MJN 2022 Issues

Malaysian Journal of Nutrition (Mal J Nutr)

Volume 28 No.1, 2022



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Table of Content


Farmers’ expenditures associated with children’s nutritional status in areas affected by Indonesia’s Sinabung eruption
Sadar Ginting, Nithra Kitreerawutiwong & Sunsanee Mekrungrongwong

doi: https://doi.org/10.31246/mjn-2021-0077

ABSTRACT

Introduction: During the time of volcano eruptions, farmers have to harvest their crops before the stipulated harvest time, which leads to quality and quantity loss. Besides, farmers also have to continue their farming activities, including purchasing farming necessities. These unaddressed issues of the agricultural restoration could be one of the key factors to malnutrition. Therefore, this study assessed the associations between farmers’ expenditures and the nutritional status of children in areas affected by Indonesia’s Sinabung eruption.
Methods: A cross-sectional study was carried out among 444 (158 farmers, 228 farmers cum farm labourers, and 58 farm labourers) households headed by farmers. The questionnaire used for data collection was the Indonesian Family Life Survey questions (IFLS).
Results: Non-food expenditures had a huge impact on household livelihoods, which was significantly associated with children’s nutritional status. Among the three groups of farmers, children of farmers and farmers cum farm labourers were prone to malnutrition. This was because these two groups had to limit food expenditures over their farming necessities and cigarettes expenditure, which took more than half of their income. However, the prevalence of malnutrition was highest in children of farmers. Children of farm labourers had better nutritional status compared to children of the other two groups.
Conclusion: Children of farmers and farmers cum farm labourers were prone to malnutrition due to limited expenditure on food. This study suggests that policymakers in Indonesia should provide food and nutrition security to children who were impacted by the Sinabung eruption.
Key words: farmers’ expenditures, child nutrition, volcano eruption

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Association of household food security and dietary diversity of mother-child pairs in the Philippines
Mildred O. Guirindola, Ma. Lynell V. Maniego* & Cristina G. Malabad

doi: https://doi.org/10.31246/mjn-2021-0046

ABSTRACT

Introduction: The majority of Filipino households experience food insecurity. Mothers and children are among the population groups suffering from poor diet quality. This study aimed to determine the extent of the association of household food security (HFS) to mothers’ and children’s dietary diversity score (DDS), and to identify the significant factors associated with meeting the DDS of these vulnerable groups.
Methods: The study was a cross-sectional, population-based study utilising secondary data from the 2015 Updating Survey. From a total of 6,692 mother-child pairs, the association between HFS and meeting the DDS of mothers and children, as well as the potential predictors for meeting the DDS were tested using descriptive and logistic regression analyses.
Results: The findings showed that HFS was significantly associated with meeting the DDS of mothers and children aged 6-36 months (p<0.001). The proportion of meeting the DDS among mothers and children was significantly higher in food-secure than in food-insecure households (20.7% vs. 14.4%). Furthermore, meeting the DDS decreased with increasing levels of food insecurity. Household food security status, education background, employment, child’s age, and wealth status were significantly associated with meeting the DDS.
Conclusion: This study showed the extent of how food security was associated with meeting the DDS of mothers, children, and mother-child pairs, and the factors associated with meeting the DDS. Results can be used to strengthen the formulation of appropriate, evidence-based policies to address household food insecurity and low DDS among mothers and young children.
Key words: household food security, dietary diversity, mother-child pairs, Philippines, NNS

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Exploring the norms of eating-out practice among adults in Malaysia
Lydiatul Shima Ashari, Ainaa Almardhiyah Abd Rashid, Mohd Razif Shahril, Yeong Yeh Lee, Yee Cheng Kueh, Bibi Nabihah Abdul Hakim, Nor Hamizah Shafiee, Raja Affendi Raja Ali & Hamid Jan Jan Mohamed

doi: https://doi.org/10.31246/mjn-2021-0008

ABSTRACT

Introduction: Eating-out is common in almost all countries, including Malaysia, but this frequent practice may affect human health. In Malaysia, data on eating-out is limited. This study aimed to assess the proportion of eating-out, to assess the association between socio-demographic factors and eating patterns, and to compare energy and nutrient intakes between people eating-out and eating-in.
Methods: This cross-sectional study was conducted among 100 adults aged 30 to 70 years old. Three-day food diaries were used to collect data on dietary intake. Eating-out was defined as eating foods prepared outside the home. Respondents who ate outside for at least one meal per day, for two or three days per week were considered as those who frequently practised eating-out.
Results: A total of 84% of respondents who ate out had significantly higher sodium intake than those who ate at home (2934 mg/day vs. 2165 mg/day, p=0.025). Foods and drinks that were most commonly consumed outside were nasi lemak, roti canai, rice, ayam masak kicap, vegetable soup, tomyam, rice vermicelli soup (mee-hoon soup), hot teh-o, iced tea, and orange juice. Occupation (p=0.004) and location type (p=0.001) were associated with eatingout. Government and semi-government workers (61%) and urban population (57%) had higher percentage of eating-out compared to eating at home (19% and 12%, respectively).
Conclusion: More than two-thirds of our respondents ate out and this habit was related to poor diet quality with excessive intake of sodium. Interventions are needed to improve the diet quality of the overall eating-out behaviour among targeted population.
Key words: eating pattern, eating-out, factors, nutrients, Malaysia

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Sociodemographic factors associated with consumption of high-sodium foods: Evidence from Malaysia
Yong Kang Cheah, Sharifah Nazeera Syed Anera, Chee Cheong Kee, Kuang Hock Lim & Mohd Azahadi Omar

doi: https://doi.org/10.31246/mjn-2021-0088

ABSTRACT

Introduction: The objective of the present study was to investigate the influences of sociodemographic factors on consumption of high-sodium foods among adults in Malaysia.
Methods: Data were extracted from the Malaysian Community Salt Survey (MyCoSS) (n=1046). A seemingly unrelated regression (SUR) was utilised to assess factors associated with the number of servings of high-sodium foods (nasi lemak, roti canai, fried rice, fried noodles, and fried vermicelli) consumed per week. The independent variables were sociodemographic factors.
Results: Younger individuals consumed more high-sodium foods than their older counterparts. Adults with secondary level education consumed more high-sodium foods compared with those with tertiary level education. Consumption of high-sodium foods was higher among males and Malays compared to females and non-Malays.
Conclusion: Consumption of high-sodium foods was common in the population. Sociodemographic factors, such as age, education level, gender, and ethnicity, play an important role in influencing the decisions of people to consume high-sodium foods.
Key words: age, food, gender, Malaysia, population study, salt, sodium

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Anaemia and its associated factors among pregnant women in Malaysia
Halimatus Sakdiah Minhat & Puganeswary Thangarajah

doi: https://doi.org/10.31246/mjn-2021-0047

ABSTRACT

Introduction: Despite remarkable improvement in maternal health, anaemia during pregnancy remains a significant public health threat to Malaysian women. This study aimed to determine the prevalence, severity, and associated factors of anaemia in pregnancy among pregnant mothers in Seremban, Negeri Sembilan.
Methods: A total of 482 pregnant mothers were recruited using cluster sampling. Data were collected using a validated and pre-tested self-administered questionnaire consisting of four sections, namely socio-demographic and socioeconomic details, obstetric history, nutritional factors, and iron supplementation status. In this study, anaemia in pregnancy was defined as haemoglobin (Hb) <11.0 g/dL, which was based on blood test taken during the first trimester. The data were analysed using IBM SPSS version 23.0. Multiple logistic regression analysis was conducted to determine the predictive model for anaemia during pregnancy among the respondents.
Results: The prevalence of anaemia in pregnancy among the respondents was 22.0%, with 95.3% respondents mildly anaemic. Respondents with an intake of iron supplementation of once daily (AOR=0.191, 95% CI: 0.074- 0.914), more than once daily (AOR=0.149, 95%CI: 0.091-0.248), and low intake of seafood (AOR=0.320, 95% CI: 0.187-0.526) were less likely to develop anaemia during pregnancy.
Conclusion: The findings revealed moderate level of anaemia in pregnancy, which was dominated by those in the mild category, with increased risk predicted among young mothers. Iron supplementation (once daily or more) and low intake of seafood protected mothers from developing anaemia during pregnancy.
Key words: anaemia, pregnancy, maternal health

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Evaluation of in vitro lipid-lowering properties of ‘Saba’ banana [Musa acuminata x balbisiana (BBB group) ‘Saba’] peel pectin from different extraction methods
Estribillo Abbie Glenn M, Gaban Prince Joseph V, Rivadeneira Joel P, Villanueva Jeric C, Torio Mary Ann O & Castillo-Israel Katherine Ann T

doi: https://doi.org/10.31246/mjn-2020-0121

ABSTRACT

Introduction: This study was conducted to investigate the in-vitro lipid-lowering properties of ‘Saba’ banana peel pectin (SBP) extracted using three methods for its possible use as a dietary fibre ingredient.
Methods: Pectin from ‘Saba’ banana peels were extracted using acid extraction (citric acid), enzymatic extraction (cellulase), and microwave-assisted extraction. In-vitro lipid-lowering assays were performed using spectrophotometry for pancreatic lipase inhibition and cholesterol binding, while liquid chromatography was used for bile acid-binding capacity.
Results: Results revealed that all SBPs were not able to inhibit pancreatic lipase activity. However, all SBPs can notably bind to cholesterol and bile acids, taurocholate, and glycocholate. Acid-extracted pectin had the highest binding capacity to cholesterol (51.36%–55.07%) and glycocholate (27.37%), whereas all SBPs were similarly bound to taurocholate.
Conclusion: The results of this study showed that acidextracted SBPs can significantly bind to cholesterol and bile acids, glycocholate and taurocholate, thereby indicating a possible reduction in lipid metabolism.
Key words: saba, pectin, pancreatic lipase inhibition, cholesterol-binding capacity, bile acid binding capacity

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Implications of undernutrition in children with acute lymphoblastic leukaemia during induction therapy – experience from a developing country
Latha M Sneha, Lakshmanan SakthiKumar, Apurva Kadiyala, Julius Scott & Dhaarani Jayaraman

doi: https://doi.org/10.31246/mjn-2020-0131

ABSTRACT

Introduction: Undernutrition is an important prognostic factor in children with acute lymphoblastic leukaemia (ALL) and higher incidences of mortality are reported during induction remission in severely undernourished children. This study was conducted to assess the prevalence and implications of malnutrition among ALL children during induction therapy.
Methods: All children ≤18 years diagnosed and treated for ALL at our institution, between June 2010 to July 2016 were included in this retrospective cohort study. Nutrition was assessed by body mass index-forage z-scores calculated using World Health Organization’s Anthro (<5 years) and Anthro-Plus Software (≥5 years). Children with a z-score of <-2 standard deviation (SD) were classified as undernourished. All events and outcomes were compared between undernourished and adequately nourished children.
Results: A total of 72 children were included in this study. Nineteen (26.4%) were undernourished at the time of diagnosis. Twenty-eight (38.8%) children had significant weight loss. Sixty-seven of them attained remissions by the end of induction chemotherapy. Five children who died had significant weight loss. Children with significant weight loss during induction phase had a higher risk of developing complications such as febrile neutropenia, pneumonia, mucositis, and drug interruptions. Those with a deteriorating nutritional status had a higher chance of poor treatment outcome (p=0.05, CI=95%).
Conclusion: It is important to assess and monitor the nutrition status of children and timely nutritional intervention is essential. A simple, cost effective nutritional intervention that will decrease morbidity and mortality associated with the disease must be devised.
Key words: acute lymphoblastic leukaemia, induction therapy, outcome, undernutrition

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Relationship between 6-n-propylthiouracil (PROP) taster status, dietary intake and dental caries among young adult subjects
Syathirah Hanim Azhar Hilmy, Ruhaya Hasan, Norkhafizah Saddki & Marina Abdul Manaf

doi: https://doi.org/10.31246/mjn-2021-0079

ABSTRACT

Introduction: Previous studies have established an association between 6-n-propylthiouracil (PROP) taster and dietary intake. However, those studies mostly emphasised on macronutrients. The present study examined the dietary intake, including macro- and micronutrients, and caries experience among university students according to their PROP taster status.
Methods: A total of 158 university students participated in this study. PROP taster status was determined using filter paper method. Dietary intake was collected using 24-hour diet recall method. Oral health examination was conducted to determine dental caries experience.
Results: The results showed that majority of subjects were supertasters. No significant differences (p>0.05) were found in the macronutrient intakes among supertasters, medium tasters, and non-tasters. Significant differences (p<0.05) were found in the intakes of micronutrients, namely pantothenic acid, vitamin D, magnesium, manganese, and fluoride. There were no significant differences among group tasters in the dental caries experience scores of decayed (D), missing (M), and filled (F) teeth.
Conclusion: In general, this study indicated that all group tasters had no difference in macronutrients intake and caries experience, but supertasters had significantly lower intakes of some micronutrients as compared to non-tasters and medium tasters. This suggested that PROP taster status could have some influence on micronutrient intakes.
Key words: caries, dietary intake, macronutrients, micronutrients, PROP, young adults

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Effectiveness of school-based obesity prevention programme among elementary school children in Jakarta
Felicia Kurniawan, Yayi Suryo Prabandari, Djauhar Ismail & Fatwasari Tetra Dewi

doi: https://doi.org/10.31246/mjn-2020-0101

ABSTRACT

Introduction: Prevention and treatment of overweight and obesity are easier in children than in adults. This study was conducted to evaluate the Smart Eating and Healthy Activity (SEHAT) programme, an intervention programme involving parents, teachers, and students in Indonesia to prevent obesity at schools. The intervention was conducted in the form of seminars and leaflets distribution to parents, training of teachers, training of student health cadres, training of students by trained teachers, health promotion to school canteen vendors, and promoting healthy home food weekly.
Methods: This non-randomised controlled trial study was conducted from January to May 2016 in North Jakarta. The primary outcome was body mass index (BMI) changes measured with SECA® digital scale for weight and microtoise for height measurements. The secondary outcomes were changes in children’s knowledge, self-efficacy and behaviours, measured using self-made questionnaires, and physical activity using the Physical Activity Questionnaire for Older Children (PAQ-C). A total of 278 fourth and fifth-grade elementary school students aged 9 to 11 years old were recruited and grouped into intervention group (121 students) and control group (157 students).
Results: The study reported a significant change between intervention and control groups on knowledge (1.28 vs 0.31), attitude (1.85 vs 0.06), physical activity (0.14 vs -0.32), eating fruits and vegetables (0.02 vs -0.78), and BMI (0.33 vs 0.71).
Conclusion: The five-month SEHAT intervention programme effectively promoted knowledge on healthy eating and physical activity for obesity prevention by increasing physical activity, eating fruits and vegetables, and maintaining students’ BMI.
Key words: body mass index, children, healthy eating, physical activity, schoolbased intervention

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Validation of questionnaire for assessing perceived benefits and barriers of vegetable consumption in Japanese adults
Yaeko Kawaguchi, Junichiro Somei, Chikana Kawaguchi, Akiko Suganuma & Naoki Sakane

doi: https://doi.org/10.31246/mjn-2021-0051

ABSTRACT

Introduction: This study aimed to develop and validate a diet consultation tool that assesses the perceived benefits and barriers of vegetable consumption attached to the stage of change in Japanese adults.
Methods: A web-based survey was conducted among university and vocational school students, medical staffs, and local residents in the Aichi, Osaka, and Kyoto prefectures of Japan between September 2017 and January 2018. Participants comprised of 379 adults aged 20–70 years (mean age: 30.5±12.6 years; men: 21.4%). The scale for decisional balance of vegetable consumption contained 15 benefit items and 15 barrier items. The internal consistency of the scale was examined using Cronbach’s alpha and construct validity was examined using an exploratory factor analysis with Promax rotation.
Results: The developed questionnaire had 12 items across two domains for benefits and 12 items across three domains for barriers that were structured with high internal consistencies (Cronbach’s alpha: 0.82, 0.79, 0.82, 0.76 and 0.76, respectively). The intraclass correlation coefficient in the test-retest reliability study was substantial (0.77). We found a very clear association between decreasing barrier score with increasing vegetable consumption and progress in the stage of change. The decisional balance score (benefits score minus barriers score) was positively correlated with the number of vegetable servings as an external parameter (Spearman’s correlation: 0.461; p<0.001).
Conclusion: The developed questionnaire was a valid, reliable, and useful tool for diet consultants to assess the perceived benefits and barriers of vegetable consumption in Japanese adults.
Key words: balance, benefits and barriers, diet consultation, questionnaire, vegetable

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Development of nutrition screening guideline content for use by healthcare staffs in older adults in health clinic setting: A scoping review
Siti Nur Amirah Sheikh Hishamuddin, Aliza Haslinda Hamirudin, Sakinah Harith, Mohd Aznan Md Aris, Karimah Hanim Abd Aziz, Iman Nabihah Noor Azam & Nurul Syaireen A Rashid

doi: https://doi.org/10.31246/mjn-2020-0117

ABSTRACT

Introduction: Malnutrition, specifically undernutrition, in community-dwelling older adults reduces their well-being and predisposes to diseases. Therefore, timely malnutrition identification through nutrition screening is needed to identify at risk and malnourished patients. This study aimed to develop the content of nutrition screening guideline to facilitate healthcare staffs in health clinics to administer a validated nutrition screening tool specifically for older adults.
Methods: A scoping review was conducted electronically using SCOPUS, PubMed, ProQuest Health & Medical Complete, and Cochrane databases. The systematic search was performed up to 31st December 2021. Search terms were created for identification of eligible and related articles. Inclusion and exclusion criteria were determined for the systematic search. The search was limited to English and Malay languages, and full text articles with no limitation of years. All data were extracted and analysed, guided by the PRISMA extension for scoping reviews (PRISMA-ScR).
Results: From 728 identified articles, 18 articles were included in the analysis. Identified information for the guideline content were: introduction, aims and objectives, definition of malnutrition, prevalence of malnutrition, implementation of nutrition screening, guidance on administering items in validated tools, and guidance on anthropometric measurements. Meanwhile, format and flow charts from established guidelines served as references for the guideline development process.
Conclusion: Appropriate content to develop a nutrition screening guideline has been identified based on this review. Development of a guideline based on this content can facilitate healthcare staffs to perform timely nutrition screening in older adults.
Key words: healthcare staffs, malnutrition, nutrition screening guideline, older adults, scoping review

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Knowledge, attitude, and behaviour towards nutrition radio programmes in mothers of children under five years with severe acute malnutrition in Northern Nigeria
Oyeduntan Adewunmi Enoch, Anorue Luke Ifeanyi, Idowu Olayinka Olajumoke, Balogun Bidemi Mutairu, Lasisi Bukola Fatima & Okunbo Victor

doi: https://doi.org/10.31246/mjn-2021-0022

ABSTRACT

Introduction: Although the mass media are increasingly becoming a platform for disseminating health messages to promote attitude and behavioural changes, little is known about how radio programmes influence safe child feeding practices among mothers of infants and children. Consequently, this study examined the knowledge, attitude and behaviour towards food and nutrition radio programmes in mothers of children under five years with severe acute malnutrition in Northern Nigeria.
Methods: This study employed a survey research design using data derived from a structured questionnaire undertaken with mothers (N=402) of children suffering from severe acute malnutrition (SAM) and who have been listening to radio programmes on tackling malnutrition within six months to the time of the fieldwork.
Results: Findings revealed that while mothers appeared to have a higher comprehension of child feeding programmes on the radio, their attitude and actual uptake of the messages were not encouraging. Furthermore, being young, having few children, having a primary education, and frequent listening to SAM-related messages on the radio were associated with mothers’ positive knowledge, attitude and actual uptake of the messages disseminated.
Conclusion: The findings provided a link between demographic characteristics of mothers and how they comprehend, believe and act on the messages they received from these radio programmes. It is therefore argued that the understanding of this link might inform the focus of future intervention aimed at promoting best child feeding practices in Northern Nigeria.
Key words: health education, intervention, malnutrition, mothers, radio programmes

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Malaysian Journal of Nutrition (Mal J Nutr)

Volume 28 No.2, 2022



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Table of Content




Soy flour snack bars lower glycaemic response in type 2 diabetes mellitus subjects: A randomised cross-over design
Naufal Muharam Nurdin, Hana Fitria Navratilova, Karina Rahmadia Ekawidyani & Mohamad Yulianto Kurniawan

doi: https://doi.org/10.31246/mjn-2021-0054

ABSTRACT

Introduction: Low glycaemic snacks may help to improve blood glucose control. However, data on the effect of soybean snack bars on postprandial glucose levels of the diabetic population is scarce. Therefore, the current study aimed to examine the effect of consuming soy flour snack bars on glycaemic response (GR) over a 180-minute period in individuals with diabetes by estimating postprandial glucose levels variation and total area under the curve (AUC).
Methods: Nine subjects (age: 54.6±4.0 years; BMI: 25.0±2.5 kg/m2) with type 2 diabetes mellitus (T2DM) diagnoses without complication enrolled in this randomised, open-label, cross-over trial. On three separate sessions, they consumed glucose standard solution, soy flour snack bar (SF), and wheat flour snack bar (WF) containing 25 g of available carbohydrate, respectively. Finger prick capillary method was executed to measure blood glucose levels at 30, 60, 90, 120, 150, 180 minutes after test product ingestion.
Results: Overall, significantly lower postprandial glucose levels were observed at 30, 60, 90, and 120 minutes (122.3±17.6, 136.3±24.9, 125.7±25.3, and 107.2±24.1 mg/dL; p<0.001) in those who consumed SF snack bars than WF snack bars (147.9±41.3, 168.0±43.6, 152.6±30.0, and 140.6±33.4 mg/dL). The AUC level after the ingestion of SF snack bar was 2044.8±503.1 mg.min/dL, >20% lower compared to ingestion of WF snack bar (4735.0±666.8 mg.min/dL), p<0.001. These glycaemic control benefits can be explained due to the high fibre and protein content linked to the physicochemical properties of SF.
Conclusion: With high nutritional properties, SF snack bar has a low GR and might help control blood glucose in T2DM subjects.
Key words: glycaemic response, hyperglycaemia, snack, soy food, T2DM diet

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Determinants of diet quality among mothers of young children in an urban slum area in Jakarta: Mother’s age, vegetables availability, and eating out frequency
Fitya Safira Birahmatika, Dian Novita Chandra & Luh Ade Ari Wiradnyani

doi: https://doi.org/10.31246/mjn-2021-0031

ABSTRACT

Introduction: Poor diet quality is a major issue, and health concerns may be related to diet. Mothers with young children usually have their meals at home; thus, home food environment plays a role in determining dietary behaviours. This study examined the association between health concerns and diet quality among mothers; additionally, the effect of home food environment on this relationship was assessed.
Methods: This cross-sectional study comprising 229 mothers (aged 19–49 years) with young children was conducted in an urban slum area in North Jakarta. Data were collected via interviews using a structured questionnaire. The General Health Interest Scale and Consumer Behaviour Questionnaire were used to assess health concern and home food environment, respectively. The 24-hour dietary recall method was used to calculate the Diet Quality Index-International (DQI-I) score. Spearman’s correlation, multiple linear regression, and path analysis were used to analyse the data.
Results: Majority of the mothers had poor diet quality (mean DQI-I score, 41.44/100). No significant correlation between health concern and diet quality was observed. After adjusting for age, the relationship between health concern and diet quality was not mediated by vegetables availability or eating out frequency (indirect effect=0.012; p=0.096). Multiple linear regression analysis revealed age as a significant predictor of diet quality (B=0.196; p=0.024).
Conclusion: Diet quality among mothers of young children differed with age and was related to both health concerns and home food environment. Thus, the development of strategies to promote healthy eating based on different age groups is warranted.
Key words: diet quality, healthy diet, home environment, mothers

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Milk supplementation increases mid-upper arm circumference and haemoglobin level among pregnant women in Kupang, Indonesia: Evidence from a regression discontinuity design
Ahmad Syafiq, Sandra Fikawati, Nindhita Priscillia Muharrani & Mardatillah

doi: https://doi.org/10.31246/mjn-2021-0023

ABSTRACT

Introduction: The high prevalence of chronic energy deficiency (CED) and anaemia among pregnant women in Indonesia is worrying. Nusa Tenggara Timur (NTT) is one of the provinces in Indonesia with the highest prevalence of CED. This study aimed to determine the effect of fortified milk supplementation on changes in mid-upper arm circumference (MUAC) and haemoglobin level among pregnant women.
Methods: This quasi-experimental study was conducted in three locations of Community Health Centers in NTT from May to August 2019. Purposive sampling was used to recruit 69 pregnant women who were divided into two groups based on haemoglobin levels; the intervention group consisted of 31 pregnant women with haemoglobin levels below 11 g/dL, and control group consisted of 38 pregnant women with haemoglobin levels above 11 g/dL. Intervention group was provided with fortified milk supplementation, while control group received education about prevention of CED and anaemia. Data were analysed using regression discontinuity design with haemoglobin of 11 g/dL as cut-off.
Results: Using regression discontinuity method, we were able to determine the effect of milk supplementation based on haemoglobin levels and confirm the result that milk supplementation significantly increased MUAC by 4.69 cm. Despite no discontinuity found, a positive increase of 0.98 g/dL in haemoglobin level was important to note.
Conclusion: Milk supplementation of 300 kcal/day for three months significantly increased MUAC and to some extent, increased haemoglobin level. Thus, it should be considered when planning nutrition programmes to improve the nutritional status of pregnant women.
Key words: haemoglobin level, milk supplementation, MUAC, pregnant women, regression discontinuity design

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Knowledge, attitude and practices (KAP) towards anaemia among female university students in Malaysia: A cross-sectional survey
Cheryl Huong, Jing Lin Chua, Rui Yi Ng, Dhanashri Kshitij Panse, Snigdha Misra & Afshan Sumera

doi: https://doi.org/10.31246/mjn-2021-0067

ABSTRACT

Introduction: Anaemia is a common health problem in Malaysia, most common being iron deficiency anaemia (IDA). This study aimed to assess knowledge, attitude, practices (KAP), and health-seeking behaviour (HSB) towards anaemia among undergraduate female students.
Methods: A cross-sectional study was conducted among 180 female university students from a medical university in Malaysia. Data were collected using an online questionnaire comprising KAP and HSB. SPSS version 25.0 was used for statistical analysis.
Results: Most participants (60%) had an appropriate level of knowledge about anaemia. A positive attitude was shown with adequate awareness of anaemia. A total of 55.5% of participants reported having good health practices. However, 52.9% of the participants consumed less iron-rich foods and 81.7% reported skipping meals. The overall observed healthseeking behaviour was good. A statistically significant relationship was found between knowledge with attitude (p=0.003) and practice (p=0.005). This study observed that the study population had poor nutritional status, long menstrual duration, and vegetarianism. Moreover, infrequent consumption of vitamin C-rich fruits and low iron-folate supplementation were also observed.
Conclusion: A good level of knowledge on IDA among students was noted. However, most of the students showed a lack of positive attitude and good practices towards preventing anaemia. University students are prone to IDA due to a lack of KAP, which can significantly affect health-seeking behaviour. This issue should not be neglected; therefore, implementing intervention programmes to educate students on the preventive measures against the risk factors of IDA is recommended.
Key words: anaemia, health-seeking behaviour, knowledge attitude practice

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Formulation of local food multimix sprinkle to enhance nutritional adequacy of preschool children in southernmost provinces of Thailand
Laksana Chaimongkol & Bisri Soison

doi: https://doi.org/10.31246/mjn-2021-0102

ABSTRACT

Introduction: This study aimed to formulate an effective Food Multimix-Sprinkle (FMM-S) by using locally available materials.
Methods: Fish (Threadfin bream), cow liver, and orange fleshed sweet potato (OSP) were cooked and dried by using applicable household (HH) method and drum drying (DD). Then, the dried materials were milled and sieved through a 20 mesh screen. Fish, cow liver, and OSP sprinkles were mixed in various proportions to meet nutrient level targets [at least 30% of Thai Recommended Dietary Allowance (RDA) for 1-3 years old children per 15 g serving size].
Results: Six alternative mixes were formulated. The mixture of 3 g of liver, 7 g of fish, and 5 g of OSP (3:7:5) when processed by HH method, and the mixture of 4 g of liver, 8 g of fish, and 3 g of OSP (4:8:3) when processed by DD method, had significant advantage in preference scores in all attributes over the others. Nutritional values of these formulas were 37-55% RDA of protein, 146-194% RDA of vitamin A, and 30-40% RDA of iron for a serving size.
Conclusion: This study demonstrated that household preparation, as well as preparation using drum drying could be used to process raw fish, cow liver, and OSP into a sprinkle mix. The FMM-S provided appropriate amounts of protein, vitamin A, and iron to supplement nutrient intake in pre-schoolers. However, a consumer test is needed to ensure acceptance by the target population.
Key words: food multimix, nutritional formulation, sprinkle

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Comparative amino acid composition and quality parameters of Moringa oleifera testa and cotyledon
Emmanuel Ilesanmi Adeyeye, Abdul Ademola Olaleye, Oluwajumoke Tolulope Idowu, Habibat Omolara Adubiaro & Kikelomo Elizabeth Ayeni

doi: https://doi.org/10.31246/mjn-2020-0130

ABSTRACT

Introduction: Moringa oleifera is a drought-resistant plant, widely used in the tropical region. The leaves and stems have been extensively utilised in foods and neutraceuticals preparation, with less attention to the seeds. In this study, amino acid (AA) compositions of M. oleifera testa and cotyledon were examined comparatively.
Methods: Samples were separately defatted, hydrolyed, and neutralised. The AA solution was purified by cation-exchange solid-phase extraction, derivatised and analysed by gas chromatography.
Results: Glutamic (acidic amino acid) and phenylalanine (essential amino acid, EAA) were the most concentrated in both samples. Total EAA (g/100g crude protein, cp) was higher in cotyledon (51.0) than testa (41.9). Predicted protein efficiency ratios (P-PERs) were higher in testa (0.605-1.530) than cotyledon 0.286-1.460). EAA index ranged between 0.951-1.13 (soybean comparison) and 83.0-96.9 (egg comparison) with corresponding biological value of 78.7-93.9. The following AA had scores >1.0 in comparison to whole hen’s egg, testa: glycine (Gly), glutamic acid (Glu), phenylalanine (Phe), histidine (His), and cysteine (Cys); cotyledon (Gly), proline (Pro), Glu, Phe, His, arginine (Arg) and Cys. In comparison with requirements of pre-school children, six AA (6/9 or 66.7%) had scores >1.0 in each sample. In provisional AA scoring pattern, isoleucine (Ile) (1.25) and Phe + tyrosine (Tyr) (1.68) had scores >1.0 in testa while methionine (Met) + Cys, Phe+Tyr, and tryptophan (Trp) in cotyledon. However, tryptophan and lysine were the limiting AAs in testa and cotyledon, respectively.
Conclusion: The study showed that both anatomical parts would complement each other in terms of amino acid supply.
Key words: amino acid scores, derivatisation, essential amino acid, hydrolysis, isoelectricpoint

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Combined effects of bee pollen supplementation and resistance training on aerobic capacity, muscular performance, antioxidant status, and bone metabolism markers in young men: A randomised controlled trial
Nurathirah Na’aim, Chee Keong Chen, Foong Kiew Ooi & Mahaneem Mohamed

doi: https://doi.org/10.31246/mjn-2021-0072

ABSTRACT

Introduction: This study investigated the combined effects of bee pollen and resistance training on aerobic capacity, muscular performance, antioxidant status, and bone metabolism markers among young men.
Methods: Forty young men were randomly assigned into four groups: sedentary control (C), bee pollen supplementation (BP), resistance training (RT), and combined bee pollen supplementation and resistance training (BPRT) groups. Bee pollen was consumed by participants in BP and BPRT groups (1500 mg daily for eight weeks). Resistance training was performed thrice per week for eight weeks in RT and BPRT groups. Participants’ anthropometry, aerobic capacity, isokinetic muscular peak torque (strength), and average power were measured. Concentrations of serum total antioxidant status (TAS), serum superoxide dismutase (SOD), serum alkaline phosphatase (ALP), and serum C-terminal telopeptide of type 1 collagen (1CTP) were determined.
Results: After eight weeks of intervention, there was a significant decrease in 1CTP in BP group. In RT group, significant increases were observed in both muscular strength and power. In BPRT group, significant increases in both muscular strength and power, and a significant decrease in 1CTP were observed after 8 weeks. There were no significant changes in aerobic capacity, serum TAS, SOD, and ALP in all the study groups.
Conclusion: Resistance training using dumbbells and elastic bands seemed to elicit beneficial effects on muscular strength and power, while bee pollen supplementation alone reduced the level of bone resorption marker. In addition, combining bee pollen with resistance training seemed to offer additive benefit in muscular strength and power.
Key words: antioxidant status, bee pollen, bone metabolism markers, muscular performance, resistance training

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Factors related to low birth weight in Indonesia
Nikmatur Rohmah, Masruroh Masruroh, Nur Baharia Marasabesy, Nasrun Pakaya, Joko Prasetyo, Saiful Walid & Agung Dwi Laksono

doi: https://doi.org/10.31246/mjn-2021-0123

ABSTRACT

Introduction: Previous studies have reported that low birth weight (LBW) correlates with neonatal death and 15 - 20% of all births worldwide are LBW. This research aimed to analyse the factors related to LBW in Indonesia.
Methods: The authors collated secondary data from the 2017 Indonesian Demographic and Health Survey (IDHS). The sample consisted of 17,443 respondents. Besides LBW as the dependent variable, the independent variables consisted of maternal age, residence, wealth, education, employment, marital status, health insurance, antenatal care (ANC) visits, smoking behaviour, and gender of the baby. The final stage employed binary logistic regression.
Results: Women aged 35-39 years were 0.688 times less likely than women aged 15-19 years to give birth to LBW babies. The wealthiest women were 0.712 times less likely than the poorest women to give birth to LBW babies. Women with higher education levels were 0.670 times less likely to have a LBW baby than women with no education level. Women who attended ≥4 ANC visits were 0.829 times less likely to have LBW babies than women who attended <4 ANC visits. Baby girls were 1.161 times more likely than baby boys to be born with LBW
Conclusion: The study concluded that the factors related to LBW in Indonesia were maternal age, wealth, education, ANC, and gender of the baby.
Key words: antenatal care visit, education level, low birth weight, wealth status, women of reproductive age

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The effect of goat’s milk consumption on the clinical health of middle-aged adults with lactose intolerance
Chanchira Phosat, Charupan Phosat, Chatrapa Hudthagosol, Pornpimo Panprathip Phienluphon & Karunee Kwanbunjan

doi: https://doi.org/10.31246/mjn-2021-0087

ABSTRACT

Introduction: People with lactose intolerance are suggested to consume dietary items containing less lactose, such as goat’s milk. This study aimed to investigate the effects of goat’s milk powder on the health of lactose intolerant middle-aged adults.
Methods: A total of 60 subjects were recruited into this randomised controlled trial. They were divided into four groups and received different dietary interventions (goat’s milk, goat’s milk with curcumin, goat’s milk with coffee, lactose-free milk) for five weeks. Health effects were compared between pre- and post-intervention. Anthropometric and biochemical parameters (blood glucose, insulin, lipid profile, C-reactive protein, and lactoferrin) were evaluated. Dietary intake was recorded using a food record.
Results: Fifty-one lactose intolerant subjects completed the study. After ingestion of goat’s milk, there were significant reductions in body fat (p=0.033) and a significant increase in the percentage of muscle (p=0.021). Waist circumference (WC) decreased in both the goat’s milk with curcumin and goat’s milk with coffee groups (p<0.05 for all). Unfortunately, high-density lipoprotein cholesterol (HDL-C) dropped after the five-week intervention in the goat’s milk group (p=0.002). Lactoferrin level of the goat’s milk group was higher than other groups at post-intervention (p<0.001). Besides, the goat’s milk with coffee group seemed to consume more carbohydrates after completing the intervention (p=0.034).
Conclusion: A five-week intake of goat’s milk reduced the risk of abdominal obesity among middle-aged adults. In addition, it resulted in improved lactoferrin levels.
Key words: goat’s milk, lactoferrin, lactose-free, lactose intolerance, middle-aged adults

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Validation of a Sustainable Diet Index among young Malaysian adults
Nur Fadzlina Zulkefli & Foong Ming Moy

doi: https://doi.org/10.31246/mjn-2021-0060

ABSTRACT

Introduction: A sustainable diet which is healthy and environmentally friendly provides the means of climate change mitigation in addition to promoting health of the population. There is an urgent need to have an indicator to measure if one’s diet is sustainable. This paper aimed to validate a newly developed Sustainable Diet Index (SDI) among young Malaysian adults. The SDI was developed based on the dietary guidelines of a sustainable diet.
Methods: Five indicators (rice, animal-based food, plant-based food, food waste, and packaging) were included in the SDI. The index was validated via content validity, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA) among young Malaysian adults. The dietary assessment tool used was an Android application named Sustainable Food Record.
Results: Content validity showed fair to moderate correlations (0.331 - 0.816) between the indicators in the SDI. EFA produced five final factors with eight indicators in the index as follows: 1) fruits and vegetables; 2) dairy, eggs, and meat; 3) rice, cereals, and grain products; 4) food packaging; and 5) food waste management with strong factor loadings (0.760 – 0.984). All five factors with eight indicators were retained and proceeded with CFA. The fit indices from CFA demonstrated that the model was an absolutely fit.
Conclusion: The validated SDI can be used as a tool to measure the sustainability of an individual’s diet in Malaysia, incorporating both health and environment considerations.
Key words: environment, health, sustainable diet index, validation

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Household income, frequency of purchasing outside meals, eating behaviour and body mass index status among undergraduate students during first phase of COVID-19 lockdown
Nur Hazirah Abdul Razak & Divya Vanoh

doi: https://doi.org/10.31246/mjn-2021-0129

ABSTRACT

Introduction: COVID-19 lockdown has changed the eating behaviours of people, which could affect their body mass index (BMI). These changes affected meal purchasing habits of university students, depending on their household income. Thus, the current study aimed to investigate the association between eating behaviour, household income, frequency of purchasing outside meals with BMI among undergraduate students.
Methods: This was a retrospective cross-sectional study conducted among 112 undergraduate students. Subjects recalled information during the first phase of COVID-19 lockdown, which was from March 2020 till July 2020. Questionnaire consisted of socio-demography, anthropometry, frequency of purchasing outside meals, and eating behaviour using the Malay version Dutch Eating Behaviour Questionnaire (DEBQ).
Results: About 64.3% of subjects reported purchasing outside meals 1-2 times per week. Higher restrained eating behaviour score was correlated with purchasing outside meals about 3-4 times and >4 times a week. Normal weight students had significantly higher restrained eating behaviour score [3.0(1.1)] than those in the obese group [2.9(1.1)]. Household income had no association with frequency of purchasing outside meals.
Conclusion: Eating behaviour affected BMI and the frequency of purchasing outside meals during COVID-19 lockdown. COVID-19 lockdown has resulted in tremendous changes in the eating behaviour and physical activity pattern of university students. Future studies should focus on increasing the nutrition knowledge of university students, especially on the aspect of eating out.
Key words: body mass index, COVID-19, eating behaviour, household income, purchasing meals

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Effect of adherence to follow-up on recovery from moderate acute malnutrition among under-fives in a supplementary feeding programme
Ekong Emmanuel Udoh, Rosemary Augustine Umoh, Kevin Bassey Edem, Frances Samue Okpokowuruk, Ekemini Nsikan Udo, Blessing Njideka Nwazuluoke & Olugbemi Oluseyi Motilewa

doi: https://doi.org/10.31246/mjn-2021-0040

ABSTRACT

Introduction: Supplementary feeding programme is a strategy for managing underfives with moderate acute malnutrition (MAM). This study aimed to determine the effect of adherence to follow-up on recovery from MAM among under-fives.
Methods: A clinical trial to evaluate the effectiveness of daily supplementary rations of a standardised milk-based formulation (SMBF), standardised non-milk-based formulation (SNMBF), and hospital-based formulation (HBF) on recovery from MAM over a four months period was conducted among eligible children aged 6 – 59 months. Recovery from MAM among participants was determined based on their status of adherence to follow-up at week 16. It was deemed statistically significant if p-value was <0.05.
Results: Of the 157 children evaluated, 41/54 (75.9%) who received the SMBF, 32/57 (56.1%) who received the SNMBF, and 22/46 (47.8%) who received the HBF had good adherence. Adherence to follow-up was significantly higher with SMBF than SNMBF and HBF (χ²=8.923; p=0.012). In all, 95/157 (60.5%) had good adherence to follow-up with 73/95 (76.8%) recovery from MAM against 42/62 (67.7%) recovery in those with poor adherence (p=0.208).
Conclusion: The status of adherence to scheduled follow-up was not significantly associated with recovery from MAM among under-fives enrolled in the supplementary feeding programme. Nevertheless, efforts at promoting adherence to scheduled follow-up visits should be sustained.
Key words: adherence, clinical, follow-up, malnutrition, nutrition, trial

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