MJN 2019 Issues

Malaysian Journal of Nutrition

Volume 25 No.1, 2019


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Table of Content

Association of socio-demographic characteristics, nutritional status, risk of malnutrition and depression with quality of life among elderly haemodialysis patients
Fatin Izzaty Mohd Shahrin, Lim Zhi Yu, Noraida Omar, Nor Fadhlina Zakaria & Zulfitri ‘Azuan Mat Daud

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Introduction: A compromised quality of life (QOL) as a result of haemodialysis (HD) is a rising global issue. Elderly HD patients face more challenges than younger counterparts. This study determined the association of socio-demographic characteristics, nutritional status, risk of malnutrition and depression with QOL, among elderly HD patients.
Methods: A cross-sectional study was conducted among 112 HD elderly patients in selected dialysis centres in Selangor, Malaysia. The patients completed interview-based questionnaires on socio-demographic characteristics, risk of malnutrition (Dialysis Malnutrition Score, DMS), depression (Patient Health Questionaire-9, PHQ-9) and QOL (KDQOL-36). Anthropometric measurements, 24-hour dietary recall and food intake information were obtained from them and biochemical data from their medical records.
Results: Just over half (50.9%) of the patients had a normal body mass index while 85.7% had optimal albumin levels. The proportion of patients who met the recommended energy and protein intakes were 19.0% and 3.4%, respectively. Patients were at moderate risk of malnutrition, had minimal depression level and perceived better QOL in terms of effects and symptoms of kidney disease. There was a significant positive correlation between protein intake and the physical domain of QOL (p=0.02) and negative correlation between risk of malnutrition with physical and mental composites of QOL (p<0.001). There was significant negative correlation between depression and physical composite, mental composite, burden, effects and the symptoms of kidney disease (p<0.001).
Conclusion: The present findings provide better insight on QOL for future screening, preventive measures and intervention. Further investigation regarding factors associated with QOL among elderly patients is recommended.
Key words: Quality of life, nutritional status, depression, haemodialysis, elderly

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Prevalence and determinants of Instrumental Activities of Daily Living (IADL) disability among communitydwelling elderly in a semi-urban setting in Peninsular Malaysia
Muhammad Faizal bin Murat, Zuriati binti Ibrahim, Siti Nur ‘Asyura binti Adznam & Chan Yoke Mun

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Introduction: The ability to perform daily living activities among the elderly is important, as physical disability may lead to dependency and various public health implications. This study aimed to determine the prevalence of instrumental activities of daily living (IADL) disability and its association with socio-demographic characteristics, dietary intake, social participation, perceived-health-status and risk of falls.
Methods: This cross-sectional study was conducted among communitybased elderly in the Gombak District of Selangor. 258 respondents aged 60-88 years old (mean age 66±6.5 years) were recruited through multi-stage proportional sampling. Most of the respondents (88.4%) aged 60-74 years and 11.6% were ≥75 years. IADL disability was determined using an eight-item IADL scale. The presence of IADL disability was defined as needing help in at least one or more of eight-IADL activities. Dietary intake and fall risk were assessed using diet history questionnaire (DHQ) and 21-item fall risk index (FRI-21), respectively.
Results: The prevalence of IADL disability among the respondents was 58.1%. A binary logistic regression analyses showed that the following factors predicted IADL disability: advanced age (≥75 years, OR=6.4; 95% CI: 1.3, 30.8), being unmarried (OR=2.5; 95% CI: 1.1, 5.9), unemployed/retired (OR=2.3; 95% CI: 1.2, 4.3), and at risk of falls (OR=2.5; 95% CI: 1.3, 6.1).
Conclusion: Predictors such as marriage and employment highlight the importance of social support among elderly. In practical terms, this means that it is incumbent upon caregivers, family members, and the community to provide both physical and emotional support if the functional status of the elderly is to be improved.
Key words: IADL disability, elderly, functional status, Malaysia

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Health-related quality of life of elderly with chronic obstructive pulmonary disease from selected government institutions
Nor-Farahain Yahya, Noraida Omar, Siti Nur’ Asyura Adznam, Ummi- Nadira Daut & Barakatun Nisak Mohd Yusof

ABSTRACT

Introduction: It is widely recognised that health-related quality of life (HRQOL) is impaired in chronic obstructive pulmonary disease (COPD) patients. Most previous studies were conducted among the younger adult population and there is limited information on the elderly population. This study aimed to determine the COPD assessment test (CAT) score in the elderly with COPD.
Methods: This was a crosssectional study involving 140 elderly patients who had been diagnosed with COPD at two selected government institutions. Data on socio-demographic and health status were collected by interviewing patients and reviewing their medical records. The HRQOL was measured using CAT. The independence sample t-test and one-way ANOVA were conducted to compare the CAT scores with socio-demographic and health status.
Results: The socio-demographic and health characteristics of the patients were as follows: majority (54%) were aged 60-70 years, male (97%), Malay (59%), married (75%), ex-smokers (72%), had attained primary education (48%), had co-morbidities (54%), no history of hospitalisation or visits to the emergency department due to COPD (57%), and were in moderate stage of airflow obstruction (53%). The mean of CAT score was 21.87±6.85 and the majority of the patients were classified as having worst symptoms of COPD (93%) as they had high CAT score which was ≥ 10.
Conclusion: Majority of the patients in this study had high scores of CAT, which indicated poor HRQOL. Ex-smokers had higher scores compared to non-smokers. More attention need to be given to these subgroups in order to increase their quality of life.
Key words: HRQOL, elderly, COPD, CAT score

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Simple method for assessing standing height using recumbent length in bedridden patients using soft and firm mattresses
Wong Wei Yee, Lim Su Lin & Chan Yiong Huak

ABSTRACT

Introduction: The accurate measurement of the height of bedridden patients is difficult. Height assessment is required for the calculation of body mass index, which is crucial for determining the nutrition status of a patient. This study aimed to validate recumbent length measurement against the standing height measurement using soft and firm mattresses and to derive predictive equations to calculate the actual height of bedridden patients on mattresses with different firmness.
Methods: Ninety-nine hospitalised participants (mean age 48.9±13.9 years; range 21–80 years) (49 men, 50 women) and 100 healthy participants (mean age 36.8±13.6 years; range 21–77 years) (50 men, 50 women) were recruited. Standing height was measured using a stadiometer. Recumbent length was measured using a 2 metre long measuring tape. Hospitalised participants lay on soft mattress and healthy participants on firm mattress.
Results: Using Bland–Altman plot, 96% of hospitalised participants using soft mattress were within 2.5±2.7 cm (mean±2SD) whereas 97% of healthy participants using firm mattress were within 2.1±2.1 cm. The regression equation developed using firm mattress was Standing height (cm) = 0.993 x Recumbent length – 0.943; (r2=0.982). The regression equation developed using soft mattress was Standing height (cm) = 1.012 x Recumbent length – 4.477; (r2=0.981).
Conclusion: We concluded that recumbent length is a valid clinical tool to estimate standing height. Standing height can be estimated from the predictive equations developed for patients lying on soft or firm mattresses.
Key words: Recumbent length, height, measuring tape, Asian, bedridden

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Identification of dietary patterns associated with characteristics of successful aging
Nik Nur Izzati Nik Mohd Fakhruddin, Suzana Shahar, Roslee Rajikan, Mohd Azahadi Omar, Normah Che Din, Rosdinom Razali, Sakinah Harith, Hamid Jan Jan Mohamed & Bibi Nabihah Abdul Hakim

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

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Prevalence and factors affecting food insecurity among university students in Pahang, Malaysia
Wan Azdie Mohd Abu Bakar, Shahidah Ismail, Suriati Sidek & Rozlin Abdul Rahman

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Introduction: Food insecurity exists whenever people are unable to access sufficient food at all times for an active and healthy life. University students are a potentially vulnerable group of people to face food insecurity. This study aimed to identify the prevalence and determinants of food insecurity among a population of university students in Kuantan, in the state of Pahang.
Methods: Food security status was identified using the United States Adult Food Security Survey Module (USAFSSM). Factors, which include demographic background, spending expenditure pattern and time constraints, were assessed. A total of 316 students were selected through stratified random sampling throughout six faculties of the International Islamic University Malaysia, of whom 307 successfully completed the survey.
Results: The result shows that 54.4% of the students were experiencing food insecurity, from which 32.9% were sub-categorised as low food security and 21.5% as very low food security. Food insecurity was found to be significantly associated with time constraints (p<0.05), spending on books (p<0.05), miscellaneous items (p<0.05), parents’ income (p<0.001) and scholarship type (p<0.001).
Conclusion: Apart from the high incidence of food insecurity among the students, time and financial affordability appeared to be critical concerns in this study. Since food insecurity has become a significant issue with university students, it should be addressed and prioritised by the relevant authorities.
Key words: Food insecurity, students, food security status

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A feasibility study of multiple micronutrient supplement for home fortification of foods among Orang Asli children in Negeri Sembilan, Malaysia
Nur Dayana Shaari, Zalilah Mohd Shariff, Gan Wan Ying & Loh Su Peng

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Introduction: The prevalence of child undernutrition and micronutrient deficiencies are higher in the Orang Asli (OA) than the general Malaysian population. The World Health Organization recommends the use of multiple micronutrient supplement (MMS) that is a blend of micronutrients in powder form that can be sprinkled onto foods for home fortification to prevent undernutrition among children. This pilot study aimed to assess the feasibility of using MMS among OA children.
Methods: A total of 25 OA children (14 boys and 11 girls) aged 6-31 months (mean±SD = 15.7±7.2 months) in Negeri Sembilan were given three sachets of MMS weekly for 5 weeks. Caregivers were instructed to add MMS to three types of food from the same food group per week varying with a different food group weekly. Written instruction for using MMS in simple language was given prior to the supplementation. Caregivers were interviewed for information on socio-demographics, compliance, acceptance, preference and adverse effect of MMS.
Results: A high level of compliance was observed (85%). All caregivers reported that the instructions for use were easy to read. No noticeable changes to the foods mixed with MMS were observed and no adverse effects were reported.
Conclusion: This study demonstrated feasibility of the use of MMS for future trials among OA children. The easy to read information that comes with the MMS, frequent monitoring of MMS use and support to caregivers were required to ensure compliance. Cultural feeding practices and financial constraints may limit the types of food that can be mixed with MMS.
Key words: Multiple micronutrients supplement, feasibility study, Orang Asli children, micronutrient powder, home food fortification

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Linguistic validity and reliability of cariogenic food frequency and oral health knowledge, attitude and practice questionnaires for parents of 6-11 years old children in Kota Bharu, Kelantan
Rosnani Ngah, Ruhaya Hasan & Normastura Abd Rahman

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Introduction: Cariogenic food intake and oral health knowledge, attitude and practices (KAP) of parents are contributing factors that influence the oral health status of children. As there is lack of a validated questionnaire in Bahasa Melayu (the Malay language) to measure the factors, this cross-sectional study was carried out to establish a linguistically valid and reliable cariogenic food frequency questionnaire (M-CFFQ) and oral health kap questionnaire (M-OHKAPQ) in Bahasa Melayu, for parents of children aged 6-11 years in Kota Bharu, Kelantan.
Methods: Relevant questionnaires in English were selected and translated to Malay language. This process included forward translation, synthesis, backward translation and consolidation to produce the preliminary drafts of M-CFFQ and M-OHKAPQ. Pretesting was conducted on ten parents of children from a primary school in Kota Bharu by face-to-face interview. The findings were reviewed to produce the final versions of M-CFFQ and M-OHKAPQ. A test-retest reliability study was undertaken involving 49 parents. The participants were asked to answer the final M-CFFQ and M-OHKAPQ versions twice, within a 7-14 days interval. Data collected were entered into IBM SPPS version 22 software and analysed using the Intraclass Correlation Coefficient (ICC) test.
Results: Semantic, idiomatic, experiential, conceptual as well as content and face validity issues were successfully resolved. Fifteen categories of food/drinks for M-CFFQ and 26 items/questions M-OHKAPQ were produced. The total ICC values achieved for M-CFFQ and M-OHKAPQ were 0.887 and 0.807, respectively.
Conclusion: The M-CFFQ and M-OHKAPQ appeared to be linguistically valid and reliable with excellent test-retest reliability (ICC>0.80).
Key words: Linguistic, cariogenic, oral health, questionnaire, test-retest reliability

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Module development and its effectiveness for improving the competencies of voluntary health workers in communicating safe complementary feeding to caregivers in Indonesia
Dwi Nastiti Iswarawanti, Siti Muslimatun, Endang Basuki & Ahmad Hadi

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Introduction: In Indonesia, most training modules for health paraprofessionals have been adapted from existing foreign modules without assessment. In addition, there have been few studies on training development for this group. We aimed to develop, using a systematic tool, implement and evaluate a training module to improve the competencies of voluntary health workers (cadres) in communicating safe complementary feeding practice to caregivers of young children in Indonesia.
Methods: A mixed methods approach was used. A qualitative study employing in-depth interviews, focus group discussions, mini-workshops, documentary reviews and expert validation was used to develop the training module, following a systematic approach. The module’s effectiveness for improving the health workers’ competencies was evaluated using a quantitative study with a non-equivalent pre-test and post-test control group design that included 70 (intervention group) and 68 (comparison group) voluntary health workers from a peri-urban district. Changes in the workers’ cognitive, affective and psychomotor competencies were tested before and after attending a 3-day training module (intervention group) or a half-day event (comparison group).
Results: A 24-hour learning session module on communicating safe complementary feeding was developed and used to train voluntary health workers. After the training, a significantly higher proportion of workers in the intervention group than in the comparison group were assessed as competent in the psychomotor and composite domains (psychomotor: 67.1% vs. 20.6%; composite: 74.3% vs. 36.8%; p<0.001).
Conclusion: This systematically developed module was effective in improving the competencies of voluntary health workers regarding communicating safe complementary feeding practice to caregivers in Indonesia.
Key words: Competencies, complementary feeding, communication, training, voluntary health workers

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Breastfeeding knowledge among indigenous Temiar women: a qualitative study
Sharifah Zahhura Syed Abdullah & Rozieyati Mohamed Saleh

ABSTRACT

Introduction: The benefits of breastfeeding for both mothers and infants are widely recognised. Breastfeeding confirms a woman’s unique ability to care for her infant in the best way possible and promotes optimum infant and maternal health.
Methods: A qualitative research method involving five focus group discussions (n=33) was chosen in this study to compare and contrast the breastfeeding practice in two different locations: the communities of Pos Pulat and the regroupment scheme settlement at Rancangan Pengumpulan Semula (RPS) Kuala Betis in Kelantan, Malaysia which represents different lifestyle experiences of indigenous Temiar population.
Results: The benefits of breastfeeding to the infants reported by some Temiar women (42.4%) were for the infant’s health and growth. Responses from urban RPS Kuala Betis women include breast milk contains antibodies (3.0%), delays in the return of regular ovulation (6.1%), thus lengthening birth intervals and bonding between maternal-baby (6.1%). In general, respondents from Pos Pulat seemed to have little knowledge regarding this issue, except for a woman who mentioned that maternal milk contains vitamins. Based on the narrative analysis, knowledge gap was observed between these two communities.
Conclusion: Although all the women interviewed had the experience of breastfeeding their infants, most of them lacked the knowledge regarding the benefits of the breastfeeding either to the infants or to the mothers. The findings from this study are crucial for the preservation of breastfeeding culture among the Temiar women and can be used to improve promotion of breastfeeding to other Orang Asli groups in Malaysia.
Key words: Breastfeeding, knowledge, health, indigenous, qualitative

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Workplace support and exclusive breastfeeding practice: a qualitative study in Jakarta, Indonesia
Yunita Febrianingtyas, Judhiastuty Februhartanty & Dian Nurcahyati Hadihardjono

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Introduction: The primary reason that compels working mothers to decrease their ability to continue to breastfeeding successfully is their return to work. Attempts to continue breastfeeding at work encounters several difficulties. This study aims to provide an overview of the workplace environment and how facilities at the workplace affect breastfeeding in Indonesia.
Methods: We used a qualitative approach to provide a detailed picture of the influence of workplace support for working mothers to perform breastfeeding. We enrolled working mothers (n=18) in Jakarta, as participants and obtained the following information from them: parity, type of family and type of work.
Results: The findings provided the general overview of the workplace environment and identified three factors that affected breastfeeding: seeking information during pregnancy, expression of breast milk at office facilities and the problem faced by working mothers.
Conclusion: Although the breastfeeding performance of most working mothers in this study comprised exclusive breastfeeding, some fed their infants with formula milk. This study suggests that working mothers who continue to breastfeed after returning to work need the support of their employers, co-workers and others in the workplace to ensure the provision of health facilities and the protection and dissemination the rights of breastfeeding working mothers that might lead them to discontinue their breastfeeding practice.
Key words: Breastfeeding performance, workplace support, qualitative study, Jakarta, Indonesia

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Nutrition labelling: an exploratory study on personal factors that influence the practice of reading nutrition labels among adolescents
Norsakira Jefrydin, Norazmir Md Nor & Ruzita Abd. Talib

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Introduction: The consumption of processed food is increasing in developing countries. Nutrition labels on food packaging are important for the education of consumers, particularly adolescents, to help them make healthier food choices. However, there is evidence to suggest that adolescents generally do not use nutrition labels. This study aims to explore the personal factors that influence the practice of Malaysian adolescents in reading nutrition labels.
Methods: The participants were adolescents, aged 13-16 years, from five public schools in Negeri Sembilan. Five semi-structured focus group discussions (FGDs) were conducted. The participants discussed their personal views, knowledge and perceptions regarding the use of nutrition labels and food selection. Data gathered from the FGDs were coded through thematic analysis using the NVivo software.
Results: While the participants were familiar with nutrition labels, their usage was relatively low during food selection due to the lack of interest in nutrition information, past experiences, hunger and cravings, time constraints and the taste of the food. The main reasons for using nutrition labels were health consciousness and their curiosity about specific nutrition information provided on the labels. The majority of participants believed that information provided on the labels was accurate because it was provided by reliable institutions. There was also misperception among some participants, mixing up nutrition labels with list of ingredients and the expiry dates. A few participants were unconvinced by the labels and stated that the labels provided misleading information.
Conclusion: Personal factors such as knowledge, misperception, awareness and trust significantly impact how adolescents read nutrition labels.
Key words: Nutrition labels, adolescents, food choice, focus group discussion

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Nutrient composition of milkfish (Chanos chanos, Forskal) from Pangkep, South Sulawesi, Indonesia
Sriwati Malle, Abu Bakar Tawali, Mulyati Muhammad Tahir & Maryati Bilang

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Introduction: Milkfish is a potential source of animal nutrition, especially for supplying human protein needs. In the present paper, we provide complete data on nutrient content of milkfish that can be used as a reference for diet formulation and for the further processing of milkfish.
Methods: Proximate analysis, amino acid and fatty acid composition, and vitamin and mineral content of milkfish were determined.
Results: The results showed that milkfish contained high concentration of protein (24.18%) and high proportion of monounsaturated fatty acids as oleic acid (32.11%). The amino acid found in the highest concentration was glutamic acid (1.28%). The macro-minerals in the milkfish were calcium (Ca), magnesium (Mg), sodium (Na) and potassium (K). Among the micro-minerals present were iron (Fe), zinc (Zn), copper (Cu) and manganese (Mn), and the main vitamins present include A, B1 and B12.
Conclusion: Based on their protein content, milkfish may be classified as a source of high protein. Glutamic acid which is the highest amino acid in milkfish as well as fatty acid content of oleic acid makes milkfish a healthful fish.
Key words: Amino acids, fatty acids, milkfish, minerals, proximate, vitamins

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Total lipid and omega-3 content in Pangasius catfish (Pangasius pangasius) and milkfish (Chanos chanos) from Indonesia
Marcelia Sugata, Priscilia Felita Wiriadi, Jap Lucy & Tan Tjie Jan

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Introduction: Supplementation of the diet with fish oil omega-3 fatty acids, especially eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) has been associated with multiple health benefits. This study aimed to determine total lipid and omega-3 content in two fishes from Indonesia, which were Pangasius pangasius (P. pangasius) and Chanos chanos (C. chanos).
Methods: Total lipid was extracted from P. pangasius and C. chanos and the lipid content was then analysed using gas chromatography–mass spectrometry (GC-MS).
Results: Lipid content of C. chanos (4.63±3.84%) was higher than P. pangasius (3.94±1.43%) but less than that found in Salmo salar (S. salar) which was found to contain 6.98±2.56% lipid. Furthermore, polyunsaturated fatty acid omega-3 (EPA and DHA) analysis showed that C. chanos oil contained 0.36% EPA and 1.17% DHA. These levels are lower than that found in S. salar, often referred to as the “gold standard” for omega-3 fatty acids.
Conclusion: C. chanos contains considerable amounts of EPA and DHA. As it is widely available in Indonesia, it may be used as source of omega-3 fatty acids instead of salmon.
Key words: Chanos chanos, Pangasius pangasius, omega-3 fatty acids

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Energy density of ethnic cuisines in Singaporean hawker centres: a comparative study of Chinese, Malay and Indian foods
Rina Yu Chin Quek, Goh Hui Jen & Christiani Jeyakumar Henry

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Introduction: A major focus in the prevention and management of obesity has been in the self-monitoring of foods consumed to reduce total energy intake. The present study used a novel instrument called the Calorie Answer™ to measure the energy content of various local foods in Singapore. The study aimed to build a database on energy density of commonly consumed Chinese, Malay and Indian foods to facilitate appropriate food choices by the consumer.
Methods: The first part consisted of measuring the energy density of 15 popular local foods purchased from 8 different hawker centres. In the second part, 46 additional local foods were analysed, again using the Calorie Answer™ instrument.
Results: Despite the different locations from which the foods were purchased, the energy content of the same foods was remarkably similar with a coefficient of variation (CV) of <15% for all foods. There was a higher average energy density of Indian foods compared to Chinese and Malay foods (Welch test, p=0.027).
Conclusion: Our results suggest that the energy density of commonly consumed foods from different locations was remarkably similar. The average energy density of Indian foods was significantly higher than that of Chinese and Malay. Knowledge of the energy density of foods is essential information that is needed in the battle against being overweight and obesity. The application of the Calorie Answer™ may be used as a means to collate data on the energy density of foods consumed in other countries in the ASEAN region.
Key words: Energy density, calories, food intake, variability, Singapore

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Malaysian Journal of Nutrition

Volume 25 No.2, 2019


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Malaysian Journal of Nutrition

Volume 25 No.3, 2019


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Malaysian Journal of Nutrition

Volume 25 No.4, 2019


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