The determinants of participation in physical activity in Malaysia

Objectives: In light of the importance of physical activity, the aim of the present study is to examine the factors affecting participation in physical activity among adults in Malaysia. Methods: A logistic regression model and the Third National Health and Morbidity Survey consisting of 30,992 respondents were used.Results: Age, income, gender, education, marital status, region, house locality,job characteristics, and medical conditions are significantly associated with participation in physical activity.In particular, old individuals, high income earners, females, the well-educated, widowed or divorced individuals, East Malaysians, urban dwellers, the unemployed, and individuals who are not diagnosed with hypercholesterolemia are less likely to be physically active than others. Conclusion: Because sociodemographic and health factors play an important role in determining physical activity, the government should take them into account when formulating policy

Kepercayaan terhadap amalan pemakanan dalam kalangan penjaga kanak-kanak leukemia dan kumpulan profesional kesihatan di Hospital Kuala Lumpur –kajian kualitatif

Kepercayaan terhadap amalan pemakanan oleh ibu bapa dan penjaga memainkan peranan penting dalam pengambilan pemakanan kanak-kanak leukemia. Namun kajian tempatan yang mengkaji amalan dan kepercayaan pemakanan dalam kalangan penjaga pesakit leukemia sangat terhad. Kajian ini bertujuan untuk mengkaji kepercayaan terhadap amalan pemakanan dalam kalangan penjaga kanak-kanak yang menghidap leukemia ahli profesional kesihatan di Institut Pediatrik Hospital Kuala Lumpur (IPHKL), Malaysia. Kajian secara kualitatif ini dijalankan bagi menilai kepercayaan dan amalan terhadap sesuatu makanan dalam kalangan penjaga pesakit leukemia kanak-kanak. Seramai 30 orang subjek yang terdiri daripada 10 orang ahli profesional kesihatan dan 20 orang penjaga pesakit telah ditemu bual menggunakan kaedah temu duga semi-struktur. Temu duga ini ditranskripkan dan dianalisa menggunakan perisian kualitatif ATLAS.ti. versi 7.5.6 yang seterusnya membentuk beberapa tema. Lima tema yang telah ditemui dalam kajian ini iaitu: (1) kepercayaan terhadap makanan yang mampu menyembuhkan kanser, (2) kepercayaan mengenai pengambilan susu dan daging, (3) kepercayaan makanan yang mengandungi pestisid,(4) kepercayaan terhadap makanan yang menyebabkan kegatalan, dan (5) sumber maklumat pemakanan dan pengetahuan pemakanan dalam kalangan penjaga. Kajian ini menunjukkan wujudnya kepercayaan terhadap amalan pemakanan tertentu dalam kalangan penjaga pesakit dan kumpulan profesional kesihatan. Maklumat daripada hasil kajian ini boleh memberikan perspektif mengenai kepercayaan terhadap amalan pemakanan tertentu dalam kalangan penjaga kanak-kanak leukemia dan kumpulan profesional kesihatan. Perkara ini penting kepada ahli profesional kesihatan terutamanya semasa merancang strategi untuk memberi pendidikan pemakanan kepada penjaga untuk memperbaiki status pemakanan pesakit

Kesan akut kafein ke atas penggunaan oksigen dan tanggapan tahap lesu semasa senaman intensiti sederhana dalam kalangan dewasa muda perempuan yang sedentari

Kafein mempunyai kesan ergogenik terhadap golongan yang terlatih; walaubagaimanapun, kajian kesan fisiologi kafein terhadap golongan sedentari adalah amat terhad. Tujuan kajian ini adalah untuk mengkaji kesan kafein ke atas penggunaan oksigen dan tanggapan tahap lesu semasa senaman intensiti sederhana dalam kalangan dewasa muda perempuan yang sedentari. Subjek terdiri daripada 16 orang mahasiswi yang berumur antara 22 hingga 24 tahun. Kriteria penerimaan adalah tahap aktiviti fizikal yang rendah dan pengambilan kafein adalah kurang daripada 50 mg sehari, disaring dengan menggunakan Soal Selidik Aktiviti Fizikal Antarabangsa (versi pendek) dan soal selidik pengambilan kafein. Reka bentuk kajian eksperimental ini adalah buta tunggal, pindah silang, kawalan plasebo dengan semua subjek menjadi kawalannya tersendiri. Subjek dikehendaki malaporkan diri ke makmal untuk menjalankan dua sesi eksperimen selepas masing-masing mengambil kapsul plasebo atau kafein dengan selang masa 3 hari antara dua sesi eksperimen tersebut. Enam puluh minit selepas mengambil kapsul plasebo (Glucolin, glukosa) atau 100 mg kafein (Pro-plus, United Kingdom), subjek dikehendaki berlari di atas treadmill selama 30 minit pada kuasa kerja yang bersamaan 60% daripada anggaran maksimum kadar denyutan jantung. Penggunaan oksigen, kadar denyutan jantung dan tanggapan tahap lesu direkod pada minit ke-20, ke-25 dan ke-30, manakala tekanan darah direkod serta-merta selepas subjek menghabiskan larian. Perbezaan direkod selepas kesemua subjek menyempurnakan kedua-dua eksperimen plasebo dan kafein. Min peratus lemak tubuh subjek adalah 28.4 ± 5.4. Ujian t bersandar menunjukkan tiada perbezaan signifikan antara trial plasebo dengan trial kafein ke atas penggunaan oksigen (13.99 ± 2.47 vs 14.49 ± 1.73, p = 0.440), tanggapan tahap lesu (12.3 ± 2.5 vs 12.3 ± 2.1, p = 1.000), tekanan darah sistolik (113 ± 10 vs 117 ± 11, p = 0.129), tekanan diastolik (67 ± 8 vs 69 ± 10, p = 0.408) dan kadar denyutan jantung (127.3 ± 11.0 vs 127.1 ± 11.6, p = 0.912). Terdapat korelasi negatif tinggi yang signifikan antara peratusan lemak tubuh dengan pengambilan oksigen (r = –0.568, p < 0.05) serta korelasi positif tinggi yang signifikan antara peratusan lemak tubuh dengan tanggapan tahap lesu (r = 0.515, p < 0.05). Hasil kajian tidak meningkatkan kesan yang signifikan mungkin disebabkan oleh kesan saiz (effect size) kajian ini yang kecil (d = 0.24). Justeru itu, kajian masa depan yang melibatkan lebih ramai subjek harus dijalankan untuk mengkaji kesan kafein semasa senaman dalam kalangan populasi sedentari

Penilaian media bercetak untuk pendidikan pemakanan kanak-kanak berlebihan berat badan dan obes

Media pendidikan bercetak merupakan saluran komunikasi yang utama dalam pendidikan kesihatan awam. Namun, kajian tempatan yang menilai penerimaan media pendidikan bercetak masih terhad di Malaysia. Maka, kajian ini dilakukan untuk menilai media pendidikan bercetak sedia ada yang mensasarkan obesiti di kalangan kanak-kanak untuk kegunaan dalam program pendidikan atau promosi pemakanan. Kajian ini melibatkan dua peringkat. Peringkat pertama merupakan tinjauan keperluan iaitu tinjauan terhadap media pendidikan bercetak sedia ada yang mensasarkan kanakkanak yang mengalami masalah berlebihan berat badan dan obes dan kajian rintis terhadap borang soal selidik yang dibentuk. Manakala peringkat kedua adalah penilaian penerimaan subjek kajian terhadap media pendidikan bercetak dan perubahan tahap pengetahuan mereka selepas membaca media pendidikan bercetak yang diberikan. Skala Likert digunakan dalam penilaian ini iaitu daripada 1 (sangat tidak memuaskan) hingga 5 (sangat memuaskan). Jumlah subjek dalam kajian ini adalah seramai 67 orang yang terdiri daripada golongan profesional dalam bidang pendidikan dan kesihatan (n = 7), subjek dewasa (n = 30) dan subjek kanak-kanak (n = 30). Di dalam kajian ini, subjek dewasa diberi satu buku kecil yang mengandungi maklumat berkenaan pencegahan dan pengurusan masalah obesiti di kalangan kanak-kanak seperti komplikasi masalah obesiti dan penyediaan makanan. Subjek kanak-kanak pula menerima satu buku kecil yang mengandungi maklumat berkenaan piramid makanan, kepentingan sarapan, aktiviti fi zikal dan sebagainya di samping satu poster yang mengandungi maklumat berkenaan pemilihan makanan sihat. Manakala golongan profesional menerima semua media pendidikan bercetak ini. Kajian ini mendapati penerimaan subjek terhadap isi kandungan, gambar, jadual dan rajah, warna, susun atur gambar, susun atur kandungan, bahasa dan saiz huruf bagi ketiga-tiga media pendidikan bercetak adalah pelbagai, iaitu daripada sangat tidak memuaskan hingga sangat memuaskan. Min skor penilaian keseluruhan terhadap buku kecil yang mensasarkan populasi dewasa adalah 3.9 ± 0.5 manakala min skor penilaian keseluruhan terhadap buku kecil yang mensasarkan populasi kanak-kanak adalah 4.3 ± 0.4 dan poster adalah 3.9 ± 0.9. Skor pengetahuan pemakanan golongan profesional meningkat dari 88.6 ± 11.2% kepada 95.5 ± 3.2% selepas membaca media tersebut. Skor pengetahuan pemakanan subjek dewasa juga meningkat secara signifi kan (p < 0.001) daripada 67.7 ± 13.6% kepada 84.8 ± 15.9%; bagi subjek kanak-kanak, skor pengetahuan pemakanan juga meningkat secara signifi kan (p < 0.001) daripada 65.3 ± 14.4% kepada 84.0 ± 11.4%. Kesimpulannya, media pendidikan bercetak sedia ada mendapat penerimaan yang baik dan dapat meningkatkan tahap pengetahuan kumpulan sasaran. Oleh itu, media pendidikan bercetak tersebut sesuai digunakan dalam mana-mana program pendidikan pemakanan yang berkaitan dengan obesiti kanak-kanak

Review on food insecurity and its relationship with iron and vitamin B12 status among children

Iron and vitamin B12 are essential micronutrients needed for the growth and development of children. Iron is critical for erythropoiesis, notably in haemoglobin synthesis whereby haemoglobin transports oxygen to cells, which is essential for cellular metabolism and energy production. Meanwhile, vitamin B12 is required for deoxyribonucleic acid synthesis, intracellular metabolism, and blood cells formation and maturation. Lack of these essential micronutrients can lead to nutritional deficiency and anaemia, especially among children. Food insecurity is a condition where there is a lack of or uncertain availability of acquiring acceptable food. Food insecurity is associated with lower nutrient intake and micronutrient deficiencies including iron and vitamin B12, which can subsequently lead to poor health outcomes. Various determinants are associated with iron and vitamin B12 deficiency, and food insecurity, such as socio-economic factors, environmental factors, and dietary intake. This review will explore the possible relationship between iron, vitamin B12, and anaemia with food insecurity among children

Juara Sihat™: study design of a school-based childhood obesity nutrition education programme in Kuala Lumpur, Malaysia

The global prevalence of overweight and obesity among children has increased rapidly in the recent decades, including in Malaysia. Thus, development of effective interventions to prevent childhood obesity in Malaysia is urgently needed. This paper describes the study design of a 12-week multi-component, school-based nutrition education programme aimed at managing childhood obesity. The objective of Juara Sihat™ is to determine the effectiveness of a nutrition education programme in improving anthropometric status, knowledge, attitude and practice (KAP) of nutrition, eating habits and physical activity level among overweight and obese children. This quasi-experimental study involves two primary schools in Kuala Lumpur with similar demographic characteristics. Eligibility criteria of research participants are overweight and obese children aged 9 to 11 years. The main components of the Juara Sihat™ intervention are nutrition education classes on healthy eating and active lifestyle; physical activity sessions; and active involvements of parents and teachers. The control school does not receive any interventions. The primary outcome is BMI-for-age z-score, while other outcomes include waist circumference, body fat percentage, KAP of nutrition score, dietary intake, physical activity level, sedentary behaviour and biochemical profile. Outcome measures will be assessed at three intervals: baseline, post-intervention 1 (3-month follow-up), and post-intervention 2 (6-month follow-up). The Juara Sihat™ programme represents a promising approach to examining the effectiveness of a school-based childhood obesity intervention with strong empowerment of Parents’ and Teachers’ Association (PTA). We anticipate that this study may provide insights towards the development of more effective strategies in formulating childhood obesity interventions

Faktor-faktor yang mempengaruhi kemapanan intervensi obesiti juara sihat daripada perspektif kanak-kanak: satu kajian kualitatif

Prevalens berlebihan berat badan dan obesiti kanak-kanak secara global telah meningkat secara mendadak dalam beberapa tahun ini, termasuk di Malaysia. Intervensi obesiti yang dijalankan di sekolah penting untuk menggalakkan gaya hidup sihat dan perubahan tingkah laku. Terdapat banyak intervensi yang telah dijalankan bagi menangani masalah obesiti kanak-kanak; namun, kemapanan intervensi obesiti kanak-kanak sering kali diabaikan. Tujuan kajian ini adalah untuk meneroka persepsi kanak-kanak tentang faktor-faktor yang mempengaruhi kemapanan intervensi Juara Sihat di sekolah rendah di Kuala Lumpur. Temu bual bersemuka mendalam dijalankan dengan 26 responden berumur 12 hingga 14 tahun yang dipilih melalui persampelan bertujuan daripada kanak-kanak yang terlibat di dalam program Juara Sihat tersebut. Transkripsi data verbatim dilakukan dan analisis tema dijalankan. Kajian ini mendapati tema utama yang dikenalpasti sebagai faktor penggalak adalah (1) sokongan keluarga, fasilitator, guru sekolah, dan kawan-kawan; (2) amalan aktiviti fizikal dan pemakanan sihat selepas intervensi; (3) kesedaran kendiri; (4) pengetahuan terhadap piramid makanan dan pemakanan sihat; dan (5) persekitaran rumah, manakala faktor penghalang adalah (1) tidak konsisten dalam pengetahuan; (2) keselamatan diri; (3) rakan sebaya; (4) sikap peribadi; dan (5) bosan terhadap program. Hasil kajian menunjukkan faktor penggalak kemapanan intervensi Juara Sihat yang utama adalah amalan aktiviti fizikal dan pemakanan sihat, manakala faktor penghalang utama adalah tidak konsisten dalam pengetahuan. Oleh itu, intervensi obesiti kanak-kanak berasaskan sekolah perlu mempertimbangkan faktor-faktor ini yang mempengaruhi kemapanan intervensi. Kajian masa depan dicadangkan untuk mempertimbangkan faktor-faktor tersebut ketika perancangan program intervensi obesiti kanak-kanak untuk meningkatkan keberkesanan intervensi obesiti untuk jangka masa yang lebih panjang

Food consumption patterns: findings from the Malaysian Adult Nutrition Survey(MANS)

This study reports the food consumption patterns of adults aged 18 to 59 years in the Malaysian Adults Nutrition Survey (MANS) carried out between October 2002 and December 2003. A total of 6,742 subjects comprising 3,274 men and 3,468 women representing the northern, central , southern and east coast of Peninsular Malaysia as well as Sabah and Sarawak were interviewed. A semiquantitative food frequency questionnaire (FFQ) which consisted of 126 food items was used to evaluate the food consumption pattern (habitual food intake) of the respondents during the previous one-year period. The results demonstrate that nasi putih (cooked rice) was consumed by 97% of the population twice daily (average 2½ plates per day). Other food items consumed daily were marine fish, (one medium fish per day), green leafy vegetables (one cup per day) and sweetened condensed milk (three teaspoons per day. The mean frequencies for daily intake of rice, leafy vegetables, marine fish, local kuih, anchovy (ikan bilis) and biscuits were significantly higher among the rural compared to the urban adults. In contrast, more urban dwellers consumed chicken and eggs more frequently than their rural counterparts. More men than women consumed chicken and eggs more frequently. Malaysian adults showed a satisfactory habit of drinking plain water, with 99% drinking at least six glasses of plain water daily. Other beverages such as tea (47%), coffee (28%), chocolate-based drinks (23%) and cordial syrup (11%) were also consumed on daily basis, however, in a smaller proportion of the population. There were differences in the prevalence of daily consumption of foods when comparing urban and rural population, and also between men and women. The prevalence of daily consumption of marine fish among rural and urban adults was 51% and 34% respectively. For sweetened condensed milk, men and women consumed 43% and 28% respectively; however, more women drank full cream milk than men. Between the age groups, 21% of adults below 20 years old consumed chicken at least once a day, while this pattern of intake was not shown in the older age groups. Our findings show that adults, aged 50 to 59 years old, had the highest prevalence of daily consumption of full cream milk with 24% while those aged 18 to 19 years old had the lowest prevalence of daily consumption at 15%. The food consumption pattern of Malaysian adults appears to be satisfactory. However, some changes in food habits are recommended especially in substituting the less wholesome sweetened condensed milk with the more nutritious full cream or skimmed milk

A single-center prospective observational study comparing resting energy expenditure in different phases of critical illness: indirect calorimetry versus predictive equations

Objectives: Several predictive equations have been developed for estimation of resting energy expenditure, but no study has been done to compare predictive equations against indirect calorimetry among critically ill patients at different phases of critical illness. This study aimed to determine the degree of agreement and accuracy of predictive equations among ICU patients during acute phase (≤ 5 d), late phase (6–10 d), and chronic phase (≥ 11 d). Design: This was a single-center prospective observational study that compared resting energy expenditure estimated by 15 commonly used predictive equations against resting energy expenditure measured by indirect calorimetry at different phases. Degree of agreement between resting energy expenditure calculated by predictive equations and resting energy expenditure measured by indirect calorimetry was analyzed using intraclass correlation coefficient and Bland-Altman analyses. Resting energy expenditure values calculated from predictive equations differing by ± 10% from resting energy expenditure measured by indirect calorimetry was used to assess accuracy. A score ranking method was developed to determine the best predictive equations. Setting: General Intensive Care Unit, University of Malaya Medical Centre. Patients: Mechanically ventilated critically ill patients. Interventions: None. Measurements and Main Results: Indirect calorimetry was measured thrice during acute, late, and chronic phases among 305, 180, and 91 ICU patients, respectively. There were significant differences (F = 3.447; p = 0.034) in mean resting energy expenditure measured by indirect calorimetry among the three phases. Pairwise comparison showed mean resting energy expenditure measured by indirect calorimetry in late phase (1,878 ± 517 kcal) was significantly higher than during acute phase (1,765 ± 456 kcal) (p = 0.037). The predictive equations with the best agreement and accuracy for acute phase was Swinamer (1990), for late phase was Brandi (1999) and Swinamer (1990), and for chronic phase was Swinamer (1990). None of the resting energy expenditure calculated from predictive equations showed very good agreement or accuracy. Conclusions: Predictive equations tend to either over- or underestimate resting energy expenditure at different phases. Predictive equations with “dynamic” variables and respiratory data had better agreement with resting energy expenditure measured by indirect calorimetry compared with predictive equations developed for healthy adults or predictive equations based on “static” variables. Although none of the resting energy expenditure calculated from predictive equations had very good agreement, Swinamer (1990) appears to provide relatively good agreement across three phases and could be used to predict resting energy expenditure when indirect calorimetry is not available