MJN 2019 Issues
Malaysian Journal of Nutrition (Mal J Nutr)
Volume 25 No.1, 2019
Table of Content
Association of socio-demographic characteristics,
nutritional status, risk of malnutrition and depression
with quality of life among elderly haemodialysis
patients
Fatin Izzaty Mohd Shahrin, Lim Zhi Yu, Noraida Omar, Nor Fadhlina
Zakaria & Zulfitri ‘Azuan Mat Daud
ABSTRACT
Introduction: A compromised quality of life (QOL) as a result of haemodialysis (HD) is a rising global issue. Elderly HD patients face more challenges than younger counterparts. This study determined the association of socio-demographic characteristics, nutritional status, risk of malnutrition and depression with QOL, among elderly HD patients.
Methods: A cross-sectional study was conducted among 112 HD elderly patients in selected dialysis centres in Selangor, Malaysia. The patients completed interview-based questionnaires on socio-demographic characteristics, risk of malnutrition (Dialysis Malnutrition Score, DMS), depression (Patient Health Questionaire-9, PHQ-9) and QOL (KDQOL-36). Anthropometric measurements, 24-hour dietary recall and food intake information were obtained from them and biochemical data from their medical records.
Results: Just over half (50.9%) of the patients had a normal body mass index while 85.7% had optimal albumin levels. The proportion of patients who met the recommended energy and protein intakes were 19.0% and 3.4%, respectively. Patients were at moderate risk of malnutrition, had minimal depression level and perceived better QOL in terms of effects and symptoms of kidney disease. There was a significant positive correlation between protein intake and the physical domain of QOL (p=0.02) and negative correlation between risk of malnutrition with physical and mental composites of QOL (p<0.001). There was significant negative correlation between depression and physical composite, mental composite, burden, effects and the symptoms of kidney disease (p<0.001).
Conclusion: The present findings provide better insight on QOL for future screening, preventive measures and intervention. Further investigation regarding factors associated with QOL among elderly patients is recommended.
Key words: Quality of life, nutritional status, depression, haemodialysis, elderly
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Introduction: A compromised quality of life (QOL) as a result of haemodialysis (HD) is a rising global issue. Elderly HD patients face more challenges than younger counterparts. This study determined the association of socio-demographic characteristics, nutritional status, risk of malnutrition and depression with QOL, among elderly HD patients.
Methods: A cross-sectional study was conducted among 112 HD elderly patients in selected dialysis centres in Selangor, Malaysia. The patients completed interview-based questionnaires on socio-demographic characteristics, risk of malnutrition (Dialysis Malnutrition Score, DMS), depression (Patient Health Questionaire-9, PHQ-9) and QOL (KDQOL-36). Anthropometric measurements, 24-hour dietary recall and food intake information were obtained from them and biochemical data from their medical records.
Results: Just over half (50.9%) of the patients had a normal body mass index while 85.7% had optimal albumin levels. The proportion of patients who met the recommended energy and protein intakes were 19.0% and 3.4%, respectively. Patients were at moderate risk of malnutrition, had minimal depression level and perceived better QOL in terms of effects and symptoms of kidney disease. There was a significant positive correlation between protein intake and the physical domain of QOL (p=0.02) and negative correlation between risk of malnutrition with physical and mental composites of QOL (p<0.001). There was significant negative correlation between depression and physical composite, mental composite, burden, effects and the symptoms of kidney disease (p<0.001).
Conclusion: The present findings provide better insight on QOL for future screening, preventive measures and intervention. Further investigation regarding factors associated with QOL among elderly patients is recommended.
Key words: Quality of life, nutritional status, depression, haemodialysis, elderly
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Prevalence and determinants of Instrumental Activities
of Daily Living (IADL) disability among communitydwelling
elderly in a semi-urban setting in Peninsular
Malaysia
Muhammad Faizal bin Murat, Zuriati binti Ibrahim, Siti Nur ‘Asyura binti
Adznam & Chan Yoke Mun
ABSTRACT
Introduction: The ability to perform daily living activities among the elderly is important, as physical disability may lead to dependency and various public health implications. This study aimed to determine the prevalence of instrumental activities of daily living (IADL) disability and its association with socio-demographic characteristics, dietary intake, social participation, perceived-health-status and risk of falls.
Methods: This cross-sectional study was conducted among communitybased elderly in the Gombak District of Selangor. 258 respondents aged 60-88 years old (mean age 66±6.5 years) were recruited through multi-stage proportional sampling. Most of the respondents (88.4%) aged 60-74 years and 11.6% were ≥75 years. IADL disability was determined using an eight-item IADL scale. The presence of IADL disability was defined as needing help in at least one or more of eight-IADL activities. Dietary intake and fall risk were assessed using diet history questionnaire (DHQ) and 21-item fall risk index (FRI-21), respectively.
Results: The prevalence of IADL disability among the respondents was 58.1%. A binary logistic regression analyses showed that the following factors predicted IADL disability: advanced age (≥75 years, OR=6.4; 95% CI: 1.3, 30.8), being unmarried (OR=2.5; 95% CI: 1.1, 5.9), unemployed/retired (OR=2.3; 95% CI: 1.2, 4.3), and at risk of falls (OR=2.5; 95% CI: 1.3, 6.1).
Conclusion: Predictors such as marriage and employment highlight the importance of social support among elderly. In practical terms, this means that it is incumbent upon caregivers, family members, and the community to provide both physical and emotional support if the functional status of the elderly is to be improved.
Key words: IADL disability, elderly, functional status, Malaysia
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Introduction: The ability to perform daily living activities among the elderly is important, as physical disability may lead to dependency and various public health implications. This study aimed to determine the prevalence of instrumental activities of daily living (IADL) disability and its association with socio-demographic characteristics, dietary intake, social participation, perceived-health-status and risk of falls.
Methods: This cross-sectional study was conducted among communitybased elderly in the Gombak District of Selangor. 258 respondents aged 60-88 years old (mean age 66±6.5 years) were recruited through multi-stage proportional sampling. Most of the respondents (88.4%) aged 60-74 years and 11.6% were ≥75 years. IADL disability was determined using an eight-item IADL scale. The presence of IADL disability was defined as needing help in at least one or more of eight-IADL activities. Dietary intake and fall risk were assessed using diet history questionnaire (DHQ) and 21-item fall risk index (FRI-21), respectively.
Results: The prevalence of IADL disability among the respondents was 58.1%. A binary logistic regression analyses showed that the following factors predicted IADL disability: advanced age (≥75 years, OR=6.4; 95% CI: 1.3, 30.8), being unmarried (OR=2.5; 95% CI: 1.1, 5.9), unemployed/retired (OR=2.3; 95% CI: 1.2, 4.3), and at risk of falls (OR=2.5; 95% CI: 1.3, 6.1).
Conclusion: Predictors such as marriage and employment highlight the importance of social support among elderly. In practical terms, this means that it is incumbent upon caregivers, family members, and the community to provide both physical and emotional support if the functional status of the elderly is to be improved.
Key words: IADL disability, elderly, functional status, Malaysia
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Health-related quality of life of elderly with chronic
obstructive pulmonary disease from selected
government institutions
Nor-Farahain Yahya, Noraida Omar, Siti Nur’ Asyura Adznam, Ummi-
Nadira Daut & Barakatun Nisak Mohd Yusof
ABSTRACT
Introduction: It is widely recognised that health-related quality of life (HRQOL) is impaired in chronic obstructive pulmonary disease (COPD) patients. Most previous studies were conducted among the younger adult population and there is limited information on the elderly population. This study aimed to determine the COPD assessment test (CAT) score in the elderly with COPD.
Methods: This was a crosssectional study involving 140 elderly patients who had been diagnosed with COPD at two selected government institutions. Data on socio-demographic and health status were collected by interviewing patients and reviewing their medical records. The HRQOL was measured using CAT. The independence sample t-test and one-way ANOVA were conducted to compare the CAT scores with socio-demographic and health status.
Results: The socio-demographic and health characteristics of the patients were as follows: majority (54%) were aged 60-70 years, male (97%), Malay (59%), married (75%), ex-smokers (72%), had attained primary education (48%), had co-morbidities (54%), no history of hospitalisation or visits to the emergency department due to COPD (57%), and were in moderate stage of airflow obstruction (53%). The mean of CAT score was 21.87±6.85 and the majority of the patients were classified as having worst symptoms of COPD (93%) as they had high CAT score which was ≥ 10.
Conclusion: Majority of the patients in this study had high scores of CAT, which indicated poor HRQOL. Ex-smokers had higher scores compared to non-smokers. More attention need to be given to these subgroups in order to increase their quality of life.
Key words: HRQOL, elderly, COPD, CAT score
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Introduction: It is widely recognised that health-related quality of life (HRQOL) is impaired in chronic obstructive pulmonary disease (COPD) patients. Most previous studies were conducted among the younger adult population and there is limited information on the elderly population. This study aimed to determine the COPD assessment test (CAT) score in the elderly with COPD.
Methods: This was a crosssectional study involving 140 elderly patients who had been diagnosed with COPD at two selected government institutions. Data on socio-demographic and health status were collected by interviewing patients and reviewing their medical records. The HRQOL was measured using CAT. The independence sample t-test and one-way ANOVA were conducted to compare the CAT scores with socio-demographic and health status.
Results: The socio-demographic and health characteristics of the patients were as follows: majority (54%) were aged 60-70 years, male (97%), Malay (59%), married (75%), ex-smokers (72%), had attained primary education (48%), had co-morbidities (54%), no history of hospitalisation or visits to the emergency department due to COPD (57%), and were in moderate stage of airflow obstruction (53%). The mean of CAT score was 21.87±6.85 and the majority of the patients were classified as having worst symptoms of COPD (93%) as they had high CAT score which was ≥ 10.
Conclusion: Majority of the patients in this study had high scores of CAT, which indicated poor HRQOL. Ex-smokers had higher scores compared to non-smokers. More attention need to be given to these subgroups in order to increase their quality of life.
Key words: HRQOL, elderly, COPD, CAT score
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Simple method for assessing standing height using
recumbent length in bedridden patients using soft and
firm mattresses
Wong Wei Yee, Lim Su Lin & Chan Yiong Huak
ABSTRACT
Introduction: The accurate measurement of the height of bedridden patients is difficult. Height assessment is required for the calculation of body mass index, which is crucial for determining the nutrition status of a patient. This study aimed to validate recumbent length measurement against the standing height measurement using soft and firm mattresses and to derive predictive equations to calculate the actual height of bedridden patients on mattresses with different firmness.
Methods: Ninety-nine hospitalised participants (mean age 48.9±13.9 years; range 21–80 years) (49 men, 50 women) and 100 healthy participants (mean age 36.8±13.6 years; range 21–77 years) (50 men, 50 women) were recruited. Standing height was measured using a stadiometer. Recumbent length was measured using a 2 metre long measuring tape. Hospitalised participants lay on soft mattress and healthy participants on firm mattress.
Results: Using Bland–Altman plot, 96% of hospitalised participants using soft mattress were within 2.5±2.7 cm (mean±2SD) whereas 97% of healthy participants using firm mattress were within 2.1±2.1 cm. The regression equation developed using firm mattress was Standing height (cm) = 0.993 x Recumbent length – 0.943; (r2=0.982). The regression equation developed using soft mattress was Standing height (cm) = 1.012 x Recumbent length – 4.477; (r2=0.981).
Conclusion: We concluded that recumbent length is a valid clinical tool to estimate standing height. Standing height can be estimated from the predictive equations developed for patients lying on soft or firm mattresses.
Key words: Recumbent length, height, measuring tape, Asian, bedridden
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Introduction: The accurate measurement of the height of bedridden patients is difficult. Height assessment is required for the calculation of body mass index, which is crucial for determining the nutrition status of a patient. This study aimed to validate recumbent length measurement against the standing height measurement using soft and firm mattresses and to derive predictive equations to calculate the actual height of bedridden patients on mattresses with different firmness.
Methods: Ninety-nine hospitalised participants (mean age 48.9±13.9 years; range 21–80 years) (49 men, 50 women) and 100 healthy participants (mean age 36.8±13.6 years; range 21–77 years) (50 men, 50 women) were recruited. Standing height was measured using a stadiometer. Recumbent length was measured using a 2 metre long measuring tape. Hospitalised participants lay on soft mattress and healthy participants on firm mattress.
Results: Using Bland–Altman plot, 96% of hospitalised participants using soft mattress were within 2.5±2.7 cm (mean±2SD) whereas 97% of healthy participants using firm mattress were within 2.1±2.1 cm. The regression equation developed using firm mattress was Standing height (cm) = 0.993 x Recumbent length – 0.943; (r2=0.982). The regression equation developed using soft mattress was Standing height (cm) = 1.012 x Recumbent length – 4.477; (r2=0.981).
Conclusion: We concluded that recumbent length is a valid clinical tool to estimate standing height. Standing height can be estimated from the predictive equations developed for patients lying on soft or firm mattresses.
Key words: Recumbent length, height, measuring tape, Asian, bedridden
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Identification of dietary patterns associated with
characteristics of successful aging
Nik Nur Izzati Nik Mohd Fakhruddin, Suzana Shahar, Roslee Rajikan, Mohd
Azahadi Omar, Normah Che Din, Rosdinom Razali, Sakinah Harith, Hamid
Jan Jan Mohamed & Bibi Nabihah Abdul Hakim
ABSTRACT
Introduction: This study aimed to identify dietary patterns (DPs) and their association with successful aging (SA).
Methods: A comparative cross-sectional study was conducted among 579 elderly subjects recruited from four states in Malaysia through a multistage random sampling method. SA was defined as having no chronic illnesses, no functional limitation, normal global function, no depression, a good quality of life and good self-perceived health. Information on dietary intake was obtained using a diet history questionnaire. Cognitive functions were assessed using the Mini Mental State Examination (MMSE), depressive symptoms using Geriatric Depression Score-15 items (GDS-15) and a question regarding their perceived health and quality of life. Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) questionnaires were used to determine functional status. DPs were obtained using the principal component analysis (PCA) approach. An ordinal logistic regression model was used to examine associations between DP scores and SA.
Results: Five DPs were identified namely ‘sweet foods-beverages’, ‘meat-vegetablesrice and noodles’, ‘local snacks-fish and seafood-high salt foods’, ‘fruits-legumes’, and ‘tropical fruits-oats’. A higher score for ‘tropical fruits-oats’ DP was associated with SA [Adjusted OR=1.59 (95% CI: 1.08-2.32)]. However, the association diminished when the model was adjusted for education level. Further analysis indicated that this DP increased the chance of SA among those with secondary education and above [Adjusted OR=2.43 (95% CI: 1.09–5.42)].
Conclusion: Tropical fruits-oats’ DP is associated with SA among elderly with secondary education and above. There is a need to investigate DPs among those with lower education.
Key words: Cognitive function, dietary pattern, elderly, principal component analysis, successful aging
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Introduction: This study aimed to identify dietary patterns (DPs) and their association with successful aging (SA).
Methods: A comparative cross-sectional study was conducted among 579 elderly subjects recruited from four states in Malaysia through a multistage random sampling method. SA was defined as having no chronic illnesses, no functional limitation, normal global function, no depression, a good quality of life and good self-perceived health. Information on dietary intake was obtained using a diet history questionnaire. Cognitive functions were assessed using the Mini Mental State Examination (MMSE), depressive symptoms using Geriatric Depression Score-15 items (GDS-15) and a question regarding their perceived health and quality of life. Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) questionnaires were used to determine functional status. DPs were obtained using the principal component analysis (PCA) approach. An ordinal logistic regression model was used to examine associations between DP scores and SA.
Results: Five DPs were identified namely ‘sweet foods-beverages’, ‘meat-vegetablesrice and noodles’, ‘local snacks-fish and seafood-high salt foods’, ‘fruits-legumes’, and ‘tropical fruits-oats’. A higher score for ‘tropical fruits-oats’ DP was associated with SA [Adjusted OR=1.59 (95% CI: 1.08-2.32)]. However, the association diminished when the model was adjusted for education level. Further analysis indicated that this DP increased the chance of SA among those with secondary education and above [Adjusted OR=2.43 (95% CI: 1.09–5.42)].
Conclusion: Tropical fruits-oats’ DP is associated with SA among elderly with secondary education and above. There is a need to investigate DPs among those with lower education.
Key words: Cognitive function, dietary pattern, elderly, principal component analysis, successful aging
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Prevalence and factors affecting food insecurity among
university students in Pahang, Malaysia
Wan Azdie Mohd Abu Bakar, Shahidah Ismail, Suriati Sidek & Rozlin Abdul
Rahman
ABSTRACT
Introduction: Food insecurity exists whenever people are unable to access sufficient food at all times for an active and healthy life. University students are a potentially vulnerable group of people to face food insecurity. This study aimed to identify the prevalence and determinants of food insecurity among a population of university students in Kuantan, in the state of Pahang.
Methods: Food security status was identified using the United States Adult Food Security Survey Module (USAFSSM). Factors, which include demographic background, spending expenditure pattern and time constraints, were assessed. A total of 316 students were selected through stratified random sampling throughout six faculties of the International Islamic University Malaysia, of whom 307 successfully completed the survey.
Results: The result shows that 54.4% of the students were experiencing food insecurity, from which 32.9% were sub-categorised as low food security and 21.5% as very low food security. Food insecurity was found to be significantly associated with time constraints (p<0.05), spending on books (p<0.05), miscellaneous items (p<0.05), parents’ income (p<0.001) and scholarship type (p<0.001).
Conclusion: Apart from the high incidence of food insecurity among the students, time and financial affordability appeared to be critical concerns in this study. Since food insecurity has become a significant issue with university students, it should be addressed and prioritised by the relevant authorities.
Key words: Food insecurity, students, food security status
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Introduction: Food insecurity exists whenever people are unable to access sufficient food at all times for an active and healthy life. University students are a potentially vulnerable group of people to face food insecurity. This study aimed to identify the prevalence and determinants of food insecurity among a population of university students in Kuantan, in the state of Pahang.
Methods: Food security status was identified using the United States Adult Food Security Survey Module (USAFSSM). Factors, which include demographic background, spending expenditure pattern and time constraints, were assessed. A total of 316 students were selected through stratified random sampling throughout six faculties of the International Islamic University Malaysia, of whom 307 successfully completed the survey.
Results: The result shows that 54.4% of the students were experiencing food insecurity, from which 32.9% were sub-categorised as low food security and 21.5% as very low food security. Food insecurity was found to be significantly associated with time constraints (p<0.05), spending on books (p<0.05), miscellaneous items (p<0.05), parents’ income (p<0.001) and scholarship type (p<0.001).
Conclusion: Apart from the high incidence of food insecurity among the students, time and financial affordability appeared to be critical concerns in this study. Since food insecurity has become a significant issue with university students, it should be addressed and prioritised by the relevant authorities.
Key words: Food insecurity, students, food security status
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A feasibility study of multiple micronutrient
supplement for home fortification of foods among
Orang Asli children in Negeri Sembilan, Malaysia
Nur Dayana Shaari, Zalilah Mohd Shariff, Gan Wan Ying & Loh Su Peng
ABSTRACT
Introduction: The prevalence of child undernutrition and micronutrient deficiencies are higher in the Orang Asli (OA) than the general Malaysian population. The World Health Organization recommends the use of multiple micronutrient supplement (MMS) that is a blend of micronutrients in powder form that can be sprinkled onto foods for home fortification to prevent undernutrition among children. This pilot study aimed to assess the feasibility of using MMS among OA children.
Methods: A total of 25 OA children (14 boys and 11 girls) aged 6-31 months (mean±SD = 15.7±7.2 months) in Negeri Sembilan were given three sachets of MMS weekly for 5 weeks. Caregivers were instructed to add MMS to three types of food from the same food group per week varying with a different food group weekly. Written instruction for using MMS in simple language was given prior to the supplementation. Caregivers were interviewed for information on socio-demographics, compliance, acceptance, preference and adverse effect of MMS.
Results: A high level of compliance was observed (85%). All caregivers reported that the instructions for use were easy to read. No noticeable changes to the foods mixed with MMS were observed and no adverse effects were reported.
Conclusion: This study demonstrated feasibility of the use of MMS for future trials among OA children. The easy to read information that comes with the MMS, frequent monitoring of MMS use and support to caregivers were required to ensure compliance. Cultural feeding practices and financial constraints may limit the types of food that can be mixed with MMS.
Key words: Multiple micronutrients supplement, feasibility study, Orang Asli children, micronutrient powder, home food fortification
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Introduction: The prevalence of child undernutrition and micronutrient deficiencies are higher in the Orang Asli (OA) than the general Malaysian population. The World Health Organization recommends the use of multiple micronutrient supplement (MMS) that is a blend of micronutrients in powder form that can be sprinkled onto foods for home fortification to prevent undernutrition among children. This pilot study aimed to assess the feasibility of using MMS among OA children.
Methods: A total of 25 OA children (14 boys and 11 girls) aged 6-31 months (mean±SD = 15.7±7.2 months) in Negeri Sembilan were given three sachets of MMS weekly for 5 weeks. Caregivers were instructed to add MMS to three types of food from the same food group per week varying with a different food group weekly. Written instruction for using MMS in simple language was given prior to the supplementation. Caregivers were interviewed for information on socio-demographics, compliance, acceptance, preference and adverse effect of MMS.
Results: A high level of compliance was observed (85%). All caregivers reported that the instructions for use were easy to read. No noticeable changes to the foods mixed with MMS were observed and no adverse effects were reported.
Conclusion: This study demonstrated feasibility of the use of MMS for future trials among OA children. The easy to read information that comes with the MMS, frequent monitoring of MMS use and support to caregivers were required to ensure compliance. Cultural feeding practices and financial constraints may limit the types of food that can be mixed with MMS.
Key words: Multiple micronutrients supplement, feasibility study, Orang Asli children, micronutrient powder, home food fortification
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Linguistic validity and reliability of cariogenic food
frequency and oral health knowledge, attitude and
practice questionnaires for parents of 6-11 years old
children in Kota Bharu, Kelantan
Rosnani Ngah, Ruhaya Hasan & Normastura Abd Rahman
ABSTRACT
Introduction: Cariogenic food intake and oral health knowledge, attitude and practices (KAP) of parents are contributing factors that influence the oral health status of children. As there is lack of a validated questionnaire in Bahasa Melayu (the Malay language) to measure the factors, this cross-sectional study was carried out to establish a linguistically valid and reliable cariogenic food frequency questionnaire (M-CFFQ) and oral health kap questionnaire (M-OHKAPQ) in Bahasa Melayu, for parents of children aged 6-11 years in Kota Bharu, Kelantan.
Methods: Relevant questionnaires in English were selected and translated to Malay language. This process included forward translation, synthesis, backward translation and consolidation to produce the preliminary drafts of M-CFFQ and M-OHKAPQ. Pretesting was conducted on ten parents of children from a primary school in Kota Bharu by face-to-face interview. The findings were reviewed to produce the final versions of M-CFFQ and M-OHKAPQ. A test-retest reliability study was undertaken involving 49 parents. The participants were asked to answer the final M-CFFQ and M-OHKAPQ versions twice, within a 7-14 days interval. Data collected were entered into IBM SPPS version 22 software and analysed using the Intraclass Correlation Coefficient (ICC) test.
Results: Semantic, idiomatic, experiential, conceptual as well as content and face validity issues were successfully resolved. Fifteen categories of food/drinks for M-CFFQ and 26 items/questions M-OHKAPQ were produced. The total ICC values achieved for M-CFFQ and M-OHKAPQ were 0.887 and 0.807, respectively.
Conclusion: The M-CFFQ and M-OHKAPQ appeared to be linguistically valid and reliable with excellent test-retest reliability (ICC>0.80).
Key words: Linguistic, cariogenic, oral health, questionnaire, test-retest reliability
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Introduction: Cariogenic food intake and oral health knowledge, attitude and practices (KAP) of parents are contributing factors that influence the oral health status of children. As there is lack of a validated questionnaire in Bahasa Melayu (the Malay language) to measure the factors, this cross-sectional study was carried out to establish a linguistically valid and reliable cariogenic food frequency questionnaire (M-CFFQ) and oral health kap questionnaire (M-OHKAPQ) in Bahasa Melayu, for parents of children aged 6-11 years in Kota Bharu, Kelantan.
Methods: Relevant questionnaires in English were selected and translated to Malay language. This process included forward translation, synthesis, backward translation and consolidation to produce the preliminary drafts of M-CFFQ and M-OHKAPQ. Pretesting was conducted on ten parents of children from a primary school in Kota Bharu by face-to-face interview. The findings were reviewed to produce the final versions of M-CFFQ and M-OHKAPQ. A test-retest reliability study was undertaken involving 49 parents. The participants were asked to answer the final M-CFFQ and M-OHKAPQ versions twice, within a 7-14 days interval. Data collected were entered into IBM SPPS version 22 software and analysed using the Intraclass Correlation Coefficient (ICC) test.
Results: Semantic, idiomatic, experiential, conceptual as well as content and face validity issues were successfully resolved. Fifteen categories of food/drinks for M-CFFQ and 26 items/questions M-OHKAPQ were produced. The total ICC values achieved for M-CFFQ and M-OHKAPQ were 0.887 and 0.807, respectively.
Conclusion: The M-CFFQ and M-OHKAPQ appeared to be linguistically valid and reliable with excellent test-retest reliability (ICC>0.80).
Key words: Linguistic, cariogenic, oral health, questionnaire, test-retest reliability
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Module development and its effectiveness for improving
the competencies of voluntary health workers in
communicating safe complementary feeding to
caregivers in Indonesia
Dwi Nastiti Iswarawanti, Siti Muslimatun, Endang Basuki & Ahmad Hadi
ABSTRACT
Introduction: In Indonesia, most training modules for health paraprofessionals have been adapted from existing foreign modules without assessment. In addition, there have been few studies on training development for this group. We aimed to develop, using a systematic tool, implement and evaluate a training module to improve the competencies of voluntary health workers (cadres) in communicating safe complementary feeding practice to caregivers of young children in Indonesia.
Methods: A mixed methods approach was used. A qualitative study employing in-depth interviews, focus group discussions, mini-workshops, documentary reviews and expert validation was used to develop the training module, following a systematic approach. The module’s effectiveness for improving the health workers’ competencies was evaluated using a quantitative study with a non-equivalent pre-test and post-test control group design that included 70 (intervention group) and 68 (comparison group) voluntary health workers from a peri-urban district. Changes in the workers’ cognitive, affective and psychomotor competencies were tested before and after attending a 3-day training module (intervention group) or a half-day event (comparison group).
Results: A 24-hour learning session module on communicating safe complementary feeding was developed and used to train voluntary health workers. After the training, a significantly higher proportion of workers in the intervention group than in the comparison group were assessed as competent in the psychomotor and composite domains (psychomotor: 67.1% vs. 20.6%; composite: 74.3% vs. 36.8%; p<0.001).
Conclusion: This systematically developed module was effective in improving the competencies of voluntary health workers regarding communicating safe complementary feeding practice to caregivers in Indonesia.
Key words: Competencies, complementary feeding, communication, training, voluntary health workers
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Introduction: In Indonesia, most training modules for health paraprofessionals have been adapted from existing foreign modules without assessment. In addition, there have been few studies on training development for this group. We aimed to develop, using a systematic tool, implement and evaluate a training module to improve the competencies of voluntary health workers (cadres) in communicating safe complementary feeding practice to caregivers of young children in Indonesia.
Methods: A mixed methods approach was used. A qualitative study employing in-depth interviews, focus group discussions, mini-workshops, documentary reviews and expert validation was used to develop the training module, following a systematic approach. The module’s effectiveness for improving the health workers’ competencies was evaluated using a quantitative study with a non-equivalent pre-test and post-test control group design that included 70 (intervention group) and 68 (comparison group) voluntary health workers from a peri-urban district. Changes in the workers’ cognitive, affective and psychomotor competencies were tested before and after attending a 3-day training module (intervention group) or a half-day event (comparison group).
Results: A 24-hour learning session module on communicating safe complementary feeding was developed and used to train voluntary health workers. After the training, a significantly higher proportion of workers in the intervention group than in the comparison group were assessed as competent in the psychomotor and composite domains (psychomotor: 67.1% vs. 20.6%; composite: 74.3% vs. 36.8%; p<0.001).
Conclusion: This systematically developed module was effective in improving the competencies of voluntary health workers regarding communicating safe complementary feeding practice to caregivers in Indonesia.
Key words: Competencies, complementary feeding, communication, training, voluntary health workers
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Breastfeeding knowledge among indigenous Temiar
women: a qualitative study
Sharifah Zahhura Syed Abdullah & Rozieyati Mohamed Saleh
ABSTRACT
Introduction: The benefits of breastfeeding for both mothers and infants are widely recognised. Breastfeeding confirms a woman’s unique ability to care for her infant in the best way possible and promotes optimum infant and maternal health.
Methods: A qualitative research method involving five focus group discussions (n=33) was chosen in this study to compare and contrast the breastfeeding practice in two different locations: the communities of Pos Pulat and the regroupment scheme settlement at Rancangan Pengumpulan Semula (RPS) Kuala Betis in Kelantan, Malaysia which represents different lifestyle experiences of indigenous Temiar population.
Results: The benefits of breastfeeding to the infants reported by some Temiar women (42.4%) were for the infant’s health and growth. Responses from urban RPS Kuala Betis women include breast milk contains antibodies (3.0%), delays in the return of regular ovulation (6.1%), thus lengthening birth intervals and bonding between maternal-baby (6.1%). In general, respondents from Pos Pulat seemed to have little knowledge regarding this issue, except for a woman who mentioned that maternal milk contains vitamins. Based on the narrative analysis, knowledge gap was observed between these two communities.
Conclusion: Although all the women interviewed had the experience of breastfeeding their infants, most of them lacked the knowledge regarding the benefits of the breastfeeding either to the infants or to the mothers. The findings from this study are crucial for the preservation of breastfeeding culture among the Temiar women and can be used to improve promotion of breastfeeding to other Orang Asli groups in Malaysia.
Key words: Breastfeeding, knowledge, health, indigenous, qualitative
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Introduction: The benefits of breastfeeding for both mothers and infants are widely recognised. Breastfeeding confirms a woman’s unique ability to care for her infant in the best way possible and promotes optimum infant and maternal health.
Methods: A qualitative research method involving five focus group discussions (n=33) was chosen in this study to compare and contrast the breastfeeding practice in two different locations: the communities of Pos Pulat and the regroupment scheme settlement at Rancangan Pengumpulan Semula (RPS) Kuala Betis in Kelantan, Malaysia which represents different lifestyle experiences of indigenous Temiar population.
Results: The benefits of breastfeeding to the infants reported by some Temiar women (42.4%) were for the infant’s health and growth. Responses from urban RPS Kuala Betis women include breast milk contains antibodies (3.0%), delays in the return of regular ovulation (6.1%), thus lengthening birth intervals and bonding between maternal-baby (6.1%). In general, respondents from Pos Pulat seemed to have little knowledge regarding this issue, except for a woman who mentioned that maternal milk contains vitamins. Based on the narrative analysis, knowledge gap was observed between these two communities.
Conclusion: Although all the women interviewed had the experience of breastfeeding their infants, most of them lacked the knowledge regarding the benefits of the breastfeeding either to the infants or to the mothers. The findings from this study are crucial for the preservation of breastfeeding culture among the Temiar women and can be used to improve promotion of breastfeeding to other Orang Asli groups in Malaysia.
Key words: Breastfeeding, knowledge, health, indigenous, qualitative
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Workplace support and exclusive breastfeeding practice:
a qualitative study in Jakarta, Indonesia
Yunita Febrianingtyas, Judhiastuty Februhartanty & Dian Nurcahyati
Hadihardjono
ABSTRACT
Introduction: The primary reason that compels working mothers to decrease their ability to continue to breastfeeding successfully is their return to work. Attempts to continue breastfeeding at work encounters several difficulties. This study aims to provide an overview of the workplace environment and how facilities at the workplace affect breastfeeding in Indonesia.
Methods: We used a qualitative approach to provide a detailed picture of the influence of workplace support for working mothers to perform breastfeeding. We enrolled working mothers (n=18) in Jakarta, as participants and obtained the following information from them: parity, type of family and type of work.
Results: The findings provided the general overview of the workplace environment and identified three factors that affected breastfeeding: seeking information during pregnancy, expression of breast milk at office facilities and the problem faced by working mothers.
Conclusion: Although the breastfeeding performance of most working mothers in this study comprised exclusive breastfeeding, some fed their infants with formula milk. This study suggests that working mothers who continue to breastfeed after returning to work need the support of their employers, co-workers and others in the workplace to ensure the provision of health facilities and the protection and dissemination the rights of breastfeeding working mothers that might lead them to discontinue their breastfeeding practice.
Key words: Breastfeeding performance, workplace support, qualitative study, Jakarta, Indonesia
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Introduction: The primary reason that compels working mothers to decrease their ability to continue to breastfeeding successfully is their return to work. Attempts to continue breastfeeding at work encounters several difficulties. This study aims to provide an overview of the workplace environment and how facilities at the workplace affect breastfeeding in Indonesia.
Methods: We used a qualitative approach to provide a detailed picture of the influence of workplace support for working mothers to perform breastfeeding. We enrolled working mothers (n=18) in Jakarta, as participants and obtained the following information from them: parity, type of family and type of work.
Results: The findings provided the general overview of the workplace environment and identified three factors that affected breastfeeding: seeking information during pregnancy, expression of breast milk at office facilities and the problem faced by working mothers.
Conclusion: Although the breastfeeding performance of most working mothers in this study comprised exclusive breastfeeding, some fed their infants with formula milk. This study suggests that working mothers who continue to breastfeed after returning to work need the support of their employers, co-workers and others in the workplace to ensure the provision of health facilities and the protection and dissemination the rights of breastfeeding working mothers that might lead them to discontinue their breastfeeding practice.
Key words: Breastfeeding performance, workplace support, qualitative study, Jakarta, Indonesia
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Nutrition labelling: an exploratory study on personal
factors that influence the practice of reading nutrition
labels among adolescents
Norsakira Jefrydin, Norazmir Md Nor & Ruzita Abd. Talib
ABSTRACT
Introduction: The consumption of processed food is increasing in developing countries. Nutrition labels on food packaging are important for the education of consumers, particularly adolescents, to help them make healthier food choices. However, there is evidence to suggest that adolescents generally do not use nutrition labels. This study aims to explore the personal factors that influence the practice of Malaysian adolescents in reading nutrition labels.
Methods: The participants were adolescents, aged 13-16 years, from five public schools in Negeri Sembilan. Five semi-structured focus group discussions (FGDs) were conducted. The participants discussed their personal views, knowledge and perceptions regarding the use of nutrition labels and food selection. Data gathered from the FGDs were coded through thematic analysis using the NVivo software.
Results: While the participants were familiar with nutrition labels, their usage was relatively low during food selection due to the lack of interest in nutrition information, past experiences, hunger and cravings, time constraints and the taste of the food. The main reasons for using nutrition labels were health consciousness and their curiosity about specific nutrition information provided on the labels. The majority of participants believed that information provided on the labels was accurate because it was provided by reliable institutions. There was also misperception among some participants, mixing up nutrition labels with list of ingredients and the expiry dates. A few participants were unconvinced by the labels and stated that the labels provided misleading information.
Conclusion: Personal factors such as knowledge, misperception, awareness and trust significantly impact how adolescents read nutrition labels.
Key words: Nutrition labels, adolescents, food choice, focus group discussion
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Introduction: The consumption of processed food is increasing in developing countries. Nutrition labels on food packaging are important for the education of consumers, particularly adolescents, to help them make healthier food choices. However, there is evidence to suggest that adolescents generally do not use nutrition labels. This study aims to explore the personal factors that influence the practice of Malaysian adolescents in reading nutrition labels.
Methods: The participants were adolescents, aged 13-16 years, from five public schools in Negeri Sembilan. Five semi-structured focus group discussions (FGDs) were conducted. The participants discussed their personal views, knowledge and perceptions regarding the use of nutrition labels and food selection. Data gathered from the FGDs were coded through thematic analysis using the NVivo software.
Results: While the participants were familiar with nutrition labels, their usage was relatively low during food selection due to the lack of interest in nutrition information, past experiences, hunger and cravings, time constraints and the taste of the food. The main reasons for using nutrition labels were health consciousness and their curiosity about specific nutrition information provided on the labels. The majority of participants believed that information provided on the labels was accurate because it was provided by reliable institutions. There was also misperception among some participants, mixing up nutrition labels with list of ingredients and the expiry dates. A few participants were unconvinced by the labels and stated that the labels provided misleading information.
Conclusion: Personal factors such as knowledge, misperception, awareness and trust significantly impact how adolescents read nutrition labels.
Key words: Nutrition labels, adolescents, food choice, focus group discussion
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Nutrient composition of milkfish (Chanos chanos,
Forskal) from Pangkep, South Sulawesi, Indonesia
Sriwati Malle, Abu Bakar Tawali, Mulyati Muhammad Tahir & Maryati
Bilang
ABSTRACT
Introduction: Milkfish is a potential source of animal nutrition, especially for supplying human protein needs. In the present paper, we provide complete data on nutrient content of milkfish that can be used as a reference for diet formulation and for the further processing of milkfish.
Methods: Proximate analysis, amino acid and fatty acid composition, and vitamin and mineral content of milkfish were determined.
Results: The results showed that milkfish contained high concentration of protein (24.18%) and high proportion of monounsaturated fatty acids as oleic acid (32.11%). The amino acid found in the highest concentration was glutamic acid (1.28%). The macro-minerals in the milkfish were calcium (Ca), magnesium (Mg), sodium (Na) and potassium (K). Among the micro-minerals present were iron (Fe), zinc (Zn), copper (Cu) and manganese (Mn), and the main vitamins present include A, B1 and B12.
Conclusion: Based on their protein content, milkfish may be classified as a source of high protein. Glutamic acid which is the highest amino acid in milkfish as well as fatty acid content of oleic acid makes milkfish a healthful fish.
Key words: Amino acids, fatty acids, milkfish, minerals, proximate, vitamins
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Introduction: Milkfish is a potential source of animal nutrition, especially for supplying human protein needs. In the present paper, we provide complete data on nutrient content of milkfish that can be used as a reference for diet formulation and for the further processing of milkfish.
Methods: Proximate analysis, amino acid and fatty acid composition, and vitamin and mineral content of milkfish were determined.
Results: The results showed that milkfish contained high concentration of protein (24.18%) and high proportion of monounsaturated fatty acids as oleic acid (32.11%). The amino acid found in the highest concentration was glutamic acid (1.28%). The macro-minerals in the milkfish were calcium (Ca), magnesium (Mg), sodium (Na) and potassium (K). Among the micro-minerals present were iron (Fe), zinc (Zn), copper (Cu) and manganese (Mn), and the main vitamins present include A, B1 and B12.
Conclusion: Based on their protein content, milkfish may be classified as a source of high protein. Glutamic acid which is the highest amino acid in milkfish as well as fatty acid content of oleic acid makes milkfish a healthful fish.
Key words: Amino acids, fatty acids, milkfish, minerals, proximate, vitamins
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Total lipid and omega-3 content in Pangasius catfish
(Pangasius pangasius) and milkfish (Chanos chanos)
from Indonesia
Marcelia Sugata, Priscilia Felita Wiriadi, Jap Lucy & Tan Tjie Jan
ABSTRACT
Introduction: Supplementation of the diet with fish oil omega-3 fatty acids, especially eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) has been associated with multiple health benefits. This study aimed to determine total lipid and omega-3 content in two fishes from Indonesia, which were Pangasius pangasius (P. pangasius) and Chanos chanos (C. chanos).
Methods: Total lipid was extracted from P. pangasius and C. chanos and the lipid content was then analysed using gas chromatography–mass spectrometry (GC-MS).
Results: Lipid content of C. chanos (4.63±3.84%) was higher than P. pangasius (3.94±1.43%) but less than that found in Salmo salar (S. salar) which was found to contain 6.98±2.56% lipid. Furthermore, polyunsaturated fatty acid omega-3 (EPA and DHA) analysis showed that C. chanos oil contained 0.36% EPA and 1.17% DHA. These levels are lower than that found in S. salar, often referred to as the “gold standard” for omega-3 fatty acids.
Conclusion: C. chanos contains considerable amounts of EPA and DHA. As it is widely available in Indonesia, it may be used as source of omega-3 fatty acids instead of salmon.
Key words: Chanos chanos, Pangasius pangasius, omega-3 fatty acids
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Introduction: Supplementation of the diet with fish oil omega-3 fatty acids, especially eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) has been associated with multiple health benefits. This study aimed to determine total lipid and omega-3 content in two fishes from Indonesia, which were Pangasius pangasius (P. pangasius) and Chanos chanos (C. chanos).
Methods: Total lipid was extracted from P. pangasius and C. chanos and the lipid content was then analysed using gas chromatography–mass spectrometry (GC-MS).
Results: Lipid content of C. chanos (4.63±3.84%) was higher than P. pangasius (3.94±1.43%) but less than that found in Salmo salar (S. salar) which was found to contain 6.98±2.56% lipid. Furthermore, polyunsaturated fatty acid omega-3 (EPA and DHA) analysis showed that C. chanos oil contained 0.36% EPA and 1.17% DHA. These levels are lower than that found in S. salar, often referred to as the “gold standard” for omega-3 fatty acids.
Conclusion: C. chanos contains considerable amounts of EPA and DHA. As it is widely available in Indonesia, it may be used as source of omega-3 fatty acids instead of salmon.
Key words: Chanos chanos, Pangasius pangasius, omega-3 fatty acids
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Energy density of ethnic cuisines in Singaporean
hawker centres: a comparative study of Chinese, Malay
and Indian foods
Rina Yu Chin Quek, Goh Hui Jen & Christiani Jeyakumar Henry
ABSTRACT
Introduction: A major focus in the prevention and management of obesity has been in the self-monitoring of foods consumed to reduce total energy intake. The present study used a novel instrument called the Calorie Answer™ to measure the energy content of various local foods in Singapore. The study aimed to build a database on energy density of commonly consumed Chinese, Malay and Indian foods to facilitate appropriate food choices by the consumer.
Methods: The first part consisted of measuring the energy density of 15 popular local foods purchased from 8 different hawker centres. In the second part, 46 additional local foods were analysed, again using the Calorie Answer™ instrument.
Results: Despite the different locations from which the foods were purchased, the energy content of the same foods was remarkably similar with a coefficient of variation (CV) of <15% for all foods. There was a higher average energy density of Indian foods compared to Chinese and Malay foods (Welch test, p=0.027).
Conclusion: Our results suggest that the energy density of commonly consumed foods from different locations was remarkably similar. The average energy density of Indian foods was significantly higher than that of Chinese and Malay. Knowledge of the energy density of foods is essential information that is needed in the battle against being overweight and obesity. The application of the Calorie Answer™ may be used as a means to collate data on the energy density of foods consumed in other countries in the ASEAN region.
Key words: Energy density, calories, food intake, variability, Singapore
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Introduction: A major focus in the prevention and management of obesity has been in the self-monitoring of foods consumed to reduce total energy intake. The present study used a novel instrument called the Calorie Answer™ to measure the energy content of various local foods in Singapore. The study aimed to build a database on energy density of commonly consumed Chinese, Malay and Indian foods to facilitate appropriate food choices by the consumer.
Methods: The first part consisted of measuring the energy density of 15 popular local foods purchased from 8 different hawker centres. In the second part, 46 additional local foods were analysed, again using the Calorie Answer™ instrument.
Results: Despite the different locations from which the foods were purchased, the energy content of the same foods was remarkably similar with a coefficient of variation (CV) of <15% for all foods. There was a higher average energy density of Indian foods compared to Chinese and Malay foods (Welch test, p=0.027).
Conclusion: Our results suggest that the energy density of commonly consumed foods from different locations was remarkably similar. The average energy density of Indian foods was significantly higher than that of Chinese and Malay. Knowledge of the energy density of foods is essential information that is needed in the battle against being overweight and obesity. The application of the Calorie Answer™ may be used as a means to collate data on the energy density of foods consumed in other countries in the ASEAN region.
Key words: Energy density, calories, food intake, variability, Singapore
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Malaysian Journal of Nutrition
Volume 25 (Supplement), 2019
Table of Content
Dietary diversity beliefs and practices among working mothers in Jakarta: a qualitative study
Aria Kekalih, Judhiastuty Februhartanty, Muchtaruddin Mansyur & Anuraj Shankar
ABSTRACT
Introduction: Dietary diversity is a global challenge in complementary feeding. Despite more women joining the workforce in developing countries, there are limited studies on the beliefs of working mothers and their experiences in relation to the provision of dietary diversity as recommended by the World Health Organization.
Methods: This qualitative study explored the behavioural, normative and control beliefs of working mothers on dietary diversity practices, based on the Theory of Planned Behaviour (TPB). A total of 25 mothers of different occupational levels were recruited from workplaces in Jakarta.
Results: Working mothers at the lower occupational levels showed a lack of understanding of the importance of dietary diversity and reported poor practices. These included the late introduction of animal protein as a food source, and few types of feeding instant foods. Due to their limited knowledge of nutrition, these working mothers tended to accept poor dietary diversity practices as normal.
Conclusion: Working mothers at the lower occupational levels practised poor dietary diversity owing to work-related factors. Efforts should be undertaken to provide correct nutritional information related to complementary feeding at workplaces, especially to working mothers in the unskilled occupations.
Key words: Child-feeding, working mothers, unskilled labour, qualitative study, Indonesia, dietary diversity
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Introduction: Dietary diversity is a global challenge in complementary feeding. Despite more women joining the workforce in developing countries, there are limited studies on the beliefs of working mothers and their experiences in relation to the provision of dietary diversity as recommended by the World Health Organization.
Methods: This qualitative study explored the behavioural, normative and control beliefs of working mothers on dietary diversity practices, based on the Theory of Planned Behaviour (TPB). A total of 25 mothers of different occupational levels were recruited from workplaces in Jakarta.
Results: Working mothers at the lower occupational levels showed a lack of understanding of the importance of dietary diversity and reported poor practices. These included the late introduction of animal protein as a food source, and few types of feeding instant foods. Due to their limited knowledge of nutrition, these working mothers tended to accept poor dietary diversity practices as normal.
Conclusion: Working mothers at the lower occupational levels practised poor dietary diversity owing to work-related factors. Efforts should be undertaken to provide correct nutritional information related to complementary feeding at workplaces, especially to working mothers in the unskilled occupations.
Key words: Child-feeding, working mothers, unskilled labour, qualitative study, Indonesia, dietary diversity
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Comparing intake adequacy and dietary diversity between adolescent schoolgirls with normal nutritional status (NG) and undernutrition (UG) based on BMI-forage (BAZ) living in urban slums in Central Jakarta
Rika Rachmalina, Helda Khusun, Luluk Basri Salim, Luh Ade Ari Wiradnyani & Drupadi HS Dillon
ABSTRACT
Introduction: Undernutrition among adolescent girls is an important concern due to their rapid growth velocity that requires adequate intake of energy and nutrients. This study compared intake adequacy and dietary diversity between adolescent public schoolgirls from slum areas in Central Jakarta who had normal and poor nutritional status.
Methods: A total of 220 eligible girls aged 14–18 years were recruited, with an equal proportion in the normal group (NG) [-1 to +1 SD body mass index-for-age z-score (BAZ)], and undernutrition group (UG) (BAZ < -1SD). Dietary intake was assessed using two non-consecutive 24-hour recalls. Dietary diversity scores (DDS) were determined with reference to the intake of 13 food groups with a minimum daily intake of 15 gram/food group. Receiver operating curve analysis was performed to obtain the DDS cut-off. The Mann–Whitney test was performed to compare DDS between the NG and UG. Logistic regression analysis was conducted to examine the likelihood of potential factors in predicting nutritional status outcome.
Results: Overall, almost half of the girls’ daily food intake showed low dietary diversity based on DDS cut-off <5, with no significant difference between NG and UG adolescents. Protein intake inadequacy showed significant unlikelihood of a NG outcome (OR=0.4; 95% CI: 0.2-0.8), while low socioeconomic status (SES) showed a strong likelihood of an UG (OR=2.7; 95% CI: 1.3-5.5) compared to high SES.
Conclusion: Low dietary intake and DDS were common among adolescent schoolgirls in slum areas in Jakarta. Nutrition interventions promoting appropriate dietary intake among adolescent girls are recommended.
Key words: Adolescent girls, dietary diversity, nutrient adequacy, undernutrition, Jakarta slums
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Introduction: Undernutrition among adolescent girls is an important concern due to their rapid growth velocity that requires adequate intake of energy and nutrients. This study compared intake adequacy and dietary diversity between adolescent public schoolgirls from slum areas in Central Jakarta who had normal and poor nutritional status.
Methods: A total of 220 eligible girls aged 14–18 years were recruited, with an equal proportion in the normal group (NG) [-1 to +1 SD body mass index-for-age z-score (BAZ)], and undernutrition group (UG) (BAZ < -1SD). Dietary intake was assessed using two non-consecutive 24-hour recalls. Dietary diversity scores (DDS) were determined with reference to the intake of 13 food groups with a minimum daily intake of 15 gram/food group. Receiver operating curve analysis was performed to obtain the DDS cut-off. The Mann–Whitney test was performed to compare DDS between the NG and UG. Logistic regression analysis was conducted to examine the likelihood of potential factors in predicting nutritional status outcome.
Results: Overall, almost half of the girls’ daily food intake showed low dietary diversity based on DDS cut-off <5, with no significant difference between NG and UG adolescents. Protein intake inadequacy showed significant unlikelihood of a NG outcome (OR=0.4; 95% CI: 0.2-0.8), while low socioeconomic status (SES) showed a strong likelihood of an UG (OR=2.7; 95% CI: 1.3-5.5) compared to high SES.
Conclusion: Low dietary intake and DDS were common among adolescent schoolgirls in slum areas in Jakarta. Nutrition interventions promoting appropriate dietary intake among adolescent girls are recommended.
Key words: Adolescent girls, dietary diversity, nutrient adequacy, undernutrition, Jakarta slums
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Food purchasing behaviour among urban slum women in East Jakarta: a qualitative study
Dian Sufyan, Judhiastuty Februhartanty, Saptawati Bardosono, Helda Khusun, Evi Ermayani, Purnawati Hustina Rachman & Anthony Worsley
ABSTRACT
Introduction: Urbanisation in Indonesia has been associated with a transition in nutrition which has been, in part, marked by an increased purchasing of readyto-eat, energy-dense, nutrient-poor foods. Women are responsible for purchasing and preparing food for the family. Their purchasing behaviours differ in various environments and population groups. This qualitative study was undertaken to explore the food environmental factors that influenced food purchasing behaviour of women who were the household food gatekeepers.
Methods: The study was conducted in a slum area in East Jakarta. Eighteen overweight-obese and nonobese women who fulfilled the study’s inclusion criteria were recruited for interviews that used a semi-structured questionnaire. Emic observations were conducted in order to identify typical food purchasing activities. The data were coded and categorised using qualitative data analysis and research software (Atlas.ti 7 for Windows).
Results: Most of the women purchased ready-to-eat foods rather than cook at home, either for the family or their own consumption. Several food environmental factors influenced women’s purchasing behaviour, including time and cost efficiency, food availability, family, exposure to ready-to-eat foods and food store marketing strategies. These factors led to the consumption of unhealthy foods that were high in fat, carbohydrate, sugar and salt that some of which may cause obesity.
Conclusion: Purchasing unhealthy food was observed to be strongly linked with food-related environmental factors. This study provides an understanding of women’s food purchasing behaviour and highlight potential ways to foster healthier purchasing behaviour among urban slum dwellers.
Key words: Food purchasing behaviour, food environment, food stores, urban slum women, Indonesia
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Introduction: Urbanisation in Indonesia has been associated with a transition in nutrition which has been, in part, marked by an increased purchasing of readyto-eat, energy-dense, nutrient-poor foods. Women are responsible for purchasing and preparing food for the family. Their purchasing behaviours differ in various environments and population groups. This qualitative study was undertaken to explore the food environmental factors that influenced food purchasing behaviour of women who were the household food gatekeepers.
Methods: The study was conducted in a slum area in East Jakarta. Eighteen overweight-obese and nonobese women who fulfilled the study’s inclusion criteria were recruited for interviews that used a semi-structured questionnaire. Emic observations were conducted in order to identify typical food purchasing activities. The data were coded and categorised using qualitative data analysis and research software (Atlas.ti 7 for Windows).
Results: Most of the women purchased ready-to-eat foods rather than cook at home, either for the family or their own consumption. Several food environmental factors influenced women’s purchasing behaviour, including time and cost efficiency, food availability, family, exposure to ready-to-eat foods and food store marketing strategies. These factors led to the consumption of unhealthy foods that were high in fat, carbohydrate, sugar and salt that some of which may cause obesity.
Conclusion: Purchasing unhealthy food was observed to be strongly linked with food-related environmental factors. This study provides an understanding of women’s food purchasing behaviour and highlight potential ways to foster healthier purchasing behaviour among urban slum dwellers.
Key words: Food purchasing behaviour, food environment, food stores, urban slum women, Indonesia
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Exposure and approval of food marketing strategies: a mixed methods study among household food providers in Jakarta
Selma Avianty, Helda Khusun, Saptawati Bardosono, Judhiastuty Februhartanty & Anthony Worsley
ABSTRACT
Introduction: Food marketing influences consumers’ food choices leading to unplanned food purchasing.
Methods: This study used a mixed methods approach to investigate the association between food marketing exposure and approval of food marketing strategies among household food providers in Jakarta. Responses from 279 survey participants to questions on exposure and their approval of marketing strategies were analysed. An additional 16 informants who fulfilled the inclusion criteria were recruited for the in-depth interview. Logistic regression was conducted to assess the relationship between the categorical predictor variable (“exposure to active or passive marketing”) and the categorical outcome variable (“approval response to food marketing strategies”).
Results: Almost half of the respondents reported not having exposure to active marketing in the past month, whereas approximately one-third had experienced such exposure 1-2 times. Most of the respondents disapproved the marketing of fast foods and sugar-sweetened foods. The highest disapproval was for the placement of vending machines carrying such foods in schools (69.9%). Respondents who were exposed to active marketing at least once in the previous month were 1.99 times more likely (AOR; 95% CI: 1.07-3.73) to approve the marketing of unhealthy foods.
Conclusion: Exposure to food marketing promotion appeared to influence approval of marketing strategies among household food providers in Jakarta. In-depth interviews provided supportive evidence for the quantitative results. A mixed methods approach is suggested for larger studies to confirm these findings.
Key words: Food marketing exposure, approval of food marketing, household food providers, Indonesia
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Introduction: Food marketing influences consumers’ food choices leading to unplanned food purchasing.
Methods: This study used a mixed methods approach to investigate the association between food marketing exposure and approval of food marketing strategies among household food providers in Jakarta. Responses from 279 survey participants to questions on exposure and their approval of marketing strategies were analysed. An additional 16 informants who fulfilled the inclusion criteria were recruited for the in-depth interview. Logistic regression was conducted to assess the relationship between the categorical predictor variable (“exposure to active or passive marketing”) and the categorical outcome variable (“approval response to food marketing strategies”).
Results: Almost half of the respondents reported not having exposure to active marketing in the past month, whereas approximately one-third had experienced such exposure 1-2 times. Most of the respondents disapproved the marketing of fast foods and sugar-sweetened foods. The highest disapproval was for the placement of vending machines carrying such foods in schools (69.9%). Respondents who were exposed to active marketing at least once in the previous month were 1.99 times more likely (AOR; 95% CI: 1.07-3.73) to approve the marketing of unhealthy foods.
Conclusion: Exposure to food marketing promotion appeared to influence approval of marketing strategies among household food providers in Jakarta. In-depth interviews provided supportive evidence for the quantitative results. A mixed methods approach is suggested for larger studies to confirm these findings.
Key words: Food marketing exposure, approval of food marketing, household food providers, Indonesia
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Association between food marketing exposure and consumption of confectioneries among pre-school children in Jakarta
Maria Meilan Y Fernandez, Judhiastuty Februhartanty & Saptawati Bardosono
ABSTRACT
Introduction: Prevalence of obesity among pre-school children in Indonesia is increasing. Since food advertisements reach all age groups, this study was conducted to assess the association between food marketing exposure and children’s consumption of confectioneries at home.
Methods: Two hundred and forty caregivers of children aged 3-5 years attending 25 early childhood education centres in Central Jakarta, were interviewed in this cross-sectional study. A structured food frequency questionnaire was used to determine food marketing exposure and child dietary consumption. Chi-square tests compared consumption of confectioneries with different levels of marketing exposure.
Results: Out of a total 240 caregivers, most were mothers of the study children (79.2%) and other family members (19.2%). The majority of the caregivers did not work (81.7%), and <15.0% had graduated from university, while 42.0% lived with extended family members. The top ten confectioneries consumed by the children included chocolate wafer crisp, chocolate stick and soft candy. Among the most common food marketing practices were as advertisements on public transport, print and electronic media. The significant associations between four food marketing practices and consumption of eight types of confectioneries were key findings of this study. Receiving food promotion through short message service (SMS) was not significantly associated with consumption of the top ten confectioneries.
Conclusion: A positive association was found between food marketing practices and consumption of confectioneries by pre-school children in Central Jakarta. An appropriate policy on food advertisements that targets children combined with parental food education is recommended for improving food consumption habits of young children.
Key words: Dietary consumption, food marketing, preschoolers, sugar and confectionery products, Indonesia
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Introduction: Prevalence of obesity among pre-school children in Indonesia is increasing. Since food advertisements reach all age groups, this study was conducted to assess the association between food marketing exposure and children’s consumption of confectioneries at home.
Methods: Two hundred and forty caregivers of children aged 3-5 years attending 25 early childhood education centres in Central Jakarta, were interviewed in this cross-sectional study. A structured food frequency questionnaire was used to determine food marketing exposure and child dietary consumption. Chi-square tests compared consumption of confectioneries with different levels of marketing exposure.
Results: Out of a total 240 caregivers, most were mothers of the study children (79.2%) and other family members (19.2%). The majority of the caregivers did not work (81.7%), and <15.0% had graduated from university, while 42.0% lived with extended family members. The top ten confectioneries consumed by the children included chocolate wafer crisp, chocolate stick and soft candy. Among the most common food marketing practices were as advertisements on public transport, print and electronic media. The significant associations between four food marketing practices and consumption of eight types of confectioneries were key findings of this study. Receiving food promotion through short message service (SMS) was not significantly associated with consumption of the top ten confectioneries.
Conclusion: A positive association was found between food marketing practices and consumption of confectioneries by pre-school children in Central Jakarta. An appropriate policy on food advertisements that targets children combined with parental food education is recommended for improving food consumption habits of young children.
Key words: Dietary consumption, food marketing, preschoolers, sugar and confectionery products, Indonesia
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Eating behaviour of young female workers with low socioeconomic status in Malang City, East Java: a qualitative study
Intan Yusuf Habibie, Inge Brouwer & Judhiastuty Februhartanty
ABSTRACT
Introduction: Eating behaviour is one of the important factors affecting nutritional status that has been widely investigated. However, there are few studies on the eating behaviour of young female workers in Indonesia. This study aimed at investigating the factors affecting eating behaviour of young female workers of low socioeconomic status in Malang, East Java province, Indonesia.
Methods: Participants were recruited using purposive sampling from low-income families living in Malang City. The eligibility criteria were based on demographic information, including monthly household income and expenses. The participants recruited comprised 21 women aged 18-22 years who were employed outside their homes, unmarried and living with their parents. A qualitative methodology was used to understand the meaning and context of the eating behaviour of these women. In-depth interviews and focus group discussions were used as the primary data collection methods.
Results: Two primary themes emerged as the main influences of the participants’ eating behaviour: individual attributes (food preferences, healthy eating knowledge and self-efficacy), and socio-environmental factors (peer influence, mother’s role and food availability). In general, the participants had some knowledge about healthy eating behaviour; however, they lacked self-efficacy to practise such behaviour.
Conclusion: Individual motivations and socio-environmental factors were found to mediate the eating behaviour of young working women from poor households. These factors should be considered when designing nutrition programmes for achieving healthier eating behaviour among young working women.
Key words: Young female workers, eating behaviour, qualitative study, low socioeconomic status, Indonesia
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Introduction: Eating behaviour is one of the important factors affecting nutritional status that has been widely investigated. However, there are few studies on the eating behaviour of young female workers in Indonesia. This study aimed at investigating the factors affecting eating behaviour of young female workers of low socioeconomic status in Malang, East Java province, Indonesia.
Methods: Participants were recruited using purposive sampling from low-income families living in Malang City. The eligibility criteria were based on demographic information, including monthly household income and expenses. The participants recruited comprised 21 women aged 18-22 years who were employed outside their homes, unmarried and living with their parents. A qualitative methodology was used to understand the meaning and context of the eating behaviour of these women. In-depth interviews and focus group discussions were used as the primary data collection methods.
Results: Two primary themes emerged as the main influences of the participants’ eating behaviour: individual attributes (food preferences, healthy eating knowledge and self-efficacy), and socio-environmental factors (peer influence, mother’s role and food availability). In general, the participants had some knowledge about healthy eating behaviour; however, they lacked self-efficacy to practise such behaviour.
Conclusion: Individual motivations and socio-environmental factors were found to mediate the eating behaviour of young working women from poor households. These factors should be considered when designing nutrition programmes for achieving healthier eating behaviour among young working women.
Key words: Young female workers, eating behaviour, qualitative study, low socioeconomic status, Indonesia
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Eating behaviour of adolescent schoolgirls in Malang, East Java: a qualitative study
Mulia Sondari, Inge Brouwer & Judhiastuty Februhartanty
ABSTRACT
Introduction: Poor eating behaviour is known to lead to nutritional deficiency among adolescents. At the same time, poor eating behaviour characterised by dietary excesses could lead to overweight and obesity. The present study aimed to explore the eating behaviour of adolescent schoolgirls in Malang, East Java Province, Indonesia, and to determine the factors that influenced their eating behaviour.
Methods: This was a qualitative study, guided by the Social Cognitive Theory (SCT), which focused on individual and environmental influences to better understand health-related behaviours, such as eating behaviour. Triangulation was applied to the study subjects (adolescent girls, their mothers, and school staff). The methods used included individual in-depth interviews and focus group discussions. Qualitative data analyses were performed using Atlas.ti 7.
Results: Most participants showed poor eating behaviour that was characterised by skipping breakfast, frequent consumption of fast foods and the consumption of local food with low nutrient content. Their eating behaviour was influenced by individual factors including personal preferences, the price of the food, and by environmental factors, such as the family, school and neighbourhood.
Conclusion: Our findings showed that adolescent girls in Malang appeared to be aware of healthy eating but they showed unsatisfactory eating practices. Interventions are suggested to improve the poor eating behaviour of the adolescents toward avoiding malnutrition consequences.
Key words: Eating behaviour, adolescent schoolgirls, Malang, Indonesia
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Introduction: Poor eating behaviour is known to lead to nutritional deficiency among adolescents. At the same time, poor eating behaviour characterised by dietary excesses could lead to overweight and obesity. The present study aimed to explore the eating behaviour of adolescent schoolgirls in Malang, East Java Province, Indonesia, and to determine the factors that influenced their eating behaviour.
Methods: This was a qualitative study, guided by the Social Cognitive Theory (SCT), which focused on individual and environmental influences to better understand health-related behaviours, such as eating behaviour. Triangulation was applied to the study subjects (adolescent girls, their mothers, and school staff). The methods used included individual in-depth interviews and focus group discussions. Qualitative data analyses were performed using Atlas.ti 7.
Results: Most participants showed poor eating behaviour that was characterised by skipping breakfast, frequent consumption of fast foods and the consumption of local food with low nutrient content. Their eating behaviour was influenced by individual factors including personal preferences, the price of the food, and by environmental factors, such as the family, school and neighbourhood.
Conclusion: Our findings showed that adolescent girls in Malang appeared to be aware of healthy eating but they showed unsatisfactory eating practices. Interventions are suggested to improve the poor eating behaviour of the adolescents toward avoiding malnutrition consequences.
Key words: Eating behaviour, adolescent schoolgirls, Malang, Indonesia
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Perceptions of the causes of obesity among normal weight, overweight and obese Indonesian women: a mixed methods approach
Ismi Irfiyanti Fachruddin, Judhiastuty Februhartanty, Saptawati Bardosono, Helda Khusun & Anthony Worsley
ABSTRACT
Introduction: Overweight and obesity (OW/OB) among adults is a public health concern in Indonesia. While OW/OB is generally attributed to consumption in excess of expended energy, understanding the perceptions of the causes of obesity among OW/OB individuals may provide insights for developing appropriate obesity-reduction interventions.
Methods: This study used a mixed methods approach, comprising a quantitative online survey and in-depth interviews. The online “International Families and Food Survey” was conducted in 2014 by Global Market Insite (GMI) to elicit response of Indonesian women to 12 likely causes of obesity, based on a 5-point rating ranging from ‘definitely disagree’ to ‘definitely agree’. A total of 377 respondents aged 18-49 years from Jakarta participated, comprising 221 normal weight (NW) and 156 OW/OB based on World Health Organization (WHO) cut-offs. Additional 16 informants who fulfilled the inclusion criteria were recruited for indepth interviews to gather further insights on causes of obesity. Logistic regression was conducted to assess the likelihood of socioeconomic factors in predicting “agreement on the likely causes of obesity”.
Results: The online survey showed that the NW and OW/OB respondents provided quite similar rating response to each of the likely causes of obesity. Unmarried and middle socioeconomic status (SES) respondents were significantly more likely to agree on the perceived causes of obesity, compared to married and high SES. In-depth interviews revealed OW/OB informants attributed obesity to environmental factors, compared to individual factors attributed by NW informants.
Conclusion: Use of mixed methods approach provided insights for the development of obesity-reduction interventions among Indonesian adult women.
Key words: Indonesia, obesity, overweight, women, perception on obesity causes
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Introduction: Overweight and obesity (OW/OB) among adults is a public health concern in Indonesia. While OW/OB is generally attributed to consumption in excess of expended energy, understanding the perceptions of the causes of obesity among OW/OB individuals may provide insights for developing appropriate obesity-reduction interventions.
Methods: This study used a mixed methods approach, comprising a quantitative online survey and in-depth interviews. The online “International Families and Food Survey” was conducted in 2014 by Global Market Insite (GMI) to elicit response of Indonesian women to 12 likely causes of obesity, based on a 5-point rating ranging from ‘definitely disagree’ to ‘definitely agree’. A total of 377 respondents aged 18-49 years from Jakarta participated, comprising 221 normal weight (NW) and 156 OW/OB based on World Health Organization (WHO) cut-offs. Additional 16 informants who fulfilled the inclusion criteria were recruited for indepth interviews to gather further insights on causes of obesity. Logistic regression was conducted to assess the likelihood of socioeconomic factors in predicting “agreement on the likely causes of obesity”.
Results: The online survey showed that the NW and OW/OB respondents provided quite similar rating response to each of the likely causes of obesity. Unmarried and middle socioeconomic status (SES) respondents were significantly more likely to agree on the perceived causes of obesity, compared to married and high SES. In-depth interviews revealed OW/OB informants attributed obesity to environmental factors, compared to individual factors attributed by NW informants.
Conclusion: Use of mixed methods approach provided insights for the development of obesity-reduction interventions among Indonesian adult women.
Key words: Indonesia, obesity, overweight, women, perception on obesity causes
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A qualitative study comparing the coping strategies between food secure and food insecure households of Kaluppini indigenous people in South Sulawesi
Nurbaya, Aria Kekalih & Judhiastuty Februhartanty
ABSTRACT
Introduction: Food insecurity remains a global challenge, especially among vulnerable indigenous populations. Coping strategies to maintain food security among indigenous groups can be unique and complex, being influenced by cultures. This study aimed to explore the coping strategies employed by food secure and food insecure households in times of food insufficiency, in the Kaluppini indigenous population of South Sulawesi, Indonesia.
Methods: The study recruited mothers of children aged below 5 years, who agreed to participate in the study’s focus group discussions (FGDs) and in-depth interviews. All information was recorded, transcribed verbatim and analysed.
Results: A total of 61 mothers participated in 22 in-depth interviews and six FGDs. Five coping strategies were used by the Kaluppini people i.e. additional income generation, dietary alteration, access to alternative food sources, access to alternative cash sources, and, traditional ways of coping. Both food insecure and secure households reported making dietary changes, such as reducing consumption or substituting foods, borrowing food or money, and practising traditional coping strategies, such as food sharing after performing rituals. In order to generate income, food insecure households reported seeking additional work in the neighbourhood areas, while food secure households migrated in search of work to the other islands or other countries.
Conclusion: Food insecure and food secure households changed their diets, borrowed food or money from relatives and relied on traditional coping mechanisms such as food sharing. It is suggested that food insecure Kaluppini households be encouraged to grow essential foods in their gardens to enhance food security.
Key words: Food security, coping strategies, indigenous people, Indonesia
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Introduction: Food insecurity remains a global challenge, especially among vulnerable indigenous populations. Coping strategies to maintain food security among indigenous groups can be unique and complex, being influenced by cultures. This study aimed to explore the coping strategies employed by food secure and food insecure households in times of food insufficiency, in the Kaluppini indigenous population of South Sulawesi, Indonesia.
Methods: The study recruited mothers of children aged below 5 years, who agreed to participate in the study’s focus group discussions (FGDs) and in-depth interviews. All information was recorded, transcribed verbatim and analysed.
Results: A total of 61 mothers participated in 22 in-depth interviews and six FGDs. Five coping strategies were used by the Kaluppini people i.e. additional income generation, dietary alteration, access to alternative food sources, access to alternative cash sources, and, traditional ways of coping. Both food insecure and secure households reported making dietary changes, such as reducing consumption or substituting foods, borrowing food or money, and practising traditional coping strategies, such as food sharing after performing rituals. In order to generate income, food insecure households reported seeking additional work in the neighbourhood areas, while food secure households migrated in search of work to the other islands or other countries.
Conclusion: Food insecure and food secure households changed their diets, borrowed food or money from relatives and relied on traditional coping mechanisms such as food sharing. It is suggested that food insecure Kaluppini households be encouraged to grow essential foods in their gardens to enhance food security.
Key words: Food security, coping strategies, indigenous people, Indonesia
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Early development process of drama and storytelling scripts as media for nutrition education on balanced diets among elementary school children
Suci Destriatania, Fenny Etrawati & Judhiastuty Februhartanty
ABSTRACT
Introduction: The Indonesian Guide on Balanced Nutrition endorsed in 2014, needs to be more widely publicised. One way is to use fun learning methods such as drama and storytelling, especially in schools. This study aimed to develop drama and storytelling scripts for educating students on balanced nutrition.
Methods: Sixteen focus group discussions (FDGs) with thematic activities were conducted among 96 mother-child pairs in four elementary schools. The mothers’ age ranged from 30-50 years and the children 9-13 years. In-depth interviews were conducted with eight teachers (two from each participating school). The FGDs and interviews were designed to elicit information on knowledge and implementation of balanced nutrition guidelines at three levels, namely intrapersonal (students), family (mother) and environment (school teacher). Content analysis was used to identify relevant themes, which were developed into scripts for drama and storytelling.
Results: The students, mothers, and teachers were not familiar with the general guidelines for balanced nutrition. The lack of variety of the food provided at home was reported. The draft scripts were discussed and modified for accuracy of the nutrition messages that were applied in character dialogues, song lyrics, dramas and storytelling.
Conclusion: Storytelling and drama are effective for use by teachers and mothers for delivering nutrition messages in schools and the home.
Key words: Drama, storytelling, nutrition education, elementary school students, Indonesia
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Introduction: The Indonesian Guide on Balanced Nutrition endorsed in 2014, needs to be more widely publicised. One way is to use fun learning methods such as drama and storytelling, especially in schools. This study aimed to develop drama and storytelling scripts for educating students on balanced nutrition.
Methods: Sixteen focus group discussions (FDGs) with thematic activities were conducted among 96 mother-child pairs in four elementary schools. The mothers’ age ranged from 30-50 years and the children 9-13 years. In-depth interviews were conducted with eight teachers (two from each participating school). The FGDs and interviews were designed to elicit information on knowledge and implementation of balanced nutrition guidelines at three levels, namely intrapersonal (students), family (mother) and environment (school teacher). Content analysis was used to identify relevant themes, which were developed into scripts for drama and storytelling.
Results: The students, mothers, and teachers were not familiar with the general guidelines for balanced nutrition. The lack of variety of the food provided at home was reported. The draft scripts were discussed and modified for accuracy of the nutrition messages that were applied in character dialogues, song lyrics, dramas and storytelling.
Conclusion: Storytelling and drama are effective for use by teachers and mothers for delivering nutrition messages in schools and the home.
Key words: Drama, storytelling, nutrition education, elementary school students, Indonesia
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Malaysian Journal of Nutrition (Mal J Nutr)
Volume 25 No.2, 2019
Table of Content
Factors associated with food choices among elderly: a scoping review
Fatin Izzaty Mohd Shahrin, Noraida Omar, Zulfitri ‘Azuan Mat Daud & Nor Fadhlina Zakaria
doi: https://doi.org/10.31246/mjn-2018-0133
ABSTRACT
Introduction: The aging population is a matter of global concern. Age-related physiological, pathological, psychosocial, economic, cultural and environmental changes are common and may greatly influence the quality of life of the elderly. The aim of this review was to explore the determinants and motivations that drive the elderly in making food choices.
Methods: The search strategy of this literature review used the PRISMA protocol. Potential literature that was related to food choices was identified using two different combinations of keywords and two major electronic search engines, namely Pubmed and Science Direct. The articles that were selected for this review had to be in the English language, open-accessed and published between January 2007 and December 2017.
Results: From a search of 1398 articles, 15 articles (seven quantitative and eight qualitative) were identified that were related to food choices among the elderly. The key factor that determined food choices among the elderly population was identified to be health. Others included convenience, sensory appeal, price, early food experience and more. The limitations of these studies that were reported were the small sample size and the reliance on self-reporting. The conclusions that were drawn were for specific groups that were studied in this review should be extrapolated or generalised with caution.
Conclusion: Strategies for intervention programmes should be undertaken in collaboration with health professionals, researchers, policymakers, and the food industry. Future research is needed in the elderly who have chronic diseases, are dependent or who have disabilities.
Key words: Food choice, food intake, elderly, nutrition, scoping review
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Introduction: The aging population is a matter of global concern. Age-related physiological, pathological, psychosocial, economic, cultural and environmental changes are common and may greatly influence the quality of life of the elderly. The aim of this review was to explore the determinants and motivations that drive the elderly in making food choices.
Methods: The search strategy of this literature review used the PRISMA protocol. Potential literature that was related to food choices was identified using two different combinations of keywords and two major electronic search engines, namely Pubmed and Science Direct. The articles that were selected for this review had to be in the English language, open-accessed and published between January 2007 and December 2017.
Results: From a search of 1398 articles, 15 articles (seven quantitative and eight qualitative) were identified that were related to food choices among the elderly. The key factor that determined food choices among the elderly population was identified to be health. Others included convenience, sensory appeal, price, early food experience and more. The limitations of these studies that were reported were the small sample size and the reliance on self-reporting. The conclusions that were drawn were for specific groups that were studied in this review should be extrapolated or generalised with caution.
Conclusion: Strategies for intervention programmes should be undertaken in collaboration with health professionals, researchers, policymakers, and the food industry. Future research is needed in the elderly who have chronic diseases, are dependent or who have disabilities.
Key words: Food choice, food intake, elderly, nutrition, scoping review
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Overweight and obesity among Orang Asli adults in Krau Wildlife Reserve, Pahang: a four-year follow-up study
Chua Ee Yin, Zalilah Mohd Shariff, Norhasmah Sulaiman & Geeta Appannah
doi: https://doi.org/10.31246/mjn-2018-0169
ABSTRACT
Introduction: Obesity and excess weight gain in adults are linked to an increased risk of cardiometabolic abnormalities. The changing lifestyle experienced by the Orang Asli predisposes the population to the risk of obesity and non-communicable diseases. This study aimed to describe the prevalence of overweight and obesity as well as body-weight change over a period of four years among Orang Asli adults.
Methods: Data were collected from Orang Asli adults aged ≥18 years, who were enrolled in the 2011-2012 and 2015-2016 surveys, and who were residing within the Krau Wildlife Reserve. Weight and height of the adults (N2011-2012=828; N2015- 2016=662) were measured at both time points. Follow-up data were available for 378 adults (male:113; female:265).
Results: The prevalence of overweight and obesity were 18.8% and 7.4% in 2011-2012 and 26.1% and 9.5% in 2015-2016. In the follow-up group, significant differences in body weight and body mass index (BMI) were observed in men and women, respectively. More than one-third (35.5%) of the adults had weight gain of more than 5.0%. The increasing percentage of body weight change was associated with being female, younger age, more years of schooling and reduced household income.
Conclusion: Obesity is a growing health problem in the Orang Asli adult population. Weight gain was associated with socioeconomic indicators and it was more prominent in women. Effective strategies are needed to address the increasing prevalence of overweight and obesity in this population to further reduce adverse health outcomes.
Key words: Overweight and obesity, weight gain, Orang Asli adults
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Introduction: Obesity and excess weight gain in adults are linked to an increased risk of cardiometabolic abnormalities. The changing lifestyle experienced by the Orang Asli predisposes the population to the risk of obesity and non-communicable diseases. This study aimed to describe the prevalence of overweight and obesity as well as body-weight change over a period of four years among Orang Asli adults.
Methods: Data were collected from Orang Asli adults aged ≥18 years, who were enrolled in the 2011-2012 and 2015-2016 surveys, and who were residing within the Krau Wildlife Reserve. Weight and height of the adults (N2011-2012=828; N2015- 2016=662) were measured at both time points. Follow-up data were available for 378 adults (male:113; female:265).
Results: The prevalence of overweight and obesity were 18.8% and 7.4% in 2011-2012 and 26.1% and 9.5% in 2015-2016. In the follow-up group, significant differences in body weight and body mass index (BMI) were observed in men and women, respectively. More than one-third (35.5%) of the adults had weight gain of more than 5.0%. The increasing percentage of body weight change was associated with being female, younger age, more years of schooling and reduced household income.
Conclusion: Obesity is a growing health problem in the Orang Asli adult population. Weight gain was associated with socioeconomic indicators and it was more prominent in women. Effective strategies are needed to address the increasing prevalence of overweight and obesity in this population to further reduce adverse health outcomes.
Key words: Overweight and obesity, weight gain, Orang Asli adults
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Overweight and obesity in patients with cancer: study in Dharmais National Cancer Hospital, Jakarta
Noorwati Sutandyo & Ririn Hariani
doi: https://doi.org/10.31246/mjn-2018-0164
ABSTRACT
Introduction: Overweight and obesity are considered risk factors for several solid and blood cancers. However, body mass index (BMI) is rarely assessed in newly diagnosed patients with cancer. This study aimed to evaluate BMI and its associated factors in patients with cancer.
Methods: This cross-sectional study enrolled newly diagnosed cancer patients over the period January 2015–December 2017 at the Dharmais National Cancer Hospital, Jakarta. Demographic and clinical data were retrieved from the medical records. BMI was calculated for each patient. Comorbidity was evaluated using the Charlson Comorbidity Index.
Results: In total, 696 newly diagnosed cancer patients were enrolled, with women in predominance (66.2%). The mean patient age was 54.0±12.8 years. Most patients (90.7%) had solid tumours; breast and lung cancers were the most common diagnosis. Among haematological malignancies, lymphoma was the most common (55.4%). Overweight or obesity, noted in 309 (44.4%) patients, was significantly associated with age, sex (women) and haematological malignancies. No association between disease stage and BMI was observed. Among patients with solid tumours, age and sex (women) was associated with overweight and obesity.
Conclusion: The prevalence of overweight and obesity in newly diagnosed cancer patients was 44.4%. The proportion of this association was more prominent in women and in those with haematological malignancies. Among solid tumours, age and the female sex demonstrated the strongest association with overweight and obesity. Additional studies to assess whether certain dietary patterns and physical activity levels are risk factors for cancer are warranted.
Key words: Body mass index, cancer, obesity, overweight
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Introduction: Overweight and obesity are considered risk factors for several solid and blood cancers. However, body mass index (BMI) is rarely assessed in newly diagnosed patients with cancer. This study aimed to evaluate BMI and its associated factors in patients with cancer.
Methods: This cross-sectional study enrolled newly diagnosed cancer patients over the period January 2015–December 2017 at the Dharmais National Cancer Hospital, Jakarta. Demographic and clinical data were retrieved from the medical records. BMI was calculated for each patient. Comorbidity was evaluated using the Charlson Comorbidity Index.
Results: In total, 696 newly diagnosed cancer patients were enrolled, with women in predominance (66.2%). The mean patient age was 54.0±12.8 years. Most patients (90.7%) had solid tumours; breast and lung cancers were the most common diagnosis. Among haematological malignancies, lymphoma was the most common (55.4%). Overweight or obesity, noted in 309 (44.4%) patients, was significantly associated with age, sex (women) and haematological malignancies. No association between disease stage and BMI was observed. Among patients with solid tumours, age and sex (women) was associated with overweight and obesity.
Conclusion: The prevalence of overweight and obesity in newly diagnosed cancer patients was 44.4%. The proportion of this association was more prominent in women and in those with haematological malignancies. Among solid tumours, age and the female sex demonstrated the strongest association with overweight and obesity. Additional studies to assess whether certain dietary patterns and physical activity levels are risk factors for cancer are warranted.
Key words: Body mass index, cancer, obesity, overweight
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Sensitivity of plasma cholecystokinin and peptide YY in obese and normal weight men
Dian Handayani, Inggita Kusumastuty, Sri Andarini, Nindy Sabrina, Achmad Rudijanto & Xu Feng Huang
doi: https://doi.org/10.31246/mjn-2018-0112
ABSTRACT
Introduction: Cholecystokinin (CCK) and peptide YY (PYY) are satiety-stimulating hormones that are released during eating. As such, their levels may be used useful in obesity intervention. The aims of this study were to determine the optimal cutoff values, sensitivity and specificity of plasma CCK and PYY in adult men, in order to determine hormonal dysfunction in obesity.
Methods: We investigated 16 obese [body mass index (BMI) ≥25.1)] and 16 normal weight (BMI 18.5–22.9) men. They ate isocaloric fast-food for breakfast. Blood for the determination of the hormones was collected at 0 (before), 30, 60, and 120 minutes after consumption. The data that was obtained were analysed using an independent t-test or the Mann– Whitney U-test. The receiver operating characteristic (ROC) curve was drawn and the trapezoidal rule analysis was performed to determine the area under the curve, to determine the optimal cut-off values, sensitivity and specificity.
Results: In obese subjects, CCK was lower compared with normal weight subjects at any time (p<0.05). There were no major differences in PYY among subject groups. ROC curve analysis demonstrated that the plasma CCK had an optimal cut-off of 6,310 pg/ ml at 120 minutes after eating, with 0.97 area under curve (AUC), sensitivity was 94%, and specificity was 94%. The cut-off for optimal PYY was an average of 294.5 pg/ml at 120 minutes after eating (AUC 0.74; sensitivity 75%; specificity 75%).
Conclusion: Our findings suggest that the plasma CCK level is a better potential predictor of obesity and constantly decreased over time compared to PYY.
Key words: Cholecystokinin, peptide yy, obese, receiver operating characteristic
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Introduction: Cholecystokinin (CCK) and peptide YY (PYY) are satiety-stimulating hormones that are released during eating. As such, their levels may be used useful in obesity intervention. The aims of this study were to determine the optimal cutoff values, sensitivity and specificity of plasma CCK and PYY in adult men, in order to determine hormonal dysfunction in obesity.
Methods: We investigated 16 obese [body mass index (BMI) ≥25.1)] and 16 normal weight (BMI 18.5–22.9) men. They ate isocaloric fast-food for breakfast. Blood for the determination of the hormones was collected at 0 (before), 30, 60, and 120 minutes after consumption. The data that was obtained were analysed using an independent t-test or the Mann– Whitney U-test. The receiver operating characteristic (ROC) curve was drawn and the trapezoidal rule analysis was performed to determine the area under the curve, to determine the optimal cut-off values, sensitivity and specificity.
Results: In obese subjects, CCK was lower compared with normal weight subjects at any time (p<0.05). There were no major differences in PYY among subject groups. ROC curve analysis demonstrated that the plasma CCK had an optimal cut-off of 6,310 pg/ ml at 120 minutes after eating, with 0.97 area under curve (AUC), sensitivity was 94%, and specificity was 94%. The cut-off for optimal PYY was an average of 294.5 pg/ml at 120 minutes after eating (AUC 0.74; sensitivity 75%; specificity 75%).
Conclusion: Our findings suggest that the plasma CCK level is a better potential predictor of obesity and constantly decreased over time compared to PYY.
Key words: Cholecystokinin, peptide yy, obese, receiver operating characteristic
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Plain water and beverage consumption patterns among university students in Puncak Alam, Malaysia
Nur Islami Mohd Fahmi Teng, Norsham Juliana Nordin & Aisyah Suraya Muhammad Shah
doi: https://doi.org/10.31246/mjn-2018-0128
ABSTRACT
Introduction: Data on water and sugar sweetened beverages (SSB) intake among young adults in Malaysia is sparse. This study aimed at measuring the intake of plain water and SSB among undergraduate students in a Malaysian university and examine its association with body mass index (BMI).
Methods: A total of 376 undergraduate students aged 18-30 years were recruited. A selfadministered questionnaire was used to determine the SSB consumption pattern. The questionnaire consisted of five sections that included the background of the participants, knowledge about SSB, SSB preferences, frequency and portion size.
Results: 23.9% of subjects in this study were overweight. Almost all of the subjects took outside food (93.1%) and drink (74.2%). The highest daily consumption was plain water (92.3%), with a majority drinking more than two cups at each intake. Caffeinated drinks (coffee or tea) were the most popular SSB among the students (18.4%). Most students (79.7%) did not consume SSB on a daily basis. A significant association was found between the proportion of plain water consumption and BMI (p<0.05). Those who were overweight consumed a greater amount of plain water as compared to those underweight.
Conclusion: Our findings of low plain water intake among the underweight may be used to tailor intervention efforts to increase its intake and reduce that of SSB, especially among underweight young adults.
Key words: Sugar sweetened beverages, SSB, plain water, obesity, undergraduate students
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Introduction: Data on water and sugar sweetened beverages (SSB) intake among young adults in Malaysia is sparse. This study aimed at measuring the intake of plain water and SSB among undergraduate students in a Malaysian university and examine its association with body mass index (BMI).
Methods: A total of 376 undergraduate students aged 18-30 years were recruited. A selfadministered questionnaire was used to determine the SSB consumption pattern. The questionnaire consisted of five sections that included the background of the participants, knowledge about SSB, SSB preferences, frequency and portion size.
Results: 23.9% of subjects in this study were overweight. Almost all of the subjects took outside food (93.1%) and drink (74.2%). The highest daily consumption was plain water (92.3%), with a majority drinking more than two cups at each intake. Caffeinated drinks (coffee or tea) were the most popular SSB among the students (18.4%). Most students (79.7%) did not consume SSB on a daily basis. A significant association was found between the proportion of plain water consumption and BMI (p<0.05). Those who were overweight consumed a greater amount of plain water as compared to those underweight.
Conclusion: Our findings of low plain water intake among the underweight may be used to tailor intervention efforts to increase its intake and reduce that of SSB, especially among underweight young adults.
Key words: Sugar sweetened beverages, SSB, plain water, obesity, undergraduate students
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Bioaccumulation of heavy metals in different tissues of Nile tilapia (Oreochromis niloticus) in Bangladesh
Afroza Parvin, Md Kamal Hossain, Shabiha Islam, Saborni Swarna Das, John Liton Munshi, Priyanka Dey Suchi, Mohammad Moniruzzaman, Badhan Saha & M Golam Mustafa
doi: https://doi.org/10.31246/mjn-2018-0153
ABSTRACT
Introduction: The culture of Nile tilapia (Oreochromis niloticus) has become wide spread because of its high productivity over a short period of time. Its production partially fulfills the demand for food in rural people in Bangladesh. However, the accumulation of toxic heavy metals in the human body through consumption of fish contaminated by it causes various diseases. The aim of this study was to evaluate the bioaccumulation of five heavy metals, namely, cadmium (Cd), chromium (Cr), lead (Pb), nickel (Ni) and copper (Cu) in cultured Nile tilapia in the Noakhali region of Bangladesh.
Methods: Fish were collected from three different fish farms in the Noakhali region and samples of gill, muscles and liver of tilapia were assayed for Cd, Cr, Pb, Ni and Cu using atomic absorption spectroscopy. Proximate composition of the tilapia was also determined.
Results: Metal accumulation in different tissues was as follows: liver > gill > muscle. The accumulation of metals in the muscle, gill and liver was Ni > Pb > Cr > Cu > Cd, Pb > Ni > Cu > Cr > Cd and Pb > Cu > Ni > Cr > Cd, respectively. The bioaccumulation of lead was significantly increased in liver and gill while muscle showed the lowest value.
Conclusion: It can be concluded that bioaccumulation of Pb, Cr and Ni in Nile tilapia in this study exceeds the permissible limits set for heavy metals by Food and Agriculture Organization (FAO) and International Atomic Energy Agency (IAEA)-407. This is potentially risky for consumers.
Key words: Bioaccumulation, heavy metal, gill, muscles, liver
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Introduction: The culture of Nile tilapia (Oreochromis niloticus) has become wide spread because of its high productivity over a short period of time. Its production partially fulfills the demand for food in rural people in Bangladesh. However, the accumulation of toxic heavy metals in the human body through consumption of fish contaminated by it causes various diseases. The aim of this study was to evaluate the bioaccumulation of five heavy metals, namely, cadmium (Cd), chromium (Cr), lead (Pb), nickel (Ni) and copper (Cu) in cultured Nile tilapia in the Noakhali region of Bangladesh.
Methods: Fish were collected from three different fish farms in the Noakhali region and samples of gill, muscles and liver of tilapia were assayed for Cd, Cr, Pb, Ni and Cu using atomic absorption spectroscopy. Proximate composition of the tilapia was also determined.
Results: Metal accumulation in different tissues was as follows: liver > gill > muscle. The accumulation of metals in the muscle, gill and liver was Ni > Pb > Cr > Cu > Cd, Pb > Ni > Cu > Cr > Cd and Pb > Cu > Ni > Cr > Cd, respectively. The bioaccumulation of lead was significantly increased in liver and gill while muscle showed the lowest value.
Conclusion: It can be concluded that bioaccumulation of Pb, Cr and Ni in Nile tilapia in this study exceeds the permissible limits set for heavy metals by Food and Agriculture Organization (FAO) and International Atomic Energy Agency (IAEA)-407. This is potentially risky for consumers.
Key words: Bioaccumulation, heavy metal, gill, muscles, liver
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Orange-fleshed sweet potato (Ipomoea batatas) extract
attenuates lipopolysaccharide-induced inflammation
in RAW264.7 cells via inactivation of MAPKs and IkB
signalling
Yada Saokosol, Kemika Praengam, Monruedee Sukprasansap & Siriporn
Tuntipopipat
doi: https://doi.org/10.31246/mjn-2019-0011
ABSTRACT
Introduction: Orange-fleshed sweet potato (OFSP) is an excellent source of b-carotene. Due to its health benefits, b-carotene-rich plants are receiving attention. This study aimed to assess the inhibitory effect of the ethanol extract of steamed OFSP on lipopolysaccharide (LPS)-induced inflammation in murine macrophage cell line (RAW 264.7 cells).
Methods: b-carotene, total phenolics and total flavonoids of OFSP were measured by high performance liquid chromatography (HPLC), the Folin- Ciocalteu assay and the aluminum chloride colorimetry, respectively. RAW264.7 cell monolayers were pre-treated with 0.5-2.0 mg/mL ethanol extract from steamed OFSP prior to co-incubation with or without LPS for 24 h. Culture media and cell lysate were collected to measure nitric oxide, interleukin-6 (IL-6), IL-1b, tumour necrosis factor-α, inducible nitric oxide synthase, cyclooxygenase-2, mitogen- activated protein kinases (MAPKs) and inhibitory kappa B (IkB), respectively.
Results: The ethanol extract from steamed OFSP significantly suppressed LPS- induced production of such pro-inflammatory mediators by the inactivation of MAPKs and IkB signalling pathway. The ethanol extract from steamed OFSP contained 226 μg/g DW (dry weight) of b-carotene, 2.13 mg gallic acid equivalent/g DW of total polyphenolics and 0.24 mg quercetin equivalents/g DW of total flavonoids.
Conclusion: These results indicated that bioactive compounds in steamed OFSP have anti-inflammatory potential.
Key words: Orange-fleshed sweet potato, b-carotene, anti-inflammation, RAW264.7 cells, lipopolysaccharide
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Introduction: Orange-fleshed sweet potato (OFSP) is an excellent source of b-carotene. Due to its health benefits, b-carotene-rich plants are receiving attention. This study aimed to assess the inhibitory effect of the ethanol extract of steamed OFSP on lipopolysaccharide (LPS)-induced inflammation in murine macrophage cell line (RAW 264.7 cells).
Methods: b-carotene, total phenolics and total flavonoids of OFSP were measured by high performance liquid chromatography (HPLC), the Folin- Ciocalteu assay and the aluminum chloride colorimetry, respectively. RAW264.7 cell monolayers were pre-treated with 0.5-2.0 mg/mL ethanol extract from steamed OFSP prior to co-incubation with or without LPS for 24 h. Culture media and cell lysate were collected to measure nitric oxide, interleukin-6 (IL-6), IL-1b, tumour necrosis factor-α, inducible nitric oxide synthase, cyclooxygenase-2, mitogen- activated protein kinases (MAPKs) and inhibitory kappa B (IkB), respectively.
Results: The ethanol extract from steamed OFSP significantly suppressed LPS- induced production of such pro-inflammatory mediators by the inactivation of MAPKs and IkB signalling pathway. The ethanol extract from steamed OFSP contained 226 μg/g DW (dry weight) of b-carotene, 2.13 mg gallic acid equivalent/g DW of total polyphenolics and 0.24 mg quercetin equivalents/g DW of total flavonoids.
Conclusion: These results indicated that bioactive compounds in steamed OFSP have anti-inflammatory potential.
Key words: Orange-fleshed sweet potato, b-carotene, anti-inflammation, RAW264.7 cells, lipopolysaccharide
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Under-reporting of energy and nutrient intake is a
persistent issue in the Malaysian Adult Nutrition
Surveys
Ahmad Ali Zainuddin, Norazmir Md. Nor, Safiah Md Yusof, Adriana Irawati
Nur Ibrahim, Tahir Aris & Foo Leng Huat
doi: https://doi.org/10.31246/nutriweb-2018-0022
ABSTRACT
Introduction: Under-reporting of energy intake is a common cause of bias in nutritional studies. This study was aimed at examining the extent of under- reporting of energy intake and its related characteristics among respondents in the Malaysian Adult Nutrition Survey (MANS) 2003 and MANS 2014.
Methods: The present study analysed energy intakes of 9,624 adults aged 18-59 years from the MANS in year 2014 (2,890 respondents) and 2003 (6,734 respondents) using a single 24-hour diet recall. Basal metabolic rates (BMR) were calculated from the age- and gender-specific equations of Schofield. Under-reporting was defined as an energy intake:BMR ratio of <1.2 as proposed by Goldberg.
Results: Under-reporting was found to have increased significantly from 53% in 2003 to 61% in 2014. In both surveys, under-reporting increased with higher body mass index (BMI) and older age groups. It was higher among women than men, lowest among those with primary schooling or below, and those living in Peninsular Malaysia. It was higher among rural respondents in 2014 but higher among urban respondents in 2003. The intake of energy and micronutrients increased when under-reporters were excluded.
Conclusion: Under-reporting was prevalent in both the nationwide MANS, and is associated with BMI, age, gender, education level, location strata, zone. It is important to take this factor into account when assessing dietary intake in population-based studies.
Key words: Energy intake, 24-hours diet recall, under-reporting, nutrition survey, adults
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Introduction: Under-reporting of energy intake is a common cause of bias in nutritional studies. This study was aimed at examining the extent of under- reporting of energy intake and its related characteristics among respondents in the Malaysian Adult Nutrition Survey (MANS) 2003 and MANS 2014.
Methods: The present study analysed energy intakes of 9,624 adults aged 18-59 years from the MANS in year 2014 (2,890 respondents) and 2003 (6,734 respondents) using a single 24-hour diet recall. Basal metabolic rates (BMR) were calculated from the age- and gender-specific equations of Schofield. Under-reporting was defined as an energy intake:BMR ratio of <1.2 as proposed by Goldberg.
Results: Under-reporting was found to have increased significantly from 53% in 2003 to 61% in 2014. In both surveys, under-reporting increased with higher body mass index (BMI) and older age groups. It was higher among women than men, lowest among those with primary schooling or below, and those living in Peninsular Malaysia. It was higher among rural respondents in 2014 but higher among urban respondents in 2003. The intake of energy and micronutrients increased when under-reporters were excluded.
Conclusion: Under-reporting was prevalent in both the nationwide MANS, and is associated with BMI, age, gender, education level, location strata, zone. It is important to take this factor into account when assessing dietary intake in population-based studies.
Key words: Energy intake, 24-hours diet recall, under-reporting, nutrition survey, adults
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Changes in energy and nutrient intakes among
Malaysian adults: findings from the Malaysian Adult
Nutrition Survey (MANS) 2003 and 2014
Ahmad Ali Zainuddin, Norazmir Md. Nor, Safiah Md Yusof, Adriana Irawati
Nur Ibrahim, Tahir Aris & Foo Leng Huat
doi: https://doi.org/10.31246/nutriweb-2018-0023
ABSTRACT
Introduction: Monitoring changes in energy and nutrient intakes of the population over the course of time is essential to help healthcare providers develop effective dietary policies. The aim of this study was to assess the changes in the nutrient intake and Recommended Nutrient Intake (RNI) achievements by using the data obtained from the Malaysian Adult Nutrition Surveys (MANS) that were carried out in 2003 and 2014. Mis-reporting of energy intake was taken into account.
Methods: Dietary data were obtained from MANS 2003 and MANS 2014, which involved a combined total of 4,044 randomly selected respondents, aged 18-59 years, using a single 24-hour diet recall. Energy and nutrients calculations were based on the Malaysian Food Composition database using the Nutritionist Pro software. The results were compared against the RNI for Malaysia to assess dietary adequacy.
Results: The proportions of calories derived from macronutrients were within the recommendations for a healthy diet. The consumption of protein, fat, calcium, iron and vitamin A was significantly higher in 2014 than in 2003. The consumption of protein, iron, vitamin C, and vitamin A was found to exceed the RNIs in 2014. However, carbohydrate and sodium intakes had significantly decreased. Despite the decrease, sodium intake still exceeded RNI recommendations.
Conclusion: Signs of changing energy and nutrient intakes were found, including increases in protein and fat intakes since 2003, and decreased carbohydrates. This could be an alarming indicator of the tendency to eat energy dense food among the population.
Key words: Nutrient intake, Malaysian population, 24-hours diet recall
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Introduction: Monitoring changes in energy and nutrient intakes of the population over the course of time is essential to help healthcare providers develop effective dietary policies. The aim of this study was to assess the changes in the nutrient intake and Recommended Nutrient Intake (RNI) achievements by using the data obtained from the Malaysian Adult Nutrition Surveys (MANS) that were carried out in 2003 and 2014. Mis-reporting of energy intake was taken into account.
Methods: Dietary data were obtained from MANS 2003 and MANS 2014, which involved a combined total of 4,044 randomly selected respondents, aged 18-59 years, using a single 24-hour diet recall. Energy and nutrients calculations were based on the Malaysian Food Composition database using the Nutritionist Pro software. The results were compared against the RNI for Malaysia to assess dietary adequacy.
Results: The proportions of calories derived from macronutrients were within the recommendations for a healthy diet. The consumption of protein, fat, calcium, iron and vitamin A was significantly higher in 2014 than in 2003. The consumption of protein, iron, vitamin C, and vitamin A was found to exceed the RNIs in 2014. However, carbohydrate and sodium intakes had significantly decreased. Despite the decrease, sodium intake still exceeded RNI recommendations.
Conclusion: Signs of changing energy and nutrient intakes were found, including increases in protein and fat intakes since 2003, and decreased carbohydrates. This could be an alarming indicator of the tendency to eat energy dense food among the population.
Key words: Nutrient intake, Malaysian population, 24-hours diet recall
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Consumer awareness and understanding of front-of-pack (FOP) energy icon labelling in Negeri Sembilan, Malaysia
Fatimah Sulong, Ruhaya Salleh & Zainudin Mohd Ali
doi: https://doi.org/10.31246/mjn-2018-0127
ABSTRACT
Introduction: The implementation of front-of-pack (FOP) energy icon labelling helps consumers in making good food choices. This is the first study in Malaysia focusing on such labelling since it was launched in 2012. It was aimed at determining the awareness and understanding of the FOP energy icon on food labels in Malaysia.
Methods: A total of 366 consumers aged 18-60 years old in the state of Negeri Sembilan participated in the study. A guided, self-administered survey was conducted using a convenient sampling method.
Results: The results showed that 85% of consumers surveyed were aware of FOP energy icon. Among those who were aware of the icon, 50% (n=155) were categorised as ‘excellent’ and 41% (n=128) categorised as ‘good’, for understanding the FOP.
Conclusion: This study indicated that the icon could be viewed as a potential tool to be used in conjunction with the nutrition information panel (NIP). Most of the respondents could extract nutrition information from the FOP (energy) icon. The study showed that those who had understood the icon were in the group categories of high education, youth and female. There was also no significant association between those who received nutrition labelling education and level of understanding nutrition information from the icon. Therefore, it is important to further explore the possibility the beneficial impact of FOP labelling system, including consumer education aspects.
Key words: Label, nutrition labelling, front-of-pack (FOP), energy icon
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Introduction: The implementation of front-of-pack (FOP) energy icon labelling helps consumers in making good food choices. This is the first study in Malaysia focusing on such labelling since it was launched in 2012. It was aimed at determining the awareness and understanding of the FOP energy icon on food labels in Malaysia.
Methods: A total of 366 consumers aged 18-60 years old in the state of Negeri Sembilan participated in the study. A guided, self-administered survey was conducted using a convenient sampling method.
Results: The results showed that 85% of consumers surveyed were aware of FOP energy icon. Among those who were aware of the icon, 50% (n=155) were categorised as ‘excellent’ and 41% (n=128) categorised as ‘good’, for understanding the FOP.
Conclusion: This study indicated that the icon could be viewed as a potential tool to be used in conjunction with the nutrition information panel (NIP). Most of the respondents could extract nutrition information from the FOP (energy) icon. The study showed that those who had understood the icon were in the group categories of high education, youth and female. There was also no significant association between those who received nutrition labelling education and level of understanding nutrition information from the icon. Therefore, it is important to further explore the possibility the beneficial impact of FOP labelling system, including consumer education aspects.
Key words: Label, nutrition labelling, front-of-pack (FOP), energy icon
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Demographic factors, food security, health-related quality of life and body weight status of adolescents in rural area in Mentakab, Pahang, Malaysia
Susanti Alie, Norhasmah Sulaiman, Fadilah Mohd Nor & Siti Farhana Mesbah
doi: https://doi.org/10.31246/mjn-2019-0001
ABSTRACT
Introduction: Adequate, nutritive and safe foods are crucial for growth and healthy living. Adolescents are vulnerable to food insecurity. This study was aimed at determining the demographic factors, food security status, health-related quality of life (HRQOL) and body weight status of adolescents in Mentakab, Pahang, Malaysia.
Methods: This study involved 160 households that comprised pairs of mothers and children aged 13-17 years. Face-to-face interviews were conducted with the mothers to assess their demographic and food security status (Radimer/Cornell Hunger and Food Insecurity Instrument). Meanwhile, the children answered a self-administered HRQOL questionnaire (Pediatric Quality of Life Inventory, PedsQL). Body weight and height were measured to obtain the body mass index (BMI).
Results: About 48.8% of the adolescents were from households with food insecurity. The number of school-going siblings, occupation status of mother, occupation status of father, household income and house ownership status were predictors of food security status (p<0.05). After controlling for covariates, the HRQOL score and BMI were higher in adolescents from food-secure households than adolescents from food- insecure households (p<0.01).
Conclusion: The prevalence of food insecurity was high and multifactorial. Food insecurity was further associated with HRQOL and BMI. Food assistance programmes are recommended to directly alleviate food insecurity. Concurrently, monetary and educational aids are advocated to reduce the economic burden, especially in low-income households.
Key words: Adolescents, food insecurity, health-related quality of life, Malaysia
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Introduction: Adequate, nutritive and safe foods are crucial for growth and healthy living. Adolescents are vulnerable to food insecurity. This study was aimed at determining the demographic factors, food security status, health-related quality of life (HRQOL) and body weight status of adolescents in Mentakab, Pahang, Malaysia.
Methods: This study involved 160 households that comprised pairs of mothers and children aged 13-17 years. Face-to-face interviews were conducted with the mothers to assess their demographic and food security status (Radimer/Cornell Hunger and Food Insecurity Instrument). Meanwhile, the children answered a self-administered HRQOL questionnaire (Pediatric Quality of Life Inventory, PedsQL). Body weight and height were measured to obtain the body mass index (BMI).
Results: About 48.8% of the adolescents were from households with food insecurity. The number of school-going siblings, occupation status of mother, occupation status of father, household income and house ownership status were predictors of food security status (p<0.05). After controlling for covariates, the HRQOL score and BMI were higher in adolescents from food-secure households than adolescents from food- insecure households (p<0.01).
Conclusion: The prevalence of food insecurity was high and multifactorial. Food insecurity was further associated with HRQOL and BMI. Food assistance programmes are recommended to directly alleviate food insecurity. Concurrently, monetary and educational aids are advocated to reduce the economic burden, especially in low-income households.
Key words: Adolescents, food insecurity, health-related quality of life, Malaysia
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Maternal diet and its association with human milk
energy and macronutrient composition among
exclusively breastfeeding Malaysian Malay mothers
Siti Munirah Abdul Basir, Radiah Abdul Ghani, Muhammad Ibrahim,
Muhammad Muzaffar Ali Khan Khattak, Muhammad Nor Omar & Nor Azwani
Mohd Shukri
doi: https://doi.org/10.31246/mjn-2019-0020
ABSTRACT
Introduction: This study aimed to determine the relationship of maternal dietary intake with human milk nutritional composition, among Malay mothers during the postpartum period of exclusive breastfeeding.
Methods: Human milk samples (20- 30ml) were collected from mothers (n=32) at least once monthly for six months postpartum. Macronutrients and fatty acids contents were determined using proximate analysis and gas chromatography methods, respectively. Maternal dietary intakes were recorded using the multiple-pass diet recall method prior to each milk sampling and were analysed using the Nutritionist ProTM software. Associations between the milk composition and maternal diet were tested using Spearman correlation.
Results: The energy content ranged between 49.6-59.2 kcal/100ml, protein 1.3-1.4 g/100ml, carbohydrate 6.5-9.7 g/100ml and total fat 6.5-9.7 g/100ml. The polyunsaturated, monounsaturated, and saturated fatty acids concentrations were 10.5-19.1 %, 40.6-43.5 %, and 38.0-49.7 %, respectively. During confinement (first month postpartum), total energy and total fat content of human milk were the highest whereas total carbohydrate was the lowest, compared to the rest of the exclusive breastfeeding period. In contrast, intakes of total calorie and total fat were the lowest, whereas protein was the highest during this period. However, no associations were detected between human milk nutritional contents and maternal dietary intake.
Conclusion: In our study population, the composition of maternal diet and nutritional content of human milk differed between confinement and post-confinement periods. However, the association between maternal diet and human milk composition itself warrants further investigation.
Key words: Breastfeeding, human milk, nutritional composition, maternal diet
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Introduction: This study aimed to determine the relationship of maternal dietary intake with human milk nutritional composition, among Malay mothers during the postpartum period of exclusive breastfeeding.
Methods: Human milk samples (20- 30ml) were collected from mothers (n=32) at least once monthly for six months postpartum. Macronutrients and fatty acids contents were determined using proximate analysis and gas chromatography methods, respectively. Maternal dietary intakes were recorded using the multiple-pass diet recall method prior to each milk sampling and were analysed using the Nutritionist ProTM software. Associations between the milk composition and maternal diet were tested using Spearman correlation.
Results: The energy content ranged between 49.6-59.2 kcal/100ml, protein 1.3-1.4 g/100ml, carbohydrate 6.5-9.7 g/100ml and total fat 6.5-9.7 g/100ml. The polyunsaturated, monounsaturated, and saturated fatty acids concentrations were 10.5-19.1 %, 40.6-43.5 %, and 38.0-49.7 %, respectively. During confinement (first month postpartum), total energy and total fat content of human milk were the highest whereas total carbohydrate was the lowest, compared to the rest of the exclusive breastfeeding period. In contrast, intakes of total calorie and total fat were the lowest, whereas protein was the highest during this period. However, no associations were detected between human milk nutritional contents and maternal dietary intake.
Conclusion: In our study population, the composition of maternal diet and nutritional content of human milk differed between confinement and post-confinement periods. However, the association between maternal diet and human milk composition itself warrants further investigation.
Key words: Breastfeeding, human milk, nutritional composition, maternal diet
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Validation of a semi-quantitative food frequency
questionnaire for estimating dietary omega-3 fatty
acids intake among urban Indonesian pregnant women
Dudung Angkasa, Rina Agustina, Helda Khusun & Erfi Prafiantini
doi: https://doi.org/10.31246/mjn-2019-0027
ABSTRACT
Introduction: Studies on the development and validation of semi-quantitative food frequency questionnaires (SQ-FFQ) for assessing omega-3 (Ω-3) long-chain polyunsaturated fatty acids (LC-PUFAs) intake by pregnant women are few. This study aimed to determine the validity of a newly developed SQ-FFQ for assessing the LC-PUFA intake among Indonesian urban pregnant women.
Methods: A cross- sectional study was carried out in 2015 on 100 Indonesian pregnant women who were in their late 3rd trimester, living in the urban setting of Jakarta. As a test tool, the SQ-FFQ was administered before the trained nutritionists executed the reference tool of non-consecutive two-day 24-hour dietary recalls (2DRs). The nutrients of interest were a total of Ω-3, eicosapentanoic acid (EPA), docosahexaenoic acid (DHA), alpha-linolenic acid (ALA), total Ω-6, linoleic acid (LA), arachidonic acid (AA), and LC-PUFAs. Statistical correlation, cross-classification and the Bland-Altman plot analysis were done to determine the agreement between tools.
Results: Energy-adjusted correlation coefficients between SQ-FFQ and 2DRs were 0.385, 0.349, 0.352, 0.380, 0.338, 0.408, 0.409, 0.331, 0.341 and 0.341 for fat, total Ω-3, ALA, EPA, DHA, total Ω-6, LA, AA and LC-PUFAs, respectively and were statistically significant (p<0.05). Misclassification of these nutrients from SQ-FFQ and 2DRs was <6%. The Bland-Altman plots showed most of the points fell within the 95% limits of acceptable agreement for DHA, EPA, and LA.
Conclusion: The newly developed SQ-FFQ of this study is a valid instrument for assessing of Ω-3 LC-PUFAs intake among Indonesian pregnant women living in urban area. Its further validation with relevant biomarkers is recommended.
Key words: Semi-quantitative food frequency questionnaire, validation, fatty acids, pregnancy, omega-3, omega-6
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Introduction: Studies on the development and validation of semi-quantitative food frequency questionnaires (SQ-FFQ) for assessing omega-3 (Ω-3) long-chain polyunsaturated fatty acids (LC-PUFAs) intake by pregnant women are few. This study aimed to determine the validity of a newly developed SQ-FFQ for assessing the LC-PUFA intake among Indonesian urban pregnant women.
Methods: A cross- sectional study was carried out in 2015 on 100 Indonesian pregnant women who were in their late 3rd trimester, living in the urban setting of Jakarta. As a test tool, the SQ-FFQ was administered before the trained nutritionists executed the reference tool of non-consecutive two-day 24-hour dietary recalls (2DRs). The nutrients of interest were a total of Ω-3, eicosapentanoic acid (EPA), docosahexaenoic acid (DHA), alpha-linolenic acid (ALA), total Ω-6, linoleic acid (LA), arachidonic acid (AA), and LC-PUFAs. Statistical correlation, cross-classification and the Bland-Altman plot analysis were done to determine the agreement between tools.
Results: Energy-adjusted correlation coefficients between SQ-FFQ and 2DRs were 0.385, 0.349, 0.352, 0.380, 0.338, 0.408, 0.409, 0.331, 0.341 and 0.341 for fat, total Ω-3, ALA, EPA, DHA, total Ω-6, LA, AA and LC-PUFAs, respectively and were statistically significant (p<0.05). Misclassification of these nutrients from SQ-FFQ and 2DRs was <6%. The Bland-Altman plots showed most of the points fell within the 95% limits of acceptable agreement for DHA, EPA, and LA.
Conclusion: The newly developed SQ-FFQ of this study is a valid instrument for assessing of Ω-3 LC-PUFAs intake among Indonesian pregnant women living in urban area. Its further validation with relevant biomarkers is recommended.
Key words: Semi-quantitative food frequency questionnaire, validation, fatty acids, pregnancy, omega-3, omega-6
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Malaysian Journal of Nutrition
Volume 25 No.3, 2019
Table of Content
Post-exercise ingestion of lactose-free skim milk affects
thirst but not subsequent performance and net fluid
balance of collegiate badminton athletes
Marla Frances T. Mallari, Alisa Nana, Metta Pinthong, Saiphon Kongkum
& Rungchai Chaunchaiyakul
doi: https://doi.org/10.31246/mjn-2018-0144
ABSTRACT
Introduction: The hydration and nutritional needs of badminton athletes are of interest because of the unique demands of the sport on the player’s physiology and skill.
Objectives: The current study investigated the acute effect of lactose-free skim milk (LFM) compared with a iso-volumic carbohydrate electrolyte sport drink (iCE) taken post exercise, on subsequent performance, net fluid balance (NFB) and other selected subjective variables (thirst, gastrointestinal comfort and palatability).
Methods: Eleven collegiate badminton athletes (five male and six female, mean age=19.6±1.7 years, body mass=56.8±5.0 kg) volunteered to participate in this crossover study, with ≥7-day washout between trials. After a 2 h training session, the participants rested for 2 h, ingested the same volume of either LFM or iCE matched for carbohydrate content of 1.0 g carbohydrate/kg body mass. Performance tests were done post-ingestion. The body mass was taken, as well as visual analog scales administered throughout the protocol.
Results: No significant difference between groups was found in terms of performance: aerobic capacity t(10)=0.147, p=0.886 and agility (sideways agility test: t(10)=0.191, p=0.852 and four-corner agility test: t(10)=0.397, p=0.700); and NFB t(10)=0.434, p=0.670. Thirst ratings between groups were significantly different at the end of the performance tests (LFM 6.71±2.09 and iCE 8.03±1.28, t(10)=-2.35, p=0.041). However, the subjective ratings for gastrointestinal comfort and palatability were similar.
Conclusion: When matched for carbohydrate content, acute post-exercise ingestion of LFM offered a significant advantage over the sports drink in terms of thirst after subsequent performance.
Key words: Lactose-free skim milk, collegiate badminton, net fluid balance, thirst
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Introduction: The hydration and nutritional needs of badminton athletes are of interest because of the unique demands of the sport on the player’s physiology and skill.
Objectives: The current study investigated the acute effect of lactose-free skim milk (LFM) compared with a iso-volumic carbohydrate electrolyte sport drink (iCE) taken post exercise, on subsequent performance, net fluid balance (NFB) and other selected subjective variables (thirst, gastrointestinal comfort and palatability).
Methods: Eleven collegiate badminton athletes (five male and six female, mean age=19.6±1.7 years, body mass=56.8±5.0 kg) volunteered to participate in this crossover study, with ≥7-day washout between trials. After a 2 h training session, the participants rested for 2 h, ingested the same volume of either LFM or iCE matched for carbohydrate content of 1.0 g carbohydrate/kg body mass. Performance tests were done post-ingestion. The body mass was taken, as well as visual analog scales administered throughout the protocol.
Results: No significant difference between groups was found in terms of performance: aerobic capacity t(10)=0.147, p=0.886 and agility (sideways agility test: t(10)=0.191, p=0.852 and four-corner agility test: t(10)=0.397, p=0.700); and NFB t(10)=0.434, p=0.670. Thirst ratings between groups were significantly different at the end of the performance tests (LFM 6.71±2.09 and iCE 8.03±1.28, t(10)=-2.35, p=0.041). However, the subjective ratings for gastrointestinal comfort and palatability were similar.
Conclusion: When matched for carbohydrate content, acute post-exercise ingestion of LFM offered a significant advantage over the sports drink in terms of thirst after subsequent performance.
Key words: Lactose-free skim milk, collegiate badminton, net fluid balance, thirst
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Physicochemical and sensory characteristics of brown
rice (Oryza sativa) noodles substituted with mung bean
(Vigna radiata) powder
Shantini Devi Muniandy & Sri Puvanesvari Gannasin
doi: https://doi.org/10.31246/mjn-2019-0022
ABSTRACT
Introduction: Rice noodles are widely consumed as a staple food in Asia. The main ingredient of rice noodle is polished white rice flour which lacks in nutritional components. Substitution of white rice flour with brown rice flour often results in noodles with better nutrient content but less favourable for cooking, textural and sensory characteristics. Thus, this study aimed to develop and characterise brown rice noodles substituted with mung bean powder at the level of 5% (g/100 g) and compared with other formulations.
Methods: Four formulations of rice noodles were prepared using: a. 100% white rice flour; b. 100% brown rice flour; c. white rice flour with 5% mung bean powder; and d. brown rice flour with 5% mung bean powder. The rice noodles were produced by conventional extrusion method and evaluated for their proximate composition, cooking qualities and sensorial properties.
Results: The results of proximate analysis indicated that protein (8.70g/100 g), dietary fibre (3.10g/100 g), ash (1.50g/100 g) and fat (2.40g/100 g) contents were significantly (p<0.05) higher in mung bean powder substituted brown rice noodles than that of white rice noodles (control). The blending of mung bean powder with brown rice flour had significantly reduced noodle cooking time and cooking loss. The sensory evaluation revealed that mung bean powder substituted brown rice noodles had similar consumer preference to control sample.
Conclusion: The blending of mung bean powder with brown rice flour had substantially improved the nutritional value and cooking qualities of the brown rice noodles while maintaining consumer acceptability.
Key words: Brown rice, mung bean, noodles, physicochemical, sensory
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Introduction: Rice noodles are widely consumed as a staple food in Asia. The main ingredient of rice noodle is polished white rice flour which lacks in nutritional components. Substitution of white rice flour with brown rice flour often results in noodles with better nutrient content but less favourable for cooking, textural and sensory characteristics. Thus, this study aimed to develop and characterise brown rice noodles substituted with mung bean powder at the level of 5% (g/100 g) and compared with other formulations.
Methods: Four formulations of rice noodles were prepared using: a. 100% white rice flour; b. 100% brown rice flour; c. white rice flour with 5% mung bean powder; and d. brown rice flour with 5% mung bean powder. The rice noodles were produced by conventional extrusion method and evaluated for their proximate composition, cooking qualities and sensorial properties.
Results: The results of proximate analysis indicated that protein (8.70g/100 g), dietary fibre (3.10g/100 g), ash (1.50g/100 g) and fat (2.40g/100 g) contents were significantly (p<0.05) higher in mung bean powder substituted brown rice noodles than that of white rice noodles (control). The blending of mung bean powder with brown rice flour had significantly reduced noodle cooking time and cooking loss. The sensory evaluation revealed that mung bean powder substituted brown rice noodles had similar consumer preference to control sample.
Conclusion: The blending of mung bean powder with brown rice flour had substantially improved the nutritional value and cooking qualities of the brown rice noodles while maintaining consumer acceptability.
Key words: Brown rice, mung bean, noodles, physicochemical, sensory
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Effect of different pre-boiling treatment on in vitro
protein and amino acid digestibility of mung beans
[Vigna radiata (L.) Wilczek]
Aree Prachansuwan, Wantanee Kriengsinyos, Kunchit Judprasong, Attawit
Kovitvadhi, & Pipatpong Chundang
doi: https://doi.org/10.31246/mjn-2019-0046
ABSTRACT
Introduction: Mung beans [Vigna radiata (L.) Wilczek] are good sources of protein. Nevertheless, its protein quality is still questionable. This study aimed to determine the effect of different processes prior to boiling, on the in vitro protein and amino acid digestibility of mung beans by using a 6-hour enzymatic digestion.
Methods: This study was based on the household method of the processes before boiling including unsoaking, soaking, and dehulling. Products from all treatment methods were analysed for proximate composition (moisture, crude protein, crude fat, ash, and dietary fibre) on a dry basis, naturally occurring anti-nutritional factors, amino acid composition, and digestibility of protein and amino acids. The amino acid composition and amino acid digestibility were used to calculate the dietary protein quality.
Results: The treatments prior to the boiling of mung beans such as dehulling, soaking and without soaking, improved protein digestibility significantly by 10.8%, 10.3%, and 12.0%, respectively, when compared with that of raw mung beans (37.9%). Of the different mung bean pre-treatments, soaking seems to have the highest value of average indispensable amino acid (IAA) digestibility (55.4%), in particularly branched-chain amino acids (66.4%). However, there was no difference in the protein quality in terms of digestible indispensable amino acid score (DIAAS) across different treatment groups.
Conclusion: The different processes performed on mung bean before boiling had only a slight impact on its amino acid digestibility and they rarely affected DIAAS values.
Key words: Protein digestibility, protein quality, amino acid digestibility, DIAAS, pre-cooking treatment, mung bean
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Introduction: Mung beans [Vigna radiata (L.) Wilczek] are good sources of protein. Nevertheless, its protein quality is still questionable. This study aimed to determine the effect of different processes prior to boiling, on the in vitro protein and amino acid digestibility of mung beans by using a 6-hour enzymatic digestion.
Methods: This study was based on the household method of the processes before boiling including unsoaking, soaking, and dehulling. Products from all treatment methods were analysed for proximate composition (moisture, crude protein, crude fat, ash, and dietary fibre) on a dry basis, naturally occurring anti-nutritional factors, amino acid composition, and digestibility of protein and amino acids. The amino acid composition and amino acid digestibility were used to calculate the dietary protein quality.
Results: The treatments prior to the boiling of mung beans such as dehulling, soaking and without soaking, improved protein digestibility significantly by 10.8%, 10.3%, and 12.0%, respectively, when compared with that of raw mung beans (37.9%). Of the different mung bean pre-treatments, soaking seems to have the highest value of average indispensable amino acid (IAA) digestibility (55.4%), in particularly branched-chain amino acids (66.4%). However, there was no difference in the protein quality in terms of digestible indispensable amino acid score (DIAAS) across different treatment groups.
Conclusion: The different processes performed on mung bean before boiling had only a slight impact on its amino acid digestibility and they rarely affected DIAAS values.
Key words: Protein digestibility, protein quality, amino acid digestibility, DIAAS, pre-cooking treatment, mung bean
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Insights into knowledge, attitude and practices on early
complementary feeding of infants among Saudi mothers
Atheer Aldossari, Dalal Alshehri, Ghadah Alzahrani, Salma Almasoud, Yousr
Alaqeel & Nada Benajiba
doi: https://doi.org/10.31246/mjn-2019-0072
ABSTRACT
Background: The World Health Organization recommends that mothers avoid early complementary feeding of infants before the age of 6 months, to promote maximum growth and health. However, this practice is still high among Saudi mothers. This study aimed to assess knowledge, attitude and practices (KAP) towards early complementary feeding among Saudi mothers in Riyadh.
Methods: A crosssectional study was conducted in Riyadh city among 771 mothers of children, aged 6-24 months. Data was collected through an online questionnaire that assessed KAP aspect regarding early complementary feeding among mothers.
Results: More than one-third of mothers (37.4%) had introduced early complementary feeding, out of which 83.3% later stated that the main reason for this was because they thought that the baby was old enough to receive complementary foods. The two most common types of complementary foods given to the baby before 6 months were liquids (83.0%) and mashed foods (72.9%). The mothers who introduced complementary feeding before 6 months of age compared to those who initiated complementary feeding after 6 months were observed to have a higher percentage of medium knowledge and neutral attitude (76.0% versus 54.4% and 55.2% versus 62.5%, (p<0.05), respectively). Mothers’ knowledge and attitude significantly influenced their practices in relation to early complementary feeding (p<0.05).
Conclusion: The findings demonstrated that the appropriate knowledge and attitude are important to promote the introduction of complementary feeding at 6 months in the population that was studied. Thus, education on complementary feeding should be promoted.
Key words: Knowledge-attitude-practices, complementary feeding before 6 months, Saudi mothers
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Background: The World Health Organization recommends that mothers avoid early complementary feeding of infants before the age of 6 months, to promote maximum growth and health. However, this practice is still high among Saudi mothers. This study aimed to assess knowledge, attitude and practices (KAP) towards early complementary feeding among Saudi mothers in Riyadh.
Methods: A crosssectional study was conducted in Riyadh city among 771 mothers of children, aged 6-24 months. Data was collected through an online questionnaire that assessed KAP aspect regarding early complementary feeding among mothers.
Results: More than one-third of mothers (37.4%) had introduced early complementary feeding, out of which 83.3% later stated that the main reason for this was because they thought that the baby was old enough to receive complementary foods. The two most common types of complementary foods given to the baby before 6 months were liquids (83.0%) and mashed foods (72.9%). The mothers who introduced complementary feeding before 6 months of age compared to those who initiated complementary feeding after 6 months were observed to have a higher percentage of medium knowledge and neutral attitude (76.0% versus 54.4% and 55.2% versus 62.5%, (p<0.05), respectively). Mothers’ knowledge and attitude significantly influenced their practices in relation to early complementary feeding (p<0.05).
Conclusion: The findings demonstrated that the appropriate knowledge and attitude are important to promote the introduction of complementary feeding at 6 months in the population that was studied. Thus, education on complementary feeding should be promoted.
Key words: Knowledge-attitude-practices, complementary feeding before 6 months, Saudi mothers
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Equations to predict height and weight in Asian-
Chinese adults
Christiani Jeyakumar Henry, Shalini Ponnalagu & Xinyan Bi
doi: https://doi.org/10.31246/mjn-2019-0033
ABSTRACT
Introduction: Height and weight measurements are required for the assessment of nutritional status. However, it is difficult to measure these parameters in nonambulatory persons. Hence, simple predictive equations that estimate these measurements using various anthropometric measurements are necessary.
Methods: A total of 441 Asian-Chinese adults (174 males, median age = 32.5, IQR: 27.8 years; 267 females, median age = 34.6, IQR: 28.5 years) were used to build height and weight sex-specific prediction equations. An additional 111 Asian- Chinese adults (44 males, median age = 31.1, IQR: 25.0 years; 67 females, median age = 30.6, IQR: 25.6 years) were used to validate the newly developed prediction equations.
Results: The best predictive model for height included arm length, knee height measurements and age (R2 = 0.70, standard error of estimate [SEE] = 3.38 for males; R2 = 0.71, SEE = 3.14 for females). The best weight predictive model included age, arm circumference and waist circumference (R2 = 0.79, SEE = 4.66 for males; R2 = 0.78, SEE = 4.38 for females). The new predictive models for height and weight have non-significant prediction biases as compared to the Cereda et al. (2010) and Ross equations, respectively.
Conclusion: Height and weight predictive equations with a higher degree of accuracy have been developed for Asian Chinese adults.
Key words: Height, weight, prediction equations, anthropometry, simple
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Introduction: Height and weight measurements are required for the assessment of nutritional status. However, it is difficult to measure these parameters in nonambulatory persons. Hence, simple predictive equations that estimate these measurements using various anthropometric measurements are necessary.
Methods: A total of 441 Asian-Chinese adults (174 males, median age = 32.5, IQR: 27.8 years; 267 females, median age = 34.6, IQR: 28.5 years) were used to build height and weight sex-specific prediction equations. An additional 111 Asian- Chinese adults (44 males, median age = 31.1, IQR: 25.0 years; 67 females, median age = 30.6, IQR: 25.6 years) were used to validate the newly developed prediction equations.
Results: The best predictive model for height included arm length, knee height measurements and age (R2 = 0.70, standard error of estimate [SEE] = 3.38 for males; R2 = 0.71, SEE = 3.14 for females). The best weight predictive model included age, arm circumference and waist circumference (R2 = 0.79, SEE = 4.66 for males; R2 = 0.78, SEE = 4.38 for females). The new predictive models for height and weight have non-significant prediction biases as compared to the Cereda et al. (2010) and Ross equations, respectively.
Conclusion: Height and weight predictive equations with a higher degree of accuracy have been developed for Asian Chinese adults.
Key words: Height, weight, prediction equations, anthropometry, simple
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Challenges in a refeeding programme: case report of an
Orang Asli boy at household level
Ajlaa A Rasid, Tang Swee Fong, Izandis Mohamad Sayed, Mohd Shazuan
Irwan Mohd Shuhaimi, Norazlina Mohd Noh, Sameeha Mohd Jamil & Poh
Bee Koon
doi: https://doi.org/10.31246/mjn-2019-0061
ABSTRACT
Introduction: The refeeding programme in government hospitals is aimed at improving the nutritional status of malnourished children with weight-for-height z-score (WHZ) below -2.0, using special therapeutic food. However, there is a lack of data on the nutritional status of indigenous (Orang Asli) children when they return to the community after hospital discharge.
Case Presentation: A 3-year-old Temiar boy residing in a tribal village in Hulu Perak was visited to determine his nutritional status following discharge from a refeeding programme in a government hospital. He was admitted to the hospital with a weight of 10.0 kg, height of 85.5 cm and WHZ of -2.09. The boy was later discharged weighing 11.0 kg, and with height unchanged at 85.5 cm and WHZ of -0.87. During our visit to the child’s home three months after discharge, his weight was 9.5 kg, height 86.0 cm, and WHZ –2.91.
Discussion: The management of the case in the hospital was based on the Malnourished Orang Asli Protocols of the hospital. Household food insecurity, feeding and care practices, unhealthy household environment and the lack of communication between hospital and community health services were all identified as risk factors for malnutrition.
Conclusion: The recurrence of malnutrition in this child, after successful improvement during hospital stay, highlights the importance of identifying factors that may affect nutritional status after hospital discharge. This knowledge will be beneficial in planning specific interventions, especially for Orang Asli children, living in remote villages.
Key words: Child, indigenous people, malnutrition, refeeding programme
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Introduction: The refeeding programme in government hospitals is aimed at improving the nutritional status of malnourished children with weight-for-height z-score (WHZ) below -2.0, using special therapeutic food. However, there is a lack of data on the nutritional status of indigenous (Orang Asli) children when they return to the community after hospital discharge.
Case Presentation: A 3-year-old Temiar boy residing in a tribal village in Hulu Perak was visited to determine his nutritional status following discharge from a refeeding programme in a government hospital. He was admitted to the hospital with a weight of 10.0 kg, height of 85.5 cm and WHZ of -2.09. The boy was later discharged weighing 11.0 kg, and with height unchanged at 85.5 cm and WHZ of -0.87. During our visit to the child’s home three months after discharge, his weight was 9.5 kg, height 86.0 cm, and WHZ –2.91.
Discussion: The management of the case in the hospital was based on the Malnourished Orang Asli Protocols of the hospital. Household food insecurity, feeding and care practices, unhealthy household environment and the lack of communication between hospital and community health services were all identified as risk factors for malnutrition.
Conclusion: The recurrence of malnutrition in this child, after successful improvement during hospital stay, highlights the importance of identifying factors that may affect nutritional status after hospital discharge. This knowledge will be beneficial in planning specific interventions, especially for Orang Asli children, living in remote villages.
Key words: Child, indigenous people, malnutrition, refeeding programme
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Validation of the 28-day mortality prognostic
performance of the modified Nutrition Risk in Critically
Ill (mNUTRIC) score in a Malaysian intensive care unit
Wan Fadzlina Wan Muhd Shukeri, Samiullah Saeed, Azrina Md Ralib & Mohd Basri Mat-Nor
doi: https://doi.org/10.31246/mjn-2019-0074
ABSTRACT
Introduction: The mNUTRIC score is a nutritional assessment tool to identify critically ill patients with high nutritional risk who could benefit from nutritional interventions. This study was conducted to validate the 28-day mortality prognostic performance of the mNUTRIC score in a Malaysian intensive care unit (ICU).
Methods: This was a retrospective cohort study of adult patients who were consecutively admitted to the ICU from January 2017 to December 2018 for >24 hours. Data were collected on variables required to calculate the mNUTRIC score. Patients with mNUTRIC score ≥5 points were considered to be at high nutritional risk. Main outcome was 28- day mortality from all causes; ICU length of stay (LOS) and prolonged mechanical ventilation (MV) (>2 days) were secondary outcomes.
Results: From a total of 432 admissions, 382 (88.4%) patients fulfilled the study criteria. Seventy-seven (20.2%) of these patients were at high nutritional risk. They had longer mean ICU LOS (7.1±7.5 days versus 4.2±4.0 days, p=0.001), greater proportion of prolonged MV (57.1% versus 14.4%, p<0.001) and higher 28-day mortality (44.2% versus 10.2%, p<0.001) compared to patients with low mNUTRIC score (≤4 points). High mNUTRIC score predicted 28-day mortality with area under the curve (AUC) of 0.797 (95% confidence interval: 0.738-0.856).
Conclusion: High mNUTRIC score was associated with a higher 28-day mortality. The prognostic performance for 28-day mortality of the mNUTRIC score is clinically valid as indicated by AUC >0.7 and is comparable to the results of other validation studies. In addition, patients with high mNUTRIC score had increased ICU LOS and prolonged MV.
Key words: Nutritional status, critically ill, mortality
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Introduction: The mNUTRIC score is a nutritional assessment tool to identify critically ill patients with high nutritional risk who could benefit from nutritional interventions. This study was conducted to validate the 28-day mortality prognostic performance of the mNUTRIC score in a Malaysian intensive care unit (ICU).
Methods: This was a retrospective cohort study of adult patients who were consecutively admitted to the ICU from January 2017 to December 2018 for >24 hours. Data were collected on variables required to calculate the mNUTRIC score. Patients with mNUTRIC score ≥5 points were considered to be at high nutritional risk. Main outcome was 28- day mortality from all causes; ICU length of stay (LOS) and prolonged mechanical ventilation (MV) (>2 days) were secondary outcomes.
Results: From a total of 432 admissions, 382 (88.4%) patients fulfilled the study criteria. Seventy-seven (20.2%) of these patients were at high nutritional risk. They had longer mean ICU LOS (7.1±7.5 days versus 4.2±4.0 days, p=0.001), greater proportion of prolonged MV (57.1% versus 14.4%, p<0.001) and higher 28-day mortality (44.2% versus 10.2%, p<0.001) compared to patients with low mNUTRIC score (≤4 points). High mNUTRIC score predicted 28-day mortality with area under the curve (AUC) of 0.797 (95% confidence interval: 0.738-0.856).
Conclusion: High mNUTRIC score was associated with a higher 28-day mortality. The prognostic performance for 28-day mortality of the mNUTRIC score is clinically valid as indicated by AUC >0.7 and is comparable to the results of other validation studies. In addition, patients with high mNUTRIC score had increased ICU LOS and prolonged MV.
Key words: Nutritional status, critically ill, mortality
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A retrospective study of weight-loss predictors
following bariatric surgery in Malaysian patients with
obesity
Fatin Hanani Mazri, Suzana Shahar, Nik Ritza Kosai, Mohd Azahadi Omar, Nilsiswati Ramilis & Reynu Rajan
doi: https://doi.org/10.31246/mjn-2018-0115
ABSTRACT
Introduction: A retrospective study was conducted with the aim of determining the factors that affect weight loss among post-bariatric surgery patients.
Methods: A successful weight loss outcome in this study was defined as achieving at least 50% excess weight loss (EWL). Eligible participants were those who had undergone bariatric surgery at least two years prior to the study. Adherence to lifestyle recommendations post-bariatric surgery, binge eating, depression, and social support were assessed.
Results: A total of 51 post-bariatric surgery patients were recruited with a mean post-operative period of 3.2±0.7 years. The mean preoperative weight of 116.6±28.8 kg and body mass index (BMI) 45.2±8.8 kg/m2 were significantly reduced to 86.6±21.0 kg and 33.6±6.7 kg/m2, respectively, during follow-up (p<0.001). A total of 66.7% of participants achieved successful weight loss following bariatric surgery, with a mean EWL of 73.6±21.9% and total weight loss (TWL) of 29.4±8.7%. According to multivariate regression analysis adjusted for age and gender, pre-operative weight (β=-1.580, p<0.05) and BMI (β=-1.398, p<0.05), rate of weight loss (β=1.045, p<0.01), and adherence to eating behaviour recommendations (β=0.177, p<0.05) were significant predictors of weight loss outcomes post-bariatric surgery.
Conclusion: The lower pre-operative weight and BMI, the faster rate of weight loss and higher adherence towards eating behaviour advice were potential predictors of greater EWL and thus could increase the chance of successful weight loss maintenance post–bariatric surgery.
Key words: Obesity, bariatric surgery, pre-operative weight, dietary adherence, rate of weight loss
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Introduction: A retrospective study was conducted with the aim of determining the factors that affect weight loss among post-bariatric surgery patients.
Methods: A successful weight loss outcome in this study was defined as achieving at least 50% excess weight loss (EWL). Eligible participants were those who had undergone bariatric surgery at least two years prior to the study. Adherence to lifestyle recommendations post-bariatric surgery, binge eating, depression, and social support were assessed.
Results: A total of 51 post-bariatric surgery patients were recruited with a mean post-operative period of 3.2±0.7 years. The mean preoperative weight of 116.6±28.8 kg and body mass index (BMI) 45.2±8.8 kg/m2 were significantly reduced to 86.6±21.0 kg and 33.6±6.7 kg/m2, respectively, during follow-up (p<0.001). A total of 66.7% of participants achieved successful weight loss following bariatric surgery, with a mean EWL of 73.6±21.9% and total weight loss (TWL) of 29.4±8.7%. According to multivariate regression analysis adjusted for age and gender, pre-operative weight (β=-1.580, p<0.05) and BMI (β=-1.398, p<0.05), rate of weight loss (β=1.045, p<0.01), and adherence to eating behaviour recommendations (β=0.177, p<0.05) were significant predictors of weight loss outcomes post-bariatric surgery.
Conclusion: The lower pre-operative weight and BMI, the faster rate of weight loss and higher adherence towards eating behaviour advice were potential predictors of greater EWL and thus could increase the chance of successful weight loss maintenance post–bariatric surgery.
Key words: Obesity, bariatric surgery, pre-operative weight, dietary adherence, rate of weight loss
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Diabetes literacy and knowledge among patients with
type 2 diabetes mellitus attending a primary care clinic
in Seremban, Malaysia
Lee Ching Li, Winnie Chee Siew Swee, Kanimolli Arasu, Kwa Siew Kim &
Siti Zubaidah Mohd Ali
doi: https://doi.org/10.31246/mjn-2019-0031
ABSTRACT
Introduction: Good health literacy and knowledge are associated with improved outcomes in diabetes. The purpose of this study was to determine diabetes-specific literacy and knowledge levels, and its associated socio-demographic factors, among adults with type 2 diabetes mellitus (T2DM).
Methods: This cross-sectional study was conducted among 196 adults from the Indian, Chinese, and Malay ethnic groups with T2DM who attended a primary care clinic in Seremban, Malaysia. The Literacy Assessment for Diabetes and Diabetes Knowledge Test 2 were used to assess diabetes-specific literacy and knowledge, respectively.
Results: The majority of participants (75.0%) had literacy scores that corresponded to Ninth Grade Level but only 3.6% of participants had a good knowledge of diabetes. Literacy scores explained up to 19.8% of the variance in knowledge scores (r=0.445, p<0.01). Indian participants had the lowest literacy and knowledge scores when compared to Chinese and Malays (p<0.05). Participants with higher education had better literacy and knowledge scores (p<0.05). Educational level was more likely than ethnicity to predict both literacy and knowledge scores (p<0.001), while gender and age did not significantly predict either score. The majority of participants could answer general questions about physical activity, diabetes-related complications and healthy eating. Knowledge of diabetes and its relation to specific foods and the effect of diet on glucose control were limited among the participants.
Conclusion: Education and ethnicity were associated with literacy and knowledge on diabetes. There existed a deficit of diabetes-related nutrition knowledge among the participants. These findings may help healthcare providers tailor individualised patient educational interventions.
Key words: Diabetes literacy, diabetes knowledge, type 2 diabetes
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Introduction: Good health literacy and knowledge are associated with improved outcomes in diabetes. The purpose of this study was to determine diabetes-specific literacy and knowledge levels, and its associated socio-demographic factors, among adults with type 2 diabetes mellitus (T2DM).
Methods: This cross-sectional study was conducted among 196 adults from the Indian, Chinese, and Malay ethnic groups with T2DM who attended a primary care clinic in Seremban, Malaysia. The Literacy Assessment for Diabetes and Diabetes Knowledge Test 2 were used to assess diabetes-specific literacy and knowledge, respectively.
Results: The majority of participants (75.0%) had literacy scores that corresponded to Ninth Grade Level but only 3.6% of participants had a good knowledge of diabetes. Literacy scores explained up to 19.8% of the variance in knowledge scores (r=0.445, p<0.01). Indian participants had the lowest literacy and knowledge scores when compared to Chinese and Malays (p<0.05). Participants with higher education had better literacy and knowledge scores (p<0.05). Educational level was more likely than ethnicity to predict both literacy and knowledge scores (p<0.001), while gender and age did not significantly predict either score. The majority of participants could answer general questions about physical activity, diabetes-related complications and healthy eating. Knowledge of diabetes and its relation to specific foods and the effect of diet on glucose control were limited among the participants.
Conclusion: Education and ethnicity were associated with literacy and knowledge on diabetes. There existed a deficit of diabetes-related nutrition knowledge among the participants. These findings may help healthcare providers tailor individualised patient educational interventions.
Key words: Diabetes literacy, diabetes knowledge, type 2 diabetes
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Existence of double burden of malnutrition among
Filipino children in the same age-groups and
comparison of their usual nutrient intake
Imelda Angeles-Agdeppa*, Patricia Isabel Gayya-Amita & Wargin P. Longalong
doi: https://doi.org/10.31246/mjn-2019-0079
ABSTRACT
Introduction: This study aimed to determine the prevalence of underweight and overweight children in the same age-groups and if differences existed in their usual nutrients intake.
Methods: Data were obtained from 8992 children aged 3-12 years who participated in 2013 National Nutrition Survey. Dietary intake information was collected using two days non-consecutive dietary recall. Usual intakes and distributions of energy and nutrients were estimated in pre-schoolers (3-5 years, n=2427), younger (6-9 years, n=3594) and older schoolchildren (10-12 years, n=2971) using PC Software for Intake Distribution Estimation (PC-SIDE) from Iowa State University. Energy inadequacy was assessed by the Estimated Energy Requirements (EER) method calculated using the equation of Institute of Medicine. The prevalence of nutrient inadequacy was estimated as the proportion of individuals with usual food intakes below the estimated average requirement (EAR).
Results: The prevalence of underweight among preschool, younger and older schoolchildren was 22%, 30% and 16%, respectively, and 4%, 9% and 10%, respectively, among overweight. The average usual energy and nutrient intake of underweight was significantly lower than overweight. The major source of energy of underweight and overweight was from carbohydrates. However, contribution of fats to total energy was higher among overweight. Most nutrients were below EAR in underweight while only folate (50-79%) and calcium (58-84%) in overweight.
Conclusion: The double burden of malnutrition co-exists in children of the same age-groups with higher prevalence nutrient inadequacies in underweight children. Percentage of fat contribution to energy intake was higher among overweight than the underweight.
Key words: Double burden of malnutrition, usual nutrient intake, Filipino children, age-groups
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Introduction: This study aimed to determine the prevalence of underweight and overweight children in the same age-groups and if differences existed in their usual nutrients intake.
Methods: Data were obtained from 8992 children aged 3-12 years who participated in 2013 National Nutrition Survey. Dietary intake information was collected using two days non-consecutive dietary recall. Usual intakes and distributions of energy and nutrients were estimated in pre-schoolers (3-5 years, n=2427), younger (6-9 years, n=3594) and older schoolchildren (10-12 years, n=2971) using PC Software for Intake Distribution Estimation (PC-SIDE) from Iowa State University. Energy inadequacy was assessed by the Estimated Energy Requirements (EER) method calculated using the equation of Institute of Medicine. The prevalence of nutrient inadequacy was estimated as the proportion of individuals with usual food intakes below the estimated average requirement (EAR).
Results: The prevalence of underweight among preschool, younger and older schoolchildren was 22%, 30% and 16%, respectively, and 4%, 9% and 10%, respectively, among overweight. The average usual energy and nutrient intake of underweight was significantly lower than overweight. The major source of energy of underweight and overweight was from carbohydrates. However, contribution of fats to total energy was higher among overweight. Most nutrients were below EAR in underweight while only folate (50-79%) and calcium (58-84%) in overweight.
Conclusion: The double burden of malnutrition co-exists in children of the same age-groups with higher prevalence nutrient inadequacies in underweight children. Percentage of fat contribution to energy intake was higher among overweight than the underweight.
Key words: Double burden of malnutrition, usual nutrient intake, Filipino children, age-groups
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