Triglyceride to high-density lipoprotein cholesterol ratio is an independent predictor of liver fibrosis among pediatrics non-alcoholic fatty liver disease

BackgroundInsulin resistance (IR), one of the key components of the metabolic syndrome, is recognized as the pathophysiological hallmark of non-alcoholic fatty liver disease (NAFLD). This study aims to investigate the relationship between surrogate markers of IR and the severity of NAFLD among overweight or obese children.MethodologyA total of 56 consecutive children aged 6 to 18 years old were recruited from the pediatric obesity and type 2 diabetes mellitus (T2DM) clinic in University Malaya Medical Centre (UMMC) from 2016 to 2019. Data on anthropometric measurements, clinical components of metabolic syndrome and fasting serum insulin were collected. Triglyceride to high-density lipoprotein cholesterol ratio (TG: HDL-C), Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) and Single Point Insulin Sensitivity Estimator (SPISE) were calculated. Transient elastography was performed with hepatic steatosis and liver fibrosis assessed by controlled attenuation parameter (CAP) and liver stiffness measurement (LSM), respectively.ResultsA total of 44 children (78.6%) had liver steatosis and 35.7% had presence of significant liver fibrosis (stage F≥2). Majority (89.3%) are obese and 24 children (42.9%) were diagnosed with metabolic syndrome. Higher number of children with T2DM and significant liver fibrosis were associated with higher tertiles of TG: HDL-C ratio (p<0.05). Top tertile of TG: HDL-C ratio was an independent predictor of liver fibrosis (OR=8.14, 95%CI: 1.24–53.36, p=0.029). ROC analysis showed that the area under the curve (AUC) of HOMA-IR (0.77) and TG: HDL-C ratio (0.71) were greater than that of metabolic syndrome (0.70), T2DM (0.62) and SPISE (0.22). The optimal cut-off values of HOMA-IR and TG: HDL-C ratio for detecting liver fibrosis among children with NAFLD are 5.20 and 1.58, respectively.ConclusionChildren with NAFLD and higher TG: HDL-C ratio are more likely to have liver fibrosis. TG: HDL-C ratio is a promising tool to risk stratify those with NAFLD who are at risk of developing advanced liver disease

A comparison study of portable foot-to-foot bioelectrical impedance scale to measure body fat percentage in asian adults and children

Objective. To compare the measurements of body fat percentage (BF%) using the foot-to-foot bioelectrical impedance analysis (FTF-BIA) with the direct segmental multifrequency BIA (DSM-BIA). Methods. There were 36 men and 52 women (37.1 ± 14.3 years) with 57% Malays, 30% Chinese, and 13% Indian. For children, there were 45 boys and 26 girls (11.5 ± 2.5 years) with 52% Malay, 15% Chinese, and 33% Indian. Results. Mean height for men was 168.4 cm, 11 cm taller than women. Men were 10 kg heavier than women at 70 kg. BF% in women was 32% and 33% whereas BF% in men was 23% and 25% when measured using FTF-BIA and DSM-BIA, respectively. In children, BF% measured with FTF-BIA and DSM-BIA was 49% and 46%, respectively. The correlations were significant for men ( = 0.92, SEE = 2.80), women ( = 0.91, SEE = 3.31), boys ( = 0.95, SEE = 5.44), and girls ( = 0.96, SEE = 5.27). The BF% in underweight/normal ( = 0.92, SEE = 2.47) and that in overweight/obese adults ( = 0.89, SEE = 3.61) were strongly correlated. The correlations were significant in normal/underweight ( = 0.94, SEE = 3.78) and obese/overweight children ( = 0.83, SEE = 6.49). All ethnic groups showed significant correlation with BF%. Malay adults ( = 0.92, SEE = 3.27) and children ( = 0.94, SEE = 0.88) showed significant mean differences in BF%. Conclusion. The FTF-BIA showed higher accuracy for all normal/underweight and Chinese group with acceptable overestimation in children and underestimation in adults. Caution should be taken when interpreting BF% depending on gender, BMI, and ethnicity

Facilitators and Barriers to Implementing Healthy School Canteen Intervention among Malaysian Adolescents:A Qualitative Study

This study evaluated implementing a school-based intervention to promote healthier dietary habits in the school environment among Malaysian adolescents using qualitative methods. This qualitative study was conducted in four secondary schools in Perak and Selangor (two urban and two rural schools) that received the intervention (either training or training and food subsidy). A total of eight focus groups (68 students aged 15 years old) and 16 in-depth interviews were conducted with canteen operators, school convenience shop operators, school teachers and school principals in each school. Thematic analysis was used to analyse the qualitative data to identify suitable themes. We found several initiatives and changes by the schools’ stakeholders to change to a healthy school canteen programme. The stakeholders also noticed the students’ food preferences that influence healthy food intake in canteens and convenience shops. The food vendors and school administrators also found that subsidising healthy meals might encourage healthy eating. Among barriers to implementing healthy school initiatives were the student’s perception of healthy food and their eating habits, which also affect the food vendors’ profit if they want to implement a healthy canteen. The school-based intervention has the potential to promotes healthier eating among school adolescents. Continuous training and monitoring of canteen operators and convenience shops are needed, including building partnerships and educating the students on healthy eating to cultivate healthy eating habits

A Novel, Homozygous c.1502T>G (p.Val501Gly) Mutation in the Thyroid peroxidase

Congenital hypothyroidism (CH) with multinodular goiter (MNG) is uncommonly seen in children. However, CH associated with goiter is often caused by defective Thyroid peroxidase (TPO) gene. In this study, we screened for mutation(s) in the TPO gene in two siblings with CH and MNG and their healthy family members. The two sisters, born to consanguineous parents, were diagnosed with CH during infancy and received treatment since then. They developed MNG during childhood despite adequate L-thyroxine replacement and negative thyroid antibody screening. PCR-amplification of all exons using flanking primers followed by DNA sequencing revealed that the two sisters were homozygous for a novel c.1502T>G mutation. The mutation is predicted to substitute valine for glycine at a highly conserved amino acid residue 501 (p.Val501Gly). Other healthy family members were either heterozygotes or mutation-free. The mutation was not detected in 50 healthy unrelated individuals. In silico analyses using PolyPhen-2 and SIFT predicted that the p.Val501Gly mutation is functionally “damaging.” Tertiary modeling showed structural alterations in the active site of the mutant TPO. In conclusion, a novel mutation, p.Val501Gly, in the TPO gene was detected expanding the mutation spectrum of TPO associated with CH and MNG

The Association of Breakfast Frequency and Cardiovascular Disease (CVD) Risk Factors among Adolescents in Malaysia

Peer reviewedPublisher PD

Cardiometabolic Risk Factors and Physical Activity Patterns Maximizing Fitness and Minimizing Fatness Variation in Malaysian Adolescents:A Novel Application of Reduced Rank Regression

Patterns of physical activity (PA) that optimize both fitness and fatness may better predict cardiometabolic health. Reduced rank regression (RRR) was applied to identify combinations of the type (e.g., football vs. skipping), location and timing of activity, explaining variation in cardiorespiratory fitness (CRF) and Body Mass Index (BMI). Multivariable regressions estimated longitudinal associations of PA pattern scores with cardiometabolic health in n = 579 adolescents aged 13–17 years from the Malaysian Health and Adolescent Longitudinal Research Team study. PA pattern scores in boys were associated with higher fitness (r = 0.3) and lower fatness (r = −0.3); however, in girls, pattern scores were only associated with higher fitness (r = 0.4) (fatness, r = −0.1). Pattern scores changed by β = −0.01 (95% confidence interval (CI) −0.04, 0.03) and β = −0.08 (95% CI −0.1, −0.06) per year from 13 to 17 years in boys and girls respectively. Higher CRF and lower BMI were associated with better cardiometabolic health at 17 years, but PA pattern scores were not in either cross-sectional or longitudinal models. RRR identified sex-specific PA patterns associated with fitness and fatness but the total variation they explained was small. PA pattern scores changed little through adolescence, which may explain the limited evidence on health associations. Objective PA measurement may improve RRR for identifying optimal PA patterns for cardiometabolic health. © 2019 by the authors. Licensee MDPI, Basel, Switzerland

Six Strategies for Optimizing Linear Growth through Improving Awareness of Breastfeeding, Dietary Diversity in Complementary Feeding, and Growth Monitoring during Early Life

Only one-fourth of the countries under the Sustainable Development Goal are ‘on track’ to reduce the burden of malnutrition as of 2020. A deficit in linear growth during the first 5 years of life is mainly due to growth faltering in the first 1000 days. This deficit has been consistently reported to be linked to suboptimal cognitive neurodevelopment, while its improvement in early childhood has been reported to offer an opportunity for rescuing neurocognitive potential. This paper describes the perspectives of multidisciplinary experts, representing a range of disciplines related to child growth and nutrition, from Nigeria, Indonesia, and Malaysia, who convened virtually to review and discuss measures aimed at preventing a further increase in growth faltering, including stunting, among children aged 0-3 years under the current prevailing circumstances. Based on the latest evidence of practices and knowledge, the expert panel proposed six strategies to support linear growth in early life which consists of 2 new initiatives: 1) increasing peer-to-peer knowledge transfer among HCP via digital engagement; 2) increasing knowledge transfer from HCPs to caregivers via social media; while maintaining the existing strategies: 1) stimulating initiatives to support breastfeeding during the first 6 months of life; 2) improving quality of complementary feeding; 3) strengthening growth monitoring to detect suboptimal growth in early childhood; 4) optimizing public-private engagement. The recommended solutions presented herein are the culmination of the collective insights of the expert panel. These recommendations offer invaluable approaches on addressing the critical public health issue of malnutrition, specifically growth faltering, and can benefit not only the three countries concerned but also other low and middle-income countries facing similar nutritional challenges