poor wealth index category. Percentage of LBW infants were lower among mothers with autonomy including taking care of their own health (18% versus 21% who were not), making large purchases (17% vs 22%), visiting relatives (18% vs 22%), and allowed to go to the market (18% vs 22%).
Conclusion: The findings indicated that the mother’s freedom of movement and financial independence were significantly associated with infant’s BW in India. Attention should be given to improving the socio-economic conditions and empowerment of Indian women.
Key words: Low birth weight, women autonomy, body mass index, wealth index, Indian National Family Health Survey

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Low birth weight, women autonomy, body mass index, wealth index, Indian National Family Health Survey
Sandra Fikawati & Vina Giolisa Permata Sari

ABSTRACT

Introduction: Weight retention during postpartum period is generally not preferred by mothers. Mothers are known to reduce energy intake during lactation in order to lose weight. Additional energy is required during lactation to provide for breast milk production. This study aimed at investigating factors that influence postpartum weight loss.
Methods: Data from a prospective cohort quasi experiment study conducted in Beji subdistrict, Depok City were used. This study had recruited lactating mothers from community health centres and they were followed up from delivery to six months postpartum. A total of 201 breastfeeding mothers determined by cohort sample size formula were included. The dependent variable was six months’ postpartum weight loss, while the independent variables included age, energy intake, education, working status, parity and exclusive breastfeeding practice. Bivariate analysis using independent t-test and multiple linear regression was used for statistical analysis.
Results: Mean age of the mothers was 30.3 years (95% CI: 29.8-31.1 years). Majority of the mothers had senior high school education, were not working, multiparous and practising exclusive breastfeeding. Mean intake of energy was 1946 kcal/day (1897-1994 kcal/day). They experienced a mean weight loss of 3.79 kg during the study period (3.27-4.31 kg). Postpartum weight loss was associated with exclusive breastfeeding (p=0.004), and education status of the mothers (p=0.029).
Conclusion: Exclusive breastfeeding for six months is the dominant factor associated with postpartum weight loss of the mother. Breastfeeding mothers should be supported on their intention to exclusively breastfeed and not be unduly concerned with gaining weight.
Key words: Exclusive breastfeeding, postpartum, retention, weight loss

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Profile of complementary food consumption during the first year of life based on Indonesia Individual Food Consumption Survey 2014
Yusra Egayanti, Nurheni Sri Palupi & Endang Prangdimurti

ABSTRACT

Background: In Indonesia, though the recommendation to start complementary foods (CF) is at six months, mothers do not comply with this recommendation.
Methods: Data from Indonesia Individual Food Consumption Survey (IFCS) 2014 of 1,514 infants aged 0-11 months was used for this study. The profiles of CF consumption during the first year of life, including frequency of consumption, types of CF, timely introduction and nutritional contents of CF were determined. Mothers were interviewed at home to determine infant intake using 24-hour dietary recall. The IFCS classified CF as home-made or manufactured. Nutrient contents were calculated using several sources. Nutrient intakes from CF for 6-11 months were compared with WHO (2001) and Dewey (2001) recommendations.
Results: There were 19.2% early and 3.2% late introduction of CF. Homemade complementary foods were widely consumed. Frequency of consumption of CF among 82.7% of infants aged 6-8 month was 2-3 times per day. Intake of fat, iron, zinc and calcium from CF were inadequate in 75.5%, 86.6%, 72.9% and 60.3% respectively among infants aged 6-8 months. Inadequate intake of fat, protein, iron, zinc and calcium were also found among infants aged 9-11 months. Inadequate intake of vitamin D was also found in 89.5% and 88.7% of infants in each age group. Excessive sodium intake was found in 37.2% and 49.3% of infants in each age groups.
Conclusion: While untimely complementary feeding introduction was found, greater concern was for inadequate intake of several key nutrients and excess intake of sodium among Indoensian infants. Complementary feeding education is recommended.
Key words: Complementary food, infants, Indonesia Individual Food Consumption Survey (IFCS) 2014

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Food choices among Malaysian adults: Findings from Malaysian Adults Nutrition Survey (MANS) 2003 and MANS 2014
Noraida Binti Mohamad Kasim, Mohamad Hasnan Bin Ahmad, Azli Bin Baharudin @ Shaharudin, Balkish Mahadir Naidu, Chan Ying Ying & Hj Tahir Bin Aris

ABSTRACT

Introduction: Changes in dietary habits are known to be associated with changes in health outcomes. This study determined food choices among Malaysian adults using secondary data of the Malaysian Adults Nutrition Survey (MANS) in 2003 and MANS in 2014.
Methods: A total of 6,742 and 3,000 adults aged 18 to 59 years participated in MANS 2003 and MANS 2014, respectively. Both studies used a semi-quantitative food frequency questionnaire (FFQ) to assess habitual food intake.
Results: Overall, the prevalence of adults consuming rice twice daily were 97.3% and 86.9% in 2003 and 2014, respectively. While the percentage of urban dwellers who consumed rice daily differed significantly between 2003 (96.7%) and 2014 (86.9%), the percentage remained quite similar among rural adults in 2003 (97.8%) and 2014 (96.3%). Other top ten food items consumed daily were sugar (2003, 58.5% vs 2014, 55.9%), marine fish (40.8% vs 29.4%), green leafy vegetables (39.9% vs 43.2%) and sweetened condensed milk (35.2% vs 29.3%). In both surveys, a higher percentage of men consumed rice, sugar and sweetened condensed milk on a daily basis compared to women, a higher proportion of whom daily consumed green leafy vegetables and marine fish. Majority of the adults reported drinking plain water daily. Other beverages taken daily were tea, coffee and chocolate-malt drinks.
Conclusion: Rice, sugar and sweetened condensed milk were among the top food items consumed daily in 2003 and 2014. Educational efforts to improve dietary intake of Malaysian adults is recommended.
Key words: Dietary, food consumption, Malaysian Adults Nutrition Survey (MANS)

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Knowledge, attitude and practice regarding dietary fibre intake among Malaysian rural and urban adolescents
Norlida Mat Daud, Nor Izati Fadzil, Lam Kit Yan, Ika Aida Aprilini Makbul, Noor Fairuzi Suhana Yahya, Arnida Hani Teh & Hafeedza Abdul Rahman

ABSTRACT

Introduction: Awareness of the importance of dietary fibre (DF) in health among adolescents is seldom reported in Malaysia. This study aimed to compare the knowledge, attitude and practice (KAP) of DF intake between Malaysian rural and urban school-going adolescents. Pulau Pangkor in Perak and Damansara in Selangor were randomly selected as rural and urban schools, respectively.
Methods: A total of 305 school adolescents with a mean age of 13.5±0.6 years were randomly selected from rural (72 Malay, 85 Chinese) and urban (86 Malay, 62 Chinese) schools completed socio-demographic, validated KAP on DF intake questionnaire, as well as a 24-hour dietary recall.
Results: Adolescents from both areas have moderate knowledge (54.4±11.3%), positive attitude (78.7±13.1%) and good practice (65.8±19.9%) scores towards DF intake. Although rural adolescents had significantly (p=0.022) higher DF intake (7.8±3.5 g) compared to urban adolescents (6.9±3.5 g), their DF intake was still lower than the Malaysian recommendation of 20-30 g/day. The attitude of DF intake of rural (r=0.390) and urban (r=0.370) adolescents showed significant positive correlations with practice score of DF intake. While a significant correlation was found between the practice score and DF intake (r=0.191, p=0.017), no significant correlation was found between knowledge and attitude scores with DF intake.
Conclusion: Public health authorities and schools should raise awareness on health benefit of consuming DF to promote an increase in DF consumption among school adolescents.
Key words: Dietary fibre intake, KAP, rural, urban, school adolescents

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Comparing the nutritional status of vegetarians and non-vegetarians from a Buddhist Organisation in Kuala Lumpur, Malaysia
Wan Ying Gan, Shirley Boo, Mei Yee Seik & Hock Eng Khoo

ABSTRACT

Introduction: A vegetarian diet is generally considered as healthy for preventing metabolic-related diseases. There is lack of studies in Malaysia comparing the nutritional status of vegetarians and non-vegetarians. This cross-sectional study aims to compare body weight status, dietary intake and blood pressure level between these two groups.
Methods: A total of 131 vegetarians and 135 non-vegetarians were recruited using convenience sampling from a Buddhist organisation in Kuala Lumpur. Body weight, height, waist circumference, percentage of body fat, and blood pressure measurements were taken, while dietary intake was assessed using a 2-day 24-hour dietary recall.
Results: More vegetarians were underweight than non-vegetarians (31.3% vs 15.6%), while prevalence of overweight and obesity was higher among the non-vegetarians (23.7% vs 9.9%). A higher proportion of non-vegetarians (34.1%) had an unhealthy range of body fat percentage and significantly higher risk of abdominal obesity (24.4%) than the vegetarians (19.1% body fat; 13.7% abdominal obesity). Mean intakes for protein and fat were significantly lower among the vegetarians, while no significant differences were observed in the mean intake for energy and carbohydrate. Vegetarians had significantly higher intakes of vitamins C, D and E, calcium, potassium and folate, while vitamin B12 intake was significantly higher in the non-vegetarians. More non-vegetarians presented with unhealthy blood pressure status.
Conclusion: Vegetarians in this study generally showed healthier dietary intake and lower body fatness than the non-vegetarians. Studies are suggested to be undertaken on a bigger sample size of vegetarians to confirm these findings.
Key words: Body weight status, dietary intake, obesity, blood pressure, vegetarian

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Effects of sports nutrition education intervention on sports nutrition knowledge, attitude and practice, and dietary intake of Malaysian team sports athletes
Siti Soraya Mohd Elias, Hazizi Abu Saad, Mohd Nasir Mohd Taib & Zubaidah Jamil

ABSTRACT

Introduction: The purpose of this study was to determine the effects of sports nutrition education intervention on improvements in sports nutrition knowledge, attitude and practice (KAP), and dietary intake among Malaysian team sports athletes.
Methods: A total of 105 male participants representing four team sports under the elite sports programme were recruited based on a name list provided by National Sports Council of Malaysia. Teams were assigned by stratified random sampling to either the experimental group (EG) (n=52) or the comparison group (CG) (n=53). The EG received seven weeks of education intervention programme based on a validated booklet covering basic sports nutrition for team sports. A self-administered sports nutrition KAP questionnaire and dietary intake assessment of total energy, carbohydrates, proteins and fats based on three-day food records was conducted before and after the intervention.
Results: There were significant increments (p<0.001) in the EG’s post-intervention mean scores for knowledge (6.21±2.95), attitude (9.04±6.65) and practice (4.39±4.27) compared to decrements in the respective mean scores of the CG (-2.15±1.45; -1.72±5.06; -0.74±2.32). Significant improvements were found in the EG’s total energy intake, total carbohydrate and total protein intake compared to those of the CG.
Conclusion: The sports nutrition education intervention was useful in improving the sports nutrition KAP scores, total carbohydrate and total protein intake of team sports athletes.
Key words: Athletes, intervention study, dietary intake, sports nutrition, knowledge

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Self-perception of body image among Saudi females at Princess Nourah University, Riyadh, Kingdom of Saudi Arabia
Asma Abdulaziz Alhussaini, Hessah Ibrahim Alsuwedan, Hessa Faleh Alnefaie, Rehab Abduallah Almubrek, Shima Abdulaziz Aldaweesh, Layam Anitha & Hind Qassem

ABSTRACT

Background: Women are influenced by many socio-cultural factors on how they perceive their body image.
Methodology: This cross-sectional study assessed self-perception of body image, body mass index (BMI), and compared the agreement between actual and perceived BMI among Saudi female adults at Princess Nourah University (PNU) in Riyadh. A total of 336 participants aged 18-50 years were recruited, by randomly selecting one of the three colleges in PNU and from among the workers in the selected college. A structured self-administered questionnaire was used to obtain socio-demographic information, weight perceptions, body satisfaction and media influence on body image. Participants had to “give best description of your perceived weight and height”.
Results: Majority of the participants were aged 18-29 years and unmarried. Mean BMI was 26.1±9.41 kg/m2, and more than half of the participants (55.7%) belonging to 55-80 kg weight range were overweight. Their mean BMI by actual measurement was 24.2±8.26 kg/m2 while their self-estimated BMI also fell in the normal BMI category. Cohen’s Kappa K value of 0.635 indicated a good agreement between the actual and perceived BMI categories. Positive body image perception was given by 68.6% of the participants; 83.9% felt appearance was very important in the context of body image perception; 47.1% agreed that changing their abdominal part was what they wanted to change most, while 52.8% opted to lose weight in improving their appearance.
Conclusion: Overall, an underestimation of body weight in terms of BMI was found among the participants. Such misconceptions should be addressed in view of the high obesity prevalence in Saudi Arabia.
Key words: Self-perception, body image, misperception, BMI, Saudi female

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NUTRIENTS, FOOD COMPOSITION, PHYTOCHEMICALS

Do probiotics and fibre in milk powder have an effect on functional constipation and general wellbeing of Filipino mothers?
Imelda Angeles-Agdeppa

ABSTRACT

Introduction: This study aimed to evaluate the effect of probiotics and fibre in milk powder on functional constipation and general well-being of a sample of Filipino mothers.
Methods: The study employed a single group, controlled, before-after intervention design. Out of 115 females recruited from 7 military camps in Metro Manila aged 21-31 years, 85 mothers met the inclusion criteria namely, defecation frequency of <3 days/week or constipated for about 2-8 weeks, experienced bloating, flatulence, gurgling, feeling heavy after eating, and abdominal pain, willing to stop vitamin supplementation a week before the start of the study. Milk powder (40 g) in 200 ml of water was consumed twice a day for 28 days under supervision at the workplace. Digestive health, health and wellness, bowel habit and Bristol stool chart questionnaires, which were modified and pre-tested, were administered every 3-4 day visits. Constipation was defined as <3 days/week defecation frequency (Rome II). Appropriate statistical tests were employed in data analysis.
Results: A total of 72 participants completed the study. At 4 weeks, a significant improvement in defecation frequency was reported. There was an increasing percentage of participants who were highly satisfied with their defecation frequency, stool characteristics, comfort during defecation and defecation duration as the number of intervention days increased.
Conclusion: The consumption of a probiotic and fibre fortified milk powder might have contributed in alleviating functional constipation and the improvement in general health and wellbeing of the participants. Further studies should be conducted to confirm these results.
Key words: Powder milk, probiotic, fibre, digestive health, constipation

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Physical properties of microencapsulated anthocyanin obtained by spray drying of Red Amaranthus extract with maltodextrin
Meenakshi Narayanan, Sasikala Shanmugam & Pavithra Mitta Suresh

ABSTRACT

Introduction: Anthocyanins are water-soluble plant pigments responsible for bright red, purple and blue colours in fruits and vegetables. Extraction of anthocyanins from plant cells becomes an important task closely related to the need of preservation of their bioactivity. Therefore, encapsulation by spray drying is a technique used to retain maximum anthocyanin and colour.
Methods: The study was designed to investigate the physical properties of spray drying of Red Amaranthus extract with maltodextrin. The extract was prepared by soaking washed and finely chopped red spinach (Red Amaranthus) leaves in water for 72 h at 4°C of with potable water (solvent), followed by storage at refrigerated condition at 4°C for 72 h. The extract was mixed with maltodextrin solution in three different ratios: 1:1, 1:2 and 1:3. Powder properties were studied for the three different extract and maltodextrin ratios that were fed in the spray dryer. All analyses were conducted in triplicates.
Results: The 1:1 ratio retains maximum anthocyanin 93.03 mg/100g of spray dried powder compared to the other ratios; the moisture content of the 1:1 ratio was 0.44% (dry basis). The color chroma value of a* of 1:1 ratio was 26.24 and density was 0.55 g/cm3 whereas the water activity of the sample was 0.62±0.01. By comparing the three ratios, the 1:1 ratio of extract and maltodextrin was the optimum combination for encapsulation of anthocyanin using spray-drying technique.
Conclusion: Encapsulation with maltodextrin at 1:1 ratio had a significant impact on retention of anthocyanin and colour in the final product.
Key words: Red Amaranthus, maltodextrin, spray drying, anthocyanin, colour

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SHORT COMMUNICATION, CASE REPORTS

Is enhanced recovery after surgery safe and beneficial for the elderly?
Ho Chiou Yi

ABSTRACT

Introduction: Enhanced recovery after surgery (ERAS) protocols are multidisciplinary perioperative care aimed to achieve early recovery after surgery by maintaining pre-operative organ function and reducing the surgical induced stress response.
Case presentation: A 79-year-old female patient with Transverse Colon Adenocarcinoma, elective admitted for colon resection. Patient was cachexia with weight 33 kg; loss of 7 kg within 1 month; PGSGA score 14 (severe malnourished); Albumin 30 g/L. She experienced very poor oral intake for past 1 month with intake of 450 kcal/day and 15 g/day protein. Carbohydrate loading with 100 g carbohydrate as evening drink and 50 g carbohydrate 3 hours pre-operation. Clear fluid (carbohydrate plus whey protein drink) was allowed on the first day of operation (POD). Regular diet was started on the POD3 since patient tolerated 500 ml of clear fluid. Patient tolerated well with solid food on POD4 and allowed discharged on POD5. As summary, length of hospital stay 5 days 2 hours, ambulation length 20 hours, length of clear fluid toleration 18 hours, length of solid food toleration 4 days and length of gastrointestinal function (flatus & bowel open) 4.5 days.
Discussion: Advanced age is a proven risk factor of post-operative complications. Shorter hospital stay was found associated with a lower risk of post-operative complications. Length of hospitalization after colorectal surgery does not significantly differ between younger and older age groups of the patients.
Conclusion: ERAS showed good overall outcome even elderly. Good quality of care at home is required and crucial as well after quicker discharged.
Key words: Enhanced recovery after surgery, clear fluid, elderly, length of hospital stay

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Malaysian Journal of Nutrition

Volume 24 No.2, 2018


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Table of Content

NUTRITIONAL STATUS, DIETARY INTAKE AND BODY COMPOSITION

Insulin resistance, inflammation and metabolic syndrome in normal weight and overweight/obese primary school children in Kuala Lumpur
Serene En Hui Tung, Mohd Nasir Mohd Taib, Yit Siew Chin, Zalilah Mohd Shariff, Zubaidah Jamil Osman & Hip Seng Yim

ABSTRACT

Introduction: Studies on metabolic syndrome (MetS) of children are important in view of rising prevalence of childhood obesity worldwide. This study compares the risks of insulin resistance, inflammation and metabolic syndrome between overweight/obese (OW/OB) and normal weight (NW) children in Kuala Lumpur.
Methods: A cross-sectional study was conducted in 12 primary schools selected using multi-stage stratified random sampling. Height and weight were taken of a total of 1971 children aged 10-11 years. Based on BMI-for-age, 235 OW/OB children matched for age, sex and ethnicity with 226 NW children were selected for the study. Overnight fasting blood samples were collected to determine insulin, high-sensitivity C-reactive protein (hsCRP), glucose and lipid profiles. Logistic regression analysis was conducted to estimate associations between weight status and metabolic risk factors.
Results: Prevalence of MetS among OW/OB children was 3.8% compared to 0% in the NW. Prevalence of insulin resistance among OW/OB was 45.5% compared to 18.6% among NW children. High risk of inflammation was found in 28.1% of the OW/OB children compared to 12.4% in the NW. The odds ratio of having insulin resistance, inflammation and metabolic risk factors among OW/OB were 3.66 (95% CI: 2.40-5.59), 2.76 (95% CI: 1.69-4.50), 4.93 (95% CI: 3.42-7.10), respectively compared to the NW.
Conclusion: The OW/OB children in this study showed higher risks of developing insulin resistance, inflammation and MetS compared to the NW counterparts. Further studies are suggested to better understand the relationships between insulin resistance, inflammation and MetS in children.
Key words: Children, insulin resistance, hsCRP, metabolic syndrome, obesity

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Sugar intake and metabolic syndrome among older adults in Peninsular Malaysia
Nur Zetty Sofia Zainuddin, Suzana Shahar, Nik Shanita Safii, Hasnah Haron & Mohd Azahadi Omar

ABSTRACT

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.
Key words: Metabolic syndrome, older adults, elderly, sugar intake, sugar consumption

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Contributions of socio-demographic and psychosocial characteristics, functional status and physical activity level on prevalence of depressive symptoms among rural elderly in Johor State
Nur Aqlili Riana Hamzah, Siti Nur ‘Asyura Adznam, Mohd Nasir Mohd Taib, Chan Yoke Mun, Zuriati Ibrahim & Syafinas Azam

ABSTRACT

Introduction: Depression and depressive symptom are common among the elderly. This study aimed to determine the influence of multiple factors and their correlations on the prevalence of depressive symptoms among elderly residents in selected FELDA schemes in Johor state.
Methods: A total of 269 respondents were recruited through systematic sampling. Face-to-face interviews were conducted to obtain information on socio-demographic and psychosocial characteristics using pre-tested validated questionnaires; For functional status, the Lawton-IADL Scale was used to assess independent living skills; the Short Physical Performance Battery (SPPB) questionnaire was used to assess physical performance; cognitive function was assessed by the Hodkinson Abbreviated Mental Test (HAMT); physical activity level was determined using the Rapid Assessment of Physical Activity (RAPA); and depressive symptoms were assessed by the Geriatric Depression Scale-15.
Results: Mean age of the respondents was 69.5±5.2 years. Prevalence of depressive symptoms was determined as 3.7%. Almost half (47.6%) were unable to perform one or more Lawton-IADL items, 30.9% had low physical performance, 15.6% had abnormal cognitive function and only 30.6% were physically active. There were significant correlations between the socio-demographic characteristics (age and monthly income; r=-0.135 and rs=-0.133 respectively; p<0.05), functional status and physical performance; r=-0.171 and rs=-0.194 respectively; p<0.01), and prevalence of depressive symptoms. Low physical performance contributed towards having depressive symptoms (ß=-0.183; p<0.05).
Conclusion: A relatively low prevalence of depressive symptoms was found among the elderly living in FELDA schemes in Johor. Low levels of physical performance was contributed towards prevalence of depressive symptoms among the elderly.
Key words: Socio-demographic, psychosocial, functional, physical activity, GDS-15

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Correlations between glycaemic control and serum chromium levels among type 2 diabetic patients in Denpasar, Bali
Ni Ketut Sutiari, Rimbawan Rimbawan, Clara M Kusharto, Purwantyastuti Ascobat & Adi T Effendi

ABSTRACT

Introduction: The National Basic Health Research (Riskesdas) in 2013 showed 6.9% diabetes prevalence in Indonesia with the highest among aged 55 years and above in urban areas. Poor glycaemic control is reported to be related to low chromium levels in type 2 diabetes mellitus (T2DM). This study aimed to determine the correlation between serum chromium and glycaemic control in T2DM patients.
Methods: A cross-sectional study was conducted at six community health centres (Puskesmas) in Denpasar, Bali in July 2015-Jan 2016. A total of 165 T2DM patients who met the inclusion criteria were included. The subjects were aged 50-70 years, registered in the Chronic Diseases Management Programme (Prolanis), members of diabetic health clubs in the Puskesmas, and were taking oral hypoglycaemic medication. Anthropometric measurements were taken, including weight, height and waist circumference. Fasting blood samples were collected for determination of glycated haemoglobin (HbA1c) using HPLC, blood glucose (FBG) by tipyrine (GODPAP) enzymatic colorimetric method, and serum chromium using atomic absorption spectrophotometry (AAS). Correlations between HbA1c and FBG with serum chromium were determined using Spearman Correlation test (95% CI).
Results: There was a significant negative correlation between FBG levels and serum chromium (r=-0.813; p<0.001); while no significant correlation was found between HbA1c and serum chromium (r=-0.059; p>0.05).
Conclusion: Serum chromium levels of T2DM patients in this study were low, while their FBG levels correlated negatively with serum chromium status. Studies on a larger sample of T2DM patients should be undertaken to verify this finding for nutritional care of diabetic patients.
Key words: Diabetes mellitus, fasting blood glucose, HbA1c, serum chromium

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Regional differences in obesity prevalence and associated factors among Indonesian adults: Indonesia Basic Health Research 2007 and 2013
Andi Imam Arundhana, Aisya Putri Utami, Asry Dwi Muqni & Maria Theresa Thalavera

ABSTRACT

Introduction: Obesity prevalence has increased worldwide. Based on the Indonesia Basic Health Research (BHR), the prevalence of obesity among adults rose from 10.3% in 2007 to 15.4% in 2013. This study is aimed at examining selected obesityrelated factors among adults aged 15 years and above from different regions of Indonesia.
Methods: The BHR data comprising of 664,196 adults from 258,366 households in 440 districts in 2007, and 722,329 adults from 294,959 households 497 districts were included in this analysis. Frequency intake of fatty, sweet and salty foods, and status of physical activity were assessed using a validated questionnaire developed for IBHR. Mental health status was assessed using WHO Self Reporting Questionnaire. Logistic regression was performed to assess the risk factors of obesity.
Results: Overall, obesity prevalence was 9.2% in 2007 and 14.2% in 2013. Obesity prevalence was comparatively higher in all regions in 2013, ranging from 14.1% to 15.5% in the western and eastern regions respectively. In 2007, the most likely risk factor contributing to obesity in the western and middle regions was frequent consumption of fatty food (OR=1.26 and OR=1.38, respectively), while physical inactivity (OR=1.27) was the highest odds for obesity risk in the eastern region. In 2013, frequent fatty food consumption showed the highest influence on obesity risk in all the regions.
Conclusion: Risk factors for obesity in adults varied in different regions in Indonesia. Future research and interventions on obesity are recommended to focus on unhealthy dietary intake and lifestyles indifferent regions of Indonesia.
Key words: Obesity, lifestyle trend, BMI, food consumption, physical activity

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Effects of conjugated linoleic acid supplementation and exercise on body fat mass and blood lipid profiles among overweight Iranians
Hanieh Fouladi, Loh Su Peng & Abas Mohaghehgi

ABSTRACT

Introduction: Conjugated linoleic acid (CLA) has been studied for its fat mass reduction effects. This study aimed to determine the effects of CLA supplementation on body fat mass (BFM) and selected blood lipid profiles among overweight Iranian.
Methods: A total of 180 adults with BMI = 26-29 kg/m2 and BFM exceeding 21% and 28% for men and women, respectively were recruited through voluntary participation from weight management clinics in Tehran. They were assigned randomly to three groups as follows: Group (1) (control group) receives weight loss diet only; Group (2) receives weight loss diet +3 gr/day CLA supplement (mixture of cis-9, trans-11 and trans-10, cis-12) twice a day and Group (3) weight loss diet +3 gr/day CLA supplement as Group (2) twice a day + regular exercise (walking at 5.5-6 km/h for at least 160 minutes/week). The trial was conducted for 12 weeks. Anthropometric measurements and blood lipid profiles were determined at weeks 0, 6 and 12.
Results: Both Group 2 and Group 3 showed a significant between-group difference in reduction of BFM (1.3% and 2.6% respectively) compared to Group 1. Group 2 supplementation showed increased free fatty acid (FFA) (0.44 mM to 0.55 mM) and decreased HDL-chol (47.5 mg/dL to 42.0 mg/dL) between weeks 0 and 12. These results were not observed for Group 3.
Conclusion: Combination of CLA supplementation with exercise showed BFM reduction in overweight Iranian adults. Further research is suggested to verify the findings of this study.
Key words: Overweight, conjugated linoleic acid, body fat mass, lipid profiles, Iranians

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Factors associated with stunting among Orang Asli preschool children in Negeri Sembilan, Malaysia
Siti Fatihah Murtaza, Wan Ying Gan, Norhasmah Sulaiman & Zalilah Mohd Shariff

ABSTRACT

Introduction: Childhood stunting is recognised as one of the most significant barriers to human development. This cross-sectional study aimed to determine the factors associated with stunting among Orang Asli (OA) preschool children in Negeri Sembilan, Malaysia.
Methods: A total of 264 children (50.9% boys and 49.1% girls) aged 2-6 years (M=4.04, SD=1.21 years) including their mothers from 14 OA villages in Negeri Sembilan participated in this study. Mothers were interviewed to obtain information regarding socioeconomic status, sanitation facility and personal hygiene. The height of the children and their mothers were measured. Venous blood samples were drawn from the children to estimate haemoglobin level, and stool samples were collected to screen for intestinal parasitic infections.
Results: Approximately one third of the children (35.6%) and 7.8% of the mothers were stunted. One in five of the children were anaemic (21.6%), while one- third had intestinal parasitic infections (35.0%). Low birth weight (AOR=2.526, 95% CI: 1.3104.872; p=0.006), anaemia (AOR=2.742, 95% CI: 1.265-5.945; p=0.011), presence of intestinal parasitic infections (AOR=2.235, 95% CI: 1.310-3.813, p=0.003), not wearing shoes (AOR=2.602, 95% CI: 1.453-4.660; p=0.001), absence of piped water at home (AOR=2.395, 95% CI: 1.047-5.476; p=0.039), dirty nails (AOR=1.956, 95% CI: 1.163-3.289, p=0.011), and stunted mothers (AOR=3.443, 95% CI: 1.334-8.890; p=0.011) were identified as significant factors for childhood stunting.
Conclusion: It is suggested that the factors identified associated with childhood stunting be included in future intervention programmes that address stunting among OA children.
Key words: Haemoglobin level, sanitation and hygiene, maternal stature, parasitic infection, stunting, Orang Asli children

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Correlations between anthropometric measurements, biochemical indicators, dietary intake and Dialysis Malnutrition Score among haemodialysis patients in Sibu, Sarawak
Lina Ho Ling Ling & Chan Yoke Mun

ABSTRACT

Introduction: Malnutrition is a common problem associated with increased risk of morbidity and mortality among haemodialysis (HD) patients.
Methods: This study determined the correlation between anthropometric measurements, biochemical indicators, dietary intake and dialysis malnutrition score among HD patients in Sibu, Sarawak. A total of 55 patients were recruited by purposive sampling and their biochemical parameters were retrieved from dialysis records. Anthropometric measurements and dietary intake were determined using standardised protocols while Dialysis Malnutrition Score (DMS) was computed to determine patients’ nutritional status.
Results: Mean age of the patients was 53.0±12.2 years. Mean DMS was low, indicating low tendency of malnutrition among the patients. Approximately one-third of the patients had high interdialytic weight gain (IDWG), indicating a poor adherence on fluid recommendation. Mean intakes of dietary energy (DEI) and protein (DPI) were low, with only approximately 15% achieving the recommendations according to Kidney Disease Outcomes Quality Initiative (K/ DOQI). Increase in age (r=0.337, p=0.012) and dialysis vintage (r=0.403, p=0.002) were associated with poorer nutritional status while higher BMI, MUAC, and serum albumin were associated with better nutritional status.
Conclusion: This study revealed a high proportion of the HD patients with poor adherence on fluid intake, and the prevalence of inadequate DEI and DPI, indicating the importance of regular dietary counselling for HD patients. In view of their non-invasive nature and close relationship with nutritional status, body mass index, mid-upper arm circumference, and serum albumin should be included as part of the comprehensive periodic nutrition assessment of HD patients.
Key words: Haemodialysis, Dialysis Malnutrition Score, dietary intakes, anthropometric parameters

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Comparison of dietary intake, energy adequacy and anthropometric parameters between Indian junior male and female hockey players
Madhurima Roy, Subhra Chatterjee (Nee Karmakar) & Swapan Kumar Dey

ABSTRACT

Introduction: Athletes’ performance is highly depended on their nutritional status for optimising performance. This study is aimed at assessing and comparing adequacy intake of nutrients and energy between male and female Indian hockey players.
Methods: A total of 40 Indian junior national hockey players with an equal number of males and females were selected randomly by the Sports Authority of India, Kolkata. Mean age of males was 18.2±2.3 years while that of females was 17.1±2.2 years. Dietary intake was assessed based on a 3-consecutive-day, 24hour dietary recall and frequency intake questionnaire. Dietary intake adequacy was determined according to the Recommended Dietary Allowance for India (2010). Energy requirement was estimated by the basal metabolic rate based on the Harris-Benedict formula and multiplied by an index of physical activity. Various anthropometric parameters were assessed using standard procedures.
Results: Total energy intake was significantly lower in both male (2622±450 kcal) and female (1848±236 kcal) when compared with their total energy expenditure (male: 3621±127 kcal, female: 3049±115 kcal; p<0.00). Dietary intake consisted of low fat (male: 53.5±14.01g; female: 34.0±8.33 g) and high carbohydrate (male: 431.7±85.90 g; female: 317.5±45.69 g). Insufficient intake of iron, folic acid, zinc, B-vitamins and vitamin-C were found among female participants, but not in the males. Significant differences were observed in muscle mass and haemoglobin level between the sexes.
Conclusion: The study revealed inadequate dietary intake among hockey players, especially among the females. Individualised nutritional orientation, nutrition education and dietary interventions are recommended for Indian hockey players towards improving their performance.
Key words: Hockey players, India, total energy expenditure, vitamins, minerals, nutrition

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Decreased weight gain and enhanced serum biochemical parameters in rats after vitamin D and Ca supplementation
Hadil Subih, Hosam Al-Tamimi, Hiba Hamdan, Hiba Bawadi & Sana Janakat

ABSTRACT

Introduction: Obese individuals tend to have lower plasma concentrations of calcidiol and higher levels of plasma parathyroid hormone (PTH). Objective of this study was to evaluate the influence of vitamin D and Ca supplementation on weight gain and biochemical parameters in rats fed a high-fat high-calorie diet.
Methods: Fifty-six male Sprague-Dawley rats were assigned randomly into 4 groups of 14 rats each, and receiving diets as follows: (1) high fat (HF) 40% total energy from fat; (2) high fat & vitamin D (HF-D) 2000 IU vit D/kg diet; (3) high fat & Ca (HF-Ca) 7 g Ca/kg of diet; and (4) high fat & vitamin D & Ca (HF-D & Ca) (2000 IU of vit D+7 g Ca/kg of diet). Measured variables included body weight gains, food intake, serum triglycerides, cholesterol, insulin, glucose, ALT, and AST at 5 weeks and 10 weeks of the trial.
Results: Lowest amount of weight gain and feeding efficiency ratio were recorded for the (HF-D & Ca) group. Rats in the HF-D group had the lowest circulating cholesterol. No significant differences in food intake, blood glucose, insulin, triglycerides, ALT and AST were found among the treatment groups.
Conclusion: This study showed that diet supplemented with vitamin D and Ca combined appeared to mitigate weight gain in weight-induced rats, while vitamin D supplementation alone lowered serum cholesterol concentrations. Further studies are recommended to confirm these results.
Key words: Obesity, calcium, rats, vitamin D

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NUTRIENTS, FOOD COMPOSITION, PHYTOCHEMICALS

Bioactive and nutritional compounds in virgin coconut oils
Chitraporn Ngampeerapong, Visith Chavasit & Robert W Durst

ABSTRACT

Introduction: Virgin coconut oil (VCO) is very much in demand among healthconscious consumers. VCO is produced from fresh coconut milk by using centrifugation (CVCO) or fermentation (FVCO). Since the conditions used for these processes are quite different, this study aimed to investigate their effects on the contents of selected bioactive compounds that have potential health benefits.
Methods: CVCO and FVCO were produced from the same batch of fresh coconut (Cocos nucifera L.) milk. CVCO was obtained by centrifuging coconut milk in three steps with vacuum evaporation, while FVCO was obtained by anaerobically fermenting coconut milk at 35°C for 16 h. The products were analysed for macronutrients, fatty acid profiles, phytosterols and phenolic compounds. Potential health benefits were determined by calculating the chance of fatty acid bioavailability and analysing antioxidant activities.
Results: Both VCO production processes removed all hydrophilic compounds, with the remaining fat and moisture contents not significantly different at 99.90% and 0.10%, respectively. Their fatty acid profiles were 90% saturated and 60% medium chain (mainly lauric acid). The phenolic compound (originally found high in coconut milk) was present in trace amounts in the VCOs. However, phytosterols became more concentrated. Chances of medium chain fatty acid becoming more available for health benefit were at 54% and 58%, and were insignificant among both VCOs. Fermentation caused more rancidity to the product.
Conclusion: Both centrifugation and fermentation production processes did not qualitatively and quantitatively affect the bioactive compounds of virgin coconut oil.
Key words: Centrifugation, fermentation, medium chain fatty acid, phytosterols, virgin coconut oil

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Effects of ripening stage and cooking methods on available glucose, resistant starch and estimated glycaemic index of bananas (Musa sapientum; Nam-wa variety)
Sunitra Chaipai, Wantanee Kriangsinyot & Warangkana Srichamnong

ABSTRACT

Introduction: Resistant starch (RS) has been associated with health benefits including reduced cholesterol absorption, and also been considered as a prebiotic. Little is known of the RS contents of bananas from Thailand.
Methods: This study determined the digestibility of starch in bananas (Nam-wa variety) at different ripeness stages, based on roasting and boiling. In vitro glycemic response of the bananas was also investigated. Based on peel colour, banana maturity stages were classified into 8 stages namely, unripe (stages 3–5) and ripe (stages 6–8). Analysis methods used were in-vitro enzymatic digestion and HPLC analysis.
Results: Unripened bananas contained less total sugar compared to ripened bananas. Rapidly Available Glucose (RAG) and Slowly Available Glucose (SAG) contents increased in tandem with progression of the ripening stage. However, there was no significant difference in the RS content with ripening stage (p>0.05). The RS content also did not show significant difference between the cooking methods. Boiling of banana at the same ripening stage considerably reduced the estimated glycemic index (eGI) (34-56), whilst roasting did not produce any marked changes in pGI (5356).
Conclusion: The RAG and SAG amounts in the bananas studied were found to be directly related to ripening stage. Boiling was shown to be a better cooking method for lowering the pGI of bananas compared to roasting.
Key words: Banana, cooking, glycemic index, processing, resistant starch

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SHORT COMMUNICATION, CASE REPORTS

Proximate composition, short and medium-chain fatty acids of selected powdered goats milk
Juliana Shamsudin, Shariza Abdul Razak, Marina Abdul Manaf & Sakinah Harith

ABSTRACT

Introduction: Goats milk provides health benefits due to its unique fatty acid composition that comprises relatively high amounts of short- and medium-chain fatty acids, which make goats milk easy to digest.
Methods: A total of 20 powdered goats milk samples were selected based on ease of availability in shops in Kubang Kerian, Kelantan. Proximate composition and fatty acids, specifically C6:0, C8:0 and C10:0 were determined using AOAC methods (2000), and gas-chromatography, respectively. Results were compared with commercial pure goats milk (CBM®).
Results: Wide variations in the proximate composition and fatty acid contents were found among the samples when compared with the CBM® sample. The mean range values for energy were 368 to 498 kcal/100 g, moisture: 2.46 to 4.28 g/100 g, ash: 2.04 to 6.61 g/100 g, protein: 2.80 to 26.24 g/100 g, fat: 1.68 to 25.90 g/100 g and carbohydrates: 44.81 to 87.64 g/100 g. The total short and medium-chain fatty acids contents ranged from 3.22% to 12.97%.
Conclusion: There is a need for standardisation of the proximate composition and fatty acids contents of goats milk available in Malaysia.
Key words: Goats milk, proximate composition, medium-chain fatty acids (MCFA)

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Cadmium and lead contents and potential health risk of brown rice (NSIC Rc222 Tubigan 18) cultivated in selected provinces in the Philippines
Marjorie Anne Abratique Layosa, Liezl Marinay Atienza & Angelina delos Reyes Felix

ABSTRACT

Introduction: Brown rice is promoted for a healthier rice-consuming population as it renders numerous nutritional benefits due to its fiber and germ, yet may contain high concentrations of metal elements from environmental effluents. The purpose of this study is to identify the potential health risk of brown rice cultivated in different major islands in the Philippines.
Methods: Concentrations of heavy metals cadmium (Cd) and lead (Pb) were investigated on brown rice of a popular modern rice variety (NSIC Rc222) cultivated from top rice-producing provinces in Luzon, Visayas and Mindanao, namely Nueva Ecija, Iloilo and Bukidnon, respectively, through nonprobability sampling. Total Hazard Quotient (THQ) and Combined Total Hazard Quotient (CTHQ), as developed by US EPA, were used to calculate the potential hazard.
Results: Cd levels of brown rice from different sites were found to be below the maximum level of 0.1 mg/kg. However, Pb content from all sites exceeds the 0.2 mg/kg allowable level as recommended by the Joint FAO/WHO Food Standards Programme. Brown rice from Ilo-ilo had the highest Pb content while Nueva Ecija the lowest. THQ values were all below 1.0 but contribution of Pb to CTHQ was higher than that for Cd.
Conclusion: The findings suggest consuming brown rice from the studied sites has low probability of inducing carcinogenic effects in the long run, but Pb has a greater contribution in the hazard risk as compared to Cd. Further studies on heavy metals especially Pb in brown rice consumed in the Philippines are suggested.
Key words: Brown rice, cadmium, lead, hazard identification, total hazard quotient

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Knowledge, attitude and practices regarding food safety among food employees in Ambon City, Indonesia
Jimmi Sihombing, Retna Siwi Padmawati & Susi Ari Kristina

ABSTRACT

Introduction: It is estimated that each year, 1.8 million people worldwide die as a result of diarrhoeal diseases attributed to contaminated food. This cross-sectional study was conducted to determine the knowledge, attitude and practices regarding food safety and hygiene among food employees in Ambon Capital City, Maluku Province, Indonesia.
Methods: A validated questionnaire was self-administered and completed by 135 food employees in small food companies in Jan-March, 2017. The knowledge section consisted of 19 yes-no questions. For knowledge, the score was considered acceptable if total score was >10. Fourteen 4-point Likert-scale questions were constructed for the attitude section, whereby a score of 3.0 and above for each question was considered positive. The practice section consisted of 13 4-point Likert scale items, and a score of =3 was considered good practice. The WHO Five Keys to Safer Food Manual was used as reference.
Results: The respondents had an acceptable level of knowledge about food safety and personal hygiene (mean score=13.08±2.55), a positive attitude (mean score=3.38±0.55) and good practices toward food hygiene measures (mean score=3.98±0.55). A significant correlation was observed between education level, training experience, knowledge, attitude and practices, indicating that having good knowledge and attitude toward food safety could have positive influence on food handling practices.
Conclusion: It is recommended that regular food safety training and adequate guidelines should be provided to improve food safety practices of food service employees in Ambon City.
Key words: Knowledge, attitude, practice, food safety, personal hygiene

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Malaysian Journal of Nutrition

Volume 24 No.3, 2018


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Table of Content

NUTRITIONAL STATUS, DIETARY INTAKE AND BODY COMPOSITION

Nutrition governance, good governance for nutrition and nutritional status of children under-five year old in Laguna, Philippines
Leah M Felismino, Ma Theresa M Talavera, Normahitta P Gordoncillo & Nelson Jose Vincent B Querijero

ABSTRACT

Introduction: Governance affects nutrition improvement. This study aimed to determine the association between nutrition governance (NG), nutritional status (NS) of children under five years (CU5) and good governance for nutrition (GGN) in Laguna, where malnutrition is a chronic problem.
Methods: This crosssectional study obtained data from thirty cities and municipalities (C/M) using desk review and face-to-face interviews. A developed scorecard generated NG and GGN data using 3-point scale with "0" as lowest/absence to "1" indicating partial to "2" as highest/full compliance. Total NG scores was 26 while 38 for GGN. NS was determined using Operation Timbang Plus data. Spearman's rank analysis statistically determined the associations between NG, NS, and GGN.
Results: Underweight and wasting prevalence were low (6.1% and 3.4%) while stunting was high (17.7%). The median percentage scores of C/M on NG and GGN were 73.0%±14.0% and 82.0%±24.0%, respectively. Rosa City and Kalayaan had the highest NG score and the lowest underweight prevalence in urban and rural areas, respectively. Significant but negative associations were found between NG and underweight (r=-0.729, p<0.001), and stunting (r=-0.753, p<0.001). Likewise, GGN and underweight (r=-0.488, p=0.006), and stunting (r=-0.380, p=0.046) showed negative associations.
Conclusion: C/M in Laguna with higher NG and GGN scores have lower CU5 underweight and stunting prevalence. The study recommended to local governments to invest in establishing separate nutrition unit, hiring technical and administrative staffs, formulating vision and mission, and building capacity on nutrition programme management.
Key words: Nutrition governance, good governance for nutrition, underweight, stunting

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Stunting trends and associated factors among Indonesian children aged 0-23 months: Evidence from Indonesian Family Life Surveys (IFLS) 2000, 2007 and 2014
Laily Hanifah, Rifda Wulansari, Rini Meiandayati & Endang Laksminingsih Achadi

ABSTRACT

Introduction: Stunting in childhood affects cognitive development and may increase the risk of non-communicable diseases in adulthood. Indonesia is the fifth largest contributor of stunting in the world, with a prevalence of 32.9% in children aged 0-2 years in 2013. This study aimed to determine the stunting trend and associated factors between 2000 and 2014.
Methods: This study used data from Indonesia Family Life Surveys (IFLS) that have been conducted periodically since 1993. This study focused on households with children aged 0-23 months. Trend analysis used the IFLS data collected in 2000, 2007 and 2014, while bivariate analysis for determination of the different factors associated with stunting used IFLS data in 2000 and 2014.
Results: Based on data from 1,263 children in 2000, 1,805 children in 2007, and 1,609 children in 2014, stunting prevalence slightly increased from 29.7% in 2000 to 32.6% in 2014. Significant associations between stunting and children's age, birth weight, mother's education, antenatal care, health sanitation and immunisation status were recorded in 2000. In 2014, stunting was significantly associated with children's age, birth weight, prelacteal food intake, ownership of Mother and Child Health Book and health sanitation status.
Conclusion: Stunting in children below 2 years in Indonesia remains high, exceeding 30%. This study identified several contributing factors to stunting. Interventions to address these factors should be undertaken toward reducing stunting among young children in Indonesia.
Key words: Stunting, stunting trend in Indonesia, undernutrition, IFLS

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Wasting and associated factors among infants aged 0-23 months in 13 provinces in Indonesia: Evidence from Indonesia Family Life Surveys (IFLS) 2000, 2007 and 2014
Rini Meiandayati, Rifda Wulansari, Laily Hanifah & Endang Laksminingsih Achadi

ABSTRACT

Introduction: Wasting is an acute form of under-nutrition. Frequent occurrence and long-term wasting can lead to stunting. Indonesia has one of the world's highest wasting prevalence of 12.1% and ranked the 4th highest for wasting globally in 2012.
Methods: Data from Rand Corp Indonesia Family Life Survey for 2000, 2007 and 2014 were used to examine wasting trend, while data for 2000 and 2014 were used to determine the associated factors of wasting in infants aged 0-23 months. Data was analysed using SPSS. Logistic regression was used to predict the variables contributing to wasting.
Results: Wasting prevalence in 2000, 2007 and 2014 were 12.0%, 11.2% and 10.1%, respectively. Birth weight correlated significantly with wasting prevalence in 2000 while in 2014, wasting prevalence correlated significantly with birth weight, birth length, poverty, and ownership of "Mother and Child Health Book". Logistic regression showed that birth weight was an important associated factor in 2000 and 2014, while ownership of "Mother and Child Health Book" was the only important associated factor of birth weight in 2014.
Conclusion: The prevalence of wasting among young Indonesian children was lower in 2014 compared to 2000, but is still at a high level. Birth weight consistently remains the significant factor affecting wasting. It is important that the nutritional status of women be taken care of before and during pregnancy for optimal birth outcomes.
Key words: Wasting, birth weight, birth length, trend, child care

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Food intake, nutritional and health status of Filipino adults according to occupations based on the 8th National Nutrition Survey 2013
Divorah Vinluan Aguila, Glenn Melvin Purisima Gironella & Mario Villasaya Capanzana

ABSTRACT

Introduction: The health and nutrition of a country's workforce plays an effective role in the social health and economic status of its society.
Methods: This study determined the food intake, nutritional and health status of 69,505 Filipino adults and their households according to occupations using the 8th National Nutrition Survey conducted in 2013 by the Food and Nutrition Research Institute. Occupational grouping was based on the 1992 Philippine Standard Occupation Code. Descriptive statistics such as mean and percentages were generated using the survey module (svy) of Stata 12.0.
Results: Chronic Energy Deficiency and anaemia were highest among adults with no occupation (12.3% and 14.8% respectively) and lowest among officials (4.3%) and those with special occupations (4.5%). Overweight, hypertension, high fasting blood sugar and high total cholesterol levels were highest among officials and lowest among farmers and professionals. Farmers had the highest percentage of smokers, alcoholic drinkers and with high physical activity level, while adults with no occupation had the lowest physical activity level. Households headed by special occupation groups had the highest energy intake, while farmers had the lowest protein, iron, vitamin A, thiamine, riboflavin, niacin and fat intakes. Crafts and related trade workers had the lowest percentage of households meeting the energy requirement (27.4%).
Conclusion: The food intake, nutrition and health status of Filipino workers in certain occupations were poor, in need of improvement. A national policy on addressing the health, nutrition and welfare of workers is recommended.
Key words: Filipino workers, nutritional status, health risks, food intake

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Prevalence of food insecurity and associated factors among freeliving older persons in Selangor, Malaysia
Siti Farhana Mesbah, Norhasmah Sulaiman, Zalilah Mohd Shariff & Zuriati Ibrahim

ABSTRACT

Introduction: Older persons are vulnerable to food insecurity. This study aimed to determine the prevalence of food security and associated factors among free-living older persons in Petaling District, Selangor.
Methods: A total of 220 free-living older persons aged 60-87 years were selected by using the cluster sampling method in this cross-sectional study. Faceto-face interviews were conducted to obtain information concerning the demographic and socioeconomic background, food security, oral health, and psychosocial status. Chi-square test and binary logistic regression analysis were used to analyse the studied variables.
Results: The median age of the respondents was 65.5 years, and 19.5% were found as food insecure. There were significant associations between marital status (χ2=6.818), education level (χ2=6.242), occupation status (χ2=7.540), monthly income (χ2=9.940,), and oral health status (χ2=9.627) with food security status. Those with a low monthly income (AOR=2.449, 95% CI: 1.046-5.732), poor oral health status (AOR: 3.306, 95% CI: 1.387-7.889) and living in rented accommodation (AOR=6.218, 95% CI: 1.458-26.518) were more likely to be food insecure.
Conclusion: Respondents with an income lower than the poverty line income (PLI), living in rented accommodation and poor oral health status face increased risk of food insecurity. A nutrition assistance programme is suggested to improve the socioeconomic and food security status of older persons. Regular oral check-ups are recommended to improve the oral health status of the elderly.
Key words: Older persons, food security status, food insecurity, Malaysia, oral health

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Comparison of maternal nutrition literacy, dietary diversity, and food security among households with and without double burden of malnutrition in Surabaya, Indonesia
Trias Mahmudiono, Triska Susila Nindya, Dini Ririn Andrias, Hario Megatsari, Qonita Rachmah & Richard R Rosenkranz

ABSTRACT

Introduction: Double burden of malnutrition in the form of stunted child and overweight/obese mother has been increasing in countries experiencing nutrition transition. This study aimed to compare maternal nutrition, literacy, dietary diversity, and food security of households categorised by nutritional status of mother-child pairs.
Methods: This cross-sectional study included a total of 685 children under 5 years of age from 14 community health centres (posyandu) in a poor urban area of Surabaya, Indonesia. The Lemeshow formula was used to compute sample size. The children and their mothers were categorised into motherchild pairs based on maternal body mass index (BMI) and height-for-age z-score for the child: non-overweight mother-non-stunted child (NM), non-overweight mother and stunted child (SC), overweight/obese mother and non-stunted child (OWT), stunted child and overweight/obese mother (SCOWT). Nutrition literacy was determined using questionnaires, dietary diversity was estimated using household dietary diversity scores, and food security was determined using the Household Food Insecurity Access Scale (HFIAS).
Results: The prevalence of households with SCOWT double burden of malnutrition was 21.2%, OWT 37.7%, SC 15.3% and 25.8% were normal (NM). There were significant differences in maternal nutrition literacy, dietary diversity and household food security status. Households with NM pairs were shown to be most food secure followed by OWT, SC and lastly, the SCOWT pairs.
Conclusion: Households with double burden of malnutrition have relatively lower nutrition literacy, dietary diversity, and food security. This study indicates the importance of developing nutritional strategies to enable low-income households to make healthy food choices.
Key words: Nutrition literacy, dietary diversity, food security, double burden of malnutrition, Indonesia

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Association between waist circumference at two measurement sites and indicators of metabolic syndrome and cardiovascular disease among Thai adults
Nopphanath Chumpathat, Chanchira Phosat, Chavit Uttamachai, Pornpimol Panprathip & Karunee Kwanbunjan

ABSTRACT

Introduction: Waist circumference (WC) is a measure of central obesity, which is an established indicator of the risk of chronic disease. The objective of this study was to investigate the applicability of WC and risk of metabolic abnormality at two frequently used measurement sites in Thailand namely, at the umbilicus level (WC-U) and midway between the lowest rib and iliac crest (WC-M).
Methods: Healthy adults aged 35-60 years living in Sung Noen District, Nakhon Ratchasima Province, Thailand were recruited by convenience for the study (N=296). WC was measured at two locations (WC-U and WC-M). Socioeconomic, health-habits, and physical-activity data were collected. Six ml blood samples from each participant were taken for analysis of glucose, lipids and C-reactive protein concentrations. Association between WC-U and WC-M was determined statistically.
Results: WC measurements taken at WC-U and WC-M correlated strongly with each other in men (r=0.978, p<0.001), and in women (r=0.873, p<0.001). Both WC-U and WC-M correlated significantly with BMI, blood pressure, triglyceride, and cholesterol levels in both men and women. Intraclass correlation analysis confirmed highly significant associations between these two WC-measurement sites in men (ICC=0.960, p<0.001) and women (ICC=0.808, p<0.001).
Conclusion: The results confirmed that both WC-U and WC-M can be used to monitor health status in men and women; however, WC-U is a simpler procedure for community health-risk surveillance and for self-monitoring.
Key words: Waist circumference, anthropometry, metabolic syndrome, cardiovascular disease, self-monitoring

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Association between intake of soy isoflavones and blood pressure among urban and rural Malaysian adults
Nurul Fatin Malek Rivan, Suzana Shahar, Hasnah Haron, Rashidah Ambak & Fatimah Othman

ABSTRACT

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.
Key words: Soy protein, soy isoflavones, adults, urban, systolic blood pressure

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Vitamin D status of Filipino adults: Evidence from the 8th National Nutrition Survey 2013
Imelda Angeles-Agdeppa, Leah Ancheta Perlas & Mario Villasaya Capanzana

ABSTRACT

Introduction: This study reports the vitamin D status of Filipino adults in selected areas in the Philippines and determinants of deficiency, based on the 2013 National Nutrition Survey (NNS).
Methods: The NNS collected blood samples from all members aged ≥20 years from selected households of the National Capital Region (NCR), Cebu and Davao del Sur. Serum vitamin D was determined by electrochemiluminescence assay. Data on age, sunscreen use, intake of supplement were collected. Body mass index was calculated.
Results: The overall prevalence of combined vitamin D deficiency (<50 umol/L) and insufficiency (51-75 umol/L) was 48.7%, and was highest in the NCR (54.1%) and lowest in Davao del Sur (28.9%). Adults in NCR were more likely to have vitamin D insufficiency compared with those in Cebu (OR=0.59) and Davao (OR=0.30). Females had higher prevalence (62.5%) of vitamin D insufficiency than males (32.1%). Higher prevalence of vitamin D insufficiency was observed among 20-39 y (55.5%) and lowest among ≥60 y (38.1%). The younger adults (20-39 y) were more likely to have vitamin D insufficiency compared to 40-59 y (OR=0.63) and the ≥60 y (OR=0.43). Among sunscreen users aged 20-39 y and 40-59 y in Cebu and Davao del Sur, mean vitamin D levels were significantly lower than non-sunscreen users.
Conclusion: The 2013 NNS revealed a high prevalence of vitamin D insufficiency among Filipino adults. Gender, age, and area of residence were significant determinants of vitamin D insufficiency. Determining the vitamin D status is crucial in crafting interventions for its prevention and control.
Key words: Vitamin D deficiency, Filipino, adults, survey

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Maternal vitamin D intake and serum 25-hydroxyvitamin D (25(OH)D) levels associated with blood pressure: A crosssectional study in Padang, West Sumatra
Nur Indrawaty Lipoeto, Arif Sabta Aji, Fanny Ayudia, Faradila Faradila & Nazla Putri Sukma

ABSTRACT

Introduction: The association between vitamin D inadequacy and blood pressure (BP) has been studied in several populations. We examined the association of maternal vitamin D intake and serum 25(OH)D levels and BP among pregnant women in West Sumatra.
Methods: This study was conducted using a comparative cross-sectional study in a maternal clinic selected by convenience in Padang. Pregnant mothers who attended the clinic in July-August 2015 were recruited. Inclusion criteria were pregnancy between 28-42 weeks, aged 20-35 years, and with less than three parity status. A total of 56 women were recruited and divided equally into either normotension or hypertension groups. Subjects with blood pressure less than 120 mmHg (SBP) and 80 mmHg (DBP) were placed in the normotension group, while subjects with ≥140 mmHg (SBP) and/or ≥90 mmHg) were in the hypertension group. Subjects completed a pre-tested semi-quantitative food frequency questionnaire. Three ml of non-fasting blood was drawn from each subject for determination of 25(OH)D, urea, creatinine, leukocyte, and blood glucose levels.
Results: There was a significant difference in mean serum 25(OH)D, between the normotension and hypertension groups, at 36.85±21.58 pg/ml and 17.36±7.91 pg/ml, respectively. Only 20% of participants from the hypertension group had adequate vitamin D intake. Blood pressure status had a significant association with vitamin D intake status (p=0.001).
Conclusion: Maternal vitamin D intake and 25(OH)D levels were associated with blood pressure status in this sample population. Further studies with a larger sample population are suggested to verify the findings of this study.
Key words: Blood pressure, pregnancy, 25(OH)D, vitamin D intake

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Workplace and individual factors influence eating practices of Thai factory workers
Pattaraporn Charoenbut, Jeeranun Klaewkla, Suwat Srisorrachatr, Sara Arphorn & Somtawin Wijitwanna

ABSTRACT

Introduction: The promotion of healthy eating practices in the workplace could reduce the burden of morbidity in the working population. Eating practices of employees are the result of multiple factors. This research aimed to examine the association between workplace and individual factors related to eating practice among factory workers by using the hierarchical linear modelling.
Methods: Data were obtained from workers and managers in 26 factories located in a central province of Thailand. Workers completed self-administered questionnaires about individual data and eating practices including consumption of foods high in fat, salt and sugar. Factory managers were interviewed along with a survey of the worksite nutrition environment.
Results: The multilevel modelling of data from 26 managers and 924 workers showed that none of the workplace factors studied predicted the employees’ eating practices, i.e. workplace policy, attitude toward food and nutrition promotion of management personnel, healthy food in canteen, and workplace nutrition environment. At the individual level, attitude towards diet and health of factory workers was associated with eating practices (b=48.67, SE=1.71). Cross-level interactions between workplace nutrition environment and canteen management attitude towards health and diet of workers, were significantly associated with eating practices. This finding indicates that nutrition promotion at the workplace should take into consideration the key factors of offering healthy foods in canteens and supporting a healthy nutrition environment.
Conclusion: Worksites should be encouraged to provide a healthy nutrition environment and offer healthy food choices in their canteens.
Key words: Eating practice, workplace, nutrition environment, multilevel analysis

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Application and validation of the weight efficacy lifestyle (WEL) questionnaire among type 2 diabetes mellitus patients in Malaysia
Harvinder Kaur Gilcharan Singh, Verna Lee Kar Mun, Ankur Barua, Siti Zubaidah Mohd Ali & Winnie Chee Siew Swee

ABSTRACT

Introduction: Self-efficacy for eating predicts successful weight loss and maintenance in Type 2 Diabetes Mellitus (T2DM) individuals. The Weight Efficacy Lifestyle (WEL) questionnaire determines self-efficacy for controlling eating. This study aims to validate the Malay-translated version of the WEL questionnaire and to establish the cut-off scores to define the level of eating self-efficacy in Malaysian T2DM individuals.
Methods: A total of 334 T2DM individuals, aged 55.0±9.0 years, were recruited from a primary healthcare clinic based on sampling ratio. Medical records were reviewed for eligibility. Inclusion criteria included BMI ≥23kg/m2, and no severe diabetes complications. The WEL questionnaire assessed eating resistance during negative emotions, food availability, social pressure, physical discomfort and positive activities, and was back translated into Malay language. Self-efficacy was rated on a 0-9 scale with higher WEL scores indicating greater self-efficacy to resist eating. Factor analysis established the factor structure of the WEL questionnaire. Inter-item and item-total correlations determined construct validity while internal consistency described the reliability of the structure.
Results: A two-factor structure accounting for 49% of variance was obtained, and it had adequate reliability, as indicated by Cronbach’s α of 0.893 and 0.781 respectively. Item-total correlations of r>0.700, p<0.01 and inter-item correlations of r<0.500, p<0.01 demonstrated construct validity. Cut-off scores of ≥44 and ≥32, respectively for factor one and two defined high eating self-efficacies in T2DM individuals.
Conclusion: The Malaytranslated version of the WEL questionnaire appears to be a valid and reliable tool to assess self-efficacy for controlling eating behaviour in Malaysian T2DM population.
Key words: Diabetes, eating self-efficacy, Malay, reliability, validity

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Development and validation of a nutrient profiling model for Malaysian older population
Rasyidah Mohamad Basiran, Hanis Mastura Yahya & Suzana Shahar

ABSTRACT

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.
Key words: Nutrient profiling, nutrient density, nutrient-dense food

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NUTRIENTS, FOOD COMPOSITION, PHYTOCHEMICALS

Finger millet (Eleusine coracana L.) and white rice diets elicit similar glycaemic response in Asian Indians: Evidence from a randomised clinical trial using continuous glucose monitoring
Shanmugam Shobana, Rajagopal Gayathri, Chandrasekaran Anitha, Vasudevan Kavitha, Nagamuthu Gayathri, Mookambika Ramya Bai, Nagarajan Lakshmipriya, Muthukaruppan Malavika, Vasudevan Sudha, Ranjit Unnikrishnan, Ranjit Mohan Anjana, NG Malleshi, Kamala Krishnaswamy, CJK Henry & Viswanathan Mohan

ABSTRACT

Introduction: Finger millet (FM) or Eleusine coracana L. is considered as a healthier cereal option, especially based on its higher dietary fibre, phytochemical and mineral contents. FM is also recommended for individuals with diabetes, as it is believed to elicit a lower glycaemic response.
Methods: The glycaemic response of FM diet was evaluated and compared with white rice (WR) diets using a continuous glucose monitoring system (CGMS™) iPro 2™ among 14 healthy male and female volunteers aged 25-45 years with normal Body Mass Index (≥22.9kg/m2) in a crossover trial. They were recruited from Madras Diabetes Research Foundation volunteers registry. The participants consumed randomised iso-caloric FM or WR based diets for five consecutive days and 24 h interstitial glucose concentrations were recorded.
Results: The FM diet had significantly higher dietary fibre than WR (29.9 g vs 15.8 g/1000 kcal, p<0.01) but the other macronutrients were similar. The 5-day average incremental area under the curve (IAUC) of FM diet [Mean (95% CI) = 73.6 (62.1-85.1) mg*min/dl] was not significantly different from that for WR diet [Mean (95% CI) = 78.3(67.9-88.7) mg*min/dl].
Conclusion: Both finger millet and white rice diets showed similar 24 h glycaemic responses, despite the former having higher amounts of dietary fibre. The result suggests that use of FM flour-based food preparations and decorticated FM grains to replace WR in the Indian diets offer no significant benefit with regards to 24 h glycaemic response. Studies of longer duration with larger sample size are needed to verify our findings.
Key words: Finger millet, white rice, dietary intervention, dietary fibre, diabetes

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SHORT COMMUNICATION, CASE REPORTS

A randomised trial on walking exercise and banana consumption on self-reported depression symptoms among female adolescents in Surakarta, Indonesia
Egy Sunanda Putra, Brian Wasita & Sapja Anantanyu

ABSTRACT

Introduction: Depression disrupts an individual's well-being and is linked to the risk of degenerative disease. Previous studies suggested the effect of exercise and banana intake could induce the production of hormones that promote relaxation. This study examined the association between walking exercise and banana consumption on self-reported depression symptoms in female adolescents.
Methods: sumption on self-reported depression symptoms in female adolescents. Methods: This was a randomised controlled trial conducted in four high schools purposively selected in Surakarta. By using the Lemeshow formula, a total of 64 female students were recruited. Inclusion criteria were ages 15-17 years, normal body mass index (BMI)for-age, consuming fruit <3 x/d, physical exercise <3 x/wk, non-smoking, non alcohol consumer, and not menstruating during study. The subjects were randomly distributed into four groups for the two-weeks study: (1) walking exercise daily for 1.6 km under 23 min, at a speed of 3.8 km/h on a treadmill; (2) banana intake of 2 servings daily (130 g/serving); (3) walking exercise and banana intake; and (4) control not prescribed banana or walking exercise. Self-reported depression symptoms was assessed by the Beck Depression Inventory II (BDI-II) questionnaire. Data were analysed using the linear regression model.
Results: Banana consumption only (MD=-4.50, SE=1.92) and combination of walking exercise and banana consumption (MD=-5.36, SD=1.95) groups showed significantly lower depression scores at the end of intervention compared to the control group (p<0.05).
Conclusion: Prescribed banana consumption or a combination of banana consumption and walking exercise showed potential for reducing self-reported depression symptoms among female adolescents.
Key words: walking exercise, banana, depressive symptoms

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Malaysian Journal of Nutrition

Volume 24 No.4, 2018



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Table of Content

Effects of micronutrient powder and complementary food blend on growth and micronutrient status of Filipino rural children: a randomised controlled trial
Eva A Goyena, Corazon VC Barba, Ma. Theresa M Talavera, Merlyne M Paunlagui, Agnes C Rola & Nancy A Tandang

ABSTRACT

Introduction: This study aimed to evaluate the effects of micronutrient powders (MNP) containing 15 versus nine nutrients, with or without complementary food blend (BigMo), on the nutritional status of rural young children in the Philippines.
Methods: The study was conducted for 6 months among 126 rural children aged 6-17 months in four villages selected by cluster randomisation. Children were randomised into four groups: VitaMix with 15 micronutrients plus Bigas Mongo (BigMo) (n=31); VitaMix without BigMo (n=31); Micronutrient Growth Mix (MGM) with nine micronutrients plus BigMo (n=29); and MGM without BigMo (n=31). Blood samples were collected at baseline and endline to determine haemoglobin, ferritin, retinol, and zinc concentrations. Intervention compliance, weight, length, and dietary intakes were collected every month. One-way ANOVA was used to compare changes in the mean estimates across groups. McNemar and Pearson’s x2 tests were used to compare changes in the proportion estimates within groups and across groups, respectively.
Results: Both VitaMix and MGM with or without BigMo improved haemoglobin concentrations and reduced anaemia (Hb<11g/dL). However, only VitaMix and MGM combined with BigMo had effects in reducing moderate anaemia (Hb<10g/dL), compared to groups without BigMo. Only MGM+BigMo group demonstrated significant reduction in the prevalence of moderate non-iron deficiency anaemia (IDA) (Hb<10g/dL and ferritin>12ug/L). A significant increase in the length-for-age z-scores was noted in the MGM with and without BigMo groups.
Conclusion: Daily supplementation of MGM with nine micronutrients combined with complementary food blend may have a greater potential than MNP with 15 micronutrients in improving the nutritional status of young children.
Key words: Micronutrient powder, complementary food blend, micronutrient deficiency, anaemia

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Development and validation of a dietary iron score for screening populations at risk for inadequate iron intake
Laksana Chaimongkol, Pattanee Winichagoon, Nipa Rojroongwasinkul & Emorn Wasantwisut

ABSTRACT

Introduction: Inadequate iron intake is a determinant of iron deficiency. A simplified tool for dietary assessment is needed. This study aimed to develop a dietary iron scoring system (DISS) and to determine the validity of the dietary iron score (DIS) for screening populations at risk for inadequate iron intake.
Methods: A three-step process was undertaken to develop the DISS, namely (1) iron score (IS) for each food was constructed based on its iron content per 100 g, adjusted for heme content equivalence; (2) the predicted modifying effect (PME) was formulated based on either enhancing or inhibiting effects of dietary constituents; (3) the DIS of a meal was obtained by multiplying the total IS and the PME of that meal. The validity of the DIS for screening populations at risk for inadequate iron intake was determined against absorbable iron calculated by the Hallberg & Hulthen algorithm. A probability of adequacy of absorbable iron intake of 0.75 was used as a cutoff in defining the population at risk.
Results: There was a significant correlation between the absorbable iron and DIS (r=0.34, p<0.001). Using the Receiver Operating Characteristic (ROC) curve , three cutoffs of DIS, namely 5, 6 and 7, had comparable results. However, sensitivity (82.9%) and specificity (50.0%) was the best for DIS cutoff of 7.
Conclusion: The proposed DISS is potentially a field-friendly tool for screening populations at risk for inadequate iron intake. Further verifications are needed, using more complete dietary data.
Key words: Iron, dietary iron score, screening tool

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Association between serum B12 and folate levels and manifestations of oral lesions in HIV adult patients
Dewi Puspasari, Dewi Marhaeni Diah Herawati & Irna Sufiawati

ABSTRACT

Introduction: Micronutrient deficiencies are common in Human Immunodeficiency Virus (HIV) infection. The long-term side effects of antiretroviral therapy (ART), specifically Azidothymine (AZT), include low serum levels of vitamin B12 and folate, which in turn, lead to megaloblastic anaemia and oral lesions.
Methods: A crosssectional study was conducted to determine the associations between manifestation of oral lesions and serum vitamin B12 and folate levels in HIV-adult patients with or without receiving ART therapy. Oral lesions were determined based on the ECClearinghouse diagnostic criteria. Serum vitamin B12 and folate were assessed by electrochemiluminescence immunoassay (ECLIA). Sixty participants (48 males and 12 females) aged 20 to 51 years were recruited from a private hospital in Bandung, Indonesia.
Results: Subnormal levels of serum vitamin B12 and folate were found in 16.6% and 6.7% HIV patients, respectively. Significantly lower serum levels of vitamin B12 and folate were shown in HIV patients receiving ART than those without ART. Oral lesions were found in all the participants with subnormal levels of serum vitamin B12 and folate. Presence of oral lesions was significantly associated with low levels of serum vitamin B12 in HIV patients with ART, but not with low folate levels.
Conclusion: Low levels of serum vitamin B12 and folate were shown in HIV patients, indicating the need for early nutritional intervention to ensure optimal nutritional status and prevention of oral lesions in HIV patients.
Key words: Serum folate and B12, HIV patients, oral lesions

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Construct validity of an adapted Radimer/Cornell measure of food insecurity in the Philippines
Ma Anna Rita Marfil Ramirez, Rowena Velasco Viajar & Glenda Pabico Azaña

ABSTRACT

Introduction: Measuring hunger and food insecurity has always been a challenge given the various tools available to provide estimates both at the macro (sufficiency in staple stock) and micro (household food security) levels. In the Philippines, estimates of food insecurity have been provided by the Food and Nutrition Research Institute (FNRI) starting 2001 using an adaptation of the Radimer/Cornell (1992) measures of hunger and food insecurity. The tool has been found to be reliable using the 2003 data extracted from the sixth National Nutrition Survey (NNS), Food Security module but was recommended for further exploratory factor analysis to test for efficiency of items.
Methods: This study assessed the construct validity of the adapted Radimer/Cornell instrument for measuring household food insecurity using principal component analysis with varimax rotation based on the 2003 NNS data.
Results: The results revealed the prevalence of food insecurity was higher at the mother’s level (33.7%) compared to the child (21.0%), indicative of “managed process” or coping with food insecurity at the households. “Altered eating” emerged (factor 1) at the individual level of food insecurity, while “anxiety over quantity and quality of food” was (factor 2) at the household level, that explained 44.0% and 23.2% of the total variance, respectively. Thus, a high cumulative variance (67.2%) was generated for these two factors, implying sufficient variance was obtained to justify the derivation of these two factors from the dataset.
Conclusion: The food security items in the adapted Radimer/Cornell instrument contained valid indicators for assessing food insecurity in Filipino households.
Key words: Radimer/Cornell, food insecurity, Philippines, Filipino households

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Household food insecurity and undernutrition in children below 5 years living in different geographical areas in East Java, Indonesia
Sri Sumarmi, Trias Mahmudiono & Soenarnatalina Melaniani

ABSTRACT

Introduction: Geographical conditions may be linked with food insecurity and growth retardation in young children. This research assessed household food insecurity status and undernutrition in different geographical areas.
Methods: A cross-sectional study was conducted in four different types of geographical areas: coastal, limestone, agricultural and municipality, which were purposely selected in East Java Province. The samples were households with children aged below 5 years. A total of 736 households that fulfilled the inclusion criteria were recruited. Household food security was assessed using the Household Food Security Supplement Measure (US-HFSSM) adapted for developing countries. Nutritional status of children was determined and classified according to World Health Organization Growth Standard (2006).
Results: Prevalence and severity of household food insecurity differed significantly among the different geographical areas. Almost half (44.8%) of the households were categorised as “food insecure without hunger”. Prevalence of “hunger” was highest in coastal (7.2%) and limestone areas (5.3%). Highest prevalence of stunting was in coastal areas (11.6%), whereas highest prevalence of wasting (6.2%) and underweight (8.9%) were in limestone areas. Prevalence of undernutrition was relatively low among children living in municipalities. The differences in the distribution of undernutrition of young children and household food insecurity status were statistically associated with the types of geographical areas.
Conclusion: Prevalence of household food insecurity differed according to the types of geographical areas in East Java. Prevalence of household food insecurity and young child undernutrition were greater for households in the coastal and limestone areas, compared to those in the agricultural and municipality areas.
Key words: Household food insecurity, underweight, wasting, stunting, geographical areas

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Nutritional status and complementary feeding among Penan infants and young children in rural Sarawak, Malaysia
Bong MW, Norimah A Karim & Ismail Mohd Noor

ABSTRACT

Introduction: The Penan people are largely settled in rural and remote areas of Sarawak with high rates of undernutrition among the children. The study aimed to determine the nutritional status and infant and young child feeding (IYCF) practices of Penan children.
Methods: Subjects consisted of 121 children, aged between 0-23 months, from 15 Penan longhouses in Belaga district. Malnutrition was assessed using anthropometric measurements of children and categorised according to the World Health Organization (WHO) Growth Standards (2006). Feeding practices were assessed using questionnaires based on WHO IYCF Indicators (2008).
Results: The prevalence of underweight was 29.8%; stunting 43.0% and wasting 5.8%. Prevalence of exclusive breastfeeding under 6 months was 44.4%. About 86% of infants aged 6-8 months were already given solid, semi-solid and soft foods. The proportion of children aged 6-23 months achieving minimum dietary diversity (MDD) was 76.6%, while minimum meal frequency (MMF) was 83.0% (breastfed and non-breastfed). Among the children who achieved MDD, 64.9% of their meals were derived from 4-5 food groups. More than half (55.3%) of all subjects (breastfed and non-breastfed) received minimum acceptable diet (MAD). Achievement of iron-rich foods (IRF) indicator was 77.7%. There was no significant association between the IYCF indicators of MDD, MMF and MAD and underweight, stunting and wasting.
Conclusion: A high prevalence of poor nutritional status was recorded among the Penan children. While the IYCF indicators apparently showed satisfactory complementary feeding practices, future studies should assess quantitatively the intake of complementary food among Penan infants and young children.
Key words: Infant and young child feeding, nutritional status, Penan, Sarawak

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High prevalence of undernutrition among preschool children in Pattani Province, southern Thailand
Sujan Sapkota, Laksana Chaimongkol & Apiradee Lim

ABSTRACT

Introduction: Malnutrition is one of the leading causes of childhood death. In the southern provinces of Thailand that are encountering a civil conflict, the extent of malnutrition among young children has not been adequately reported.
Methods: A cross-sectional study was undertaken to assess the nutritional status of children aged 2-5 years enrolled in early childhood development centres (ECDC) in Pattani Province. A total of 112 ECDCs were randomly selected and 871 children who met the inclusion criteria were recruited. Anthropometric measurements were taken and nutritional status determined according to World Health Organization (2006) growth standards. Statistical analyses of nutritional indicators, namely wasting, stunting, underweight and Composite Index of Anthropometric Failure (CIAF) across sociodemographic variables were carried out. Binary logistic regression models, based on the different nutritional indicators, were used to determine the relationships between undernutrition status and associated factors.
Results: Prevalence of wasting (7.7%), stunting (19.6%) and underweight (16.8%) were determined. Based on CIAF, 27.4% of the children were undernourished. Logistic regression odds showed that prevalence of all forms of undernutrition was statistically independent of sex and place of residence. Religion was associated with all four indicators of undernutrition. Stunting was associated with child’s age and religion, while underweight and CIAF were associated with the child’s age, religion and mother’s occupation.
Conclusion: Prevalence of undernutrition was estimated to be high in comparison with the national average figure. The study findings highlighted the need for more effective nutrition promotion activities to alleviate undernutrition problems among young children in Pattani Province.
Key words: Nutrition status, preschool children, southern Thailand

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Maternal factors associated with vitamin A concentration in colostrum of postpartum mothers in South Sulawesi Province, Indonesia
Abdul Salam, Dodik Briawan, Drajat Martianto, Abdul Razak Thaha, Andi Imam Arundhana & Luh Ade Ari Wiradnyani

ABSTRACT

Introduction: Newborns have low vitamin A reserves and rely on breastmilk to meet their vitamin A needs. This study aimed to determine factors associated with vitamin A concentration in colostrum of rural postpartum mothers.
Methods: Out of 180 postpartum women interviewed at seven Community Health Centers in South Sulawesi Province, 160 who met the inclusion criteria were included in the study. Breastmilk (colostrum) samples were obtained shortly after delivery from the breast that was not full and not fed to the infant for at least 30 min. Breastmilk samples of 3-5 mls were collected into sterile plastic tubes using a manual pump. The samples were immediately placed in an icebox and transported to the laboratory within six hours after collection. Vitamin A concentrations were determined using HPLC method. Socioeconomic characteristics, anthropometric measurements, gestational age, and dietary intake of mothers (24-hour recall) were obtained. Bivariate and multiple linear regression analysis were undertaken to determine factors associated with vitamin A concentration in colostrum.
Results: Dietary assessment showed unsatisfactory intake levels of calories, fat, protein, vitamin A, iron and zinc compared to the recommendations for Indonesia. Mean vitamin A concentration in colostrum was 58.2 μg/dl, and about 81.2% of the participants had normal colostrum vitamin A concentration. Iron intake and gestational age were significantly associated with colostrum vitamin A concentrations.
Conclusion: Majority of the postpartum mothers had normal colostrum vitamin A concentration. Maternal dietary intake including iron is important to ensure adequacy of vitamin A in breastmilk.
Key words: Breastmilk vitamin A, colostrum, postpartum mother

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Fruit consumption and associated determinants in a sample of young urban Malaysian adults
Bibi Nabihah Abdul Hakim, Hanis Mastura Yahya, Suzana Shahar & Zahara Abdul Manaf

ABSTRACT

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.
Key words: Fruit, fruit juice, abdominal obesity, barriers, young adults

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Delivery of healthy lunch to worksites: a two weeks pilot study in a sample of working adults in Selangor, Malaysia
Mohd Khairuddin Noor Khalib, Zahara Abdul Manaf, Suzana Shahar & Arimi Fitri Mat Ludin

ABSTRACT

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.
Key words: Healthy food delivery service, diet quality, working adults

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Food consumption and dietary diversity of women in transmigrant area Buol, Central Sulawesi and original location Demak, Central Java, Indonesia
Nia N Wirawan, Ratna C Purwestri, Ilmia Fahmi, Ignasius Radix AP Jati, Lucy W Kariuki, Ziba Barati, Jens Hartung, Betha Lusiana & Hans K Biesalski

ABSTRACT

Introduction: The transmigration scheme of the Indonesian government was aimed at easing overpopulation in Java by moving people to less populated areas. This study investigated food consumption and dietary diversity of women from the original location and transmigration rice farming areas.
Methods: Food intake using a single 24-hour dietary recall was determined among women of reproductive age in Demak, Central Java (original location) and Buol, Central Sulawesi (transmigrant area). Food taboos were investigated using focus group discussions (FGDs). Dietary diversity and its score were obtained from 387 and 121 women in Demak and Buol, respectively, while 38 women from both areas participated in four FGDs on food taboos.
Results: On average, women from both study areas had low dietary diversity scores, especially among lactation mothers. Rice, swamp cabbage, spinach and tempeh were popular in both areas. Fruits and vegetables from own cultivation or collected as wild foods were consumed in Buol, while women in Demak consumed comparatively more purchased foods (fruits and vegetables, legumes, meat and fish). Fewer types of food was avoided during pregnancy and lactation in Buol.
Conclusion: While some food intake behaviour was similar in both study areas, differences were observed as influenced by economic and environment factors. Food intake of Demak women was influenced by household purchasing power, while Buol women depended on own grown food and gatherings from nearby forest. As dietary diversity scores in both areas was low, nutrition interventions are suggested to improve maternal food intake during pregnancy and lactation.
Key words: Transmigration, women, dietary diversity

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Microencapsulation of red palm oil and its stability during accelerated storage
Feblinesia Alfrecha & Kar Lin Nyam

ABSTRACT

Introduction: Sensitivity of red palm oil (RPO) towards oxidation is known to result in degradation of nutritional value and organoleptic properties. This study aimed to determine the stability of microencapsulated RPO during accelerated storage at 65˚C for 24 days.
Methods: Microencapsulated was undertaken by co-extrusion technology using sodium alginate with high methoxyl pectin, and calcium chloride solution enhanced with chitosan as cross-linking agent in the presence of Tween® 80 as surfactant. The encapsulated beads were freeze dried and the physical properties, antioxidant activities and total carotenoid content of dried powder were determined. Microencapsulated red palm oil (MRPO) was then subjected to accelerated storage at 65°C for 24 days.
Results: Antioxidant activity of both RPO and MRPO measured by DPPH (2,2-diphenyl-1-picrylhydrazyl) radical scavenging activity was significantly decreased, with higher percentage loss in MRPO during accelerated storage. RPO and MRPO also experienced decreases in percentage inhibition with higher percentage of loss as measured by Azino-bis (3-ethylbenzothiazoline-6-sulpohnic acid) (ABTS) radical scavenging activity. Both RPO and MRPO showed decreasing trends in total carotenoid content, with higher content in MRPO than RPO at end of storage period. Antioxidant activities of RPO and MRPO correlated well with the carotenoid content, with best correlation coefficient in RPO between the ABTS assay and total carotenoid content measured by high performance liquid chromatography (r=0.952). Very strong association between DPPH and ABTS values (r=0.871) for the MRPO, and between DPPH and total carotenoid content (r=0.856) were noted.
Conclusion: The study showed that microencapsulation effectively protected the carotenoid content in MRPO, but not its other natural antioxidants.
Key words: Carotenoids, microencapsulation, co-extrusion, antioxidants, accelerated storage

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Development of food products using fish maw (Pangasius hypophthalmus) and roasted sunflower kernel (Helianthus annuus) for branched-chain organic acidurias patients
Suthida Chatvuttinun, Visith Chavasit, Duangrurdee Wattanasirichaigoon, Umaporn Suthutvoravut & Nalinee Chongviriyaphan

ABSTRACT

Introduction: Branched-chain organic acidurias include maple syrup urine disease (MSUD), isovaleric acidemia (IVA), propionic acidemia (PA), and methylmalonic acidemia (MMA). Long term management requires diets of adequate energy and protein with restriction of the offending amino acids. Standard commercial formulas are expensive and unaffordable to patients of low socio-economic status.
Methods: This study aimed to develop food products for branched-chain organic acidurias children aged 4-15 years using locally available raw materials in Thailand. Fish maw (Pangasius hypophthalmus) and roasted sunflower kernel (Helianthus annuus) were selected as protein sources due to their low leucine contents. Five formulations were developed, namely (i) powder (low leucine, isoleucine, and valine for MSUD) for tube feeding preparation, (ii) – (v) rice sprinkle powder, bouillon cube, instant cocoa drink, and snack bar, respectively with low leucine for IVA; low valine, isoleucine, methionine and threonine for PA and MMA.
Results: All five formulated products provide 500-600 kcal/100 g, adequate protein in which the offending amino acids were controlled at non-harmful levels. These products were shelf stable at room temperature (Aw = 0.3-0.5).
Conclusion: The products that were formulated from fish maw and roasted sunflower kernel provide proteins of appropriate quality and quantity for long-term management of branched-chain organic acidurias. The developed products should be further tested for efficacy among patients in accordance with an adequately powered study design.
Key words: Branched-chain organic acidurias, Pangasius hypophthalmus, Helianthus annuus, leucine, valine

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Indigenous pigmented corn (Zea mays L.) flour as substitute for all-purpose flour to improve the sensory characteristics and nutrient content of crackers
Zarah G Sales, Clarissa B Juanico, Erlinda I. Dizon & Wilma A Hurtada

ABSTRACT

Introduction: There is growing interest in using indigenous crops as alternative food sources that can address food and nutrition insecurity in developing countries. This study aimed to evaluate the nutrient content and sensory characteristics of crackers developed from indigenous pigmented corn (Zea mays L.) called camotes.
Methods: Eleven camotes and all-purpose flour (APF) combinations were made into crackers following the modified method of Manley (2001) at University of the Philippines Los Baños. Sensory evaluation was conducted using the linear scale of quality scoring based on standard methods. Proximate composition analysis, nutrient contents and phytochemical components were conducted using standard methods. Data from the sensory evaluation were analysed using non-parametric Analysis of Variance (ANOVA), while results from the chemical analysis were analysed using One-Way ANOVA and Tukey’s honestly significant difference (HSD) test.
Results: Sensory characteristics of the cracker containing 80% camotes flour were comparable with those of the 100% APF cracker except in colour. Crackers containing 100% and 80% camotes flour had significantly higher levels of protein, dietary fibre, lysine, tryptophan, zinc, antioxidant activity, phenols, and flavonoids than crackers made of 100% APF.
Conclusion: Crackers formulated at 80:20 camotes:APF blend compares most favourably with that from APF crackers. Incorporation of camotes flour into making of crackers increases its nutrient content. Such crackers can serve as a nutrient-dense alternative food source to address the food and nutrition insecurity situation in the Philippines.
Key words: Cracker, pigmented corn, all-purpose flour

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Clinical audit on adherence to using Malnutrition Screening Tool and dietitian referral in the Oncology Outpatient Clinic, National Cancer Institute, Malaysia
Ng Wai Han, Norshariza Jamhuri, Zuwariah Abdul Rahman, Betti Sharina Mohd Haniff Lai & Siti Nuraini Mohd Samwil

ABSTRACT

Introduction: Malnutrition is a frequent complication in cancer patients and can negatively affect treatment outcome. Preliminary audit conducted at the Oncology Clinic, National Cancer Institute (NCI), found that only 5.8% of outpatients underwent nutrition screening using the Malnutrition Screening Tool (MST), and only 2.6% of dietitian referrals were recorded. This audit aims to determine the rate of adherence to nutritional screening, and to implement remedial measures for improved patient care.
Methods: This was a cross-sectional audit comprising three phases, namely initial audit, remedial measures and re-audit. Criteria audited include screening rate using MST and dietitian referral based on MST scores. Standards were set at 100% for both criteria. Data collected for initial audit were patients’ MST scores records and total dietitian referral forms retrieved from Electronic Medical Records. After initial audit, self-administered questionnaires for nurses and physicians were developed to identify barriers. Measures implemented for change included patientadministered MST to shorten screening time, and procedure flowchart to facilitate referral. After 6 months, a re-audit was conducted.
Results: Total subjects for initial audit and re-audit were 349 and 390, respectively. Initial audit and re-audit showed screening rate using MST increased significantly from 6.3% to 79.5%, but there was no significant change for the dietitian referral rate.
Conclusion: This clinical audit has led to a change in the policy in NCI outpatient clinics whereby nurses directly schedule dietitian referrals without going through physicians for patients with MST scores ≥2. Continuous audit and monitoring are necessary to facilitate improvement in MST implementation for better outpatient care.
Key words: Malnutrition Screening Tool (MST), cancer patients, clinical audit, dietitian referral

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