Cardiovascular epidemiology in the Asia–Pacific region

By 2020, non-communicable diseases including cardiovascular diseases (CVD) are expected to account for seven out of every 10 deaths in the developing countries compared with less than half this value today. As a proportion of total deaths from all-causes, CVD in the Asia–Pacific region ranges from less than 20% in countries such as Thailand, Philippines and Indonesia to 20–30% in urban China, Hong Kong, Japan, Korea and Malaysia. Countries such as New Zealand, Australia and Singapore have relatively high rates that exceed 30–35%. The latter countries also rank high for coronary heart disease (CHD) mortality rate (more than 150 deaths per 100 000). In contrast, death from cerebrovascular disease is higher among East Asian countries including Japan, China and Taiwan (more than 100 per 100 000). It is worth noting that a number of countries in the region with high proportions of deaths from CVD have undergone marked declining rates in recent decades. For example, in Australia, between 1986 and 1996, mortality from CHD in men and women aged 30–69 years declined by 46 and 51%, respectively. In Japan, stroke mortality dropped from a high level of 150 per 100 000 during the 1920s–1940s to the present level of approximately 100 per 100 000. Nonetheless, CVD mortality rate is reportedly on the rise in several countries in the region, including urban China, Malaysia, Korea and Taiwan. In China, CVD mortality increased as a proportion of total deaths from 12.8% in 1957 to 35.8% in 1990. The region is undergoing a rapid pace of urbanization, industrialization and major technological and lifestyle changes. Thus, monitoring the impact of these changes on cardiovascular risks is essential to enable the implementation of appropriate strategies towards countering the rise of CVD mortality

Food production strategies for improving household food security amidst rising food prices: sharing the Malaysian experience

Food and fuel prices have soared in recent years affecting most adversely the poor and those with fixed incomes. Since 2000, wheat price in the international market has more than tripled and maize prices have more than doubled. The price of rice, the staple of billions in Asia, has tripled in the past year. The surge of food prices has been blamed on multiple factors including higher energy and fertilizer costs, greater global demand, drought, the loss of arable land to biofuel crops, and price speculation. In light of the spiraling rise in food prices, there is the prospect of increasing rates of under-nutrition worldwide. As it is, 800 million are estimated to be suffering from chronic malnourishment, with another 2.1 billion people living close to subsistence levels on less than US$2 a day. Some perspectives of the food production experience of Malaysia are shared here as a case of a country that has built up capabilities and resources through high level of foreign and domestic investment leading to a diversified economy. In response to the recent surge in the price of rice, the Malaysian government announced the setting up of a dedicated fund amounting to US$1.25 billion to increase production of food including fruits and vegetables, and targeting 100% self-sufficiency in rice, by growing rice on a massive scale in Sarawak. During the current five-year development plan for the period of 2006-2010, (Ninth Malaysia Plan), the role of the agriculture sector is considerably enhanced to be the third pillar of economic growth, after manufacturing and services. Among the measures taken, are those aimed at increasing incomes of smallholders and fishermen mainly through improving productivity. These measures include encouraging more rice farmers to participate in mini-estates and group farming, providing financial assistance to rehabilitate cocoa, pepper and sago smallholdings, enhancing the capabilities of coastal fishermen, and setting up of a special program to assist poor households in the agriculture sector to diversify their sources of income. The various socio-economic programs in Malaysia that have been put in place over the years may have cushioned to some extent so far the severity of the dramatic hikes in food prices

Nutrition and cardiovascular disease: an Asia Pacific perspective

Changes in the dietary intake patterns of countries in the Asia Pacific region are considered in relation to trends of cardiovascular disease mortality. Cardiovascular disease now constitutes the major cause of mortality in many of the countries of the region. The mortality rate for coronary heart disease (CHD) has been on the decline since the mid-1960s in countries such as Australia, New Zealand and Japan, while a decline in other countries, including Singapore and Hong Kong, appears to be occurring about two decades later after a delayed increase. In contrast, countries like Malaysia and China have had and continue an upward trend for CHD mortality. Nonetheless, the mortality rates due to CHD in New Zealand, Australia, Singapore followed by Hong Kong rank among the highest in the region. In China, Taiwan and Japan, death due to cerebrovascular disease remains a major cause of death, although the latter two countries have undergone a significant decline in stroke death rates since 1970. The intakes of fat from land animal products, fish and vegetable oils, depending on fatty acid patterns and, possibly other constituents, are candidate contributors to the different atherogenic and thrombotic effects. Countries which have a higher mortality from CHD tend to have a higher intake of energy from fat and proportion of fat from animal products. These fat intakes may operate to increase hypercholesterolemia and overweight in various countries. Again, intakes of other food items and constituents used in the region such as soybeans, dietary antioxidants in fruits, vegetables, seeds, cereals, nuts and tea and alcohol consumption are candidate cardioprotectants. The wide dietary scope of Asia Pacific populations, from diverse socio-cultural backgrounds, and at different levels of economic and technological development poses several analytic challenges and opportunities. Future research should improve the datasets and think laterally about pathogenesis and intervention

Resettlement and Nutritional Implications: the Case of Orang Asli in Regroupment Schemes

Since the mid-1970s, increasingly more Orang Asli from the interior have been relocated into regroupment schemes, where they are introduced to the cultivation of cash crops including rubber and oil palm. This involves a major change to their socia-economic lifestyle, in having to switch from subsistence cropping coupled with hunting-gathering activity to being drawn into the market economy. Some 15 years after relocation, the nutritional status of Orang Asli children in regroupment schemes can be described as poor with a moderate to high prevalence of underweight, acute and chronic malnutrition. Their dietary intakes are deficient in calories and several major nutrients. This article also presents findings of the deleterious impact of resettlement on nutritional status experienced in other countries. There exists an over-simplified assumption that introduction to cash cropping will lead to increased income, which will provide more money for food, and in turn result in improvement in nutritional status. Evidence involving indigenous groups and peasant farmers is provided to show that this linkage does not necessarily emanate. In reality, relocation entails cultural uprooting and lifestyle changes which may not be overcome by the provision of physical facilities and economic incentives only

Food-based approaches to combat the double burden among the poor : challenges in the Asian context.

Estimates of FAO indicate that 14% of the population worldwide or 864 million in 2002-2004 were undernourished in not having enough food to meet basic daily energy needs. Asia has the highest number of undernourished people, with 163 million in East Asia and 300 million in South Asia. Meanwhile obesity and diet-related non-communicable diseases continue to escalate in the region. The double burden of malnutrition also affects the poor, which is a serious problem in Asia, as it has the largest number of poor subsisting on less than $1/day. As poverty in the region is predominantly rural, agriculture-based strategies are important for improving household food security and nutritional status. These measures include shifting toward production of high-value products for boosting income, enhancing agricultural biodiversity, increasing consumption of indigenous food plants and biofortified crops. Urban poor faces additional nutritional problems being more sensitive to rising costs of living, lack of space for home and school gardening, and trade-offs between convenience and affordability versus poor diet quality and risk of contamination. Time constraints faced by working couples in food preparation and child care are also important considerations. Combating the double burden among the poor requires a comprehensive approach including adequate public health services, and access to education and employment skills, besides nutrition interventions

Iron intake and iron deficiency anaemia among young women in Kuala Lumpur

Objective: To assess the prevalence of iron deficiency, anaemia and iron deficiency anaemia (IDA) in women aged 20-40 years and its association with iron intake. Methods: A total of 388 women were recruited from universities and work sites in Kuala Lumpur and its suburbs. The subjects comprised 135 Malays, 130 Chinese and 123 Indians. Dietary intake was estimated using a single 24-hour food recall and a semi-quantitative food frequency questionnaire. Haemoglobin (Hb), haematocrit (hct), mean corpuscular volume (MCV) and serum ferritin were determined. Results: The prevalence of anaemia (Hb <12g/dL) was 20.9%, being highest among the Indians (26.4%) and lowest among the Malays (16.4%). About 10.3% of the women showed iron deficiency anaemia (IDA) (Hb <12g/dL + serum ferritin < 15μg/L + MCV <80fl/). The prevalence of IDA was highest in Indians (18.0%) followed by Chinese (9.9%) and Malays (4.3%). The mean (95%CI) intake of total iron was at 14.4 mg/day (95% CI 13.4, 15.5), amounting to 49.7% of the Malaysian recommended nutrient intake (RNI). Intake of iron was the highest for the Indians (16.0 mg/d) and the lowest for the Chinese (11.3 mg/d). Conclusions: The overall prevalence of IDA was lower compared to prevalence of anaemia. Nonetheless, the markedly higher prevalence of IDA among the Indians, despite relatively higher intake levels of iron-rich foods warrants further investigations, including the bioavailability of iron in the context of cultural practices that may influence food preferences and meal preparation

Household food insecurity and coping strategies in a poor rural community in Malaysia

This cross-sectional study assessed household food insecurity among low-income rural communities and examined its association with demographic and socioeconomic factors as well as coping strategies to minimize food insecurity. Demographic, socioeconomic, expenditure and coping strategy data were collected from 200 women of poor households in a rural community in Malaysia. Households were categorized as either food secure (n=84) or food insecure (n=116) using the Radimer/Cornell Hunger and Food Insecurity instrument. T-test, Chi-square and logistic regression were utilized for comparison of factors between food secure and food insecure households and determination of factors associated with household food insecurity, respectively. More of the food insecure households were living below the poverty line, had a larger household size, more children and school-going children and mothers as housewives. As food insecure households had more school-going children, reducing expenditures on the children's education is an important strategy to reduce household expenditures. Borrowing money to buy foods, receiving foods from family members, relatives and neighbors and reducing the number of meals seemed to cushion the food insecure households from experiencing food insufficiency. Most of the food insecure households adopted the strategy on cooking whatever is available at home for their meals. The logistic regression model indicates that food insecure households were likely to have more children (OR=1.71; p<0.05) and non-working mothers (OR=6.15; p<0.05), did not own any land (OR=3.18; p<0.05) and adopted the strategy of food preparation based on whatever is available at their homes (OR=4.33; p<0.05). However, mothers who reported to borrow money to purchase food (OR=0.84; p<0.05) and households with higher incomes of fathers (OR=0.99; p<0.05) were more likely to be food secure. Understanding the factors that contribute to household food insecurity is imperative so that effective strategies could be developed and implemented

Gender Differences in Eating Behavior

University students may encounter personal, family, social, and financial stresses while trying to cope with their academic challenges. Such constraints could affect their eating behavior and health status which, in turn may have negative effects on their studies. In light of little information in Malaysia on this subject, this study was undertaken on a sample of 180 students pursuing different academic programs in a Malaysian university. The study objectives were to determine the students’ eating behavior including body weight control and the extent of fear of being fat, their social self concept that reflects the five selves namely, the psychological self, the social self, the sexual self, the family self and the physical self. Eating behavior and social self concept were determined based on various methods previously validated in studies on young adults in Asia and Australia. This article focuses on gender comparisons for these determinants. The results showed that psychological and emotional factors have a significant bearing on the eating behavior of university students. Uninhibited eating behavior of both the males and females showed significant and negative correlations with feelings pertaining to personal worth, the physical self, and their relationships with peers and families. Gender differences were manifested for some determinants. The females showed more restrained eating behavior than the males; the females have a significantly higher score for family relationship, which appears to be a significant factor on male students’ eating behavior. Future studies on a larger sample size may help to unravel the extent to which psychological factors influence eating behavior of students, and the underlying psychosocial basis for some of the gender differences reported in this study. ,

Determination of folate content in commonly consumed Malaysian foods

Currently, data concerning the content of naturally occurring dietary folate in Malaysian foods is scarce. The aim of this study was to determine the folate content of vegetables, fruits, legumes and cereals that were commonly consumed among Malaysians. The total folate content of 156 samples (51 vegetables, 33 fruits, 22 legumes and legume products, and 50 cereals and cereal products) available in Malaysia was determined by microbiological assay using Lactobacillus casei (L. casei) after trienzyme treatment with protease, α-amylase and folate conjugase (from rat serum). An internal quality control system was used throughout the study by analyzing CRM 121 (wholemeal flour) and CRM 485 (lyophilized mixed vegetables); percent recovery (as mean ± SD) of 97 ± 2.0 and 101 ± 4.0 was obtained. The range of folate content in vegetables, fruits, legumes and cereals were 1-11 μg/100 g and 1-31on the basis of fresh weight and 1-31 μg/100 g and 2-156 μg/100 g on the basis of dry weight, respectively. This study has shown that some of these underutilized vegetables and fruits are good sources of folate and could fulfill the recommended dietary intake of total folate

Association between dietary folate intake and blood status of folate and homocysteine in Malaysian adults.

Folate is of prime interest among investigators in nutrition due to its multiple roles in maintaining health, especially in preventing neural tube defects and reducing the risk of cardiovascular diseases. We investigated the effect of dietary folate intake on blood folate, vitamin B(12), vitamin B(6), and homocysteine status. One hundred subjects consisting of Chinese and Malay subjects volunteered to participate in this cross-sectional study. Dietary folate intake was assessed by 24-h dietary recall and a food-frequency questionnaire (FFQ). Serum and red blood cell folate were analyzed using a microbiological assay, while serum vitamin B(12) was determined by electrochemiluminescence immunoassay (ECLIA), and high-performance liquid chromatography (HPLC) was used for the determination of serum vitamin B(6) and homocysteine. The mean folate intake, serum folate, RBC folate, serum vitamin B(12), and B(6), were higher in female subjects, with the exception of serum homocysteine. The Chinese tended to have higher folate intake, serum folate, RBC folate, and vitamin B(12). A positive association was found between folate intake and serum folate while a negative association was found between folate intake and serum homocysteine. Stepwise linear regression of serum folate showed a significant positive coefficient for folate intake whilst a significant negative coefficient was found for serum homocysteine when controlling for age, gender, and ethnicity. In conclusion, high dietary folate intake helps to increase serum folate and to lower the homocysteine levels