Faktor Risiko Bagi Penyakit Kardiovaskular Dalam Kalangan Pengidap Diabetes Mellitus Jenis 2 Dan Individu Normal

Kajian kes kawalan telah dilakukan untuk menentukan faktor-faktor risiko yang berkaitan dengan penyakit diabetes mellitus jenis 2 di kalangan peneroka FELDA Gugusan Palong, Gemas, Negeri Sembilan. Subjek dipilih melalui kaedah persampelan rawak kluster dan dipasangkan berdasarkan umur, jantina dan etnik. Data yang dianalisis merangkumi 237 subjek diabetik dan 229 subjek bukan diabetik. Borang soal selidik telah dibentuk, diprauji dan divalidasi. Pengambilan makanan telah dinilai melalui pengingatan diet 24 jam untuk tiga hari (dua hari berkerja dan satu hari cuti) dan soal selidik kekerapan pengambilan makanan. Pemeriksaan fizikal telah dijalankan tennasuklah pengukuran ketinggian, berat, lilitan pinggang dan punggung, tekanan darah sistolik (TDS) dan diastolik (TDD) serta kadar nadi. Nisbah pinggang punggung (NPP) dan indeks jisim tubuh CUT) telah dikira. Sampel darah berpuasa telah dipungut untuk menilai aras glukosa, profil lipid dan aras antioksida. Faktor risiko yang dikaji merangkumi faktor sosiodemografi, faktor gaya hidup, profillipid, apolipoprotein (a-I), apolipoprotein (b), hs-CRP; aras antioksida, faktor antropometri, tekanan darah dan kadar denyutan nadi. Analisis statistik merangkumi ujian t, ujian khi kuasa dua, pengiraan nisbah mungkin (OR) dan ujian regrasi logistik pelbagai telah dilakukan menggunakan perisian SPSS versi 12.0. Basil kajian menunjukkan risiko diabetes yang dikira berdasarkan OR kasar di ka1angan responden lelaki, didapati signifikan bagi faktor sosiodemografi yang terdiri daripada umur yang meningkat (OR 2.50, 95% CI 1.37,4.54), rendah jumlah pendapatan (OR 2.82, 95% CI 1.57,5.05) dan tahap pendidikan yang rendah (OR 2.26, 95% CI 1.11,4.60). IJT yang tinggi (OR 2.62, 95% CI 1.44,4.79), tinggi lilitan pinggang (OR 2.81, 95% CI 1.12,7.05) dan TDS yang tinggi (OR 1.91, 95% CI 1.06,3.46) juga didapati secara signifikan berkaitan dengan peningkatan risiko diabetes. Bagi pembolehubah biokimia pula, tinggi hs-CRP (OR 2.01, 95% CI 1.10,3.66) dan apolipoprotein (b) yang tinggi (OR 5.13, 95% CI 2.13,12.38) didapati juga mempunyai perkaitan dengan risiko diabetes. Tahap aktiviti fizikal yang rendah (OR 3.65, 95% CI 1.54,8.69), pengambilan serabut diet yang rendah (OR 3.55, 95% CI 1.84,6.83) dan pengambilan lemak yang tinggi (OR 2.06,95% CI 1.16,3.67) merupakan faktor gaya hidup yang mempunyai kaitan dengan risiko diabetes. Manakala tinggi tahap apolipoprotein (a-I) (OR 0.49,95% CI 0.26,0.90), tinggi plasma vitamin A (OR 0.33, 95% CI 0.15,0.74), tinggi plasma vitamin C (OR 0.25, 95% CI 0.13,0.50) dan plasma selenium yang tinggi (OR 0.37, 95% CI 0.17,0.82) merupakan faktor pelindung kepada risiko diabetes.OR kasar telah dianalisis berdasarkan jantina. Di kalangan subjek perempuan, faktor sosiodemografi yang mempunyai perkaitan dengan risiko diabetes adalah peningkatan umur (OR 1.37, 95% CI 1:05,1.79), rendah jumlah pendapatan (OR 4.72, 95% CI 2.81,7.91) dan tahap pendidikan yang rendah (OR 3.05, 95% CI 1.46,6.40). Lilitan pinggang yang tinggi (OR 2.43, 95% CI 1.70,3.48), NPP yang tinggi (OR 2.61, 95% CI 1.93,3.55), tinggi TDS (OR 1.61,95% CI 1.02,1.58) dan kadar denyutan nadi yang tinggi (OR 1.50, 95% CI 1.13,2.00) juga didapati meningkatkan risiko diabetes. Manakala pembolehubah biokimia pula terdiri daripada plasma lipoprotein kolesterol berdensiti tinggi (HDLC) yang rendah (OR 3.54, 95% CI 1.83,6.90) dan apolipoprotein (b) yang tinggi (OR 5.93, 95% CI 2.61,13.83). Tahap aktiviti fizikal yang rendah (OR 1.35, 95% CI 1.05,1.75) dan pengambilan serabut yang rendah (OR 1.36, 95% CI 1.09,1.70) juga didapati mempunyai perkaitan yang signifikan dengan peningkatan risiko diabetes. Manakala rendah pengambilan natrium (OR 0.66, 95% CI 0.47,0.92), tinggi tahap apolipoprotein (a-I) (OR 0.56, 95% CI 0.39,0.82), serta tinggi plasma vitamin A (OR 0.41, 95% CI 0.27,0.62), plasma vitamin C (OR 0.64,95% CI 0.52,0.80) dan plasma selenium (OR 0.81,95% CI 0.66,0.99) merupakan faktor pelindung bagi risiko diabetes di kalangan subjek perempuan. OR terlaras telah diperolehi daripada ujian regrasi logistik pelbagaL Analisis telah menunjukkan beberapa faktor risiko didapati signifikan di dalam meramalkan risiko diabetes. Di kalangan lelaki, pembolehubah yang didapati berpengaruh di dalam meramalkan risiko diabetes adalah jumlah pendapatan yang rendah (OR 5.38, 95% CI 2.00,14.47), rendah tahap aktiviti fizikal (OR 4.71,95% CI 1.41,15.73), tahap apolipoprotein (b) yang tinggi (OR 4.22,95% CI 1.37,13.05), tahap pendidikan yang rendah (OR 3.36,95% CI 1.17,9.63), kadar denyutan nadi yang tinggi (OR 3.28, 95% CI 1.31,8.22), lilitan pinggang yang tinggi (OR 2.65, 95% CI 1.14,6.15) dan pengambilan serabut diet yang rendah (OR 2.36, 95% CI 1.03,5.40). Peratusan kalori daripada karbohidrat yang tinggi (OR 0.38,95% CI 0.17,0.83), serta plasma vitamin A (OR 0.19, 95% CI 0.06,0.57), plasma vitamin C (OR 0.28, 95% CI 0.10,0.72), dan plasma selenium yang tinggi (OR 0.26,95% CI 0.09,0.77) merupakan faktor pelindung bagi risiko diabetes bagi responden lelaki. Bagi responden perempuan, tinggi NPP (OR 6.31, 95% CI 3.09,12.87), tinggi kadar denyutan nadi (OR 6.24, 95% CI 2.02,19.33), rendah jumlah pendapatan (OR 3.68,95% CI 1.80,7.51), rendah HDLC (OR 3.68,95% CI 1.80,7.51) dan TDD yang tinggi (OR 2.31, 95% CI 1.12,4.75) didapati signifikan sebagai faktor yang meningkatkan risiko diabetes manakala tinggi plasma vitamin A (OR 0.31,95% CI 0.14,0.68), plasma vitamin C (OR 0.15, 95% CI 0.06,0.36) dan plasma selenium (OR 0.04,95% CI 0.01,0.16) merupakan faktor pelindung kepada risiko diabetes. Secara ringkasnya, kajian ini telah menunjukkan beberapa faktor risiko dan faktor pelindung yang signifikan dengan penyakit diabetes bagi subjek lelaki dan perempuan. Faktor sosioekonomi yang rendah adalah merupakan antara faktor utama yang meningkatkan risko diabetes. Manakala plasma antioksida seperti vitamin A, C dan selenium didapati berperanan sebagai faktor pelindung .kepada risiko diabetes di kalangan responden kajian. Faktor pemakanan terpenting yang didapati meningkatkan risiko diabetes adalah pengambilan serabut diet yang rendah dan peratusan kalori daripada karbohidrat yang tinggi namun begitu ianya hanya signifikan di kalangan lelaki. Manakala kadar denyutan nadi yang rendah didapati meningkatkan risiko diabetes di kalangan lelaki dan perempuan. Tekanan .darah yang tinggi, rendah tahap HDLC dan NPP yang tinggi didapati meningkatkan risiko diabetes di kalangan perempuan tetapi tidak signifikan bagi lelaki. Manakala tinggi lilitan pinggang didapati tuTUt meningkatkan risiko diabetes dan signifikan tetapi hanya bagi lelaki. Kesimpulannya, pencegahan penyakit diabetes perlu dititikberatkan kepada golongan yang mempunyai tahap sosioekonomi yang rendah. Pengambilan serabut diet dan antioksida yang mencukupi haTUslah digalakkan dan didapati berfungsi sebagai faktor pelindung kepada risiko diabetes. Strategi yang bersesuaian untuk program intervensi di dalam komuniti diperlukan terutamanya untuk meningkatkan tahap aktiviti fizikal, penjagaan berat badan dan meningkatkan kualiti pengambilan makanan untuk menurunkan risiko berkaitan komplikasi diabetes dan pencegahan penyakit kronik seperti penyakit kardiovaskular

Factors associated with body weight status among students in infrastructure University Kuala Lumpur (IUKL), Kuala Lumpur, Malaysia

The occurrence of obesity and overweight status in the population has caught public attention. This is in line with the World Health Organization's concern (2013). The present study aimed to determine factors associated with body weight status among students in Infrastructure University Kuala Lumpur (IUKL), Kuala Lumpur, Malaysia. A cross-sectional study was conducted to asses physical activity level, environmental factors affecting physical activity level and their association with body weight status among 280 students in Infrastructure University Kuala Lumpur (IUKL), Kuala Lumpur, Malaysia. The mean of respondent’s total physical activity per week was 3988.50 ± 6758.45 METs minute/week. This was significantly higher (t = 3.020, p = 0.003) among male respondents (5496.37 ± 7860.26 METs minute/week) compared to females (3032.93 ± 5779.55 METs minutes/week). The overall environmental supports for physical activity among the respondents were at moderate level (2.17 ± 0.72), although the total environmental supports for physical activity among female is slightly higher compared to male (2.17 ± 0.77 vs 2.15 ± 0.63), no significant different was observed (t = - 0.25; p = 0.805). In general over weight / obese status was highly prevalent among those with low involvement with neighbourhood environment for physical activity (28%) (the lowest quartile). Although adjusted crude analysis of support to neighbourhood environment for physical activity showed reverse associations with overweight / obese status, no significant trend was observed

Glycaemic control, lipid profile, blood pressure and body weight status among diabetics in rural Malaysia.

Diabetes is associated with a high risk of cardiovascular disease. The management of blood glucose, dyslipidaemia and other modifiable risk factor, is a key element in the multifactorial approach to prevent complications of type 2 diabetes. Materials and Methods: A cross sectional study was conducted to determine the level of glycaemic control, lipid profile, blood pressure and body weight status among type 2 diabetics in rural Malaysia. A total of 237 diabetic subjects participated in this study. Physical examination was carried out, including measurements of height, weight, waist and hip circumferences, and systolic and diastolic blood pressure. Fasting venous blood samples were collected to determine the glucose level and lipid profile. Results: About 70% of the subjects had a high body mass index (BMI), equal to or above 25 kg/ m2. More than 60% of the subjects had systolic blood pressure ≥ 140 mmHg and/or diastolic ≥ 90 mmHg. Mean fasting blood glucose was 9.84±4.54 mmol/L. Mean total cholesterol was 5.18±1.35 mmol/L. High density lipoprotein cholesterol (HDLC) and triglyceride (TG) and glucose levels were higher in male than in female, but not statistically significant (p>0.05). However, low density lipoprotein cholesterol (LDLC) was higher in females than males (p<0.05). Mean HDLC was below 1.0 mmol/L in all subjects. Conclusion: Glycaemic control, lipid profile, blood pressure and body weight status were not satisfactory and may increase the risk of microvascular and macrovascular complications among these subjects. Appropriate intervention programs should be implemented for better diabetes control among rural subjects

The effect of the Malaysian food guideline guidance on a group of overweight and obese women during Ramadan

Objectives: To determine the effect of imparting knowledge of the Malaysian Food Guideline (MFG) on a group of overweight and obese women during Ramadan. Methods: This intervention study was conducted during the months of Ramadan 2011. A group of 84 Malay Muslim women with a body mass index (BMI) ≥25 kg/m2 were recruited. Prior to Ramadan, the respondents were educated regarding MFG, and how to monitor and record their daily food intake in a food diary. Their quantity of food intake, BMI, blood pressure (BP), blood lipid profile, and fasting blood sugar (FBS) were measured before Ramadan as a baseline. Their quantity of food intake was then measured again in the third week, whereas their BMI, BP, blood lipid profile, and FBS were determined on the fourth week of Ramadan. Results: At baseline, compared with the MFG recommendations, the intake of protein (107.5%), and milk and dairy products (133%) was higher, whereas the intake of carbohydrates (78.5%), and vegetables and fruits (44.4%) was lower. During Ramadan, carbohydrate intake, BMI, high density lipoprotein-cholesterol (HDL-C) and low density lipoprotein-cholesterol (LDL)-C (all p=0.000), triglyceride (p=0.005), and FBS (p=0.002) were reduced, but the TC/HDL-C ratio was increased (p=0.000). Conclusion: A month-long Ramadan fast guided by the knowledge of MFG resulted in certain positive changes in this group of respondents. These changes can be a good start for health improvement, provided that they are followed-up after Ramadan

Disordered eating behaviors, depression, anxiety and stress among Malaysian University students.

The aim of this study was to examine the relationships between depression, anxiety and stress with disordered eating among university students. The Eating Attitudes Test-26 (EAT-26) and Depression, Anxiety and Stress Scale-21 (DASS-21) were administered on 584 Malaysian university students (59.4% females and 40.6% males). About one in five participants (18.2%) were at risk of eating disorders. Females had significantly higher proportion of at risk of eating disorders (21.3%) compared to males (13.5%). There was no sex difference in mean EAT-26 scores. The prevalence of depression, anxiety and stress of moderate severity or above were 29.3%, 55.0% and 21.6% respectively. No sex differences in depression and anxiety scores were found but females had significantly higher stress score compared to males. There was significant relationship between EAT-26 and DASS-21 subscales. Further, no significant interaction effect was found for sex and ethnicity with EAT-26 and DASS-21 subscales. The prevalence of at risk of eating disorders, depression, anxiety and stress among university students were high. There were positive correlations between depression, nxiety, and stress with disordered eating. Further studies on their associated risks are warranted

Differences in eating behaviors, dietary intake and body weight status between male and fermale Malaysian University students.

University students are potentially important targets for the promotion of healthy lifestyles as this may reduce the risks of lifestyle-related disorders later in life. This cross-sectional study examined differences in eating behaviours, dietary intake, weight status, and body composition between male and female university students. A total of 584 students (59.4% females and 40.6% males) aged 20.6 +/- 1.4 years from four Malaysian universities in the Klang Valley participated in this study. Participants completed the Eating Behaviours Questionnaire and two-day 24-hour dietary recall. Body weight, height, waist circumference and percentage of body fat were measured. About 14.3% of males and 22.4% of females were underweight, while 14.0% of males and 12.3% of females were overweight and obese. A majority of the participants (73.8% males and 74.6% females) skipped at least one meal daily in the past seven days. Breakfast was the most frequently skipped meal. Both males and females frequently snacked during morning tea time. Fruits and biscuits were the most frequently consumed snack items. More than half of the participants did not meet the Malaysian Recommended Nutrient Intake (RNI) for energy, vitamin C, thiamine, riboflavin, niacin, iron (females only), and calcium. Significantly more males than females achieved the RNI levels for energy, protein and iron intakes. This study highlights the presence of unhealthy eating behaviours, inadequate nutrient intake, and a high prevalence of underweight among university students. Energy and nutrient intakes differed between the sexes. Therefore, promoting healthy eating among young adults is crucial to achieve a healthy nutritional status

The prevalence and symptoms characteristic of functional constipation using Rome III diagnostic criteria among tertiary education students

Background and Aims Functional constipation is very common with heterogeneous symptoms that have substantial impact on patient quality of life as well as medical resources which are rarely reported as life-threatening. The aim of this study is to examine the prevalence and symptoms characteristic of functional constipation (FC) by using Rome III diagnostic criteria among tertiary education students with an intention to introduce treatment in the future. Methods Demographic, socio-economics characteristics and symptoms of FC using the Rome III criteria were sought using a questionnaire administered to Malaysian students in a tertiary education setting. Other data obtained were the general health status, lifestyle factors and anthropometric measurements. Using a simple random sampling method, a total of 1662 students were recruited in the study with a response rate of 95.0%. Sampled data are presented as frequency and percentage and stratified accordingly into categories for Chi-square analysis. Results The prevalence of functional constipation among the students was 16.2%, with a significantly higher prevalence among women (17.4%) than men (12.5%). Hard or lumpy stool, incomplete evacuation, anorectal obstruction and straining were reported as the commonest symptoms experienced. Type 3 was the most frequent stool consistency experienced among the constipated individuals (35.2%). Only 4.4% of individuals reported having less than three defecations per week. Using univariable analysis, FC was significantly associated with sex (odds ratio: 1.48, 95% CI: 1.06–2.06) and age group (odds ratio: 1.34, 95% CI: 1.01–1.79) with P value < 0.05 significance level. In multivariate logistic regression analysis, only sex was found significantly associated with FC (adjusted odds ratio: 1.53, 95% CI: 1.08–2.17, P < 0.05). Conclusions Based on the prevalence rate, constipation is a common problem among tertiary education students (16.2%), with significantly more prevalence among the female respondents. Early detection of symptoms and further intervention studies focusing on treatment recommendation in improving the symptoms are essential

Barriers to food quantity intake control and healthy eating among overweight and obese working Malay women in public service

Introduction: The objective of this study is to look at the barriers faced by a group of working women who are overweight and obese that hinders control of their food quantity intake and healthy eating habit. Methods: 140 respondents were recruited. Data was collected using self-administered questionnaires. The four forms of barriers to ‘food quantity intake control’ assessed were ‘lack of knowledge’, ‘lack of motivation’, ‘difficult when eating out’ and ‘have to attend meetings often’ and the six forms of barriers to ‘eat healthily more frequent’ assessed were ‘lack of knowledge’, ‘lack of motivation’, ‘difficult when eating out’, ‘costly’, ‘work commitment’ and ‘family commitment’. Results: For barrier to ‘food quantity intake control’, 60.0% of respondents agree that it is due to having to ‘attend meetings often’ and this is associated with level of education (P=0.02) while 57.9% agree it is due to ‘difficulty when eating out’ and this is associated with marital status and having children (P=0.01 and P=0.02, respectively). For barriers to ‘eating healthily more frequent’, 79.3% agree it is due to ‘lack of knowledge’ and this is associated with having children (P=0.03), 67.9 % agree it is due to healthy food items being ‘costly’ and this is associated with level of education and employment position (P=0.01 and P=0.02, respectively) while 65.7% agree it is due to ‘work commitment’ and this is associated with education level (P=0.04). Conclusion: Barriers to food quantity intake control and healthy eating are associated with socio demographic and socioeconomic characteristics among this group of overweight and obese women

Effect of ethnicity, dietary intake and physical activity on plasma adiponectin concentrations among Malaysian patients with type 2 diabetes mellitus

Background: The Malaysian Health and morbidity Survey (2006) reported the highest prevalence of type 2 diabetes mellitus (T2DM) among the Indian population compared to the Malay and Chinese populations. Many studies have supported the important role of adiponectin in insulin-sensitizing, which is associated with T2DM. These studies have raised a research question whether the variation in prevalence is related to the adiponectin concentrations or the lifestyle factors. Objectives: The purpose of this study is to determine whether the adiponectin concentrations differ between the Malay, Chinese and the Indian populations with T2DM. It is to investigate the association of adiponectin concentrations with ethnicity, dietary intake and physical activity too. Materials and Methods: In this cross-sectional study, a total of 210 T2DM patients with mean (SD) age of 56.73 (10.23) years were recruited from Penang, Malaysia. Data on demographic background, medical history, anthropometry (weight, height, visceral fat, percentage of body fat and waist circumference), dietary intake (3 days 24 hours diet recall) and physical activity (International Physical Activity Questionnaire) were obtained accordingly. Plasma adiponectin and routine laboratory tests (fasting blood sugar, HbA1c, total cholesterol, LDL, HDL and triglyceride) were performed according to standard procedure. Results: After adjustment for physical activity and dietary intakes, the Indian population had significantly lower adiponectin concentrations (P = 0.003) when compared with the Malay and the Chinese populations, The Indian population also had significantly higher value of HbA1c (P = 0.017) and significantly lower HDL (P = 0.013). Plasma adiponectin concentrations was significantly associated with ethnicity (P = 0.011), dietary carbohydrate (P = 0.003) and physical activity total MET score (P = 0.026), after medical history, age, sex, total cholesterol and visceral fat adjusted. However, dietary carbohydrate and physical activity did not show significantly difference among the various ethnic groups. Conclusions: In conclusion, lower concentration of adiponectin in the Indian population when compared with the Malay and the Chinese populations is not associated with lifestyle factors. The possibility of adiponectin gene polymorphism should be discussed further

Prevalence of obesity and factors associated with it in a worksite setting in Malaysia

Socio-economic status, lifestyle behaviors, and psychosocial factors have been implicated in the development of overweight and obesity. This study aims to observe the prevalence of overweight and obesity in an academic worksite and to examine the possible association between variables such as socio-economic characteristics, work factors, psychosocial factors, and weight control behaviors and obesity. In this study, the target population were full-time academic and non-academic staff. Body mass index (BMI) and waist circumference (WC) were computed to determine obesity. A pretested self-administered questionnaire was used to obtain information on socio-demographic factors, work related factors, psychosocial factors, and weight control behaviors. Data were obtained on 367 adults of whom 39.2% were males and 60.8% females. Overweight was seen in 31.9% of males and 26.5% of females while 16.1% of them were obese, irrespective of gender. Central obesity was noted in about 37% of males and 39% of females. The results showed that socio-demographic factors (age, gender, and education) and psychosocial factors (perceived health status, body weight perception, and weight-control goals) were significantly associated with BMI. Working hours were also significantly associated with BMI. However, weight control practices (diet-control practices and physical activity practices) were not significantly associated with BMI. In conclusion, this study found a higher prevalence of overweight and obesity among employees of a selected public university in comparison to the general population. Socio-demographic, psychosocial factors, and working hours were found to contribute to obesity in this sample of adults