A nutritional study was carried out on six (five rural and one urban) low income groups in Peninsular Malaysia from 1992-1995. In this paper, the socio-economic data for the five rural groups - padi farmers, rubber smallholders, coconut smallholders, estate workers, and fishermen - are presented. With the exception of the estate workers, the sample was predominantly Malay, with an overall mean household size of 5.30. Household incomes were generally low, and 47% of all households had incomes that were below the poverty line income (PLI) of RM405. Based on this PLI, the prevalence of poverty was above 50% among the padi, rubber, coconut, and fishing households. Nevertheless, the study population appeared to be better off in terms of the other indicators examined. Poultry rearing, for example, was widespread in the padi, rubber, and coconut villages; 65% of all households owned at least one motorised vehicle, 53% owned a refrigerator, and 83% owned a television set. Furthermore, over 80% of all households had access to piped water, 96% had electricity supply, and over 90% had a flush or pour-flush latrine. In comparison to the 1979-1983 poverty villages study (Chong et al., 1984), the households in the current study enjoyed better living conditions. Strict comparisons between the two studies, however, is difficult owing to the different criteria adopted in the selection of the study villages.
This paper presents the results of anthropometric assessment of 2,364 boys and 2,415 girls aged 18 years and below drawn from the estates and rural community groups engaged in padi farming, rubber planting, coconut cultivation and fishing. The children were mainly Malay, however in the estates, Indians predominated. The results showed that the percentage of boys who have normal weight-for-age, height-forage and weight-for-height were respectively 69.4%, 68.3% and 88.8%. Among girls, the percentage with normal values for weight-for-age, height-for-age and weight-for-height were 73.8%, 72.6% and 89.5% respectively. This study also showed the persistence of underweight, stunting and wasting amongst children in the study communities. Overall, the prevalence of underweight among boys was 29.8% and for girls 25.5%. The prevalence of stunting was 31.3% for boys and 26.9% for girls, while wasting was found in 9.3% boys and 8.5% girls. By age groups, the prevalence of underweight was lowest among the infants (16.8% for boys and 13.3% for girls), and highest among children aged above 1 to 6 years old (32.6% and 35.9% for boys and girls respectively). Children from the fishing, rubber and padi villages showed a higher prevalence of acute and chronic undernutrition than those from the coconut and the estate communities. In contrast, the mean prevalence of overweight in the five community groups did not exceed 2%. When compared with another peninsula-wide nutritional assessment of poverty villages undertaken in 1979-1983, it is found, over the past decade, that the prevalence of underweight in rural communities appeared to have decreased somewhat while that of stunting showed a more substantial decline. The persistence of current undernutrition has led to the manifestation of children who were too thin for their “non-stunted” height, thus giving rise to an apparently higher prevalence of wasting as found in this study. The implications of these results are discussed.
An interview administered food frequency questionnaire (FFQ) consisting of 75 food items was developed and calibrated against a four day weighed record (WR). The FFQ was also calibrated against a proxy for biomarker, the energy intake/basal metabolic rate ratio (EI/BMR). A total of 58 subjects (35 women, 23 men) aged between 19 and 76 years of Pakistani and Indian origin in Southampton, United Kingdom (UK) participated in this calibration study. The results for men and women combined together suggested reasonable agreement between FFQ and WR estimates of intake with Spearman rank correlation coefficient ranging between 0.26 and 0.38 (energy unadjusted). Gender specific agreement was however, poor. The percent mean difference between nutrient estimates by FFQ and WR was in general within 10% for energy, fat and protein in women while in the range of 11% to 25% in men. The percent mean difference for other nutrients such as sugar and dietary fibre ranged between 18% and 99% in men and women; while was 9% and 6% for starch in men and women respectively. The ranking of subjects into the thirds of distribution was poor with gross misclassification in the range of 5% to 14% in men and 15% to 29% in women. Comparison of both FFQ and WR with EI/BMR ratio showed that there were more underreporters of energy intake when reporting intake using WR than FFQ in both men and women. Based on these results, it was concluded that further development of the FFQ was needed before the FFQ could be used to evaluate the usual dietary intake in the South Asian population.
Fasting serum specimens from (a) 217 male and 46 female patients with coronary artery disease (CAD), aged 35-75 years, who had undergone angioplasty (PTCA) / coronary artery bypass graft (CABG), and (b) 160 apparently healthy controls (106 males, 54 females, aged 30-75 years), were assessed for serum lipid profile. Both sex and ethnicity significantly influenced the levels of serum high density lipoprotein cholesterol (HDLC); in the controls, females had higher HDLC levels than males (46.7 mg/dl vs 38.5 mg/dl, p<0.00l), while the Indian males possessed significantly lower HDLC values than the male Malay or Chinese. HDLC, triglycerides (TG) and the atherogenic index- LDLC/HDLC ratio were significantly different between the CAD patients and the healthy controls, while total cholesterol (TC) and LDLC did not seem to be of diagnostic value. Serum HDLC was lower in the CAD patients compared to the healthy controls in both sexes (p<0.001), either expressed as HDLC per se or as % HDLC. This observation combined with the odds ratio (OR) values of 0.24 and 0.28 for HDLC and % HDLC respectively in males, firmly establishes HDL as a protective factor of CAD in Malaysians. Significance testing for the X2 values associated with the OR values for the various lipid indices, together with the findings on the receiver-operating characteristices (ROC) curves, i.e. plots of sensitivity vs 1-specificity, indicated that HDLC, % HDLC and TQ were equally efficient as a means of risk assessment to CAD in Malaysians.
A study to predict energy requirements of national athletes, 84 males and 24 females in 9 and 4 different types of sports respectively, were conducted during centralised training. Parameters assessed were anthropometry, 3-day activity pattern and energy cost (kcal/min) of common activities to derive total daily energy expenditure (TDEE). Based on body mass index (BMI), 68 males or 81% and 19 females or 79% of the athletes were classified as normal. The mean body fat content for males and females were 13.8 ± 4.5% and 24.7 ± 5.3%, respectively. The mean daily activity pattern of males and females athletes were similar for light activities (16½ hr or 68% of day), for moderate activities (3½ hr or 15% of day in male, 4 hr or 17% in females) while moderate to heavy activities related to training were 4 hr (17%) and 3½ hr (15%) in males and females, respectively. Energy cost of some common activities ranges from 1.00-3.00 kcal/min in males and 0.84-2.04 kcal/min in females, while values for jogging were 6.60 kcal/min and 5.62 kcal/min in males and females, respectively. The mean TDEE in male ranges from 2938 kcal (12.3 MJ) in boxers (57 kg) to 4861 kcal (20.3 MJ) in weightlifters (110 kg) while the mean TDEE in female ranges from 2099 kcal (8.8 MJ) in athletics (51 kg) to 3098 kcal (13.0 MJ) in basketball (61.4 kg). The calculated physical activity level (PAL) values using measured BMR for males and females athletes ranges from 1.99-2.58 and 1.77-2.34, respectively. In conclusion, the estimated energy requirement for the various sports event studied ranges from 44-55 kcal/kg/day in males and 38-50 kcal/kg/day in female athletes.
A retrospective study of anaemia in pregnancy in rural Kelantan was conducted. The study sample consist of 9,860 mothers who had antenatal care at one of the 102 rural health clinics selected and had delivered a live baby. Anaemia in pregnancy was determined by reviewing the antenatal records for the haemoglobin level recorded at the first and last antenatal visit. Estimation of haemoglobin was done either by photocalorimetric methods or the Sahliís method in these rural clinics. At the time of booking, 47.5% of the mothers were anaemic by WHO criteria (Hb < 11.0 g/dl), with 1.9% having less than 9.0 g/dl. Age of mother, parity and late gestational age at the first antenatal visit were associated with anaemia during pregnancy at the time of booking. However, practise of contraception by the mother did not show any association with anaemia in pregnancy. There were 594 mothers (6.0%) who delivered a baby weighing less than 2.5 kg. There was no association between the low birth weight of the child and the status of anaemia in the mother at the last antenatal visit.
An assessment of the daily intake of major nutrients among 409 adults (males and females aged between 18-60 years, normal body mass index) residing in four regions in Malaysia was carried out as part of a major study on energy requirement. Subjects from both urban and rural areas completed a 3-day food record during the study. Mean energy intake among the men and women were 9.05 ± 2.21 MJ/day (2163 kcal/day) and 7.19 ± 1.60 MJ/day (1718 kcal/day) respectively, corresponding to 90% of the Malaysian RDA. A mean of 14% of the total energy was derived from protein, 23% from fat and 63% from carbohydrate. Energy intake amongst male subjects in the rural area (8.47 MJ/day, 2024 kcal) was significantly lower than their urban counterparts (9.52 MJ/day, 2275 kcal). There was no difference in mean energy intake in both the urban (7. 19 MJ/day, 1718 kcal) as well as rural women (7.16 MJ/day, 1711 kcal) corresponding to 86% of the RDA. The distribution of nutrients to the total energy intake amongst rural subjects were 13% for protein in both males and females, 65% for carbohydrate in males and 66% in females and 19% for fat in males and 21% for females. In the urban male and female subjects, the distribution of protein, carbohydrate and fat to the total energy intake were 14%, 55% and 29% and 30% respectively. The rural subjects showed a poorer mean intake of vitamins and minerals compared to the urban subjects. The diets of the male subjects in the rural area were deficient, less than two-third RDA in calcium, riboflavin and niacin. Calcium and iron intakes were less than two-third RDA in both the rural as well as the urban women. The rural women also had a poor intake of vitamin A and niacin. Overall, only protein and vitamin C intake met the RDA in most subjects from rural and urban areas.
Kajian ini bertujuan untuk mengkaji tahap pengetahuan, sikap dan amalan terhadap penyakit jantung koronari serta faktor-faktor risiko (CHD) di kalangan pesakit CHD di Institut Jantung Negara (IJN), Kuala Lumpur. Subjek kajian ini merupakan semua pesakit penyakit jantung koronari yang mendapat rawatan perubatan di IJN dalam jangkamasa kajian ini dijalankan, iaitu antara 5 Mei 1997 dan 24 Mei 1997. Seramai 105 orang pesakit telah ditemubual dengan menggunakan borang soal selidik. Kajian ini meliputi empat faktor risiko penyakit jantung koronari iaitu pengambilan makanan, amalan merokok, pengambilan alkohol dan aktiviti fizikal. Hasil kajian ini menunjukkan bahawa majoriti pesakit (92.4%) berumur 45 tahun dan ke atas. Kebanyakan pesakit (85.7%) mempunyai sekurang-kurangnya satu masalah kesihatan kronik seperti diabetes mellitus dan hipertensi sebelum dimasukkan ke IJN. Hasil kajian mendapati min jumlah kolesterol darah bagi pesakit adalah 6.1 (1.3mmol/L dan seramai 75.2% adalah hiperkolesterolemik (5.2 mmol/L). Min tekanan darah sistolik adalah 151.2 (27.5mmHg. Min bagi indeks jisim tubuh di kalangan pesakit adalah 25.9 (3.9kg/m2 dan seramai 58.1% berlebihan berat badan (BMI (25.0). Selain itu, didapati setengah daripada pesakit (49.6%) pernah merokok tetapi hanya 8.6% yang masih merokok. Daripada 56 orang pesakit yang bukan Muslim, seramai 9 orang (16.1%) sentiasa meminum alkohol. Kebanyakan pesakit mengatakan hanya berjalan sebagai senaman yang dilakukan. Didapati juga kebanyakan pesakit memakan nasi, sayur-sayuran dan buah-buahan hampir setiap hari. Hasil kajian ini menunjukkan perhubungan yang signifikan di antara (i) tahap pengetahuan dengan sikap terhadap faktor risiko CHD (r=0.624, p<0.001), (ii) tahap pengetahuan dengan amalan pencegahan terhadap faktor risiko CHD (r=0.316, p<0.0 1) dan (iii) sikap dengan amalan pencegahan terhadap faktor risiko CHD (r=0.234, p<0.05). Dicadangkan bahawa lebih banyak maklumat mengenai penyakit jantung koronari serta faktor-faktor risikonya perlu disebarkan kepada orang ramai supaya mereka dapat meningkatkan pengetahuan dan seterusnya dapat mengamalkan cara gaya hidup yang sihat.
Coronary Heart Disease (CHD) is recognised as an important public health problem in Malaysia. Hyperlipidaemia is one of the main risk factors related to CHD. The mainstay of treatment is diet therapy which should be maintained even if drug treatment is indicated. Since dietitians are the primary providers of dietary treatment to hyperlipidaemic patients, this retrospective study attempts to report the dietary approaches and methodologies adopted by Malaysian dietitians in managing their patients. A postal questionnaire covering various aspects of dietary management of hyperlipidaemia were sent to 47 dietitians practicing in private and government hospitals. A response rate of 53 % was elicited. The survey found that there was a disparity amongst the respondents in the approach to the dietary management of hyperlipidaemia in Malaysia. This was largely due to the absence of a standardised dietary protocol for general lipid lowering in patients with hyperlipidaemia.
Effects of soaking, boiling and roasting on TDF (total dietary fiber), SDF (soluble dietary fiber) and IDF (insoluble dietary fiber) of legumes (mung bean, soya bean, ground nut) and cereals (rice, wheat, barley) were studied. Results indicated that thermal processing gave different effects on TDF, IDE and SDF when analyzed using enzymatic-gravimetric methods. The changes in IDE content may explain the observed changes in TDF since SDF of most samples remained the same. In samples with high protein both SDF and IDE increases with thermal treatments, and this could be attributed to the production of Maillard reaction products.
This article examines the fat and fibre intakes of Malaysian adults and highlights discrepancies and practical limitations if these intakes are to match the levels for these nutrients advocated in the World Health Organisation (WHO) and American Heart Association (AHA) ‘diet models’. Local data on food consumption showed that the total fat intakes amongst Malaysian adults, contrary to common perception, were not high and the mean values obtained fell within the range of 40-66g or 22-26% kcal. As such, the dietary target of 30% kcal total fat or its intermediate target of 30-35% kcal, advocated by WHO and AHA mainly to address the problem of a high consumption of dietary fats in western populations, should not be adopted indiscriminately by Malaysians. Dietary fatty acid (FA) analysis by high performance liquid chromatography (HPLC) coupled with the use of food composition tables, showed that the typical Malaysian diet prepared with palm olein or palm olein-groundnut oil blends as cooking oil contained 3.2-4.0% kcal polyunsaturated fatty acids (PUFA), mainly as the w-6 linoleic acid, which is also the predominant essential fatty acid (EFA) in humans. This level of linoleic acid, with an ω-6/ ω--3 FA ratio approximating 10, is adequate for basal PUPA and EFA needs but fell short of the 4-10% kcal linoleic acid recommended by WHO (1993) to counter the effects of the cholesterol-raising saturated fatty acids (SFA). This raised upper limit of 10% kcal linoleic acid (previously 7% kcal), which equals the level of PUFA implied in the AHA diet model, appears unnecessarily high considering that the cholesterol-lowering potential of linoleic acid is maximum at about 6% kcal, while the health hazards associated with long-term high intakes of PUPA have never been completely dismissed. The new WHO lower limit for dietary linoleic acid (4% kcal) would have a controversial impact of raising the previous minimal 3% kcal EFA to above 4% kcal (linoleic + alpha-linolenic acids). Similarly, the WHO recommendation for total dietary fibre of 27-40g (equivalent to a daily combined intake of 400g of vegetables and fruits, 30g of which should come from pulses) appears at present, too high a dietary target for the average Malaysian adult whose habitual daily diet was estimated to contain about 180g of vegetables plus fruits, providing only about 13-16g total dietary fibre. Appropriately, an expert panel on Malaysian Dietary Guidelines has recommended instead, 20-30% kcal total fat containing 3-7% kcal PUFA, and 20-30g total dietary fibre for the local population.
This review paper describes briefly on the history of aflatoxins, the metabolism of aflatoxin B1 (AFB1) that leads to the activation and detoxification of AFB1, and the findings of some of the studies relating to food nutrients and additives, and drugs on AFBJ carcinogenicity and detoxification. Aflatoxins have been linked to many public health problems, especially to liver cancer incidences, in different parts of the world. Many studies have shown the potential of dietary factors modulating the formation of AFB1 - DNA adduct, the initial and important step of AFB1 carcinogenesis process. Among the food nutrients that have been shown to reduce the binding of AFB1 to DNA are vitamin A, vitamin C and riboflavin. On the contrary, vitamin E and β-carotene increase the DNA binding. Choline-deficient animals when subjected to multiple doses of AFB1 had higher amount of the DNA adduct being formed than the choline-sufficient animals. Carnitine supplement, feed restriction, and some vegetables and their extracts can also decrease the AFB1 -DNA adduct formation. The observed and proposed mechanisms for the reduction include the inhibition of bioactivation of AFB1 and induction of glutathione S-transferase activity that detoxify the activated AFB1. However, more research is needed before nutritional recommendations could be given to the public to control AFB1 toxicity and carcinogenicity.