MJN 2021 Issues

Malaysian Journal of Nutrition (Mal J Nutr)

Volume 27 No.1, 2021



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Table of Content


Vitamin A knowledge and household consumption frequency of vitamin A – rich foods in Tangail, Bangladesh
Rokeya Begum, Md. Nannur Rahman, Robiul Islam, Md. Rakibul Hasan, Md. Yusuf Jamil & Sanjida Anjom Tamanna

doi: https://doi.org/10.31246/mjn-2020-0063

ABSTRACT

Introduction: Vitamin A deficiency is one of the most serious health problems in developing countries. This study aims to explore the comparative figure of vitamin A knowledge, household consumption frequency of vitamin A-rich foods, and association of socio-demographic factors with knowledge and consumption in four residential areas in Tangail district, Bangladesh.
Methods: This study used a population-based cross-sectional design with 400 study participants selected using purposive sampling technique. Knowledge and consumption frequency were assessed by a structured questionnaire along with food frequency table. Data were analysed using descriptive statistics.
Results: Only 33.5% participants had primary vitamin A knowledge, where most from urban (48.5%) and semi-urban (30.6%) areas had comparatively higher knowledge than those from rural (11.2%) and slum (9.7%) areas. Specific knowledge level was also poorer in rural and slum areas than urban and semi-urban areas. Most of the participants received knowledge through commercial advertisements (65.7%). Household consumption frequency of vitamin A-rich foods (plant and animal) was comparatively lower in rural and slum areas than in urban and semi-urban areas. Different socio-demographic factors (place of residence, education and household income) significantly influenced participant’s vitamin A knowledge and household consumption of vitamin A-rich foods (p<0.05).
Conclusion: In general, the study population lacked knowledge regarding the importance of vitamin A. Consumption frequency of vitamin A-rich foods was still poorer in slum and rural areas than in urban and semi-urban areas.
Key words: Vitamin A knowledge, consumption frequency, plant sources, animal sources, socio-demographic factors

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Determinants of fathers’ involvement in breastfeeding practices in Kuala Selangor
Nurul Izyan Mat Nawi & Syahrul Bariah Abdul Hamid

doi: https://doi.org/10.31246/mjn-2020-0070

ABSTRACT

Introduction: Fathers’ knowledge, attitude, and involvement in breastfeeding practices are crucial factors to determine the success of breastfeeding outcomes such as decision-making on breastfeeding, successfulness of exclusive breastfeeding, and continuation of breastfeeding practices. This study aimed to identify the determinants of fathers’ involvement in breastfeeding practices.
Methods: This cross-sectional study involved 203 fathers attending Maternal and Child Health Clinics in Kuala Selangor. Self-administered questionnaires were used to obtain information regarding fathers’ sociodemography, breastfeeding knowledge, attitudes, and involvement towards breastfeeding practices.
Results: Mean age of the fathers was 32.1±5.9 years, ranging between 21 to 50 years. Findings showed that majority of the fathers were involved in breastfeeding practices (52.7%; n=107, 57.0±6.2), had fair knowledge in breastfeeding (62.6%; n=127, 13.8±3.2), and showed low attitude towards breastfeeding (68.0%; n=138, 61.9±6.7). Multiple logistic regression analysis revealed factors with significant influence on fathers’ involvement towards breastfeeding practices were: (1) fathers’ breastfeeding knowledge, (2) fathers’ attitudes towards breastfeeding practices, and (3) mode of infant delivery.
Conclusion: These significant predictors may help healthcare professionals to establish effective strategies by advocating the role of fathers in the breastfeeding process such as by offering continuous support, active involvement, and effective participation.
Key words: Breastfeeding support, paternal involvement, breastfeeding knowledge, breastfeeding attitude, involvement

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REVIEW

Malnutrition and its risk factors among children and adolescents with intellectual disability (ID) in Asian countries: A scoping review
Siti Fathiah Mohamed, Soo Kah Leng & Divya Vanoh

doi: https://doi.org/10.31246/mjn-2020-0067

ABSTRACT

Introduction: Children with intellectual disability (ID) have higher probability of experiencing poor health status due to their limited ability to understand and assess information about nutrition and health. Malnutrition remains a significant health problem as it is prevalent among both typically developing and disabled children. This scoping review aims to discuss the prevalence of malnutrition among children and adolescents with ID in Asian countries.
Methods: The review was based on the PRISMA-ScR method. A systematic electronic search was conducted using databases namely PUBMED, Science Direct, Scopus, and Google Scholar for articles published from 2006-2019, written in English and involved studies in Asian countries.
Results: A total of 255,100 article’s titles were identified and only 17 articles that met the inclusion criteria were included for further analysis. The findings revealed that the range of prevalence for underweight was 5.7%-76.3% and 28.9%-45.0% for stunting. The prevalence estimated for overweight was 3.9%-46.6%, while obesity was 1.6%- 26.6%. The body mass index values ranged from 17.4±4.3kg/m2-23.0±6.3kg/m2. There were several risk factors related to malnutrition such as co-morbidity factors, behavioural factors, and parental factors.
Conclusion: This review demonstrated concern regarding the prevalence of malnutrition among children and adolescents with ID, which is high in certain Asian countries. It was varied and thus difficult to compare due to different reference standards and definitions used for malnutrition. Establishing nutrition and health-related intervention programmes can help to prevent further rise in the prevalence of malnutrition in this group.
Key words: Intellectual disability, malnutrition, overweight, obesity, underweight

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Effect of resistance training exercise combined with high protein diet on body weight and muscle mass in underweight adolescent males
Wittawas Sajjapong, Preeya Leelahagul, Sitha Pongphibool & Narupon Thongsuk

doi: https://doi.org/10.31246/mjn-2020-0039

ABSTRACT

Introduction: Many underweight males take commercial protein supplements to increase their body weight and build muscle. Nonetheless, commercial protein supplements may cause adverse effects. This study aimed to determine the effects of resistance training exercise combined with a high protein diet on body weight and muscle mass in underweight adolescent males.
Methods: A repeated measures design study was conducted on nine males aged 12-15 years with low body weight. Energy and protein requirements were calculated, and energy and protein consumptions were measured for each meal during the high protein diet without exercise (HP) period and the high protein diet with resistance exercise (HPE) period. Subjects engaged in three resistance training sessions each week during HP-E period, for eight weeks. Dietary intake, body composition, blood biochemistry, physical fitness, and self-esteem were assessed.
Results: In HP-E period, resistance training exercise combined with a high protein intake (2.14 g/kg/d) increased body weight and lean tissue mass (LTM) by 0.5 kg and 0.5 kg, respectively. Resistance training during HP-E period increased arm, leg, and trunk muscle strength by 20.2%, 7.2%, and 14.5%, respectively, more than high protein diet alone during HP period. High protein intake in HP-E period did not affect blood urea nitrogen (BUN) and creatinine levels (11.0 mg/dL and 0.70 mg/dL, respectively).
Conclusion: Eight weeks of resistance training combined with a high protein diet increased body weight and LTM without adverse effects. In particular, resistance exercise predominantly increased muscle strength. Kidney function was not affected by high protein consumption throughout this study.
Key words: High protein diet, resistance exercise, adolescent male, body weight, muscle strength

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The acceptability of weekly iron-folic acid supplementation and its influencing factors among adolescent school girls in Yogyakarta city: a mixmethods study
Muhammad Ridwan Ansari, BJ Istiti Kandarina, Nuraini Kusmayanti, Destriyani, Masfufah & Rizka Fikrinnisa

doi: https://doi.org/10.31246/mjn-2020-0019

ABSTRACT

Introduction: Indonesia has initiated the weekly iron-folic acid supplementation programme (WIFS) among adolescent school girls since 2016. However, its acceptability needs to be investigated. This study aimed to assess the acceptability of WIFS and its influencing factors.
Methods: A mixed-methods study was conducted in six schools in Yogyakarta from January-April 2018. Totally, 211 participants aged 12-18 years were involved in the cross-sectional survey, followed by four focus group discussions (FGDs) and in-depth interviews (IDIs). Body mass index-for-age, haemoglobin, serum ferritin, habitual intake, and acceptability (defined as selfreported iron-folic acid tablet consumption) were assessed.
Results: This study reported that 22.3% and 12.4% of the participants were categorised as iron deficient and anaemic, respectively. Almost 90% of participants had received the tablet, but only 62.0% of them reported consuming it. Logistic regression test indicated that the participants were more likely to take the tablet if it tasted good [OR (95%CI): 4.66 (1.90-11.43)]. Meanwhile, motivation for tablet consumption declined when respondents perceived the odour of tablet was unpleasant, reported forgetfulness, lacked peer support, and experienced side effects, with OR (95%CI) of 0.23 (0.07- 0.77), 0.35 (0.13-0.95), 0.30 (0.08-0.58), and 0.04 (0.04-0.39), respectively. The results from FGD and IDIs strengthened the findings that the experience of nausea, organoleptic properties of iron-folic acid tablet, forgetfulness, and mother’s support play important roles in students’ acceptability.
Conclusion: This study found moderate acceptability towards the WIFS programme. The inhibiting and reinforcing factors of WIFS acceptability in this study could be considered as inputs for programme improvements in the future.
Key words: Adolescent girls, Indonesia, programme acceptability, school-based programmes, weekly iron-folic acid supplementation

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Fruit and vegetable intake among overweight and obese school children: A cluster randomised control trial
Rusidah Selamat, Junidah Raib, Nur Azlina Abdul Aziz, Norlida Zulkafly, Ainan Nasrina Ismail, W Nurul Ashikin W Mohamad, Muhammad Yazid Jalaludin, Fuziah Md Zain, Zahari Ishak, Abqariyah Yahya & Abdul Halim Mokhtar

doi: https://doi.org/10.31246/mjn-2020-0023

ABSTRACT

Introduction: Adequate daily intake of fruits and vegetables is crucial for the prevention of chronic diseases. This study aimed to determine the effects of My Body is Fit and Fabulous at School (MyBFF@school) with nutrition education intervention (NEI) on the stages of change for fruit and vegetable intake among overweight and obese secondary school children based on the trans-theoretical model (TTM).
Methods: This was a cluster randomised controlled trial involving 15 out of 415 eligible government secondary schools in central Peninsular Malaysia, which were randomly assigned into intervention (six schools; 579 school children) and control (nine schools; 462 school children). The intervention group was given NEI for 24 weeks, while the control group followed the existing school programme by the Ministry of Education.
Results: There was no significant difference between the intervention and control groups for the stages of change, with majority at the maintenance stage after six months (intervention: 34.9%; control: 39.0%). The within group analysis showed a significant reduction after six months for those at the action stage (action and maintenance stage) from 68.0% to 60.4% in the intervention group and from 71.4% to 65.6% in the control group. However, there was a significant increase among those with adequate fruit and vegetable intake in the intervention group and no significant increase in the control group.
Conclusion: MyBFF@school with NEI based on TTM provided acceptable changes in fruit and vegetable intake among overweight and obese secondary school children.
Key words: Trans-theoretical model, nutrition education intervention, childhood obesity, secondary school children, cluster randomised controlled trial

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Energy and protein intakes are associated with stunting among preschool children in Central Jakarta, Indonesia: a case-control study
Sandra Fikawati, Ahmad Syafiq, Rienzy Kholifatur Ririyanti & Syilga Cahya Gemily

doi: https://doi.org/10.31246/mjn-2020-0074

ABSTRACT

Introduction: Stunting is a major nutritional problem in Indonesia. The prevalence of stunting in DKI Jakarta province was relatively high at 27.5% in 2013 and 17.7% in 2018. This study aims to describe nutrient intakes of children aged 25-30 months and to determine the proportional differences in nutrient intakes between stunting and normal children in Central Jakarta, Indonesia.
Methods: A case-control study with a total sample of 121 children aged 25-30 months was conducted in Gambir and Sawah Besar sub-districts, Central Jakarta, where the prevalence of stunting was high. All children were exclusively breastfed for at least four months and had similar socio-economic levels. Data collected included height measurement, questionnairebased interview, and 24-hour food recall. T-test and chi-square test were used to investigate the differences between two groups and logistic regression was used in multivariate analysis.
Results: Factors associated with stunting were energy intake (AOR=6.0; 95% CI=1.0-35.0) and protein intake (AOR=4.0; 95% CI=1.1-15.5) after controlling for fat, carbohydrate, vitamin C, iron, and zinc intakes. The percentage of children with energy intake below the recommendation was much higher in stunted children (86.1%) compared to normal children (43.5%). Similarly, the percentage of children with protein intake below the recommendation was very much higher among stunted children (30.6%) compared to 8.2% in normal children.
Conclusion: Children who lacked energy and protein intakes were at a higher risk of stunting than children who had sufficient intakes. Macronutrient intakes are important and should be consumed in sufficient quantities every day to prevent stunting.
Key words: Stunting, energy intake, protein intake, preschool children, nutrient intake

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Determination of the prevalence of hypertension and factors associated with blood pressure among hospitalised elderly in Hospital Serdang, Selangor, Malaysia
Siti Nurhaliza Hashidi, Noraida Omar & Siti Nur ’Asyura Adznam

doi: https://doi.org/10.31246/mjn-2020-0086

ABSTRACT

Introduction: Increasing trends of hypertension has been recognised as a common disease among the elderly. This study aimed to determine the prevalence of hypertension and factors associated with blood pressure among hospitalised elderly.
Methods: This was a cross-sectional study involving 124 patients in Hospital Serdang, Selangor, Malaysia. Data on socio-demography, medical background, anthropometry, blood biochemistry and lifestyle were collected through face-to-face interviews and medical records. Dietary intake was obtained through two days of food history. Malnutrition risks and stress level were determined using the Mini Nutritional Assessment Short-Form (MNA-SF) and the Geriatric Depression Scale (GDS).
Results: There were 59.7% males and 40.3% females with mean age of 66.81±5.35 years. Majority were found to have hypertension (72.6%). Approximately 38.7% had normal body mass index (BMI). Most of them reported insufficient dietary intakes except for trans fats, sodium, and caffeine. Nearly 62.1% were engaged with physical activity, 23.4% were smoking, and 4.8% were taking alcohol. Approximately 66.1% and 86.3% were classified as having normal nutritional status and normal stress levels. In this study, the prevalence of hypertension among elderly patients warded in Hospital Serdang, Selangor was 72.6% and factors such as length of stay, number of co-morbidities, number of medications, having co-morbidities of hypertension, dyslipidaemia and diabetes mellitus, polypharmacy, height, BMI, fibre, polyunsaturated fat, dietary cholesterol, caffeine, and duration of physical activity were found to be associated with blood pressure.
Conclusion: The present study found that majority of patients (72.6%) had hypertension. Future studies regarding factors associated with blood pressure are recommended.
Key words: Hypertension, blood pressure, elderly

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Associations of eating behaviours, fast food purchasing and availability with BMI-for-age z-score among adolescents in Labuan, Malaysia
Ho Shu Fen, Chin Yit Siew, Abdul Rashid Bin Mohamed Shariff & Lim Poh Ying

doi: https://doi.org/10.31246/mjn-2020-0026

ABSTRACT

Introduction: A cross-sectional study was conducted to determine the associations of socio-demographic factors, eating behaviours, fast food purchasing by parents for family meals, and availability of neighbourhood fast-food outlets with BMI-for-age z-score (BAZ) among adolescents.
Methods: Through multi-stage stratified cluster sampling method, a total of 420 adolescents from five selected public secondary schools participated in the current study. Data on socio-demographic factors, eating behaviours, and parent’s purchases of fast food were obtained through selfadministered questionnaires. The availability of fast-food outlets was assessed using Geographic Information System (GIS). Body weight and height of the adolescents were measured.
Results: The prevalence of overweight, obesity, thinness and severe thinness among adolescents in the present study were 17.6%, 15.5%, 3.1% and 0.7%, respectively. The current findings showed that a higher monthly household income (rs=0.12, p=0.02) and less purchases of fast food by parents for family meals (rs=-0.11, p=0.03) were significantly associated with higher BAZ of the adolescents. However, there were no significant associations between eating outside of home, eating at fast-food restaurants, buying delivery fast food, and availability of neighbourhood fast-food outlets with BAZ. Multiple linear regression showed that less purchases of fast food by parents for family meals significantly contributed towards higher BAZ (β=−0.25, p=0.02).
Conclusion: A higher household income and less fast food purchasing by parents were associated with higher BAZ. Fast food purchasing of adolescents were not associated with BAZ. Therefore, an appropriate obesity intervention programme should focus on adolescents and their parents from middle- and high-income households in Labuan.
Key words: Obesity, adolescents, household income, fast-food, GIS

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Risk factors of stunting during the complementary feeding period 6-23 months in the Philippines
Mildred O. Guirindola, Eva A. Goyena & Ma. Lynell V. Maniego

doi: https://doi.org/10.31246/mjn-2020-0112

ABSTRACT

Introduction: Stunting persists as a public health problem in the Philippines, affecting 30% of under-five children. This study aimed to identify the drivers of stunting in young Filipino children aged 6-23 months.
Methods: Data were extracted from the cross-sectional Updating Survey conducted in 2015 by the Food and Nutrition Research Institute of the Department of Science and Technology (FNRI-DOST). Potential predictors of stunting, which were categorised into childrelated characteristics, feeding practices, maternal socio-demographic status and health practices, and household economic and food security status, were examined using descriptive and regression analyses.
Results: Of the 2,275 children aged 6-23 months, 18.7% were stunted and 8.3% were severely stunted. The risk of stunting increased significantly among older children aged 12-23 months (relative risk ratio, RRR 3.04), males within 6-23 months of age (RRR 1.99), and low-birth-weight infants (RRR 2.19). Children born from teenage mothers (RRR 1.90), mothers with short stature (RRR 2.33), and mothers with low education (RRR 1.59) posed higher risks of becoming stunted relative to their counterparts. Mothers with >4 children (RRR 2.44), coming from the poorest households (RRR 4.27), having untimely introduction of complementary foods (RRR 4.44), and not meeting the minimum meal frequency (RRR 2.30) increased the risks of severe stunting.
Conclusion: The study illustrated the multi-factorial nature of stunting among Filipino children aged 6-23 months old. Therefore, a multi-sectoral approach is needed to address the underlying factors of stunting among young Filipino children to help achieve the country’s nutrition targets by 2025.
Key words: Stunting, complementary feeding, 1000 days, Philippines

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Malnutrition and its associated factors among children under 5 years old in Putrajaya: a study protocol
Mohamad Hasnan Ahmad, Nor Azian Mohd Zaki, Fatimah Othman, Azli Baharudin, Ruhaya Salleh, Cheong Siew Man, Adibah Huda Mohd Zainul Arifien, Nurin Iman Ahmad Kamal, Noor Ani Ahmad, Hazizi Abu Saad, Poh Bee Koon, Mohd Azahadi Omar & Tahir Aris

doi: https://doi.org/10.31246/mjn-2020-0075

ABSTRACT

Introduction: Prevalence of malnourished children in Putrajaya was unexpectedly high in 2016. This paper describes the study protocol for a case-control study conducted to identify the associated factors of malnutrition among children under 5 years old in Putrajaya.
Methods: This study involved two phases. Phase I was ‘screening’ where all children aged 6-59 months in 118 preschools and four government health clinics were measured for their weight and height. The World Health Organization Anthro software was used to determine the nutritional status of these children. Phase II was the ‘interview’ where children from screening were sampled into four pairs of case and control. The optimum sample size for the case of stunted, wasted, underweight, and overweight were 380, 335, 318, and 308, respectively. The same number of controls were recruited. Parents/caregivers of selected children were approached to obtain data on parental factors, children factors, food intake factors, and environmental factors that contributed to malnutrition. Data analysis was performed by multiple logistic regression in SPSS version 26.
Results: Screening phase successfully measured 8,261 (50.1%) children from an estimated 16,500 children under 5 years old in Putrajaya. The number of children who were stunted, wasted, underweight, and overweight were 2,105 (25.5%), 512 (6.2%), 1,516 (18.4%), and 248 (3.0%), respectively. As overweight was undersampled, the number of controls for overweight was doubled to increase the power of the study. Parents/caregivers of selected cases and controls were interviewed in their household or any other venues at their convenience.
Conclusion: This protocol promises beneficial outputs to stakeholders and policy makers that can be used for combating malnutrition in children.
Key words: Malnourished children, children under five, study protocol, case-control, Putrajaya

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The effect of Hylocereus polyrhizus (red dragon fruit) on whole gut transit time of young Malaysian adults
Lim Kean Ghee & Ling Chian Voon

doi: https://doi.org/10.31246/mjn-2020-0100

ABSTRACT

Introduction: The red dragon fruit (Hylocereus polyrhizus) is a popular fruit, not only where it originated from, in Central America, but across the world including in Asia. It contains healthy minerals, vitamins and antioxidants, and has been shown to have gut motility action in animals.
Methods: To determine the effect of red dragon fruit on whole gut transit time, a cross-sectional study of whole gut transit time using two different stool markers was conducted among 128 young Malaysian adults.
Results: Red dragon fruit, in a half fruit serving of 225±25 grams, reduced mean whole gut transit time from 26.0±12.9 hours to 21.9±12.8 hours (p<0.001) when colour change in stools was used as an indicator. The tests also showed that 14.8-17.3% of individuals had whole gut transit time ≥40 hours with carbon as a stool marker compared to only 7.8-8.6% when red dragon fruit was consumed and used as a marker.
Conclusion: This study demonstrated a laxative effect of red dragon fruit among young adults.
Key words: Hylocereus polyrhizus, laxative, whole gut transit time, young adult

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Effect of high-intensity interval training and pre-meal water consumption on lipid profile in overweight and obese students
Nazhif Gifari, Hardinsyah, Drajat Martianto & Mury Kuswari

doi: https://doi.org/10.31246/mjn-2020-0034

ABSTRACT

Introduction: Obesity and overweight in adolescents and adults are associated with chronic diseases. The objective of this study was to determine the effect of high-intensity interval training and pre-meal water intake on the lipid profile of overweight and obese students.
Methods: This was a pre-post experimental study. Twenty-seven overweight and obese students (mean BMI 26.0±3.1 kg/m2 and mean age 19.7±0.7 years) were divided randomly into three groups. The first group (n=9; BMI=26.6±3.6 kg/m2) received Plain Water Intake (PWI) intervention, whereby students received three bottles of plain water (600 mL) per mealtime (total 1.8 L/ day) and consumed ad libitum 30 to 45 minutes before mealtime (breakfast, lunch, and dinner). The second group (n=9; BMI=25.9±2.4 kg/m2) received High-Intensity Interval Training (HIIT) intervention and underwent three exercise sessions per week (18 minutes/day; 70–85% of HRmax) that was introduced through a video recording. The last group (n=9; BMI= 25.7±3.4 kg/m2) received a combination of PWI+HIIT intervention. Nutritional status, nutrient intake, and lipid profile [total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C)] were assessed before and after the interventions. Data were analysed using paired sample t-test and Analysis of Variance (ANOVA).
Results: The PWI group showed a significant increase in HDL-C, while the HIIT group showed a significant reduction in TC (p<0.05). On the other hand, the PWI+HIIT group showed significant improvements in lipid profile (TC, TG and HDL-C) (p<0.05).
Conclusion: A combination of PWI+HIIT intervention may be effective in improving lipid profile.
Key words: High-Intensity Interval Training; lipid profile; water consumption

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Risk factors of hospital-acquired malnutrition in children: A study in a rural hospital of West Borneo, Indonesia
Damar Prasetya, Sri Haryanti & Neti Nurani

doi: https://doi.org/10.31246/mjn-2020-0083

ABSTRACT

Introduction: Hospital-acquired malnutrition (HAM) is prevalent among hospitalised children in developing countries. This condition relates to worse clinical outcomes, prolongs length of stay in hospitals, and increases mortality. A multidisciplinary approach should be performed to prevent and manage this problem. However, HAM is often underdiagnosed, especially in rural hospitals with limited human resources. This study aims to delineate the risk factors of HAM among hospitalised children in a rural hospital.
Methods: This nested case-control study derived from the implementation of a nutritional screening programme in Parindu Hospital, Sanggau, West Borneo, was conducted from December 2018 to February 2019. HAM was defined as a loss of body weight of >2% after hospitalisation. Independent variables such as the age of patients, fever, gastrointestinal loss, pre-existing malnutrition, length of stay, and grade of disease were analysed in univariate and multivariate analyses using logistic regression. Risk factors were expressed as odds ratio and adjusted odds ratio (aOR) with 95% confidence interval (CI).
Results: Thirty-three patients were analysed as cases with 59 controls. Median age was younger in the case group (49 months, IQR 14-72.5) than control group (88 months, IQR 43-116). After adjustment for other covariates, age <5 years old (aOR 5.50, 95% CI 1.95- 15.59) and moderate-to-severe grade of disease (aOR 3.50, 95% CI 1.09-11.09) were significant risk factors of HAM in our study.
Conclusion: Risk factors of HAM in children hospitalised in a rural hospital were age <5 years old and moderate-tosevere grade of disease.
Key words: Hospital-acquired malnutrition, children, rural hospital

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Factors associated with sugar-sweetened beverages consumption among Malaysian adolescents: findings from the Adolescent Nutrition Survey 2017
Ruhaya Salleh, Ahmad Ali Zainuddin, Safiah Md Yusof, Cheong Siew Man, Mohamad Hasnan Ahmad, Nur Shahida Abd. Aziz, Lalitha Palaniveloo, Azli Baharudin & Norazizah Ibrahim Wong

doi: https://doi.org/10.31246/mjn-2020-0040

ABSTRACT

Introduction: Childhood obesity is a public health problem in Malaysia. Intake of sugar-sweetened beverages (SSB) is associated with obesity in children. There is a lack of studies on factors associated with SSB consumption in Malaysia. This study aimed to determine the sociodemographic factors associated with SSB consumption among Malaysian adolescents.
Methods: Data of 2,021 students, aged 10-17 years on sociodemographic, SSB intake and anthropometrics were drawn from the school-based Adolescent Nutrition Survey 2017. A multistage stratified cluster sampling was used to obtain a nationally representative sample of primary and secondary school students. Body mass index (BMI)-for-age status was determined based on calculated z-score using the World Health Organization 2007 reference. SSB consumption was obtained from a food frequency questionnaire.
Results: The prevalence of overweight and obesity among Malaysian adolescents were 16.6% and 14.7%, respectively. Malaysian adolescents consumed 1.4 cups of SSB per day. Rural children had a significantly higher SSB intake (1.5 cups) than urban (1.3 cups) children, while males (1.5 cups) had a significantly higher intake than females (1.3 cups). There were no significant differences in SSB consumption between thin, normal, overweight and obese adolescents.
Conclusion: Almost all Malaysian adolescents consumed SSB during one month prior to the survey and the average amount consumed was 1.4 cups per day. Rural locality and male were associated with higher SSB consumption. There were differences in SSB consumption between Chinese and Malays, between Chinese and Indians, and between Chinese and Bumiputra Sarawak. There were no differences in consumption between the different BMI-for-age categories.
Key words: Sugar-sweetened beverage, adolescent, obesity, Malaysia

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Malaysian Journal of Nutrition (Mal J Nutr)

Volume 27 No.2, 2021



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Table of Content


Knowledge, attitude, practice (KAP) and dietary intake of young university athletes following sports nutrition education
Nur Najiah Zaidani Kamarun Zaman, Ayu Suzailiana Muhamad & Mohd Rahimi Che Jusoh

doi: https://doi.org/10.31246/mjn-2020-0098

ABSTRACT

Introduction: Nutrition plays a vital role in sports. Athletes must understand the importance of diet and ensure that they meet the nutrient requirements to enhance sports performance. The lack of understanding in sports nutrition will lead to poor dietary practices that can cause detrimental effects on athletic achievements. This study aims to evaluate the effects of knowledge, attitude, and practice (KAP) regarding sports nutrition and dietary intake among young university athletes.
Methods: Twenty-one local university athletes (23.8±3.4 years) were recruited, and their anthropometric and socio-demographic data were assessed. All participants attended a 1-day sports nutrition class. The KAP-Sports nutrition questionnaire was administered. Three days of dietary intake were also recorded at the same timepoints among the participants.
Results: There was a significant increment (p<0.05) in the mean scores for KAP among the participants. Total energy and total carbohydrate intakes per day were significantly increased (p<0.05). However, overall protein and fat intakes did not improve as the readings were higher than the recommended values.
Conclusion: In this study, sports nutrition education improved participants’ KAP, but not the actual dietary intake. Changes in habit require more effort, with extra attention on protein and fat intakes.
Key words: Knowledge, attitudes, and practice (KAP), dietary intake, sports nutrition education, athletes

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SHORT COMMUNICATION

Recommendations to promote breast milk feeding and enhance nutritional care for preterm infants in the Asia-Pacific region: highlights from a roundtable discussion of key opinion leaders
Fook-Choe Cheah, Tian-Lee Tan, Ursula Herulah, Charisma Dilantika, Leilani Muhardi, Girish Deshpande, Rinawati Rohsiswatmo, Satish Saluja & Ruurd Van Elburg

doi: https://doi.org/10.31246/mjn-2020-0124

ABSTRACT

Introduction: Preterm infants are vulnerable to nutritional deficiencies, thus optimal nutrition is crucial in promoting growth among these infants. However, socio-cultural complexities and limited resources in the Asia-Pacific demands a judicious approach in implementing nutritional care that is pragmatic to align with current evidence-based recommendations.
Methods: A roundtable meeting was held in Jakarta in 2017 for key opinion leaders in neonatology from the Asia- Pacific to discuss issues when delivering nutritional care in this region and the unique circumstances encountered.
Results: Priority areas discussed include: (i) breast milk feeding, (ii) donor milk bank/sharing, (iii) human milk fortification, and (iv) nutrient-enriched breast milk substitutes. Socio-cultural practices impeding breastfeeding, insufficient maternity leave, the religious issue of milk kinship, and limited availability of specialty nutritional care products were among the most challenging factors.
Conclusion: The group proposed recommendations to enhance breastfeeding uptake, accessibility to a complete portfolio of specialty nutritional care products, and encouraging more active collaborations to engage policy makers in addressing these contemporary issues.
Key words: Breastfeeding, donor human milk, human milk fortifier, milk kinship, preterm infant

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Dietary diversity and nutritional status of 2 to 5 years old children in households with and without home gardens in selected districts in Siem Reap province, Cambodia
Liny SEK, Aimee A. Sheree Barrion, Clarissa B. Juanico, Josefina T. Dizon & Hurtada A. Wilma

doi: https://doi.org/10.31246/mjn-2020-0041

ABSTRACT

Introduction: There is a high prevalence of malnutrition in Cambodia during the past 10 years. One of the programmes implemented to secure household food security in order to alleviate malnutrition was home gardening. This study aimed to compare the nutritional status of 2 to 5 years old children in households with and without home gardens.
Methods: Twenty-five households with home gardens and 60 households without home gardens were sampled.
Results: The households sampled had a mixed type of home garden with three to five crop varieties occupying 20 to 200 square meters area. The purpose of the garden was to increase vegetable consumption and produce additional income. Results showed that 72% and 65% of the children resided in households with and without home gardens, respectively. Majority had medium dietary diversity score, i.e. consumed four to five different food groups per day. Except for stunting, higher prevalences of undernutrition (32%) and wasting (8%) were observed among children residing in households with home gardens compared to children in households without home gardens.
Conclusion: There were no associations for dietary diversity score and nutritional status of children from households with and without home gardens. Among the sociodemographic and economic factors, age, sex, family size, and vegetable consumption were significantly associated with dietary diversity score and nutritional status of the children.
Key words: Home garden, dietary diversity score, nutritional status

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Environmental enteric dysfunction, soil transmitted helminthiasis and stunting among 36- to 59-month-old children in Quezon Province, Philippines
Angelina R. Bustos, Carmelita M. Rebancos, Corazon VC. Barba, Victorio B. Molina, Merlyne M. Paunlagui & Nancy A. Tandang

doi: https://doi.org/10.31246/mjn-2020-0043

ABSTRACT

Introduction: Environmental enteric dysfunction (EED) is relevant in public health as it is a potential cause of child stunting. In the Philippines, stunting affects 33.4% of children in 2015. As of date, no local studies on EED exist. This study primarily aimed to determine the prevalence of EED, soil transmitted helminthiasis (STH) and stunting; and their relationships.
Methods: A cross-sectional study was conducted among 120 children aged 36-59 months old in Quezon Province, Philippines. EED was assessed via glucose hydrogen breath test with a cut-off of >20 ppm over baseline by 90 minutes suggestive of small intestinal bacterial overgrowth (SIBO), a biomarker of EED. Kato Katz Technique was used to determine STH. Stunting was determined using the 2006 World Health Organization Child Growth Standards. Descriptive and correlation analyses of data were done at 10% level of significance. The study received approval from the National Ethics Committee of PCHRD-DOST, Philippines.
Results: Data on expired hydrogen level of <20ppm were documented. The prevalence of STH among children were 38.1% for Ascaris lumbricodes, 15.3% for Trichuris trichiura, and 1.7% for hookworm infections. A high rate of stunting at 40.0% was observed. There was a significant positive association between stunting and the presence of Ascaris (p=0.01).
Conclusion: There was no case of EED detected in the study. The severity of stunting was high at 40.0%. Among the STH, the prevalence of 38.1% children having Ascaris lumbricodes was alarming in terms of morbidity control. Nutrition interventions including WASH practices and the use of anthelminthic drugs need to be intensified to address stunting and STH.
Key words: Environmental enteric dysfunction, stunting, small intestinal bacterial overgrowth, soil transmitted helminthiasis

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Comparison of anthropometric profile, bone-related parameters, biochemical parameters, functional capacity, and vitamin D status – A study on postmenopausal Malaysian women
Mitra Soma R & Abidin Nurdiana Z

doi: https://doi.org/10.31246/mjn-2020-0080

ABSTRACT

Introduction: The optimal level of total 25(OH)D in Malaysian postmenopausal women that is necessary to ameliorate the combined effects of decreased bone mineral and muscle mass, and increase in adiposity, as seen in osteosarcopenic obesity, is unknown. Given that these are common pathologies existing in bone, muscle and excess fat-related disorders, this study investigated the association between body composition, functional capacity and total 25(OH)D levels.
Methods: This was a cross-sectional study involving 117 postmenopausal Malaysian women aged 50-88 years. Total 25(OH)D was analysed by chemiluminescent microparticle immunoassay CMIA on Siemens® platforms. Bone mineral was measured by broadband ultrasound attenuation. Functional performance was assessed using modified components of short physical performance battery test. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS Version 25.0).
Results: Overall, 47% women were vitamin D deficient; 3% had none, 22% had one, 65% had two, and 10% had all three adverse body composition indicators (osteosarcopenic obesity). Individuals without any adverse body composition indicator had higher total 25(OH) D (74.7±7.0nmol/L, p=0.004) compared to all the other groups [1 (53.0±3.8nmol/L); 2 (48.7±1.9nmol/L) and 3 (58.3±5.4nmol/L)]. The single inflection point (ROC curve) for total 25(OH)D in predicting osteosarcopenic obesity was 58.9nmol/L.
Conclusion: Higher vitamin D levels were associated with lower body fat, enhanced bone quality, and improved functional capacity. Maintaining vitamin D levels above >58.9nmol/L may protect Malaysian postmenopausal women against the combined pathologies of bone, muscle and excess fat.
Key words: Vitamin D, osteosarcopenic obesity, postmenopausal, Malaysian women

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Association between dietary intake, physical activity and stress level with constipation among undergraduate students
Nor Baizura Md. Yusop & Nor Qubbul Ain Mohamed Yasin

doi: https://doi.org/10.31246/mjn-2019-0099

ABSTRACT

Introduction: Constipation is one of the most common health problems among university students. This study aims to determine the association between sociodemographic characteristics, dietary intake, physical activity, and stress level with constipation among undergraduate students.
Methods: The study was a crosssectional study and the participants comprised of 140 undergraduate students (27.9% males and 72.1% females). A 3-day dietary record was obtained to determine energy, fibre and fluid intakes, while physical activity was determined using the International Physical Activity Questionnaire. Stress level and constipation were assessed using the Cohen’s Perceived Stress Scale and Agachan’s Constipation Score System Questionnaire, respectively. Data were analysed using IBM SPSS Statistics version 23. Multivariate linear regression analysis was done to determine factors that were associated with constipation.
Results: Mean age of the participants was 20.9±1.5 years old and majority were third year students (32.1%). Mean intakes of energy, dietary fibre, and fluids per day were 1567±438kcal, 5.6±3.5g, and 2301±946ml, respectively. The median score for physical activity was 1135.5 METminutes/ week. Most of the participants (77.1%) had a high or a very high stress level and 64.3% had slight constipation. Age, dietary fibre, fluid, energy, and perceived stress scale explained a significant amount of the variance in the occurrence of constipation [F(6.133)=16.373, p<0.001, R2=0.425, R2 Adjusted=0.399].
Conclusion: Age, energy, fluid and fibre intakes, as well as perceived stress were factors that were associated with constipation among undergraduate students. Therefore, undergraduate students should be encouraged to practise a healthy lifestyle to modify these identified risk factors.
Key words: Constipation, energy intake, dietary fibre, fluid intake

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Fulfilment of minimum acceptable diet (MAD), short birth length and family income level are associated with stunting in children aged 6-23 months in Central Jakarta
Madinar*, Ervida Andina & Endang L. Achadi

doi: https://doi.org/10.31246/mjn-2020-0045

ABSTRACT

Introduction: Stunting is a condition characterised by retardation in the growth and development of children as a result of chronic inadequate nutritional intake and/or recurrent infectious diseases. This research aims to determine the factors related to stunting occurrence among children aged 6-23 months.
Methods: This cross-sectional study was carried out in 2019. The sample was 231 children selected by multistage random sampling technique from 13 Posyandu (integrated healthcare centres) in six administrative villages located across three sub-districts of the Central Jakarta region.
Results: The results showed that the prevalence of stunting was 26.0% and minimum acceptable diet (MAD) was only met by 31.6% of the children studied. Chi-square analysis revealed that short birth length (OR=2.176; 95% CI: 1.155–4.098) and family income level (OR=0.388; 95% CI: 0.201–0.749) were significantly associated with stunting. Logistic regression showed that fulfilment of MAD, short birth length (OR=0.471; 95% CI: 0.244–0.909), and family income (OR=0.387; 95% CI: 0.197–0.759) were significant factors for stunting among children 6-23 months in Central Jakarta in 2019, with fulfilment of MAD as a dominant factor (OR=3.29; 95% CI: 1.171–9.241).
Conclusion: More efforts need to be done to achieve the recommended MAD for all children aged between 6-23 months and to prevent short birth length. Large scale studies to explore the role of MAD in reducing stunting and qualitative studies to identify the constraints and promoting factors to better infant and young child feeding practices are imperative for programme improvement.
Key words: stunting, fulfilment of minimum acceptable diet, children aged 6-23 months

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Stability of lactoferrin and lysozyme in human milk at various temperatures and duration of storage
Kasiati, Sumirah Budi Pertami, Agus Setyo Utomo & Siti Nur Arifah

doi: https://doi.org/10.31246/mjn-2020-0132

ABSTRACT

Introduction: Exclusive breastfeeding, especially in the first six months, is essential for infants as it provides nutrition and protection against various diseases. Colostrum, which is found in the first breast milk produced, contains various protective factors, such as lactoferrin and lysozyme. Human milk can be stored at room temperature, refrigerated, or kept frozen. Several factors affect the stability of the bioactive content in human milk, such as temperature and storage time. The aim of this study was to measure the stability of lactoferrin and lysozyme levels in human milk during the first six hours (h) at different temperatures and compare it with that of frozen human milk.
Methods: Human milk samples were obtained from 11 breastfeeding mothers using certain criteria. The human milk was stored at room temperature and 4°C for 1, 3, and 6 h and classified as never frozen, while frozen human milk was stored at -20°C for 1, 3, and 6 days. Measurement of the lactoferrin and lysozyme levels was performed using enzyme-linked immunosorbent assay.
Results: The results showed that storage at room temperature significantly reduced lactoferrin and lysozyme levels. Lactoferrin levels in frozen human milk did not significantly decrease during the first six days. Meanwhile, the lysozyme levels in frozen human milk decreased significantly.
Conclusion: The levels of lactoferrin and lysozyme in frozen human milk stored for the first six days were more stable than those stored at room temperature and 4°C in the first 6 h.
Key words: human milk, lactoferrin, lysozyme, storage duration, temperature

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Association between nutrition knowledge and nutrition practice among Malaysian adolescent handball athletes
Normah Jusoh, Jeffrey Low Fook Lee, Ruaibah Yazani Tengah, Siti Hartini Azmi1 & Adang Suherman

doi: https://doi.org/10.31246/mjn-2020-0113

ABSTRACT

Introduction: Previous literature suggests that good nutrition knowledge does not necessarily translate into desired eating behaviours among adolescent athletes, which may affect their sports performance. The purposes of the study were twofold, which were to examine nutrition knowledge and practice between the sexes, and to evaluate the magnitude of relationship between nutrition knowledge and practice among adolescent handball athletes in Malaysia.
Methods: Three hundred and twelve male and female adolescent handball players competing in a national level competition voluntarily participated in this study. The participants were asked to complete a questionnaire which consisted of items on their demographic information and about their nutrition knowledge and eating practices. Independent t-test and Pearson’s correlation were used to compare nutrition knowledge and practice between the sexes and to describe the relationship between variables, respectively.
Results: The results showed that there were no significant differences (p>0.05) observed for nutrition knowledge and practice between the sexes. Besides, the results demonstrated that nutrition knowledge had a significant but weak positive correlation with eating habit (r=0.114, p=0.003) among the athletes.
Conclusion: This study showed that nutrition knowledge and practice were moderately adequate, and that knowledge does not necessarily translate into good dietary practices. Therefore, the athletes would benefit from a comprehensive and innovative nutrition education, a strategy which warrants further investigation.
Key words: nutrition knowledge, dietary practice, young athletes, handball

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Proximate, mineral and fatty acid compositions of healthy recipes used in Fit, Eat, Active, Training (F.E.A.T) programme
Nurulhusna Abdullah, Hasnah Haron, Ruzita Abd Talib, Wan Nurul Najwa Wan Nik & Wirdah Mohamed

doi: https://doi.org/10.31246/mjn-2020-0115

ABSTRACT

Introduction: Many people are seeking knowledge and skills about preparing healthy meals at home. This study aimed to determine the content of nutrients in 60 healthy dishes prepared for the recipe book Mudah, Sihat, Sedap used in the F.E.A.T nutrition intervention programme. The recipe book was developed as an educational material to guide participants in preparing healthy meals at home.
Methods: A needs assessment survey was done to identify food preferences for breakfast, lunch and dinner of obese and overweight respondents. Recipes for these foods were then modified to reduce the calorie, fat, and sugar contents, while adding in fibre sources. Proximate analysis was done based on standard methods of AOAC, while total carbohydrate and calorie contents were calculated using the differentiation and Atwater methods, respectively. Mineral content was determined using atomic absorption spectrophotometer, while fatty acids content was analysed by gas chromatography using the FAME method.
Results: Proximate analysis results showed that Kobis Goreng had the most calories (305 kcal/100g) (p<0.05) in all categories. Mineral analysis showed that sodium was significantly highest (p<0.05) in Asam Pedas Daging (554 mg/100g). For fatty acid analysis, Masak Lemak Telur Itik had the highest amount of MUFA (45.1%), Masak Lemak Sotong had the highest amount for SFA (71.8%), and Masak Lemak Cili Api Udang had the highest amount of PUFA (33.7%).
Conclusion: This study successfully modified original recipes of selected cuisines used in the recipe book, which contained lower calories compared to original recipes. The calorie and nutrient values for each recipe will be included as nutrition composition information in the recipe book.
Key words: obesity, calories, proximate contents, mineral, fatty acid

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Calcium and iron intakes of adolescents in Malaysia and their relationships with body mass index (BMI): Findings from the Adolescent Nutrition Survey 2017
Syafinaz Mohd Sallehuddin, Ruzita Abd. Talib, Ruhaya Salleh, Rashidah Ambak, Munawara Pardi, Nur Shahida Abdul Aziz, Norazizah Ibrahim Wong & Mohd Azahadi Omar

doi: https://doi.org/10.31246/mjn-2020-0054

ABSTRACT

Introduction: Adolescent health is a priority considering they represent the future generation. Data from the Adolescent Nutrition Survey 2017 were analysed to determine the prevalence of micronutrient inadequacy, particularly calcium and iron, and the relationship with body mass index (BMI) among Malaysian secondary school students.
Methods: This cross-sectional study included students aged 13 to 17 years old studying at public and private schools. Twenty-four hours dietary recall via face-to-face interview was conducted by trained nutritionists to obtain data on dietary intake. For nutritional status, BMI-for-age z-score (BAZ) was analysed using WHO Anthroplus software.
Results: From 999 respondents, 449 were boys and 550 were girls. Overall findings indicated that both boys and girls had inadequate intakes of calcium and iron in their daily diet. Mean intakes of calcium (695.7±463.2 mg/day) and iron (23.4±21.0 mg/day) were higher among boys aged 16 to 17 years old. Mean intake of iron were higher among the older age groups. Majority of the respondents (boys: 94%; girls: 97%) did not meet the recommended nutrient intake (RNI) for calcium and more than half (boys: 50%; girl: 80%) did not achieve the RNI for iron. Current findings also found significant positive but weak correlations between calcium (r=0.112, p=0.001) and iron (r=0.084, p=0.008) intakes with BMI-for-age.
Conclusion: BMI-for-age was related to calcium and iron intakes among secondary school students in Malaysia. Thus, intervention strategies should focus on early screening and nutrition education on food choices of high calcium and high iron contents, including iron supplementation programmes, if needed.
Key words: adolescents, calcium, iron, intake, Malaysia

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Healthier pineapple tart pastry using oleogel-based solid fat replacement
Shaun Yong Jie Sim, Kah Xuan Wong & Christiani Jeyakumar Henry

doi: https://doi.org/10.31246/mjn-2021-0007

ABSTRACT

Introduction: Pineapple tarts are a commonly consumed Southeast Asian pastry made using solid fats like butter and palm shortening. These solid fats predominantly contain high amounts of saturated fats which have been implicated in negative health effects. However, solid fats impart important textural properties in pastry formation and is not easy to replace. To overcome this challenge, a concept to enhance the nutritional value whilst maintaining the textural properties of pineapple tart pastry formed the basis of this study.
Methods: This short study explored the use of “healthy” avocado-olive oil-based oleogels structured with food-grade ethylcellulose (EC), monoglycerides (MG) or its combination (EC-MG) as solid fat replacements to butter and palm shortening. The textural properties of the pastry dough and tart were determined using a texture analyser, while the nutritional content of the pastries was compared.
Results: The firmness of pastry dough decreased in the order: EC >> EC-MG > butter ~ MG ~ shortening, while tart hardness decreased: EC > shortening ~ butter > MG > EC-MG. The combination EC-MG oleogel had positive effects on the textural properties by improving the dough workability and reducing the tart hardness compared to EC. Remarkably, the oleogel tart pastries had up to 70% less saturated fat compared to the butter or palm shortening pastries.
Conclusion: This study confirms the ability to create healthier pastries whilst maintaining its texture.
Key words: oleogels, fat mimetics, ethylcellulose, monoglyceride, pastry

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Validity and reliability of plant-based culinary nutrition model questionnaire for fitness among sports science students
Bina Baboo Morji, Ahmad Zabidi Abdul Razak & Sareena Hanim Hamzah

doi: https://doi.org/10.31246/mjn-2020-0114

ABSTRACT

Introduction: There is an emerging focus on plant-based foods that have the added advantage of being nutritious without side effects. Besides, its preparation with nutritional awareness and culinary skills could be an effective solution for improving personal fitness. This study aimed to determine validity and reliability of a questionnaire for the development of a plant-based culinary nutrition model for fitness among sports science students.
Methods: This study employed exploratory sequential mixed method design and was carried out in two phases. Phase 1 employed a qualitative design utilising modified Delphi method to determine content validity index (CVI) of the questionnaire, while phase 2 was a quantitative design using Cronbach’s alpha statistical analysis to evaluate reliability of the instrument. The questionnaire consisted of the need for plant-based culinary nutrition model (Section A) and the model’s components (Section B). Thirteen expert panels from diverse expertise in sports nutrition and 30 sports science students took part.
Results: Phase 1 resulted in development of a questionnaire where Section A and Section B scored CVI of 0.834 and 1.000, respectively. For phase 2, Cronbach’s alpha score for reliability of the questionnaire was 0.836 with a total of 15 items. The Cronbach’s alpha score for questionnaire items from Sections A and B were 0.709 and 0.832, respectively.
Conclusion: The questionnaire developed in this study is validated and is considered reliable for use as a significant tool for plantbased culinary nutrition among sports science students.
Key words: plant-based nutrition, culinary, health and fitness, sports science students

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Clinical utility of low branched-chain amino acid modular diets in patients with isovaleric aciduria and maple syrup urine disease
Suthida Chatvuttinun, Duangrurdee Wattanasirichaigoon, Visith Chavasit, Oraporn Dumrongwongsiri, Thipwimol Tim-Aroon, Umaporn Suthutvoravut & Nalinee Chongviriyaphan

doi: https://doi.org/10.31246/mjn-2020-0071

ABSTRACT

Introduction: Modular diets (MDs) with low amount of offending amino acids have been developed using locally available food ingredients as alternatives to commercial formulas for the treatment of branched-chain organic acidurias (BCOAs). Herein, we conducted a clinical investigation of MDs in patients with BCOAs.
Methods: Modular diet A (MDA), with low leucine was produced for maple syrup urine disease (MSUD), and modular diet B (MDB) products, MDB-1, -2, -3, and -4, with low leucine, valine, methionine and threonine were made for isovaleric aciduria (IVA)/methylmalonic aciduria (MMA)/propionic aciduria (PA). Children aged 4-18 years, with MSUD, IVA, PA or MMA were invited to participate in the study. The research subjects switched from metabolic formula protocol to modular diet protocol. They were followed-up at 0, 1, 2, 4, and 6 months. Clinical efficacies of MDs were determined by completion of study, compliance to MDs, clinical outcomes and complications, and parental satisfaction.
Results: Six children (2 MSUD and 4 IVA) participated and completed the study. Compliance to MDA was 100% in MSUD subjects with G-tube feeding, while compliance to MDB varied among self-fed individuals with IVA. One subject with MSUD was clinically stable throughout the study, while the other experienced metabolic instability. All IVA individuals showed clinical and laboratory stability during the study. One MSUD and three IVA families preferred the metabolic formula, whereas the other IVA family reported no preference and the other MSUD subject preferred MDs.
Conclusion: We provided a proof of concept in developing modular diets for BCOAs, and showed favourable outcomes when using MDs in IVA and varying clinical benefits in MSUD.
Key words: branched-chain organic acidurias, isovaleric aciduria, maple syrup urine disease, metabolic disorders, modular diet

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Malaysian Journal of Nutrition (Mal J Nutr)

Volume 27 No.3, 2021



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Table of Content