MJN 2013 Issues

Malaysian Journal of Nutrition

Volume 19 No.1, 2013




Table of Content

In Memoriam - Professor Nevin S. Scrimshaw
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The Impact of Early Nutrition on Health: Key Findings from the Cebu Longitudinal Health and Nutrition Survey (CLHNS)
Judith B Borja

ABSTRACT

Introduction: The Philippines’ Cebu Longitudinal Health and Nutrition Survey (CLHNS) is one of the longest running birth cohort studies in Southeast Asia. This paper illustrates the pathways through which maternal and infant nutrition influence later health outcomes using selected CLHNS findings.
Methods: The CLHNS initially examined the determinants and consequences of low birth weight and early nutrition on child growth and development. It has since expanded to study other health, nutrition, and demographic issues in the life course of the cohort participants such as the consequences of early nutrition on adult health.
Results: CLHNS findings have documented important effects of poor maternal nutrition beyond impaired foetal growth (manifested through low birth weight). Mothers who had lower energy intakes and poorer nutritional status during pregnancy had offsprings who were at risk of having higher blood pressure measurements in adolescence. Infants born small at birth were not only more likely to be stunted through adolescence, but were also at greater risk of cardiovascular disease later in life. Among the males, those born thin at birth and have high BMI in adulthood had increased risk of elevated systolic blood pressure. Early infant feeding also had long-term effects on health. Breastfeeding not only protected against morbidity and stunting in childhood, but also lowered the risk of insulin resistance and high triglyceride levels in adulthood among the males. Delayed complementary feeding was associated a with lower risk of overweight in young adulthood. An intergenerational matrilineal effect was also observed among the participants, with maternal birth weight being positively associated with offspring birth weight.
Conclusion: The CLHNS findings support the WHO recommendations for exclusive breastfeeding until six months, timely introduction of complementary foods, and continued breastfeeding until two years. Since child nutrition begins in utero, programs should focus on improving maternal nutrition during pregnancy to minimise the risk of low birth weight.
Key words: Maternal nutrition, health, Cebu Longitudinal Health and Nutrition Survey, infant feeding

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Lowering Dietary Glycaemic Index through Nutrition Education among Malaysian Women with a History of Gestational Diabetes Mellitus
Sangeetha-Shyam, Fatimah A, Rohana AG, Norasyikin AW, Karuthan C, Nik Shanita S, Mohd Yusof BN & Nor Azmi K

ABSTRACT

Introduction: Gestational diabetes mellitus (GDM) increases risks for type 2 diabetes and cardiovascular diseases. Low glycaemic index (GI) diets improve cardio-metabolic outcomes in insulin-resistant individuals. We examined the feasibility of lowering GI through GI-based-education among Asian post-GDM women.
Methods: A 3-month investigation was carried out on 60 Malaysian women with a mean age of 31.0±4.5 years and a history of GDM. Subjects were randomised into two groups: LGIE and CHDR. The CHDR group received conventional healthy dietary recommendations only. The LGIE group received GI based-education in addition to conventional healthy dietary recommendations. At baseline and after 3-months, dietary intake of energy and macronutrient intakes including GI diet and glycaemic load was assessed using 3-day food records. Diabetes-Diet and GI-concept scores and physical activity levels were assessed using a questionnaire. Adherence to dietary instructions was measured at the end of 3 months.
Results: At the end of 3 months, the LGIE group had significant reductions in energy intake (241.7±522.4Kcal, P=0.037, ES=0.463), total carbohydrate (48.7±83.5g, P=0.010, ES=0.583), GI (3.9±7.1, P=0.017, ES=0.549) and GL (39.0±55.3, P=0.003, ES=0.705) and significant increases in protein (3.7±5.4g, 0.003, ES=0.685) and diet fibre (4.6±7.3g, P=0.06). The CHDR group had a significant reduction in fat only (5.7±9.4g, P=0.006, ES=0.606). There was a 30% increase in GI-concept scores in the LGIE group (p< 0.001). Changes in GI-concept scores correlated significantly to the reduction in dietary GI (r = -0.642, P=0.045). Dietary adherence was comparable in both groups.
Conclusion: GI-education improves GI-concept knowledge and helps lower dietary glycaemic index among women with a history of GDM.
Key words: Diet, gestational diabetes mellitus, glycaemic index, glycaemic load, prevention, type 2 diabetes

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Relationship between Family Meals away from Home and Nutritional Status of Adolescents
Cynthia J, Zalilah MS & Lim MY

ABSTRACT

Introduction: Despite the many benefits of family meals, data on association between family meals away from home (FMAFH) and nutritional status of adolescents is limited. This study determined the association between FMAFH with dietary intake and body mass index of adolescents (N=408).
Methods: Data were obtained through interviewer-administered questionnaire and anthropometric measurements of adolescents.
Results: For all groups, calorie intake of those who succeeded in exclusive breastfeeding was significantly (p - value < 0.05) higher than those who failed. Calorie intake of lactating mothers is the most dominant factor (OR=5.6) for the success of 6 months of exclusive breastfeeding. The milk supplementation group had the highest calorie intake and highest percentage of mothers who were successful in providing 6 months of exclusive breastfeeding.
Conclusion: With increasing dependence on foods outside the home, FMAFH can be a source of healthy diet for families provided they have the knowledge, skills and motivation to make healthy food choices.
Key words: Family meals, adolescents, dietary intake, Body Mass Index

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A Workplace Email-linked Website Intervention for Modifying Cancer-related Dietary and Lifestyle Risk Factors: Rationale, Design and Baseline Findings
Ang YK, Mirnalini K & Zalilah MS

ABSTRACT

Introduction: The use of email and website as channels for workplace health information delivery is not fully explored. This study aims to describe the rationale, design, and baseline findings of an email-linked website intervention to improve modifiable cancer risk factors.
Methods: Employees of a Malaysian public university were recruited by systematic random sampling and randomised into an intervention (n=174) or control group (n=165). A website was developed for the intervention and educational modules were uploaded onto the website. The intervention group received ten consecutive weekly emails with hypertext links to the website for downloading the modules and two individual phone calls as motivational support whilst the control group received none. Diet, lifestyle, anthropometric measurements, psychosocial factors and stages of change related to dietary fat, fruit and vegetable intake, and physical activity were assessed.
Results: Participants were predominantly female and in non-academic positions. Obesity was prevalent in 15% and 37% were at risk of co-morbidities. Mean intake of fats was 31%, fruit was ~1 serving/day and vegetable was <1 serving/day. Less than 20% smoked and drank alcohol and about 40% were physically inactive. The majority of the participants fell into the Preparation stage for decreasing fat intake, eating more fruit and vegetables, and increasing physical activity. Self-efficacy and perceived benefits were lowest among participants in the Precontemplation/Contemplation stage compared to the Preparation and Action/Maintenance stages.
Conclusion: Baseline data show that dietary and lifestyle practices among the employees did not meet the international guidelines for cancer prevention. Hence the findings warrant the intervention planned.
Key words: Cancer, risk factors, email, website, worksite

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Stool Patterns of Malaysian Adults with Functional Constipation: Association with Diet and Physical Activity
Mazlyn Mena M, Nagarajah Lee HL, Fatimah A, Norimah AK & Goh KL

ABSTRACT

Introduction: Diet and lifestyle modification is commonly used in constipation management. As there is a dearth of studies on this topic in Malaysia, we aim to elucidate the relations between stool patterns, dietary intake and physical activity levels among adults with functional constipation.
Methods: From a database collected via surveys at public events, a convenience sample of 100 adults diagnosed with Rome II-defined functional constipation was enrolled in this cross-sectional study. After severity assessment using the Chinese Constipation Questionnaire, subjects completed 2-week bowel movement diaries to determine stool frequency, consistency and output. Dietary intake and physical activity levels were assessed twice using three-day 24-hour diet recalls and International Physical Activity Questionnaire, respectively. Ninety subjects who completed the study were included in the analysis.
Results: Mean weekly stool frequency was 3.9±1.9 times, consistency score was 2.6±0.6 (range 1.0-4.0), output was 11.0±6.3 balls (40 mm diameter) and severity score was 10.3±3.3 (range 5.0-22.0). Mean daily dietary intakes were: energy 1,719±427kcal, dietary fibre 15.0±4.9g and fluid 2.5±0.8L. The majority of subjects were physically inactive. Stool frequency and output were positively associated with dietary fibre (rs=0.278, P<0.01; rs=0.226, P<0.05) and fluid intake (rs=0.257, P<0.05; OR=3.571, 95% CI [1.202-10.609]). Constipation severity was associated with higher physical activity levels (OR=2.467, 95% CI [1.054-5.777]).
Conclusion: Insufficient intake of dietary fibre and fluid are associated with aggravated constipation symptoms. Further studies are necessary to confirm usefulness of dietary intervention in treatment of constipation as dietary factors alone may not influence overall severity and stool consistency, an integral element of constipation.
Key words: Constipation, stool, diet, physical activity, dietary fibre

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Malnutrition Risk and its Association with Appetite, Functional and Psychosocial Status among Elderly Malays in an Agricultural Settlement
Suzana S, Boon PC, Chan PP & Normah CD

ABSTRACT

Introduction: Malnutrition is a common phenomenon among the elderly and quite often related to psychosocial problems. The objective of this study was to determine malnutrition risk and its association with appetite, functional and psychosocial status among elderlyMalays in an agricultural settlement, i.e. FELDA Sungai Tengi, Selangor.
Methods: A cross-sectional study was conducted among 160 subjects (men=36.2%), with a mean age of 65.0 ± 3.9 years, who were interviewed to obtain information on malnutrition risk and appetite using Mini Nutritional Assessment Short Form and Simplified Nutritional Appetite Questionnaire, respectively. Functional status was determined using Instrumental Activities of Daily Living (IADL), Elderly Mobility Scale (EMS) and handgrip strength. Mini Mental Status Examination (MMSE), Geriatric Depression Scale and De Jong Gierveld Loneliness Scale were used to identify cognitive impairment, depressive symptoms and loneliness status of subjects respectively. A total of 42.5% of subjects were at risk of malnutrition and 61.2% had poor appetite. The mean scores of IADL and EMS were lower in subjects at risk of malnutrition, compared to those who were not at high risk (p<0.05 for both parameters). Multiple linear regression showed that 19.8% of malnutrition risk was predicted by poor appetite, decreased functional status (IADL) and depression.
Conclusion: Malnutrition risk was prevalent and associated with poor appetite, functional status and psychosocial problems among the elderly subjects. The psychosocial aspect should also be incorporated in nutrition intervention programmes in order to improve mental well-being and functional independancy.
Key words: Malnutrition, elderly, functional, psychosocial aspects, Malaysia

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Prevalence of Metabolic Syndrome Among Staff in a Malaysian Public University Based on Harmonised, International Diabetes Federation and National Cholesterol Education Program Definitions
Heng KS, Hejar AR, Rushdan AZ & Loh SP

ABSTRACT

Introduction: Metabolic syndrome (MetSyn) as defined by the latest Harmonised definition and the agreement between the Harmonised definition and other definitions is poorly studied among Malaysians. This study was conducted to determine and compare the prevalence of MetSyn according to the Harmonised, International Diabetes Federation (IDF) and National Cholesterol Education Program (NCEP ATPIII) definitions among Malay staff of Universiti Putra Malaysia (UPM).
Methods: Subjects aged between 20 to 65 years were recruited by convenient sampling. Waist circumference, blood pressure, lipid profiles and fasting plasma glucose levels were assessed. The agreement between the Harmonised and other definitions was determined by Kappa statistics.
Results: A total of 227 subjects with a mean ± SD age of 37.9±9.6 years participated in the study. The overall prevalence of MetSyn was 38.3%, 38.8% and 33.5% according to Harmonised, IDF and NCEP ATP III definitions, respectively. Generally, men had higher prevalence of MetSyn than women. The prevalence increased with age in both genders with a more progressive trend in women. Men in the age group of 20-39 years had a high prevalence of metabolic syndrome. A strong agreement was found between the Harmonised and the IDF definitions (Kappa index=0.991), and between the Harmonised and the NCEP ATP III definitions (Kappa index=0.857).
Conclusion: Regardless of definitions used, the prevalence of metabolic syndrome in the study, especially in young men, was high and warrants further investigation. The Harmonised definition is suitable for diagnosing metabolic syndrome in any population with similar socio-demographic characteristics.
Key words: Prevalence of metabolic syndrome, components of metabolic syndrome, agreement between definitions

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The Trans Fatty Acids Content of Selected Foods in Malaysia
Akmar ZD, Norhaizan ME, Azimah R, Azrina A & Chan YM

ABSTRACT

Introduction: There is a lack of information on the trans fatty acid (TFA) content in Malaysian foods. The objective of this study is to determine the TFA content of bakery products, snacks, dairy products, fast foods, cooking oils and semisolid fats, and breakfast cereals and Malaysian fast foods. This study also estimated the quantity of each isomer in the foods assayed.
Methods: The trans fatty acid content of each food sample was assessed in duplicate by separating the fatty acid methyl esters (FAME) in a gas chromatography system equipped with HP-88 column (USA: split ratio 10: 1) for cis/trans separation. Five major TFA isomers, palmitoelaidic acid (16: 1t9), petroselaidic acid (18:1t6), elaidic acid (18:1t9), vaccenic acid (18: 1t11) and linoelaidic acid (18:2t9, 12), were measured using gas chromatography (GC) and the data were expressed in unit values of g/100 g lipid or g/100 g food.
Results: The total TFA contents in the studied foods were <0.001 g-8.77 g/100 g lipid or <0.001 g-5.79 g/100 g foods. This value falls within the standard and international recommendation level for TFA. The measured range of specific TFA isomers were as follows: palmitoelaidic acid (<0.001 g-0.26 g/100 g lipid), petroselaidic acid (<0.001 g – 3.09 g/100 g lipid), elaidic acid (<0.001 g-0.87 g/100 g lipid), vaccenic acid (<0.001 g-0.41 g/100 g lipid) and linoelaidic acid (<0.001 g-6.60 g/100 g lipid).
Conclusion: These data indicate that most of the tested foods have low TFA contents (<1 g/100 g lipid).
Key words: Malaysian foods, trans fatty acids (TFA), isomers of TFA, palmitoelaidic, linoelaidic, elaidic, vaccenic and palm oil

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Fibre from Pumpkin (Cucurbita pepo L.) Seeds and Rinds: Physico-chemical Properties, Antioxidant Capacity and Application as Bakery Product Ingredients
Nyam KL, Lau M & Tan CP

ABSTRACT

Introduction: The aims of this study were to determine the proximate composition, functional properties and antioxidant activity of pumpkin seeds and rind. Besides, the effects of dietary fibre in pumpkin seeds and rinds on bread qualities and properties were evaluated.
Methods: Formulations for bread substituted with 0%, 5% and 10% pumpkin seed and rind, respectively were produced. Sensory evaluation of the prepared bread samples for such attributes as appearance, aroma, flavour, texture and overall acceptability was undertaken. The physical properties of the bread samples, including dough expansion, loaf volume, crumb colour and bread texture, were determined. Proximate analysis and determination of antioxidant activity of the bread samples were also conducted.
Results: Crude fibre of the pumpkin seeds and pumpkin rinds was high at 31.48% and 14.83%, respectively. The total phenolic compound (TPC) and DPPH radical scavenging activity for the pumpkin rinds were 38.60 mg GAE/100 g dry weight and 69.38%, respectively, which were higher than those of pumpkin seeds. A 5% level of pumpkin rind bread gave the best overall acceptability and sensory attributes, followed by 5% pumpkin seed bread. Total dietary fibre, total phenolic compound and DPPH radical scavenging activity in breads substituted with 5% pumpkin seed and 5% pumpkin rind flour were higher than the values in control bread.
Conclusion: Pumpkin seeds and rinds can be used as dietary fibre sources in bakery.
Key words: Pumpkin seeds and rinds, dietary fibre, bread, sensory evaluation

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Effect of Storage Conditions on Quality of Prebiotic Dark Chocolate
Norhayati H, Rasma Suzielawanis I, & Mohd Khan A

ABSTRACT

Introduction: A prebiotic such as inulin is a well-known functional plant food ingredient. It is capable of stimulating growth of beneficial bifidobacteria in the intestine thus protecting against intestinal infections, preventing constipation, increasing mineral absorption, reducing the incidence of colon cancer, and producing B vitamins. Inulin added to food therefore has to be stable during food processing especially against heat treatment, low pH and Maillard reaction.
Methods: Newly developed dark chocolate, DC-1, containing inulin (replacing sugar component) as an added value, was stored at 18oC, 60% relative humidity and 25oC, 80% relative humidity (RH) to determine shelf life stability compared to control dark chocolate, DC-0 (with high content of sugar). Sensory evaluation (quantitative descriptive analysis), water activity (aw), microbiological content and presence of inulin after storage of the prebiotic chocolate under both conditions were evaluated to determine shelf life.
Results: The DC-1 chocolate had at least 12 months of shelf life at 18oC, 60% RH with better acceptance than DC-0; moreover, it did not experience microbiological and inulin content changes. At 25oC, 80% RH, the growth of Aspergillus sp. was observed on the surface of both DC-0 and DC-1 with aw >0.50 after a 2-month storage.
Conclusion: Shelf life stability of DC-1 is almost similar to DC-0.
Key words: Inulin, dark chocolate, shelf life, water activity and sensory evaluation.

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Formulation of a Functional Fat Spread Stabilised by Natural Antioxidants and Emulsifiers
Rege SA, Momin SA, Wadekar SD & Bhowmick DN

ABSTRACT

Introduction: Essential fatty acids (EFAs) play a vital role in the human body and need to be taken through a regular diet. EFAs are susceptible to autoxidation, hence the stability of the EFAs and their products is a matter of concern.
Methods: Margarine containing sunflower oil as a carrier of EFAs was prepared and the effects of water content, incorporation of EFAs, emulsifiers and antioxidants on the physical properties of margarine, that is, slipping point, dropping point and spreadability were studied. The oxidative stability of the formulated margarine was also evaluated after incorporation of EFAs and antioxidants.
Results: The incorporation of EFAs in the form of sunflower oil resulted in improved physical properties especially spreadability. The study revealed that up to 45% sunflower oil can be incorporated using glycerol monostearate as an emulsifier with total fat to water ratio of 85:15. Lecithin imparted better spreadability and grainy structure but is known to be susceptible to microbial attack. The capsicum oleoresin showed good activity as an antioxidant. Further addition of kalonji seeds ethanol extract (KEE) as well as curcuminoids resulted in improved spreadability but showed a decrease in oxidation stability.
Conclusion: A stable and nutritional margarine was developed with the addition of natural antioxidants. Consumers can avail the benefits of both the EFAs and natural antioxidants in the margarine.
Key words: Margarine, antioxidants, capsicum oleoresin, curcuminoids, kalonji seeds extract

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Proceedings of the 3rd Expert Consultation and Planning Meeting on Infant and Young Child Nutrition-(Part 1)
Sofia Amarra & Pauline Chan

During the 2nd ILSI SEA Region Expert Consultation and Planning Meeting in 2011, the following information gaps were identified: (i) Some Southeast Asian countries did not have data on infant and young child feeding (IYCF) indicators; (ii) There is a need to know the reasons for the disparities in duration of breastfeeding, age of giving complementary foods, and other breastfeeding and complementary feeding practices in Southeast Asian populations; (iii) Optimal complementary feeding practices that are most suitable in the context of Southeast Asia need to be identified. This report presents highlights from a literature review regarding the above topics. Findings from nationwide surveys and small scale studies were compiled to provide a snapshot of the state of infant and young child feeding practices in the region. Results for Cambodia, Indonesia, Philippines, and Vietnam are presented here.
Key words: Infant young child feeding (IYCF), breastfeeding, complementary feeding, information gaps

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Proceedings of the 3rd Expert Consultation and Planning Meeting on Infant and Young Child Nutrition-(Part 2)
Sofia Amarra & Pauline Chan

ABSTRACT

Introduction: The Infant and Early Childhood Nutrition Task Force, International Life Sciences Institute Southeast Asia (ILSI SEA) Region, organised the 1st and 2nd Expert Consultation and Planning Meeting on Infant and Early Childhood Nutrition in 2009 and 2011, respectively. The goal of the consultations was “to generate and promote relevant science-based information that will help improve nutritional status, growth and development of infants and young children in Southeast Asia.”
Methods: An Expert Panel Core Group was created whose role is to provide advice and recommendations through a review of current scientific knowledge regarding issues related to early childhood growth and nutrition. The Panel is composed of experts representing 7 countries (China, Indonesia, Malaysia, Philippines, Singapore, Thailand, and Vietnam). In July 2012, the Panel convened the 3rd Expert Consultation and Planning Meeting on Infant and Young Child Nutrition in Singapore. This report presents the highlights of the meeting and recommendations made by the Panel on ways to improve infant and young child nutrition in Southeast Asia.
Results & Conclusion: The effective use of WHO indicators for assessing infant and young child feeding practices, mitigating the effects of maternal employment on breastfeeding, using behaviour change communication, updating the education of health personnel, and improving maternal health were considered important actions to be taken. Since current feeding practices in Southeast Asia fall short of WHO recommendations, studies are needed to develop strategies which take into consideration the diverse cultural settings that characterise the region.
Key words: Southeast Asia, infant, nutrition, feeding, nutritional status, children

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SHORT COMMUNICATIONS

Caffeine and Total Polyphenol Contents of Market Tea Cultivated and Processed in Bangladesh
Rabiul Islam GM, Gias Uddin M, Mahfuzur Rahman M & Yousuf A

ABSTRACT

Objective: The aim of this study was to determine the contents of caffeine and total polyphenol in six brands of market tea cultivated and processed in Bangladesh.
Methods: Caffeine and polyphenol contents were determined by solvent extraction (AACC) and the International Organisation for Standardisation Method (ISO) 14502-1 respectively.
Results: Caffeine contents of the different tea samples ranged between 0.99 ± 0.17% to 2.08 ± 0.16% (g/100g materials), while that of total polyphenol was from 36.90 ± 1.39% to 17.29 ± 2.30% of gallic acid equivalents (GAE). The order of caffeine concentration in tea samples was found as follows: Organic Black Tea > Taaza Tea > Organic Green Tea > Magnolia Tea > Organic Zinger Tea > Organic Tulsi Tea. The polyphenol concentration in the tea samples was highest in Organic Green Tea followed by Taaza Tea and the rest as follows: Magnolia Tea > Organic Black Tea > Organic Zinger Tea > Organic Tulsi Tea. An indicative difference in amounts of caffeine and polyphenols for different tea brand samples is seen in this study.
Conclusion: This systematic screening provides information to producers as well as consumers on the quantities of caffeine and polyphenols in commercial tea available in the markets of Bangladesh.
Key words: Caffeine, polyphenol, market tea, Bangladesh

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Malaysian Journal of Nutrition

Volume 19 No.2, 2013

Table of Content

Nutritional Status of Malaysian Primary School Children Aged 8-10 Years: Findings from the 2008 National IDD Survey
Ahmad Ali Zainuddin, Rusidah Selamat, Azli Baharudin, Suhaila Abdul Ghaffar, Norsyamline Che Abdul Rahim & Tahir Aris

ABSTRACT

Introduction: Child malnutrition continues to be a major public health problem in developing countries. This study aims to determine the current nutritional status of Malaysian school children using the anthropometric indicators of weight for age (WAZ), height for age (HAZ), and body mass index for age (BAZ).
Methods: A nationwide school-based survey was undertaken in all Malaysian states and territories, which included 18,078 children aged 8-10 years attending 445 primary schools. The software WHO AnthroPlus was used to calculate z-scores for the nutritional status (WAZ, HAZ and BAZ) of the target population relative to the World Health Organization (WHO) 2007 reference.
Results: The national prevalence of underweight among school children was 13.6% and in rural areas, this rate was nearly double that of urban areas. The national prevalence rate for stunting was 10.9%, double among rural school children compared to their urban counterparts. As for thinness, the national prevalence was 6.5%. Using the WAZ indicator, we found that the national prevalence of overweight children was 7.6%. Additionally, we found that urban areas showed a higher prevalence of overweight children (8.8%) than rural areas (5.9%).
Conclusion: The findings of this study indicate that Malaysian school children face the burden of malnutrition, suffering from both undernourishment and overweight. Malaysia must make a concerted effort to overcome the problems of malnutrition among children.
Key words: Obesity, overweight, stunted, thinness, underweight

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Which is a Better Anthropometric Indicator of Cardiovascular Risk Factors in Type 2 Diabetes Mellitus Patients? Waist Hip Ratio or Body Mass Index?
Koo HC, Daniel Robert S & Hamid Jan JM

ABSTRACT

Introduction: The increasing prevalence of adiposity is associated with the development of type 2 diabetes mellitus (T2DM). The two most popular methods to measure adiposity are body mass index (BMI) and waist-hip-ratio (WHR), which measure the overall and abdominal adiposity, respectively. The aim of this study was to determine whether BMI or WHR was more strongly associated with macronutrient intakes and lipid profiles in T2DM patients.
Methods: In this cross-sectional study, a total of 210 T2DM patients, mean age of 56.73(SD 10.23) years, were recruited from Penang. Information on socio-demographic, body measurements (height, weight, waist circumference and hip circumference)and macronutrient intakes (three 24-hour dietary recalls) were recorded. Routine laboratory tests (fasting blood glucose, HbA1c, LDL, HDL, triglyceride and total cholesterol) were performed according to standard procedure.
Results: Among the respondents, 84% had abdominal and 63% had overall adiposity respectively. There was a significant correlation between WHR and the total calorie(r=0.27; p<0.001), carbohydrate (r=0.30; p<0.001) and protein intakes(r=0.18; p=0.009). WHR was significantly associated with serum triglycerides(r=0.18; p=0.011) and the HDL levels (r=-0.20; p=0.003). On the other hand, neither lipid profiles nor dietary intakes showed significant correlation with BMI.
Conclusion: In T2DM, WHR is more strongly associated with macronutrient intakes, HDL and triglyceride compared with BMI. Hence, WHR is a better anthropometric indicator of plasma lipids in T2DM.
Key words: Adiposity, body mass index, lipid profiles, macronutrient intakes, type 2 diabetes mellitus, waist hip ratio.

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Effect of Tempeh Dates Biscuits on Nutritional Status of Preschool Children with Tuberculosis
Fatmah H

ABSTRACT

Introduction: Preschool children with tuberculosis (TB) often experience weight loss. Previously, underweight childrenhave been given a supplement of soy protein biscuits made from tempeh. However, the efficacy of tempeh dates biscuits on nutritional status on underweight TB children has not been previously done. This study aimed to assess the effects of tempeh dates biscuit supplementation on the nutritional status of underweight TB children.
Methods: A quasi experimental study was conducted on 41 subjects from the intervention group (tempeh dates biscuit) and control groups (tempeh and placebo biscuits). Parameters such as anthropometric data, hemoglobin, albumin, and macro-micronutrients intake were analysed before and after the intervention.
Results: The three groups showed significant difference in weight, height, and albumin, except for hemoglobin, after six weeks. Tremendous weight and height gain was shown by the tempeh biscuit group (1 kg) and the placebo biscuit group (3.5 cm). The biggest positive change in nutritional status (weight for age) was recorded by the tempeh group (0.5 points). Hemoglobin level was increased by 0.4 point in the intervention group. The mean for blood albumin levels increased by 0.1 point among the intervention and the control groups.
Conclusion: Although no evidence was found of a large gain in weight and height in the intervention group, the inclusion of the tempeh dates biscuits in the diet was able to increase hemoglobin level compared with the control group. A similar study in anemic children is necessary to assess the effect of tempeh dates biscuits on hemoglobin changes.
Key words: Albumin, height, hemoglobin, tempeh dates biscuits, under-five children, weight

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Relationship of Body Mass Index, Waist Circumference and Waist-Stature Ratio with Body Fat of the Indian Gorkha Population
Varte LR, Rawat S & Singh I

ABSTRACT

Introduction: Body mass index (BMI) has traditionally been the chosen indicator by which to measure body size, composition, and to diagnose underweight and overweight. However, alternative measures that reflect abdominal adiposity, such as waist circumference, waist–hip ratio and waist–height ratio, have been suggested as being superior to BMI in predicting cardio-vascular diseases (CVD) risk. This study was aimed at determining the predictive power of anthropometric indicators like body mass index, waist circumference and waist stature ratio with body fat in an Indian military personnel population group, and to establish cut-off points as discriminators of high body fat.
Methods: The study was cross-sectional in nature with a sample size of 388 active Gorkha male personnel aged 20-49 years (mean age 33.1±5.33). Anthropometric indicators included body mass index, waist circumference, waist-hip ratio and waist-stature ratio. The analysis of receiver operating characteristic curves (ROC) with a confidence interval of 95% was adopted to identify predictors of obesity. Subsequently, the cut-off points with their relevant sensitivities and specificities were identified.
Results: Areas under the ROC curves with 95% confidence intervals were body mass index = 0.86 (0.84-0.88); waist circumference = 0.82 (0.80-0.84); waist- hip ratio = 0.74 (0.71-0.77); waist-stature ratio = 0.81 (0.78-0.84). Different cut-off points of anthropometric indicators with better predictive power and their relevant sensitivities and specificities were identified. The following cut-offs with their corresponding sensitivity and specificity values are suggested for determining obesity for the study population: body mass index= 23.4 (98.00, 62.00), waist circumference= 77.8 (98.00, 60.50) and waist stature ratio= 0.47 (98.60, 68.00) respectively.
Conclusion: The results showed that among active military personnel, BMI, WC and WSR may serve well in classifying individuals into broad categories corresponding to percentage fat categories. Further studies on different populations should be undertaken for the verification of the cut-off levels identified.
Key words: Body mass index, cut-off waist circumference, waist-hip ratio, waist-stature ratio

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Nutritional Status of Children Associated with Socio-Demographic Variables and Food Security in Rural Bangladesh
Quddus MA & Bauer S

ABSTRACT

Introduction: The study was undertaken to investigate the nutritional status of children and its association with their socio-demographic variables and food security status in disadvantaged rural Bangladesh.
Methods: A cross-sectional study was conducted in fifteen villages of three different ecological zones. Three anthropometric indicators, namely stunting, underweight and thinness were measured among children aged 2-10 years. Six child-referred questions were used to construct the children’s food security scale. Simple and multiple binary logistic regression analyses were used to assess the likelihood of children’s nutritional and food security level.
Results: A total of 156 children aged 24-59 months and 246 children aged 5-<10 years (60-119 months) were included in the study. Among the younger children, the prevalence of severe stunting and thinness were 14.1% and 31.4% respectively, while in the older age group, the respective prevalence was 17.5% and 22.3%. Among the children aged 24-59 months, boys were 73% more likely to stunt, 27% less likely to thin and 21% more likely to face food insecurity. Maternal education, number of children in the family and household income were the strong predictors of child nutritional status. Food insecure children aged 60-119 months were 39% more likely to stunt but 3.5 times more likely to thin than the food secured children.
Conclusion: Children of the studied population are at high risk of malnutrition. Awareness, availability and accessibility to family planning should be strengthened to limit number of children in the family and increase female education including nutritional knowledge. A Nutrition Rehabilitation Programme (NRP) should be formulated for the children under 5 years. It is suggested that the Government starts free nutritious food for rural disadvantaged school going children during school hours.
Key words: Anthropometric measurements, children, disadvantaged region, food security, nutritional status

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Body Fat Percentage Distribution of an Orang Asli Group (Aborigines) in Cameron Highlands, Malaysia
Azuwani AR, Noor Khairiah K, Cheong YZ, Kok CC, Aw NSL, Nadiah Mhd S & Abdul Rashid K

ABSTRACT

Background: Although body fat percentage (BFP) is a widely accepted indicator of total body fat, it has not been extensively used in studies conducted among the Orang Asli in Peninsular Malaysia.
Objective: This study was undertaken to determine the BFP distribution in a group of Orang Asli adults living in Cameron Highlands, Malaysia.
Methods: Kampung Sungai Ruil, one of the Orang Asli settlements in Cameron Highlands, was conveniently selected for this cross-sectional study. A total of 138 respondents aged 18 years and above were assessed. Skinfold thickness was measured using the Slim Guide skinfold caliper to calculate BFP. Waist circumference, BMI, blood pressure and random plasma glucose were also measured.
Results: The mean BFP of the females (29.7%) was higher than the males (18.9%) and the respondents with abdominal obesity (36.2%) had higher mean BFP compared to those with normal waist circumference (23.7%) Those in the age group of 18-28 years old (22.1%) had lower BFP than respondents in the age groups 29-39 years old (27.3%) and 40-50 years old (29.1%) (p=<0.001) and married respondents (26.8%) had higher mean BFP than single (21.2%) respondents. According to the BMI categorisation, respondents categorised as overweight (25.9%) had higher mean BFP than the normal weight/healthy (19.2%) respondents, and obese (32.0%) more than underweight (18.1%), normal weight/healthy (19.2%) and overweight (25.9%) respondents. Linear regression showed age (regression coefficient = 0.16, p=<0.001), BMI (regression coefficient = 1.06, p=<0.001) and being a woman (regression coefficient = 8.26, p=<0.001) were significant predictors of BFP.
Conclusion: The BFP is higher in women and is significantly associated with age and BMI.
Key words: Aborigines, body fat percentage, body mass index, Malaysia, waist circumference

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Efficacy of Millets in the Development of Low Glycemic Index Sweets for Diabetics
Bisht AT & Srivastava S

ABSTRACT

Introduction: Three types of burfi (a sweet confection), namely, foxtail millet burfi (FMb), barnyard millet burfi (BMb) and control Bengal gram flour burfi (CBGFb) were developed for the consumption of diabetics.
Methods: The flour blends for FMb and BMb contained 43% of foxtail millet and barnyard millet flour, respectively and 57% of bengal gram flour. The CBGFb was prepared by using 100% Bengal gram flour and served as control. The burfis were analysed for sensory quality, acceptability, storage stability, nutritional quality, glycemic index (GI) and glycemic load (GL).
Results: All the three burfis were acceptable to diabetic as well as non-diabetic subjects and could be stored easily for 15 days under ambient conditions. The millet burfis possessed fibre and starch contents which contributed to a low GI value of 37.5 for FMb compared to the control. The GL values were 14.7, 17 and 17.9 for FMb, BMb and CBGFb, respectively.
Conclusion: The millet, especially foxtail millet which had a low GI value has the potential of being served to diabetics in the form of sweets.
Key words: Foxtail millet, barnyard millet, glycemic index, glycemic load, sweets

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Total Phenolic Content, Antioxidant and Cytotoxic Activity of Cocoa (Theobroma cacao L.) Polyphenols Extracts on Cancer Cell Lines
Hazirah AR, Zainal B & Abdah MA

ABSTRACT

Introduction: Cancer chemopreventive agents from natural sources have been actively investigated over the years to seek prevention against cancer. In this study, cocoa polyphenols extract (CPE) was examined to explore its antioxidant and cytotoxicity activities.
Methods: CPE was analysed for total phenolic content (TPC) and antioxidant activity (DPPH radical scavenging activity and FRAP ferric-reducing antioxidant power assays). In vitro cytotoxicity effect of CPE against HepG2, HT-29, HeLa, MCF-7, MDA-MB-231 and WRL-68 cell lines after 48 h exposure was measured by MTT assay.
Results: The study showed that CPE had higher total phenolic content (13560.0±420.1 mg GAE/100g dry weight of sample) than vitamin E (p<0.05). CPE exhibited strong antioxidant activity comparable with ascorbic acid in both DPPH (IC50 = 14.73±1.47 μg/ml) and FRAP (2130.33±2.33 μM of FE/1 mg of dry weight of sample). The cytotoxicity study showed that CPE exhibited the highest cytotoxicity effect against MCF-7 with lowest IC50 value (3.00±0.29 mg/ml) compared to other cancer cell lines after 48h treatment (p<0.05).
Conclusion: Our results indicate that CPE demonstrated high total phenolic content, free radical scavenging activity, ferric reducing ability and cytotoxicity activity towards HepG2, HT-29, HeLa, A549, MDA-MB-231 and MCF-7 cancer cell lines. Further isolation of bioactive constituents from CPE should be done to characterise its potential chemopreventive activity as well as to elucidate the mechanism of cancer cell death induced by CPE.
Key words: Cocoa polyphenols extract, DPPH, FRAP, MTT assay,TPC

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Effect of Extent of Gelatinisation of Starch on the Glycaemic Responses of Carbohydrate Rich Breakfast Meals
Widanagamage RD, Ekanayake S & Welihinda J

ABSTRACT

Introduction: Previous studies have shown that roti and pittu, which are South Asian foods, when prepared with the same composition of wheat flour and coconut scrapings had significantly different (p<0.05) glycaemic index (GI) values. The only difference was in the processing where roti (GI 57) was dry-heated(roasted) and pittu (GI 80) was wet-heated (steam cooked). The present study was carried out to investigate the association between GI and the properties of starch during processing for the observed variations of GI values of roti and pittu prepared with different flour varieties.
Methods: The characteristics of isolated starch granules, molecular size distribution pattern of carbohydrates, amylose, amylopectin contents and change in temperature during the cooking of ‘pittu’and ‘roti’ were analysed.
Results: The results indicate that the contribution to GI from starch gelatinisation correlates positively and corroborates with reported data. Thus the significantly low GI values of roti compared to pittu could be mainly attributed to less disintegrated and less swollen starch granules of flour used in the preparation of roti. This was observed irrespective of the variety of flour.
Conclusion: This study confirms that wet heat gelatinises starch to a greater extent than dry heat and provides evidence of a possibility that foods processed using dry heat to be associated with lower GI values, than the wet processed foods if other factors are constant.
Key words: Roti, pittu, Glycaemic Index, starch granules, starch gelatinisation

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Total Phenol Content and Antioxidant Potential of Traditional Breakfast Meals of Sri Lanka
Senavirathna RMISK, Ekanayake S, Jansz ER & Welihinda J

ABSTRACT

Introduction: According to folklore and Ayurveda, many tubers and flour made from various plant parts, traditionally used to made breakfast meals, are rich in nutrients and polyphenols. The objective of the study was to determine the total phenolics content (TPC) and antioxidant potential of some tubers and foods made with seeds and other plant parts.
Methods: The TPC in the extracts was determined according to the Folin-Ciocalteu method (mg Gallic acid equivalents (GAE/100g FW) and antioxidant activity by 2, 2’–Azino–bis (3-ethylbenzothiazoline-6-sulfonic acid) diammonium salt (ABTS)cation free radical decolouration assay (—mol/g Trolox equivalent antioxidant capacity; TEAC).
Results: The TPC of raw and processed tubers ranged from 127-517 mg GAE/100g FW. Among the tuber varieties, Dioscorea alata, violet had the highest antioxidant potential. Among raw flour, Vateriaco pallifera had the highest phenolic content (1162) and lowest (79) was in Caryota urens. Antioxidant potential of raw and food prepared from indigenous flour ranged from 3-225 —mol/g TEAC with Vateriaco pallifera raw flour having the highest antioxidant potential (225—mol/g). Processing decreased both the phenolics and antioxidant potential significantly (P<0.05). A significant correlation was observed between polyphenolic content and antioxidant capacity in raw flour (r2=0.993).
Conclusion: The traditional tubers and food prepared incorporating indigenous flour varieties are rich sources of phenols and antioxidants indicating their potential for utilisation in home food preparation and by the food industry.
Key words: ABTS assay, antioxidants, indigenous flour, total phenolics content (TPC), tubers

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Selective Uptake of Alpha-Tocotrienol and Improvement in Oxidative Status in Rat Brains Following Short- and Long-Term Intake of Tocotrienol Rich Fraction
Musalmah M, Leow KS, Nursiati MT, Raja Najmi Hanis Raja I, Fadly Syah A, Renuka S, Siti Norsyamimi MS, Mohamad Fairuz Y & Azian AL

ABSTRACT

Introduction: Tocotrienol exerts neuroprotective effects resulting in an improved circulating oxidative status. However, accumulation of tocotrienol due to long-term intake may exert pro-oxidant effects. Thus the effects of short- and long-term supplementation of vitamin E tocotrienol rich fraction (TRF) on the parameters of oxidative status in rat brains were determined.
Methods: Wistar rats aged 3 months were supplemented with TRF for 3 or 8 months. Control groups received equivolume of distilled water. Rats were sacrificed and brains harvested, weighed and homogenised. Supernatants were analysed for catalase (CAT), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) activities, vitamin E and protein carbonyl.
Results: A significant decline in the level of total vitamin E and its isomers with increasing age were found. TRF supplementation increased the level of total vitamin E with alpha-tocotrienol (ATT) being the major isomer raised. Glutathione peroxidase activity was also significantly increased in the long-term supplemented group compared to the short-term supplemented and control groups. The results also showed significantly higher superoxide dismutase activity (p<0.001), lower protein peroxidation (p<0.05) and heavier brain weights (p<0.05) in both supplemented groups but catalase activity remained unchanged.
Conclusion: The study showed long- term TRF supplementation exerts positive effects on brain oxidative status
Key words: Antioxidant, brain, long-term supplementation, oxidative stress, tocotrienol rich fraction (TRF)

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Nutritional Composition of Medicinal Plants Commonly Grown in the Kurukshetra District, Haryana, India

ABSTRACT

Introduction: Medicinal plants, believed to possess hypoglycemic and hypolipidemic potential namely, Gymnema sylvestre, Momorodica charantia, Murraya koenigii, Terminalia arjuna and Trigonella foenum graecum, were analysed for nutritional composition.
Methods: Proximate analysis was done following the methods of AOAC. Available carbohydrate, β-carotene and minerals were analysed using spectrophotometer and atomic absorption spectrophotometer, respectively. One-way variance analysis was used to statistically analyse the variations in nutrient contents among the plants.
Results: Moisture, crude protein, crude fibre, crude fat, ash, carbohydrate and energy content ranged between 10.86 - 91.81 , 2.81-25.60, 6.22-13.63, 0.48-7.41, 3.27-19.40, 52.87- 68.20 g/100 g and 292.78-400.17 Kcal/100 g on dry weight basis, respectively. Total soluble, reducing, non-reducing sugar and starch varied from 3.02-7.74, 1.74-4.78, 0.65-5.49 and 1.99-19.38 g/100 g, respectively. Neutral detergent fibre, acid detergent fibre, hemicellulose, cellulose and lignin ranged between 22.82-39.68, 1.98-20.69, 8.98-31.19, 1.21-8.93, 0.72-12.50 g/100 g, respectively. Gymnema sylvestre had the highest concentration of β-carotene (7950 + 0.45 mg/100 g) and iron (37.21 + 0.50 mg/100g), while Murraya koenigii had the highest copper (2.71 + 0.09 mg/100 g) and calcium concentration (42.76 + 0.43 mg/100 g). Chromium and zinc were highest in Momorodica charantia (2.93 + 0.22 mg/100 g) and Trigonella foenum graecum (3.61 + 0.46 mg/100 g), respectively. Significant difference was observed in the crude protein, crude fat, carbohydrate, energy, acid detergent fibre and lignin content of the medicinal plants.
Conclusion: These medicinal plants can be considered as potential sources of protein, fat, dietary fibre, β-carotene and minerals for diabetic and dyslipidemic patients.
Key words:

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Rainer Gross Prize

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Malaysian Journal of Nutrition

Volume 19 No.3, 2013

Table of Content

Comparison of Malnutrition Prevalence Between Haemodialysis and Continuous Ambulatory Peritoneal Dialysis Patients: A Cross-sectional Study
Harvinder GS, Chee WSS, Karupaiah T, Sahathevan S. Chinna K, Ghazali A, Bavanandan S & Goh BL

ABSTRACT

Introduction: Malnutrition is a serious unresolved nutritional problem amongst dialysis patients associated with increased mortality and morbidity and prevalence differs according to dialysis modalities. This study compared protein-energy malnutrition (PEM) prevalence in haemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients.
Methods: A total of 155 HD and 90 CAPD patients were enrolled. PEM prevalence was determined using body mass index (BMI), serum albumin, Dialysis Malnutrition Score (DMS) and dietary intake.
Results: CAPD patients had significantly higher BMI (24.1 ± 4.8 kg/m2 vs. 22.7 ± 4.8 kg/m2; p=0.024) and mid-arm muscle area (32.1 ± 12.4 cm2, vs. 29.5 ± 15.9 cm2; p=0.044) than HD patients. They also had significantly lower serum albumin (31 ± 5 g/L vs. 35 ± 6 g/L; p<0.001) and dietary protein intake (0.82 ± 0.37 g/kg/day vs. 1.07 ± 0.47 g/kg/ day; p<0.001) compared to the HD patients. PEM was more prevalent in CAPD patients compared to HD patients based on serum albumin <40 g/L (97% vs. 81%) and dietary protein intake <1.2 g/kg/ day (79% vs. 67%). However, bawd on DMS scores (74% vs. 71%) and dietary energy intake <30 kcal/kg/day (84% vs. 77%), the HD and CAPD patients had equally high PEM risks. BMI of <18.5 kg/m2, serum albumin of <40 g/L and dialysis duration of >5 years were independent risk factors of PEM in dialysis patients.
Conclusion: Periodic nutritional assessments, education and dietary counseling should be emphasised in these patients as a preventive measure of PEM.
Key words: Dialysis, malnutrition, nutritional assessment, nutritional status

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Prevalence and Associated Risk Factors of Osteoporosis in Post-Menopausal Women in North India
Maninder Kaur

ABSTRACT

Introduction: Osteoporosis is a global health problem contributing to increased functional limitations (mortality, morbidity, disability) and economic costs. The study aimed at assessing the prevalence and risk factors of osteoporosis in a sample of post-menopausal women from the states of Punjab, Haryana and Chandigarh in North India.
Methods: A total of 250 post-menopausal women, ranging in age from 45 to 80 years, were selected by purposive sampling from three states in North India. Information was collected on height, weight, waist and hip circumferences, grip strength, dietary intake, physical activity, and exposure to sunlight. Bone mineral density (BMD) was evaluated by using Dual Energy X-ray Absorptiometry (DXA) at lumbar spine (L1-L4).
Results: The prevalence of osteoporosis at lumbar spine (L1-L4) was found in 26.4% of the post-menopausal women. Osteoporotic women were significantly shorter (155.17 vs. 157.57, p<0.05) and lighter (55.5 vs. 63.96, p<0.05) than non-osteoporotic women. Non-osteoporotic subjects exhibited significantly higher mean values for waist circumference (83.78 vs. 79.51, p<0.05) as well as hip circumference (93.05 vs. 86.83, p<0.05) as compared to osteoporotic subjects. Grip strength of both dominant and non-dominant hand was significantly higher in non-osteoporotic women than their osteoporotic counterparts. Bone mineral density was highest in women with body weight between 51-60 kg and BMI between 18.5-24.9 kg/ m5. Binary logistic regression analysis identified weight (OR=1.13; CI 1.05-1.21) as possible predictors of osteoporosis.
Conclusion: A positive trend was observed between bone mineral density and non-vegetarian diet as well as moderate physical activity in both osteoporotic and non-osteoporotic subjects.
Key words: Bone mineral density, osteoporosis, post-menopausal women, vegetarian diet

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Association Between Anthropometric Status, Dietary Intake and Physical Activity with Bone Health Status among Premenopausal Chinese Women in the Klang Valley, Malaysia
Yee YSS, Zaitun Y, Chan YM & Norhaizan ME

ABSTRACT

Introduction: There is a lack of information on bone health status of premenopausal women in Malaysia. This study investigated the bone health status of premenopausal women and its associations with anthropometric, dietary and physical activity.
Methods: Bone mineral density (BMD) was measured using dual X-ray absorptiometry (DEXA) at the lumbar spine, femoral neck, total hip and total body. Serum osteocalcin, parathyroid hormone (PTH), beta-crosslaps were also determined.
Results: A total of 73 Chinese premenopausal women were recruited in the study with a mean age of 39.3 ± 5.0 years. Average BMI, body fat percentage and lean body mass were 22.2 ± 3.4 kg/m2, 33.9 ± 4.6% and 34.5 ± 4.4 kg, respectively. Mean BMD at the spine, total hip, femoral neck, and total body were 1.025 ± 0.118 g/cm2, 0.876 ± 0.109 g/cm2, 0.739 ± 0.110 g/cm2, and 1.061 ± 0.755 g/cm2, respectively. Their serum beta-crosslaps and PTH were within normal range, but serum osteocalcin (8.5 ± 4.2 ng/ml) was low. On average, calorie intake (1506 ± 427 kcal/day) was below the Malaysian Recommended Nutrient Intake (RNI) while their calcium intake achieved only 67% of RNI. Their mean metabolic equivalent score (MET) was 771.4 ± 926.1 mm/week. Body weight and related indices (BMI, lean mass, fat mass) were significantly positively correlated with BMD at all skeletal sites.
Conclusion: The study revealed that Chinese premenopausal women in the Klang Valley have low calcium intake and low level of physical activity.
Key words: Bone mineral density, premenopausal women

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Reliability and Validity Test of Digital Infant Length Measurement Board with Sonar Sensor Precision
Syafiq A & Fikawati S

ABSTRACT

Introduction: The most prevalent malnutrition problem in Indonesia among young children is low height for age. Height or length of the young is known to be difficult to measure. This study was aimed at developing an instrument called Pengulcur Panjang Badan Bayi Digital (P2B2D) Version 1.0 based on the main consideration of WHO recommendations on accuracy and precision of length measurements.
Methods: Design of the study included instrument development, and reliability and validity tests on the instrument. This study involved 53 children aged below 2 years measured by three examiners using three different instruments namely, the P2B2D, wood length-board, and mica length-board.
Results: The reliability coefficients of the P2B2D ranged from 0.747 (inter-method reliability against mica length-board using TEM analysis) to 0.966 (inter-method reliability against wood length-board using Pearson correlation analysis). The corresponding validity coefficients were 0.864 and 0.963, respectively. The only problem that emerged with the P2B2D was its weight, which was relatively heavy (6 kg).
Conclusion: The reliability and validity of the P2B2D could be considered as substantial to excellent. It is recommended that this instrument be improved by minimising possible source of error and experimenting with different types of sensors.
Key words: Child length measurement, sonar sensor

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Influence of Maternal Characteristics on Exclusive Breastfeeding Practice Among Urban Mothers in Umuahia, Nigeria
Ukegbu PO & Anyika-Elekeh JU

ABSTRACT

Introduction: The rate of exclusive breastfeeding is still low among nursing mothers in developing countries. This descriptive cross-sectional study was designed to identify maternal factors affecting the practice of exclusive breastfeeding among a group of urban mothers in Unnuahia located in South¬east, Nigeria.
Methods: The study was carried out at four health facilities in Umuahia which were selected randomly from 15 listed facilities. All eligible mothers were consecutively selected using simple random sampling (balloting) technique by trained interviewers for 4 weeks in each of the health facilities until the required sample size of 240 was attained. A structured questionnaire was used to obtain information on socio-demographic characteristics as well as knowledge, attitude and practice of exclusive breastfeeding. Data were analysed using descriptive statistics and Chi square was used to determine maternal characteristics associated with the practice of exclusive breastfeeding.
Results: The majority of the mothers were in the age range of 26 to 35 years. Their main source of information on breastfeeding was the antenatal clinics (87.9%). Knowledge of the mothers about exclusive breastfeeding was adequate (99.2%), while only one-third (31.7%) had a positive attitude to exclusive breastfeeding (EBF). More than half (64.6%) initiated breastfeeding within the first hour after delivery. Only 22.9% practised EBF for the first six months. Exclusive breastfeeding rate was associated with larger household size, while breastfeeding initiation was associated with maternal older age, higher education, been a civil servant and having a larger household size.
Conclusion: There is need for intervention programmes which support and promote optimal breastfeeding practices, focusing more on younger and less educated mothers.
Key words: Exclusive breastfeeding, health facilities, practice, urban

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Growth, Cognitive Development and Psychosocial Stimulation of Preschool Children in Poor Farmer and Non-Farmer Households
Khorasan A, Anwar F, Hernawati N, Suhanda NS, Warsito O & Herawati T

ABSTRACT

Introduction: This study aimed to analyse factors that influence cognitive development of preschool children.
Methods: Four hundred and two children were recruited by purposive methods from poor farmer and non-farmer households. Nutritional status data were obtained through anthropometric measurements and processed by using the WHO Anthro 2005 software. Child cognitive development was measured using the instrument developed by the Department of National Education of Indonesia. Meanwhile, psychosocial stimulation was measured by using the instrument of Home Observation for Measurement of the Environment (HOME) Inventory.
Results: The nutritional status data show that in farmer households, 28.6% children were underweight, 12.1% wasted, and 30.7% stunted, while in non-farmer households 31.3% children were underweight, 15.3% wasted, and 35.5% stunted. However, no statistical differences were found (p>0.05). The percentage of children who reached cognitive development in the high category in the farmer household was 8% and in the non-farmer group, it was 17.4%. Nevertheless, more than half of the children in farmer and non-farmer households had cognitive development scores in the low category (<60%). Most children in farmer and non-farmer households had psychosocial stimulation in the moderate category (30-45). The correlation test showed that length of mother's education (p<0.01), psychosocial stimulation (p<0.01), participation in early childhood education (p<0.01), nutritional status based on the index of weight for age (p<0.01) and height for age (p<0.01) respectively, had a positive and significant relationship with cognitive development of children. This means that the better the education of mothers, as well as psychosocial stimulation, participation in early childhood education and nutritional status will improve cognitive development of children.
Conclusion: The nutritional status of children in farmer and non-farmer households was not different. The nutritional status and psychosocial stimulation as well as the participation of children in early childhood had an important role in the cognitive development of children.
Key words: Children's nutritional status, cognitive development, psychosocial stimulation

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Multimodal Nutrition Education Intervention: A Cluster Randomised Controlled Trial Study on Weight Gain and Physical Activity Pattern Among University Students in Terengganu, Malaysia
Lua PL, Wan Dali WPE & Shahril MR

ABSTRACT

Introduction: This cluster randomised controlled study design aimed to evaluate the effectiveness of implementing nutrition education intervention (NEI) that targeted at incremental reduction of body weight and increased physical activity level among university students.
Methods: Body weight and physical activity level were assessed before and after intervention. A total of 417 university students from four public universities in Terengganu participated in the study. They were randomly selected and assigned into two arms, that is, intervention group (IG) or control group (CG) according to their cluster. The IG received 10 weeks intervention focused on NEI promotion using three modes which were conventional lecture, three brochures as take-home messages and text messages for intervention reinforcement while CG did not receive any intervention. Analysis of covariance (ANCOVA) and adjusted effect size were used to determine differences in body weight and physical activity levels between groups and time.
Results: No significant changes in body weight were observed among both groups. The average weight and body mass index (BM!) were slightly reduced in IG compared to CG after the 10-week intervention (p>0.05). Nevertheless, physical activity level improved significantly among IG participants compared to CG with increased metabolic equivalent (MET) min/ week spent for walking, moderate and vigorous activities and significantly decreased sitting time. The largest adjusted effect size was shown in total physical activity (0.75).
Conclusion: The multimodal NEI had a positive influence on physical activity outcomes among university students. NEI should be continuously implemented in this particular population group.
Key words: Brochure, nutrition lecture, physical activity, text messaging, university students

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Use and Understanding of Nutrition Labeling among Elderly Men and Women in Malaysia
Cheong SM, Jasvindar Kaur, Lim KH, Ho BK & Mohmad S

ABSTRACT

Introduction: Consumers are advised to read the nutrition labeling when purchasing packaged food. To what extent consumers read nutrition labeling and understand what they read is not well established among Malaysian older persons.
Methods: Data from the National Health and Morbidity Survey III (NHMS III) undertaken in 2006 was analysed to determine the use and understanding of nutrition labeling and its associated factors among free living elderly men and women aged >60 years. Descriptive analysis and binary Logistic Regression were used to analyse the data.
Results: A total of 4,898 respondents provided self-reported information on their use and understanding of nutrition labeling when they bought or received food. Use of nutrition labeling was higher among elderly men [61.9% (95% CI: 59.6-64.1)] than for women [36.6% (95% CI: 34.5-38.8)]. Nutrition labeling use was significantly associated with age, formal education, higher household income levels and marital status among both elderly men and women. Understanding of nutrition labeling among elderly men and women was 91.8% (95% CI: 90.1-93.2) and 89.7% (95% CI: 87.4- 91.7) respectively and was significantly associated with formal education for both elderly men and women.
Conclusion: Overall, the reading of nutrition labeling among Malaysian elderly is moderate. Elderly men and women with formal education were more likely to understand nutrition labeling. The importance of reading nutrition labels should be inculcated in consumers including older persons so that they choose foods that are nutritious and safe.
Key words: Nutrition information, nutrition labeling, older adults, socio-demography

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Food Insecurity Prevalence and its Related Factors in Households in Ahvaz, Iran
Abedi P, Abbaspor Z, Montazeri S, Vakili M & Haghigheizadeh M

ABSTRACT

Introduction: Household food security is defined as accessibility of adequate, safe and nutritious food for all people, at all times, to fulfill their dietary needs and food preferences for a healthy and active life. The primary aim of this study was to assess the prevalence of household food insecurity and related factors in Ahvaz, Iran.
Methods: A total of 1,260 households from 20 health clinics in Ahvaz, Iran were identified for this cross-sectional study. Sixty-three women from each centre were selected randomly for the interview. A socio-demographic questionnaire and the USDA 18-item questionnaire on food insecurity were used for data collection. The data were analysed using the descriptive statistics and the Chi-square test and logistic regression.
Results: Out of the total of 1,256 households, 440 (35%) were food secure, 422(33.6%) had food insecurity without hunger, 294 (23.4%) showed moderate food insecurity while 100 (8.0%) had food insecurity with hunger. Families with lower income had a greater risk for food insecurity (OR= 16.773, CI= 7.98-35.24, p<0.001). Families with 1-3 children and families with a bigger dimension had greater risk for food insecurity (OR= 0.1666, CI= 0.076- 0.360, p<0.001) and (OR= 0.61, CI= 0.47-0.78, p<0.001) respectively.
Conclusion: This study showed that the prevalence of food insecurity in Ahvaz, Iran is high due to the current tight economic situation faced by the people. As food insecurity over a long period could have serious deleterious effects, especially on children, the authorities should pay close attention to addressing this problem.
Key words: Food insecurity, households, Iran, prevalence

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Comparative Study of Nutritional Profiles and Phytochemical Components of Raw, Blanched and Fermented Flour from the Leaves of Moringa olezfera lam
Ijarotimi OS, Fagbemi, TN & Osundahunsi OF

ABSTRACT

Introduction: The medicinal properties of Moringa oleifera plants have been extensively investigated but less is known of its nutrients and phytochemical components. This study evaluated the nutritional and phytochemical profiles of Moringa leaves.
Methods: Moringa leaves were freshly harvested from Federal University of Technology community in Akure. The leaves were processed into flour and evaluated for nutritional qualities after being subjected to shade drying, blanching and fermentation techniques.
Results: The moisture contents of flour from raw, blanched and fermented leaves ranged from 6.88±0.70g/100g to 7.19±0.64g/100g, while the protein contents were between 24.39±0.18g/100g and 29.93±2.77g/100g. Among the minerals present, potassium had the highest concentration, while copper the lowest value. The Ca/P and Na/K molar ratios of the samples ranged between 18.3 to 24.5 and 0.3 to 0.4 respectively. Total essential amino acids plus histidine and arginine ranged between 38.16g/100g and 42.24g/100g. The phytochemical/antinutrient concentrations in fermented leaf flour had significantly lower tannin, phytate, trypsin, oxalate, phenolic, alkaloid, flavonoid, saponin and terpenoid contents when compared with the flour of blanched and raw leaves. The predicted protein efficiency ratio, essential amino acid index and biological values were highest in raw leaf flour and lowest in blanched leaf flour. The digestible indispensable amino acid index ranged from 51.7% in raw leaf flour to 85.2% in fermented samples.
Conclusion: Flour from fermented Moringa oleifera leaves had better nutrient composition, nutritional quality, and a reduction in some antinutrients/phytochemicals than flour from blanched leaves.
Key words: Chemical composition, Moringa oleifera leaves, nutritional quality

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REVIEW

Oxidative Stress in Early Life and Later Obesity Development
Loy SL, Sirajudeen KNS & Hamid Jan JM

ABSTRACT

Introduction: Critical time windows exert profound influences on foetal physiological and metabolic profiles, which predispose an individual to later diseases via a 'programming' effect. Obesity has been suggested to be 'programmed' during early life. Foetuses and infants who experience adverse growth are subjected to a higher risk of obesity. However, the key factors that link adverse foetal growth and obesity risk remain obscure. To date, there is considerable evidence showing that the overall balance between free radical damage and the antioxidative process being challenged occurs throughout gestation. With the view that pregnancy is a pro-inflammatory state confronted with enhanced oxidative stress, which possesses similar characteristics to obesity (a chronic inflammatory state with increased oxidative stress), oxidative stress is thus biologically plausibly be proposed as the underlying mechanism between this causal-disease relationship. Oxidative stress could act as a programming cue for the development of obesity by inducing complex functional and metabolic deregulations as well as inducing the alteration of the adipogenesis process. Thereby, oxidative stress promotes adipose tissue deposition from early life onwards. The enhancement of fat accumulation further exaggerates oxidative derangement and perpetuates the cycle of adiposity. This review focuses on the oxidative stress pathways in prenatal and early postnatal stages, from the aspects of various endogenous and exogenous oxidative insults. Because oxidative stress is a modifiable pathway, this modifiability suggests a potential therapeutic target to fight the obesity epidemic by understanding the causal factors of oxidant induction.
Key words: Antioxidants, foetal growth, obesity, oxidative stress, pregnancy

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SHORT COMMUNICATIONS

Factors Associated with Breakfast Skipping among School-going Adolescents in Sarawak, Malaysia
Law LS, Mohd Nasir MT & Hazizi AS

ABSTRACT

Introduction: Breakfast skipping is an unhealthy eating behaviour reportedly common among adolescents. A cross-sectional study was carried out to determine the differences in body weight status, socio-demographic, behavioural, and psychological characteristics between daily breakfast takers and breakfast skippers.
Methods: Data were collected from form four students of four randomly selected secondary schools in Sibu, Sarawak using a self-administered questionnaire. Body weight and height were measured using standard procedures and BMI-for-age z-scores were determined.
Results: A total of 375 students were recruited (male: 32.0%, female: 68.0%; Chinese: 39.5%, than: 26.4%, Malay: 17.1% and Melanau: 17.1%; mean age = 16.45 ± 0.53 years). The prevalence rate of breakfast skippers at 40.3% was higher compared to the national prevalence of 32.7%. About 19.7% of the students were found to be at risk of eating disorders. In addition, the prevalence rates of overweight and obesity were 10.9% and 7.7%, respectively. Significant associations were found between breakfast skipping with sex, lunch skipping, dinner skipping, eating attitudes, and body weight status. Binary logistic regression analysis showed that female students and those who skipped lunch or dinner were more likely to skip breakfast.
Conclusion: Breakfast skipping was quite common in this sample of adolescents in Sarawak. As frequent breakfast skipping has negative health and academic performance implications, increased nutrition education and health awareness campaigns on the importance of breakfast taking among school students should be undertaken.
Key words: Adolescents, breakfast skipping behaviour, socio-demography, Sarawak

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