Dietary And Lifestyle Factors Associated With Risk Ofcolorectal Adenoma In Patients At Hospital Kuala Lumpur

Cancer is now the third leading cause of death in Malaysia and one in four Malaysians is at risk of developing cancer. In Peninsular Malaysia, there was a slight decline in percentage of colon (-0.2%) and rectal (-0.2%) cancer incidence in males in the year 2003 compared to the previous year as reported by National Cancer Registry (2004). Yet, there was an increase in percentages of these cancer incidences in women (+0.4% in colon cancer and +0.7% in rectal cancer). Colorectal cancers are thought to develop over a period of several years, and most of them develop from benign, neoplastic adenomatous polyps (Bond, 2000). Colorectal adenomas have been shown, but not always, significantly related to various dietary and lifestyle factors. These factors have yet to be reported in relation to colorectal polyps in the Malaysian population. This case-control study was carried out to determine the relationship between dietary and lifestyle characteristics, and risk for colorectal adenomas among Malaysians. After screening for inclusion and exclusion criteria, 11 8 men and women with good cognition and who were at least 30 years at the time of interview and have undergone colonoscopy in Hospital Kuala Lumpur were enrolled in the this study upon obtaining ethical clearance. Fifty nine patients diagnosed with colorectal adenomas were recruited as case subjects, while a similar number of patients diagnosed negative for any polyps were recruited as controls. A structured and pre-tested interviewer administrated questionnaire was used for data collection. The fasting blood samples were collected by trained and qualified nurse, and analyzed using relevant analysis in the laboratory. The collected data were then analyzed with SPSS version 12.0. Multivariate analysis concluded that the higher servings of fruits (adjusted OR = 0.150, 95% CI = 0.052 - 0.434) and vegetables (adjusted OR = 0.344, 95% CI = 0.149 - 0.794), crude fibre intake (adjusted OR = 0.659, 95% CI = 0.481 - 0.905) and plasma levels of total cholesterol (adjusted OR = 5.370, 95% CI = 1.861 - 15.495), LDL (adjusted OR = 1.093, 95% CI = 1.022 - 2.386) and vitamin E (adjusted OR = 0.481, 95% CI = 0.306 - 0.758) found to significantly contribute to the risk for colorectal adenomas, upon adjusting for potential covariates. A larger study and possibly a prospective study which recruits study subjects from various places in Malaysia will be an excellent effort to confirm these findings. Interventions with focuses on behavioural change may be able to reduce one's risk for colorectal adenomas which in the long-term reduce hisher risk for developing colorectal cancer in the future

Dietary risk factors for colorectal adenomatous polyps: a mini review

At least 6 million deaths occurred worldwide are due to cancer and this figure is expected to rise to 15 millions by the year 2020. Colorectal cancer is among the most commonly occurring cancers both globally and in Malaysia. Numerous studies have shown significant relationships between various dietary components and the risks for colorectal cancer. Meanwhile, several theories have been suggested as etiological explanations, one of which is the influence of dietary factors on the cell proliferation rate. A higher cell proliferation rate is statistically associated with increased risk of colorectal cancer. However, evidence of a significant relationship between diet and colorectal adenomas, a potential precursor for colorectal cancer, remains insufficient. Colorectal adenomas or polyps are vital in their relationship with colorectal cancers as almost 70% of all colorectal cancers are developed from these polyps. Studying the modifiable risk factors related to polyps will provide an opportunity for the prevention of colorectal cancer even before it develops. This paper reviews the available evidence linking dietary factors with the risk for colorectal adenomas. As the numbers of published studies are limited, of which most are concentrated in Western countries, there is a need for epidemiological studies in Malaysia to strengthen the evidence of a relationship between diet and colorectal adenomas

Obesity and Risk of Colorectal Adenomatous Polyps: a Case-Control Study in Hospital Kuala Lumpur

Colorectal adenomas are precursor lesions of colorectal cancer. Several studies have proposed that obesity is a risk factor for colorectal adenoma. This case-control study examined the relationship between body mass index (BMI), waist circumference, waistto-hip ratio (WHR), body fat percentage and colorectal adenomatous polyps (CRA) in patients who have had a colonoscopy at the Hospital Kuala Lumpur (HKL). Fifty-nine patients (42 males and 17 females) positively identified as having CRA and 59 polypfree subjects were recruited as controls (33 males and 26 females). A pre-tested questionnaire was used to collect socio-economic information, while anthropometric measurements were determined directly by established methods. The mean BMI of female case subjects was significantly higher than control females (25.63 + 4.87 kg/m2 vs. 23.86 + 3.70 kg/m2, p<0.05) but the difference in BMI was not significant in men. The mean WHR of male subjects was significantly higher in the case group (0.92 + 0.07 vs. 0.90 + 0.06, p<0.05). After adjusting for confounders, waist circumference was the only indicator that was found to significantly increase the risk for CRA in women (OR = 6.349, 95% CI = 1.063 � 37.919). Higher BMI, WHR and body fat percentage showed a non-significant risk in female subjects. In men, none of the obesity indicators were found to be significant risk factors for CRA. These findings suggest that abdominal obesity may be a contributing factor to CRA risk particularly in women. A prospective study is needed to confirm the role of obesity in the development of CRA in Malaysians. A1, Kandiah M2, H3, & JA

Randomised-controlled trial of a web-based dietary intervention for patients with type 2 diabetes mellitus: Study protocol of myDIDeA

<p>Abstract</p> <p>Background</p> <p>The potential of web-based interventions in dietary behaviour modification of the diabetics has not been fully explored. We describe the protocol of a 12-month match-design randomised controlled trial of a web-based dietary intervention for type 2 diabetic patients with primary aim to evaluate the effect of the intervention on their dietary knowledge, attitude and behaviour (KAB). The secondary objective of this study is to improve the participants' dietary practices, physical measurements and biomarkers.</p> <p>Methods/Design</p> <p>A minimum total sample of 82 Type 2 diabetics will be randomised, either to the control group, who will receive the standard diabetes care or the e-intervention group, who will participate in a 6-month web-based dietary intervention in addition to the standard care. The dietary recommendations are based on existing guidelines, but personalised according to the patients' Stages of Change (SOC). The participants will be followed up for 6 months post-intervention with data collection scheduled at baseline, 6-month and 12-month.</p> <p>Discussion</p> <p>We are aiming for a net improvement in the KAB score in participants of the e-intervention group, besides investigating the impact of the e-intervention on the dietary practices, physical measurements and blood biomarkers of those patients. The successful outcome of this study can be a precursor for policy makers to initiate more rigorous promotion of such web-based programmes in the country.</p> <p>Trial registration</p> <p>Clinicaltrials.gov <a href="http://www.clinicaltrials.gov/ct2/show/NCT01246687">NCT01246687</a></p

Dietary intervention among patients with type 2 diabetes mellitus: an e-approach

myDIDeA was a 12-months two-armed randomised controlled trial conducted in three tertiary public hospitals in Klang Valley, Malaysia. The primary outcome was the Dietary Knowledge, Attitude and Behaviour (DKAB) score, while the secondary outcomes included measures of food intake, anthropometry measurements, blood pressure and resting heart rate, some blood biomarkers and the Dietary Stages of Change (DSOC) score. The study was designed according to the recommendations of the CONSORT statement for randomised trials of non-pharmacologic treatment. The study commenced in November 2009 after obtaining the ethical approvals from relevant authorities, and the trial has been registered with Clinicaltrials.gov (NCT01246687). After being screened for eligibility, 128 patients with Type 2 Diabetes Mellitus (T2DM) from the outpatient clinics at these hospitals were recruited with informed consent, and then randomised into the e-intervention (n=66) or the control (n=62) group. The e-intervention group received an intensive six-month dietary intervention through the study website, which was developed based on various established guidelines and recommendations but personalised according to the participants’ DSOC, in addition to the usual standard treatment at the outpatient clinics. In contrast, the control group continued their usual standard treatment for patients with T2DM in the hospitals. Data were collected at baseline, six months post-intervention and at 12 months follow-up. A pre-tested and validated questionnaire was used for this purpose. The anthropometry measurements, blood pressure and resting heart rate were measured at data collection, while details on the blood biomarkers were obtained from the hospital medical records. All data were analysed with IBM® PASW® Statistics 17.0. On average, each participant logged into the website once a week and spent 11 minutes at the website per visit. myDIDeA was found to be a successful intervention programme to improve the overall DKAB score, due to the improvement in the knowledge and attitude sub-domains. Additionally, the intervention programme also successfully improved the DSOC score of the intervention group, which suggests participants were also making small but significant progress in changing their dietary behaviour. Some additional improvements in diet quality (reduction in carbohydrate and protein intake), glycaemic control and total cholesterol were also detected. myDIDeA is one of few web-delivered dietary interventions for patients with chronic disease. The reach, flexibility, accessibility and conversion of established guidelines into a more user-friendly format have contributed to the success of this intervention programme. Future related studies are suggested to emphasise on the interactivity, familiarise the participants with the system prior to the intervention, encourage self-monitoring and built the intervention on a strong theoretical background

Dietary intervention among patients with type 2 diabetes mellitus: an e-approach

myDIDeA was a 12-months two-armed randomised controlled trial conducted in three tertiary public hospitals in Klang Valley, Malaysia. The primary outcome was the Dietary Knowledge, Attitude and Behaviour (DKAB) score, while the secondary outcomes included measures of food intake, anthropometry measurements, blood pressure and resting heart rate, some blood biomarkers and the Dietary Stages of Change (DSOC) score. The study was designed according to the recommendations of the CONSORT statement for randomised trials of non-pharmacologic treatment. The study commenced in November 2009 after obtaining the ethical approvals from relevant authorities, and the trial has been registered with Clinicaltrials.gov (NCT01246687). After being screened for eligibility, 128 patients with Type 2 Diabetes Mellitus (T2DM) from the outpatient clinics at these hospitals were recruited with informed consent, and then randomised into the e-intervention (n=66) or the control (n=62) group. The e-intervention group received an intensive six-month dietary intervention through the study website, which was developed based on various established guidelines and recommendations but personalised according to the participants’ DSOC, in addition to the usual standard treatment at the outpatient clinics. In contrast, the control group continued their usual standard treatment for patients with T2DM in the hospitals. Data were collected at baseline, six months post-intervention and at 12 months follow-up. A pre-tested and validated questionnaire was used for this purpose. The anthropometry measurements, blood pressure and resting heart rate were measured at data collection, while details on the blood biomarkers were obtained from the hospital medical records. All data were analysed with IBM® PASW® Statistics 17.0. On average, each participant logged into the website once a week and spent 11 minutes at the website per visit. myDIDeA was found to be a successful intervention programme to improve the overall DKAB score, due to the improvement in the knowledge and attitude sub-domains. Additionally, the intervention programme also successfully improved the DSOC score of the intervention group, which suggests participants were also making small but significant progress in changing their dietary behaviour. Some additional improvements in diet quality (reduction in carbohydrate and protein intake), glycaemic control and total cholesterol were also detected. myDIDeA is one of few web-delivered dietary interventions for patients with chronic disease. The reach, flexibility, accessibility and conversion of established guidelines into a more user-friendly format have contributed to the success of this intervention programme. Future related studies are suggested to emphasise on the interactivity, familiarise the participants with the system prior to the intervention, encourage self-monitoring and built the intervention on a strong theoretical background