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IntroductionThe accrual of iron that is reflected in high maternal hemoglobin (Hb) status is increasingly recognized as a risk factor for gestational diabetes mellitus (GDM). Changes in maternal Hb level could also implicate glycemic status in pregnancy. This study aimed to determine the associations between maternal Hb levels and their changes with GDM.MethodsIn this retrospective cohort study, a total of 1,315 antenatal records of mothers with singleton pregnancies from eight health clinics of a district in the northern region of Peninsular Malaysia who delivered between 1st January 2016–31st December 2017 were analyzed. Data extracted from the records were socio-demographic, anthropometric, obstetrical, and clinical data. Hb levels were extracted at booking (

Abstract Background The disease burden of indigenous peoples has been augmented by the rising prevalence of obesity and hypertension in this population. This study assessed the ability of obesity indices to predict hypertension among indigenous adults of Peninsular Malaysia. Methods In this cross-sectional study, 482 adults (223 men, 259 women) aged ≥18 years old were measured for body mass index (BMI), waist circumference (WC), waist-height ratio (WHtR), waist-hip ratio (WHR), and blood pressure. Receiver operating characteristic (ROC) analysis was used to determine the predictive ability of obesity indices for hypertension in men and women. Gender-specific logistic regression analyses were done to examine the association between obesity, defined by BMI, WC, WHtR and WHR, and hypertension. Results Prevalence of hypertension was 25.5%. Overall, WHtR was the best predictor of the presence of hypertension, in both men and women. The optimal WHtR cut-off values for hypertension were 0.45 and 0.52 in men and women, respectively. Obese adults with WHtR ≥0.5 had about two times increased odds of having hypertension compared to non-obese adults. Conclusions WHtR may serve as a simple and inexpensive screening tool to identify individuals with hypertension in this relatively difficult to reach population.

Introduction: Traditional cardiovascular (CV) risk factors are constituents of Metabolic Syndrome (MetS) and Framingham Risk Score (FRS). However, CV risk exists even when these risk parameters are normal and have been attributed to the atherogenic small dense low-density lipoprotein cholesterol (sdLDL). This study aimed to determine the association of Pattern B and LDL subfractions with MetS and FRS among selected Malaysian population. Materials and Methods: A cross-sectional study of 380 subjects ≥30 years old at health screening. Sociodemographic factors and clinical characteristics were recorded. Fasting serum lipids, LDL subfractions and plasma glucose were analysed. Results: Being older, Malay with Pattern B independently predicted MetS. Being male, Chinese with Pattern B and increased body mass index (BMI) and diastolic blood pressure (DBP) were more likely to be in the intermediate to high risk FRS group. Common independent biochemical predictors include LDL1 and sdLDL: LDL3 in MetS and non-high-density lipoprotein cholesterol in FRS. Conclusion: BMI and DBP may provide incremental prognostic value to FRS risk estimates if included. Considering a significant incidence of Pattern B in low FRS risk subjects (13.4%), routine LDL subfraction analysis could identify these individuals that would be overlooked if their risk were predicted solely based on their FRS only. The non-specific lowering of LDL1 by lipid-lowering therapy based on conventional lipid profile might have a negative effect on several physiological processes. Hence, if LDL subfractions are determined, therapy can be targeted towards sdLDL. Recognising asymptomatic individuals who carry high CV risk is pertinent in primary prevention. [ABSTRACT FROM AUTHOR]

Introduction: There is limited evidence on dietary patterns and the risk of type 2 diabetes (T2D) in women with a history of gestational diabetes mellitus (GDM) compared to their non-GDM counterparts, especially in the Asian population. The pilot study investigated dietary patterns in women with a history of GDM (HGDM) and without a history of GDM (non-HGDM), and the association with T2D risk. Methods: This comparative cross-sectional study involved 64 women (32 HGDM, 32 non-HGDM). Food intake was assessed using a validated food frequency questionnaire. Principal component analysis derived the dietary patterns. T2D risk score was determined using the Finnish Diabetes Risk Score tool. Results: HGDM group had significantly higher proportion of first-degree family history of diabetes; higher risk of T2D and better diabetes knowledge; lower gestational weight gain and postpartum weight retention; and consumed more fast food than non- HGDM. 'Rice-noodle-pasta-meat' dietary pattern was significantly associated with increased T2D risk after adjusting for age ( β=0.272, p=0.032). 'Bread-cereals-fast food-meat' dietary pattern was positively and significantly associated with T2D risk after adjusting for confounders, including age, education level, family history of diabetes, diabetes knowledge score, gestational weight gain, and postpartum weight retention ( β=0.251, p=0.012). Conclusion: Dietary patterns high in bread, cereals and cereal products, fast food and meat, as well as rice, noodle, pasta and meat were associated with an elevated T2D risk. A more extensive study is warranted to establish the association between dietary patterns and risk of T2D, focusing on women with a history of GDM. [ABSTRACT FROM AUTHOR]

Background: The objective of the present study is to investigate the influences of sociodemographic and household factors on consumption expenditure on processed meat among households in Malaysia. Methods: Data were extracted from the Malaysian Household Expenditure Survey (HES) 2016. Lognormal hurdle models were utilized to assess the likelihood of consuming processed meat and the amount consumed. The independent variables consisted of household heads' age, educational level, gender, marital status, employment status, ethnicity, as well as household income, household region and household locality. Results: Bumiputera households with younger heads were more likely to consume processed meat and spent more than households with older heads. Chinese and Indian households in a higher income group had a higher likelihood of consuming and spending on processed meat than those in a lower income group. The probability of consuming processed meat and the amount consumed were positively associated with being from East Malaysia and urban areas. Conclusions: There are distinguished roles of sociodemographic and household factors across ethnic groups in consumption expenditure on processed meat. Policy makers should take account of age, income, education, household region and household locality factors when formulating intervention measures. [ABSTRACT FROM AUTHOR]

Introduction: Cardiovascular disease and osteoporosis (OP) have been shown to have similar risk factors but studies have demonstrated contradictory results with regards to their associations. This study evaluated relationships between bone characteristics and cardiovascular risk factors among adults in selected urban areas in Malaysia. Materials and Methods: A cross-sectional study was performed involving 331 subjects between 45-90 years recruited at a health screening programme. Sociodemographic and clinical characteristics were recorded. Biochemical analyses on fasting blood samples and dual energy X-ray absorptiometry scan to determine bone mineral density (BMD) were performed. Results: Increased waist circumference (WC) was protective for abnormal BMD status (osteopenia and OP). Males with increased high-density lipoprotein cholesterol (HDL) were more likely to be osteoporotic. WC, fasting blood glucose (FBG) and triglyceride (TG) were positively associated with BMD at all sites but was gender specific. In contrast, WC was negatively associated with trabecular bone score (TBS) for females but this association became attenuated when adjusted for fat percentage. HDL and MetS were negatively and positively associated with BMD, respectively in males. Conclusion: The cardiovascular risk factors of raised WC, FBG, TG and low HDL were significantly associated with increased BMD with skeletal site and gender specific differences after adjusting for confounders. However, a higher WC was associated with a weaker skeletal microstructure reflected by lower TBS in females driven by fat percentage. A higher BMD was demonstrated among MetS individuals. These findings suggest that adiposity may have a protective effect on BMD. [ABSTRACT FROM AUTHOR]

Women with previous gestational diabetes mellitus (post-GDM) have an increased risk of cardiometabolic diseases including type 2 diabetes (T2D). Current diabetes screening is based on the oral glucose tolerance test without nutritional assessments, even though unhealthy dietary patterns were found to expedite disease progression in women post-GDM. While a healthful dietary pattern reduces T2D risk, limited data support a dietary pattern tailored to the Asian population, especially in the Malaysian context. Metabolomic profiles associated with dietary patterns in this population are also lacking. The proposed study aims to investigate both components of dietary patterns and metabolomic profile, known as nutritype signatures, and their association with T2D in women post-GDM. The comparative cross-sectional study will involve a minimum of 126 Malaysian women post-GDM aged 18–49 years. Dietary patterns will be analysed using principal component analysis. Plasma and urinary metabolites will be quantified using one-dimensional proton nuclear magnetic resonance (1H NMR) spectroscopy. The aim of the study is identifying the nutritype signatures associated with T2D. The findings will support the development of early prevention measures against T2D in women post-GDM. [ABSTRACT FROM AUTHOR]

Introduction: Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is an uncommon condition due to maternal alloimmunization of fetal platelet leading to thrombocytopenia in fetal and neonate. Our study determine the incidence, common platelet alloantibodies and the associated maternal and neonatal factors of FNAIT in Malaysia. Methods: Matched case control study of FNAIT and control (39 FNAIT cases and 39 randomly selected controls) through retrospective record review from the year 2011 to 2019 was performed at National Blood Centre, Malaysia. Data were analysed using Statistical Package for Social Sciences (SPSS) version 26.0. Differences between cases and controls were evaluated using chi-square test for categorical variables and t-test or Mann-Whitney test for normally and non-normally distributed variables. Results: The incidence of FNAIT in Malaysia was 0.85 per 100 000 live births. Common anti-Human Platelet Antigen (-HPA) identified in this study were Anti-HPA-5b, Anti-HPA-3a and Anti-HPA-5a. Fifty-eight (58%) (p=0.012) of mothers in the study were younger than 35 years old, of Malay ethnicity and multiparous. Malay mothers were five times more likely to develop FNAIT as compared to non-Malay. For neonates, the most significant factor associated with FNAIT was the neonatal presentation. Symptomatic neonates were more likely to develop FNAIT. Whereas, the neonates onset of presentation, platelet count and blood group were not significantly different than in control group. Conclusion: Incidence of FNAIT among Malaysians was lower than reported in the literature. Malay mothers and neonates presenting with symptoms are more likely to have FNAIT. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to determine the prevalence of vertebral fractures (VF) in a selected urban population in Malaysia and to explore possible variables associated with VF in the study population. Methods: A cross-sectional study involving community-living, healthy subjects aged between 45–90 years from the state of Selangor, Malaysia, were invited to attend a bone health check-up. Subjects with diseases known to affect bone metabolism or were on treatment for osteoporosis (OP) were excluded. Bone mineral density (BMD) was measured using dual energy X-ray absorptiometry (DXA). Lateral and antero-posterior view lumbar spine x-rays were performed and VF was determined by the semi-quantitative Genant method. Results: A total of 386 subjects were studied. Asymptomatic morphometric VF were found in 44 (11.4%) subjects. T12 was the most common vertebrae to be fractured. The prevalence of VF was significantly higher in menopausal women (12.4%) compared to non-menopausal women, in those above the age of 60 (18.5%), in those of Chinese ethnicity (16.5%), in those with a low body fat percentage (17.1%) and among those with OP (27.0%). The mean (standard deviation) 25-hydroxyvitamin D [25(OH)D] levels were significantly higher in those with VF compared to those without VF, 67.64 (23.50) and 57.47 (21.71) nmol/L, respectively. However, after multiple regression analysis, age over 60 years and OP on DXA BMD measurement were the only significant associated factors for VF. Conclusion: Overall, 11.4% of a selected Malaysian urban population had asymptomatic morphometric VF. Age over 60 years and OP on DXA BMD measurement, but not 25(OH)D levels, were associated with VF. [ABSTRACT FROM AUTHOR]

Objective: To examine the gestational weight gain (GWG) trajectory and its possible association with pregnancy outcomes.Design: GWG trajectories were identified using the latent class growth model. Binary logistic regression was performed to examine the associations between adverse pregnancy outcomes and these trajectories.Setting: Negeri Sembilan, Malaysia.Participants: Two thousand one hundred ninety-three pregnant women.Results: Three GWG trajectories were identified: 'Group 1 - slow initial GWG but followed by drastic GWG', 'Group 2 - maintaining rate of GWG at 0·58 kg/week' and 'Group 3 - maintaining rate of GWG at 0·38 kg/week'. Group 1 had higher risk of postpartum weight retention (PWR) (adjusted OR (AOR) 1·02, 95 % CI 1·01, 1·04), caesarean delivery (AOR 1·03, 95 % CI 1·01, 1·04) and having low birth weight (AOR 1·04, 95 % CI 1·02, 1·05) compared with group 3. Group 2 was at higher risk of PWR (AOR 1·18, 95 % CI 1·16, 1·21), preterm delivery (AOR 1·03, 95 % CI 1·01, 1·05) and caesarean delivery (AOR 1·02, 95 % CI 1·01, 1·03), but at lower risk of having small-for-gestational-age infants (AOR 0·97, 95 % CI 0·96, 0·99) compared with group 3. The significant associations between group 1 and PWR were observed among non-overweight/obese women; between group 1 and caesarean delivery among overweight/obese women; group 2 with preterm delivery and caesarean delivery were only found among overweight/obese women.Conclusions: Higher GWG as well as increasing GWG trajectories was associated with higher risk of adverse pregnancy outcomes. Promoting GWG within the recommended range should be emphasised in antenatal care to prevent the risk of adverse pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Introduction: This cross-sectional study aimed to investigate relationships between diet quality assessed by Malaysian Healthy Eating Index (HEI) and cardiometabolic risk factors in adolescents aged 13 years. Methods: 336 adolescents from various public secondary schools provided information on sociodemography and their anthropometric measurements including height (cm), weight (kg) and waist circumference (cm) were measured. Body mass index (BMI) was estimated thereafter. Dietary intakes assessed using a validated adolescent food frequency questionnaire (FFQ) was used to estimate Malaysian HEI. Biomarker parameters including lipid profile, fasting glucose, insulin and insulin resistance were also assessed. Associations of diet quality indicators to cardiometabolic risk factors were examined using regression models. Results: The overall diet quality of the adolescents was rather poor (49%), with a greater percentage of males were found to have low dietary quality score compared to females (56% vs. 39%; p<0.05). While males were more obese, a higher number of females (46.7%) were found to have at least one risk factors for cardiometabolic health compared to males (37.7%). After adjusting for covariates, no significant associations were observed among adolescents in the lowest quartile compared to those in the highest quartile of HEI score for obesity and abdominal obesity, as well as other cardiometabolic risk factors, in both males and females. Conclusion: Despite of poor dietary quality, no significant associations were observed between dietary quality assessed by Malaysia HEI and cardiometabolic risk factors in adolescents. Prospective studies are needed to establish a causal link between dietary patterns and cardiometabolic risk factors during adolescence. [ABSTRACT FROM AUTHOR]

Introduction: Dyslipidaemia is a recognised conventional risk factor for cardiovascular disease (CVD). However, even when traditional lipid parameters are normal, CVD risk can exist. Small dense lowdensity lipoprotein cholesterol (sdLDL) has appeared as a significant risk marker for CVD. This study aimed to determine the prevalence and associated factors of atherogenic lipoprotein Pattern B in the Malaysian population. Materials and Methods: This cross-sectional study included 150 subjects aged 30 years and above who attended a health screening in a Malaysian tertiary institution. Sociodemographics, clinical characteristics and laboratory parameters (lipids, glucose, and sdLDL) were obtained. Lipoprotein subfraction was analysed using the polyacrylamide gel electrophoresis method. Results: Malays and females made up the majority of subjects and the median age was 37 years. Normolipidaemic Pattern B was significantly higher in women (p=0.008). Significant independent predictors of Pattern B were gender (p=0.02), race (p=0.01), body mass index (BMI) [p=0.02] and lipid status (p=0.01). Triglyceride was the only independent predictor of sdLDL (p=0.001). Conclusion: The prevalence of Pattern B of 33% in this study was comparatively high, of which 6.7% were normolipidaemic. Chinese males with dyslipidaemia and increased BMI independently predicted Pattern B. Differences in triglyceride levels alone among these ethnic groups do not fully explain the differences in the prevalence of Pattern B although it was the only lipid parameter to independently predict sdLDL. Individuals with atherogenic normolipidaemia are at greater risk for a CVD event as they are not included in the protective measures of primary CVD prevention. [ABSTRACT FROM AUTHOR]

Introduction. The effect of weight loss magnitude on cardiometabolic risk markers has been sparsely studied, particularly among overweight and obese women from low socioeconomic areas. Objectives. To examine the association of weight loss magnitude with changes in cardiometabolic risk markers in overweight and obese women from low socioeconomic areas engaged in a lifestyle intervention. Methods. Analyses were performed on 243 women (mean body mass index 31.27 ± 4.14 kg/m2) who completed a 12-month lifestyle intervention in low socioeconomic communities in Klang Valley, Malaysia. Analysis of covariance (ANCOVA) was used to compare changes of cardiometabolic risk factors across weight change categories (2% gain, ±2% maintain, >2 to <5% loss, and 5 to 20% loss) within intervention and control group. Results. A graded association for changes in waist circumference, fasting insulin, and total cholesterol (p = 0.002 , for all variables) across the weight change categories were observed within the intervention group at six months postintervention. Participants who lost 5 to 20% of weight had the greatest improvements in those risk markers (−5.67 cm CI: −7.98 to −3.36, −4.27 μU/mL CI: −7.35, −1.19, and −0.59 mmol/L CI: −.99, −0.19, respectively) compared to those who did not. Those who lost >2% to <5% weight reduced more waist circumference (−4.24 cm CI: −5.44 to −3.04) and fasting insulin (−0.36 μU/mL CI: −1.95 to 1.24) than those who maintained or gained weight. No significant association was detected in changes of risk markers across the weight change categories within the control group except for waist circumference and adiponectin. Conclusion. Weight loss of >2 to <5% obtained through lifestyle intervention may represent a reasonable initial weight loss target for women in the low socioeconomic community as it led to improvements in selected risk markers, particularly of diabetes risk. [ABSTRACT FROM AUTHOR]

Generally, dietary patterns (DP)s have been linked to the risk of diabetes mellitus, however, only few studies examined the associations between DPs in early pregnancy and the risk of gestational diabetes mellitus (GDM). This study aims to determine the association between DPs before and during pregnancy and risk of GDM in Malaysian pregnant women. DPs were derived using principal component analysis of consumed 126 food and beverage items assessed using a validated semi-quantitative food frequency questionnaire collecting data retrospectively for pre-pregnancy, but prospectively for the first and second trimester. Three different DPs were identified at each time point and labelled as DP 1–3 (pre-pregnancy), DP 4–6 (first trimester), and DP 7–9 (second trimester). About 10.6% (n = 48) of pregnant women were diagnosed with GDM in our cohort. Women with high adherence (HA) to DP 2 (adjusted OR: 0.45, 95% CI: 0.20–0.91) and DP 5 (adjusted OR: 0.28, 95% CI: 0.11–0.68) showed a significantly reduced risk of GDM compared to women with low adherence (LA). Other DPs were not significantly associated with GDM risk. Compared to women with GDM, non-GDM women showed HA scores for all DPs throughout pregnancy. Overall, a relative low percentage of women with GDM was found in this cohort. The risk was lower in women with HA to a relatively unhealthy dietary pattern, i.e. DP 2 and DP 5. The lower body mass index (BMI) status and energy intake of women showing a HA to DP 2 in the first trimester may underlie the observed association with a lower GDM risk. Additionally, genetic variance might explain the less susceptibility to GDM despite HA to unhealthy DPs among non-GDM women. [ABSTRACT FROM AUTHOR]

Background: Despite perennial sunshine, vitamin D deficiency is prevalent among Malaysians especially pregnant women. This study determines the vitamin D status and its associated factors among third trimester pregnant women attending government health clinics in Selangor and Kuala Lumpur, Malaysia. Methods: Information on socio-demographic characteristics, obstetrical history, and sun exposure were obtained through face-to-face interviews. Vitamin D intake was assessed using a semi-quantitative food frequency questionnaire (FFQ). Serum 25-hydroxyvitamin D concentration was measured and classified as deficient (< 30 nmol/L), insufficient (30–50 nmol/L), and sufficient (≥ 50 nmol/L). Results: Of the 535 pregnant women recruited, 42.6% were vitamin D deficient. They consumed an average of 8.7 ± 6.7 μg of vitamin D daily. A total of 80.4% of the vitamin D were obtained from the food sources, while 19.6% were from dietary supplements. Fish and fish products showed the highest contribution to vitamin D intake (35.8%). The multivariable generalized linear mixed models, with clinic as a random effect, indicates that higher intake of vitamin D is associated with lower odds of vitamin D deficiency among pregnant women (OR = 0.96; 95% CI = 0.93–0.99). The odds of having vitamin D deficiency was reduced by 87% in non-Malays (OR = 0.14; 95% CI = 0.05–0.41) compared to Malays. No associations were found between age, educational level, monthly household income, work status, gravidity, parity, pre-pregnancy body mass index, total hours of sun exposure, total percentage of body surface area, and sun exposure index per day with vitamin D deficiency. Conclusion: Vitamin D deficiency is prevalent among Malaysian pregnant women. Considering the possible adverse obstetric and fetal outcomes of vitamin D deficiency during pregnancy, future nutrition education should emphasise on vitamin D-fortified foods consumption among pregnant women by taking into consideration ethnic differences. [ABSTRACT FROM AUTHOR]

Food price is a determining factor of food choices; however its relationship with diet quality is unclear in Malaysia. This study aimed to examine socio-economic characteristics and daily dietary cost (DDC) in relation to diet quality in the state of Selangor, Malaysia. Dietary intake was assessed using a Food Frequency Questionnaire (FFQ) and diet quality was estimated using a Malaysian Healthy Eating Index (M-HEI). DDC in Malaysian Ringgit (RM) was calculated from dietary intake and national food prices. Linear regression models were fitted to determine associations between DDC and M-HEI scores and predictors of diet quality. The mean M-HEI score of respondents was 61.31 ± 10.88 and energy adjusted DDC was RM10.71/2000 kcal (USD 2.49). The highest quintile of adjusted DDC had higher M-HEI scores for all respondents (Q1: 57.14 ± 10.07 versus Q5: 63.26 ± 11.54, p = 0.001). There were also positive associations between DDC and M-HEI scores for fruits (p < 0.001) and vegetables (p = 0.017) for all respondents. Predictors of diet quality included carbohydrate (b = 0290; p < 0.001) and fat intakes (β = -0.242; p < 0.001) and energy adjusted DDC (b = 0.196; p < 0.001). Higher dietary cost is associated with healthy eating among Malaysian adults. [ABSTRACT FROM AUTHOR]

Despite the increasing use of dietary patterns (DP) to study diet and health outcomes, relatively few studies have examined the reliability of DP using different dietary assessment methods. Reduced-rank regression (RRR) is an emerging statistical method that incorporates a priori information to characterise DP related to specific outcomes of interest. The aim of the present study was to compare DP identified using the RRR method in a FFQ with those in a 3 d food record (FR). Participants were 783 adolescents from the Western Australian Pregnancy (Raine) Cohort Study who completed both a FFQ and FR at 14 years of age. A similar ‘energy-dense, high-fat and low-fibre’ DP was identified in the FFQ and FR that was characterised by high intakes of processed meat and sugar-sweetened beverages, and low intakes of vegetables and fresh fruit. Nutrient profiles for this DP were consistent in the FFQ and FR. Pearson's correlation coefficient between participants' z-scores for the DP identified in the FFQ and FR was 0·35 for girls and 0·49 for boys (P< 0·05). The mean difference between DP z-scores derived from the FFQ and FR was − 0·08 (95 % CI − 0·21, 0·04) for girls and − 0·05 (95 % CI − 0·17, 0·07) for boys. The 95 % limits of agreement were − 2·55 to 2·39 for girls and − 2·52 to 2·41 for boys. These findings suggest that very similar DP may be identified and their z-scores show modest agreement when applying the RRR method to dietary intake data collected from adolescents using a FFQ or FR. [ABSTRACT FROM PUBLISHER]

Socioeconomic status and nutrition knowledge are the determining factors of food choices. However, their relationship with diet quality is ambiguous among aboriginal women in Malaysia. Henceforth, the objective of this study was to examine diet quality and its predictors among the aboriginal women from the Mah Meri ethnic group in Malaysia. Data on socioeconomic characteristics, nutrition knowledge, and 24-h dietary recalls were obtained through face-to-face interviews with the respondents. Household food insecurity was assessed using Radimer/Cornell Hunger and Food Insecurity Instrument. The Malaysian Healthy Eating Index (HEI) was used to measure the diet quality of this population. The overall diet quality of the respondents was poor, with a mean Malaysian HEI score of 45.3%. Household income (r = 0.242, p < 0.001) and nutrition knowledge (r = 0.150, p < 0.05) were positively correlated with diet quality. More importantly, the predictors of diet quality were marital status (β = 0.181, p < 0.01), household income (β = 0.237, p < 0.001), food security status (β = −0.151, p < 0.01), and fat intake (β = −0.438, p < 0.001). Women being married and those with higher household income was associated with a better diet quality among Malaysian aborigines. [ABSTRACT FROM AUTHOR]

Background: The objective of TDQ development is to provide an early detection instrument for thyroid dysfunction based on the biopsychosocial aspects, particularly in women of reproductive age. Face validity was required as a method to attain the accuracy of the instrument based on regularity, clarity, the preference of words and grammar. Face validity is also significant in an attempt to make the design of the instrument attractive and easy to use. Methods: The assessment of face validity of TDQ used a multi-step process, as follows: 1st field trial of TDQ; second, review by professional; third, the development of TDQ manual book. The participants of TDQ field testing were women (n=15) in an endemic area of iodine deficiency in Prambanan Subdistrict, Sleman Regency, Yogyakarta, Indonesia. The selected subjects were interviewed on a one-to-one basis. Participants were in 20 to 45 years of age. Assessment of the draft of TDQ was done through direct method discussions with the physicians from hospital and community health services centers. Results: The results from the focus group discussion (FGD) indicated that the development of TDQ required four stages (from the first to the fourth draft) whereby in each stage the TDQ was improvised further so that it will be implemented easily by the interviewers. Conclusion: The improvements at each stage involved the display of questionnaire, the selection of words and sentences, the clarity of instructions in the questionnaire, the reduction or the join of redundant items, the ease of filling process, and the process of scoring. [ABSTRACT FROM AUTHOR]

Background: Poor diet quality may contribute to undernutrition, particularly affecting young children from low-income households. Therefore, affordable and healthy local food-based recommendations (FBRs) are needed., Objectives: This study aimed to (1) identify problem nutrient(s), (2) identify locally available nutrient-dense food sources that can provide adequate nutrients to meet the recommended dietary intakes of undernourished urban poor children aged 2-5 years, and (3) use linear programming to recommend a daily diet based on the current food patterns that achieves dietary adequacy and meets average food costs for these children., Methods: A cross-sectional study was conducted in Seremban, Malaysia. Three-day 24hour dietary recalls were collected from the mothers (n = 168). Food costs were estimated using market surveys. The FBRs were formulated by linear programming analysis using Optifood software., Results: Folate was an "absolute problem nutrient" (such a nutrient does not achieve the 100% recommended nutrient intake even upon diet optimization). Full-cream milk, chocolate malted milk, fortified cornflakes, and chicken egg were the common locally available nutrient-dense foods that would provide adequate nutrients to meet the recommended dietary intakes of undernourished urban poor children. The final FBR set would ensure dietary adequacy for eight to nine of 11 nutrients at a cost of ringgit Malaysia (RM) 4.80/day (US $1.05/day) and RM6.20/day (US $1.34/day), depending on the age group., Conclusions: Interventions are required to ensure dietary adequacy for undernourished urban poor children under 5 years old. Dietary adequacy could be improved via realistic changes in habitual food consumption practices., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Growing evidence suggesting that dietary intakes of adolescents are generally of poor quality but not adequately assessed in relation to the early manifestation of non-communicable diseases. This study aimed; (1) to examine tracking of an empirical dietary pattern (DP) linked to cardiometabolic risk factors and, (2) to assess prospective relationships between a DP characterised by high intakes of dietary energy density (DED) and added sugar, and cardiometabolic risk factors, non-alcoholic fatty liver disease (NAFLD), carotid intima-medial thickness (CIMT) and mental well-being during adolescence., Methods and Analysis: The PUTRA-Adol is a prospective follow-up study that builds up from 933 Malaysian adolescents who were initially recruited from three southern states in Peninsular Malaysia in 2016 (aged 13 years then). Two sessions are planned; the first session will involve the collection of socio-economy, physical activity, dietary intakes, mental well-being, body image, risk taking behaviour, sun exposure, family functioning and menstrual (in women) information. The second session of data collection will be focused on direct assessments such as venesection for blood biochemistry, anthropometry and ultrasonography imaging of liver and bilateral carotid arteries. Z-scores for an empirical DP will be identified at 16 years using reduced rank regression. Multilevel modelling will be conducted to assess the tracking of DP and prospective analysis between the DP, cardiometabolic health, NAFLD, CIMT and mental well-being., Ethics and Dissemination: Ethical approval for the conduct of this follow-up study was obtained from the Universiti Putra Malaysia's Ethics Committee for Research Involving Human Subjects (JKEUPM) (Reference number: JKEUPM-2019-267). The findings from this study will be disseminated in conferences and peer-reviewed journals., Discussion: The findings gathered from this study will provide evidence on prospective relationships between DPs, cardiometabolic risk factors, NAFLD, early atherosclerosis and mental well-being and that it may be mediated particularly DED and added sugar during adolescence., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background/objectives: This cross-sectional study assessed household food security status and determined its association with diet quality and weight status among indigenous women from the Mah Meri tribe in Peninsular Malaysia., Subjects/methods: The Radimer/Cornell Hunger and Food Insecurity Instrument and the Malaysian Healthy Eating Index (HEI) were used to assess household food security status and diet quality, respectively. Information on socio-demographic characteristics and 24-hour dietary recall data were collected through face-to-face interview, and anthropometric measurements including weight, height, and body mass index (BMI) were obtained from 222 women., Results: Majority of households (82.9%) experienced different levels of food insecurity: 29.3% household food insecurity, 23.4% individual food insecurity, and 30.2% fell into the child hunger group. The food-secure group had significantly fewer children and smaller household sizes than the food-insecure groups ( P < 0.05). The mean household income, income per capita, and food expenditure significantly decreased as food insecurity worsened ( P < 0.001). The food-secure group had significantly higher Malaysian HEI scores for grains and cereals ( P < 0.01), as well as for meat, poultry, and eggs ( P < 0.001), than the food-insecure groups. The child-hunger group had significantly higher fat ( P < 0.05) and sodium ( P < 0.001) scores than the food-secure and household food-insecure groups. Compared to the individual food-insecure and child-hunger groups, multivariate analysis of covariance showed that the food-secure group was significantly associated with a higher Malaysian HEI score while the household food-insecure group was significantly associated with a higher BMI after controlling for age ( P < 0.025)., Conclusions: The majority of indigenous households faced food insecurity. Food insecurity at the individual and child levels was associated with lower quality of diet, while food insecurity at the household level was associated with higher body weight. Therefore, a substantial effort by all stakeholders is warranted to improve food insecurity among poorer households. The results suggest a pressing need for nutritional interventions to improve dietary intake among low income households., Competing Interests: CONFLICT OF INTEREST: The authors declare no potential conflicts of interests.

There are approximately 220 million (about 12% regional prevalence) adults living with diabetes mellitus (DM) with its related complications, and morbidity knowingly or unconsciously in the Western Pacific Region (WP). The estimated healthcare cost in the WP and Malaysia was 240 billion USD and 1.0 billion USD in 2021 and 2017, respectively, with unmeasurable suffering and loss of health quality and economic productivity. This urgently calls for nothing less than concerted and preventive efforts from all stakeholders to invest in transforming healthcare professionals and reforming the healthcare system that prioritizes primary medical care setting, empowering allied health professionals, improvising health organization for the healthcare providers, improving health facilities and non-medical support for the people with DM. This article alludes to challenges in optimal diabetes care and proposes evidence-based initiatives over a 5-year period in a detailed roadmap to bring about dynamic and efficient healthcare services that are effective in managing people with DM using Malaysia as a case study for reference of other countries with similar backgrounds and issues. This includes a scanning on the landscape of clinical research in DM, dimensions and spectrum of research misconducts, possible common biases along the whole research process, key preventive strategies, implementation and limitations toward high-quality research. Lastly, digital medicine and how artificial intelligence could contribute to diabetes care and open science practices in research are also discussed.

Many studies in Asia have demonstrated that Asian populations may require lower cut-off levels for body mass index (BMI) and waist circumference to define obesity and abdominal obesity respectively, compared to western populations. Optimal cut-off levels for body mass index and waist circumference were determined to assess the relationship between the two anthropometric- and cardiovascular indices. Receiver operating characteristics analysis was used to determine the optimal cut-off levels. The study sample included 1833 subjects (mean age of 44+/-14 years) from 93 primary care clinics in Malaysia. Eight hundred and seventy two of the subjects were men and 960 were women. The optimal body mass index cut-off values predicting dyslipidaemia, hypertension, diabetes mellitus, or at least one cardiovascular risk factor varied from 23.5 to 25.5 kg/m2 in men and 24.9 to 27.4 kg/m2 in women. As for waist circumference, the optimal cut-off values varied from 83 to 92 cm in men and from 83 to 88 cm in women. The optimal cut-off values from our study showed that body mass index of 23.5 kg/m2 in men and 24.9 kg/m2 in women and waist circumference of 83 cm in men and women may be more suitable for defining the criteria for overweight or obesity among adults in Malaysia. Waist circumference may be a better indicator for the prediction of obesity-related cardiovascular risk factors in men and women compared to BMI. Further investigation using a bigger sample size in Asia needs to be done to confirm our findings.