Nutritional Status and Quality of Life among Hemodialysis Patients in Malaysia

Hemodialysis treatment provides progressive improvement in decreasing the risk of mortality and mobility. However, insufficient hemodialysis treatment and hemodialysis related complications tend to decrease patient’s nutritional status and overall quality of life. The objective of this cross-sectional study was to determine the nutritional status and quality of life among hemodialysis patients. A total of 90 subjects were recruited from Hospital Kuala Lumpur and dialysis centres of the National Kidney Foundation of Malaysia. Data on socioeconomics, demography, medical history, hemodialysis treatment and nutritional status were collected. Anthropometry assessment included weight, height, mid-arm circumference and mid-arm muscle circumference, skin fold thicknesses at four sides (biceps, triceps, subscapular and suprailliac), calf circumference and bioimpedance assessment. Subjective Global Assessment was conducted. Biochemical indices including renal function test, liver function test, glucose test, electrolytes, lipid profile, hemoglobin and hematocrit were ascertained. Information on dietary intake were collected using 24-hour diet recall and one-day food record. Information on appetite level and eating habits were collected. Kidney Disease Quality of Life Short Form was used to determine quality of life of the subjects. Subjects comprised 48.9% males and 51.1% females. The sample size predominately Chinese (n=62, 68.9%), followed by Malays (n=19, 21.1%), Indians (n=7, 7.8%) and others (n=2, 22.0%). The mean age of subjects was 49.7 ± 14.1. Approximately 30% of the subjects achieved the recommended body mass index for hemodialysis patients. Approximately 80% and 34% of the subjects had triceps skinfold and mid-arm circumference less than 50th percentiles, respectively. Approximately 48% subjects had serum albumin level lower than 4.0 mg/dL. About 58.6% had elevated serum phosphate (> 1.6 mmol/L). For lipid profile, 28.8% subjects had elevated total cholesterol (> 5.2 mmol/L), 71.1% had serum cholesterol of less than 5.2 mmol/L. The mean total energy and protein intake was 26.8 ± 7.0 kcal/kg and 1.0 ± 0.3 g/kg, respectively. Results of the Kidney Disease Quality of Life Short Form analysis showed that the highest score was for dialysis staff encouragement (75.28 ± 23.55). The lowest score was for work status (27.78 ± 34.4). In the General Linear Model univariate analysis, blood flow was found to contribute to complication of the kidney, while calf circumference and mid-arm muscle circumference were predictors for the support and satisfaction of the treatment, blood flow, serum albumin, serum creatinine and protein intake were predictors for the physical health composite. As for mental health composite, diabetes was the only contributory factor. Multivariate regression showed similar results were obtained with exception of treatment support and satisfaction. In conclusion, low blood flow, diabetes, increased serum calcium and low serum creatinine had an impact on quality of life of the subjects. Longitudinal study is required to determine the cause and effect mechanism between the associated factors and quality of life

Total cholesterol level and its associated factors among hospitalized elderly: a cross-sectional study

Introduction: The total cholesterol level of hospitalized elderly should be monitored as the long-term consequence of hypercholesterolemia is the development of cardiovascular diseases. This study aimed to determine the total cholesterol level among hospitalized elderly and its associated factors in Hospital Serdang, Selangor. Methods: A total of 115 hospitalized elderly aged 60 and above have participated in the study. Data on socio-demographic characteristics, medical backgrounds, anthropometric measurements, biochemical, dietary intake, malnutrition risk, lifestyle, and total cholesterol level were obtained through face-to-face interviews and physical examination. Dietary intake was assessed using the two-day diet history. Mini Nutritional Assessment (MNA-SF) was used to determine the malnutrition risk of the subjects. Results: The prevalence of hypercholesterolemia among the subjects was 29.6% with a mean value of 4.08 ± 1.51 mmol/L. Comorbidities specifically dyslipidemia (χ2 =14.291, p≤0.0005), and other comorbidities (χ2 =7.843, p=0.005), waist circumference (r=0.199, p=0.033), LDL-C (r=0.455, p≤0.0005), triglyceride (r=0.459, p≤0.0005), fasting blood glucose (r=0.386, p≤0.0005), carbohydrate (r=-0.333, p≤0.0005), fat (r=0.327, p≤0.0005), saturated fat (r=0.304, p=0.001), PUFA (r=0.275, p=0.003), MUFA (r=0.327, p≤0.0005), sodium (r=0.211, p=0.024), and duration of physical activity (r=-0.287, p=0.002) were found to be significantly associated with the total cholesterol level. Meanwhile, other variables were found not to be associated. Conclusion: Current study reported the prevalence of hypercholesterolemia of 29.6%. Comorbidities specifically dyslipidemia and other comorbidities, waist circumference, LDL-C, TG, fasting blood glucose, carbohydrate, fat, saturated fat, PUFA, MUFA, sodium, and duration of physical activity were significantly associated with the total cholesterol level. Meanwhile, other variables were not significantly associated

Factors associated with quality of life among hemodialysis patients in Malaysia

Although hemodialysis treatment has greatly increased the life expectancy of end stage renal disease patients, low quality of life among hemodialysis patients is frequently reported. This cross-sectional study aimed to determine the relationship between medical history, hemodialysis treatment and nutritional status with the mental and physical components of quality of life in hemodialysis patients. Respondents (n=90) were recruited from Hospital Kuala Lumpur and dialysis centres of the National Kidney Foundation of Malaysia. Data obtained included socio-demography, medical history, hemodialysis treatment and nutritional status. Mental and physical quality of life were measured using the Mental Composite Summary (MCS) and Physical Composite Summary (PCS) of the Short-Form Health Survey 36-items, a generic core of the Kidney Disease Quality of Life Short Form. Two summary measures and total SF-36 was scored as 0–100, with a higher score indicating better quality of life. Approximately 26 (30%) of respondents achieved the body mass index (24 kg/m2) and more than 80% (n=77) achieved serum albumin level (>35.0 mg/dL) recommended for hemodialysis patients. The majority of respondents did not meet the energy (n=72, 80%) and protein (n=68,75%) recommendations. The total score of SF-36 was 54.1±19.2, while the score for the mental and physical components were 45.0±8.6 and 39.6±8.6, respectively. Factors associated with a higher MCS score were absence of diabetes mellitus (p=0.000) and lower serum calcium (p=0.004), while higher blood flow (p=0.000), higher serum creatinine (p=0.000) and lower protein intake (p=0.006) were associated with a higher PCS score. To improve the overall quality of life of hemodialysis patients, a multidisciplinary intervention that includes medical, dietetic and psychosocial strategies that address factors associated with mental and physical quality of life are warranted to reduce further health complications and to improve quality of life

Dietetic practices in the management of childhood obesity in Malaysia

Introduction: Dietitians play an essential role in the management of childhood obesity and consistency in dietetic practices is required to ensure the effectiveness of treatment. This study assessed dietitians' current practices in the management of childhood obesity, compared the practices with nutrition practice guidelines used by dietitians in other countries and identified practice components for the development of nutrition practice guidelines for the management of childhood obesity in Malaysia. Methods: A cross-sectional study was conducted among 40 dietitians in 16 Ministry of Health hospitals and three teaching hospitals. Information on current dietetic practices in the management of childhood obesity was obtained through a mailed survey questionnaire. The practices included nutritional assessment, determination of energy requirement, dietary prescription and physical activity modification. Emails were sent to 31 dietetic associations in other countries to obtain information on practice guidelines used by dietitians. Results: Frequently used dietary intervention and physical activity modification approaches were high fibre diet (65%), low fat diet (40%), reduction of sedentary pursuits and screen times (67.5%) and an increase in duration of current physical activities (60%). In comparison to other dietetic practice guidelines, the current dietetic practices in Malaysia do not usually include waist circumference, biochemical and blood pressure data. However, similar to other guidelines, the current dietetic practices included low dietary fat, high fibre diet, decreased sedentary activity and increased physical activity level. Conclusions: The dietetic practices in the management of childhood obesity in Malaysia are diverse. A comprehensive nutrition practice guideline for management of childhood obesity is urgently needed for standardisation of dietetic practices in Malaysia

The effectiveness of a stage-based lifestyle modification intervention for obese children

This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background Interventions that encompass behavioural modifications of dietary intake and physical activity are essential for the management of obesity in children. This study assessed the effectiveness of a stage-based lifestyle modification intervention for obese children. Methods A total of 50 obese children (7–11 years old) were randomized to the intervention group (IG, n = 25) or the control group (CG, n = 25). Data were collected at baseline, at follow-up (every month) and at six months after the end of the intervention. IG received stage-based lifestyle modification intervention based on the Nutrition Practice Guideline for the Management of Childhood Obesity, while CG received standard treatment. Changes in body composition, physical activity and dietary intake were examined in both the intervention and control groups. Results Both groups had significant increases in weight (IG: 1.5 ± 0.5 kg; CG: 3.9 ± 0.6 kg) (p < 0.01) and waist circumference (IG: 0.1 ± 0.5 cm; CG: 2.2 ± 0.7 cm) (p < 0.05), but the increases were significantly higher in CG than IG. Body Mass Index (BMI)-for-age z scores decreased significantly in IG (− 0.2 ± 0.0, p < 0.01) but not in CG. The physical activity of the IG significantly increased (0.44 ± 0.13) compared with that of CG (− 0.28 ± 0.18), and the difference in mean change between groups was statistically significant (p < 0.05). Dietary intake was not significantly different between the two groups. However, calorie and carbohydrate intake decreased significantly in both groups. Conclusions A stage-based intervention that modified dietary and physical activity behaviour may be effective in weight management for obese children. Trial registration NCT03429699 retrospectively registered 9 February 2018

Impact of dietitian delivered intensive nutrition intervention on dietary intake and weight outcome among gynecology cancer outpatient prior to surgery

Introduction: This is open label randomised control trial, aimed to identify whether an early (commenced at the time of diagnosis) and intensive nutrition intervention (INI) (individualised dietary counselling, oral nutritional supplements [ONS], telephone, and home visit) can improve weight and dietary intake of gynaecological cancer (GC) patients preoperatively. Methods: Selected GC patients planned for surgery were randomly grouped into control group (CG) (n = 35) and intervention group (IG) (n = 34). Malnutrition screening tool (MST) was used as a screening tool, while Patient-Generated Subjective Global Assessment (PG-SGA) was used as a nutrition assessment tool. IG received an intensive individualised dietary counselling with the supply of ONS at baseline (Day 1). This continued with telephone and home visit follow-up by research dietitian (Day 3 and Day 6). Meanwhile, CG only received general nutritional counselling without supply of ONS. Final assessment was conducted on Day 14. The primary outcomes included weight changes measured using TANITA and dietary intake assessment using 24-hour diet recall. Results: Mean duration of INI was 14 days. At the end of the treatment period, there was a significant weight change between groups (p < 0.001), with 0.14% weight gain in IG and 1.3% weight reduction in CG. Mean energy and protein intake of IG were higher compared to CG by +329 kcal/day and +12.2 g/day, respectively. Conclusion: This study showed that INI that incorporated individualised dietary counselling, ONS, telephone counselling, and home visit can increase energy and protein intake of GC patients, resulting in weight gain

Development of nutrition practice guidelines and its efficacy in combination with N3-LCPUFA supplement for the management of childhood obesity

The worldwide prevalence of overweight and obese children has steadily increased from 4.7% in 1990 to 6.7% in 2012. Dietary intake and physical activity modification are the first line of treatment for obesity in any weight management programme. However, both are highly dependent on the child’s ability to follow recommendations. A combination of long-chain polyunsaturated fatty acids (n-3 LCPUFA), docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA) and lifestyle modification showed positive results in weight management among adults. There were three phases in the study. Phase I was aimed to develop Nutrition Practice Guidelines (NPG) for the Management of Childhood Obesity; the aim of phase II was to evaluate the effectiveness of the NPG; and phase III was aimed to determine the effect of Stage-based Lifestyle Modification for the Management of Childhood Obesity and n-3 LCPUFA supplementation on body composition, biochemical profile, diet and physical activity of obese children. Phase I had two parts. In part I, a survey was conducted to assess dietitians’ current practices in the management of childhood obesity. In part II, a survey on the use of practice guidelines by dietitians in other countries was conducted. A comparison of the current practices of local dietitians and practice guidelines used by dietitians in other countries was conducted to identify relevant practice components for the development of the NPG. In Phase II, a pilot study including 40 obese children aged 7–11 years old was conducted for a duration of 24 weeks. The intervention group received the NPG, while the control group received standard treatment for the management of childhood obesity. Outcome measurements of the intervention study including stages of change (SOC), dietary intake, body composition and physical activity were taken at baseline and every four weeks. None of the dietary intake outcomes had significantly different between the groups, while physical activity mean change difference between groups was significant (p<0.05). The post-treatment mean of weight and WC between the intervention group and the control group also did reach significance level (p<0.05). Overall, the results demonstrated that the developed NPG are effective in managing childhood obesity. In phase III, 37 obese children were included in a randomised controlled trial of effects of n-3 LCPUFA supplementation for the management of childhood obesity. Both groups received stage-based lifestyle modification, and the intervention group was also required to consume n-3 LCPUFA for a duration of 16 weeks. Outcome measurements of the study including body composition, biochemical profile, dietary intake and physicalactivity were taken at baseline, week 16 and week 24. The results showed that none of the differences in dietary intake, physical activity and body composition outcomes did reach significance level (p<0.05) between groups. Only, LDL was significantly different between the two treatments. However, there were interactions of time and group for physical activity, weight, HDL, LDL and TC-HDL, which indicated that the values changed over time due to the treatments. N-3 LCPUFA is effective in improving the lipid profile but not dietary intake, physical activity and body composition of obese children

Association between dietary intake, physical activity and stress level with constipation among undergraduate students

Introduction: Constipation is one of the most common health problems among university students. This study aims to determine the association between sociodemographic characteristics, dietary intake, physical activity, and stress level with constipation among undergraduate students. Methods: The study was a crosssectional study and the participants comprised of 140 undergraduate students (27.9% males and 72.1% females). A 3-day dietary record was obtained to determine energy, fibre and fluid intakes, while physical activity was determined using the International Physical Activity Questionnaire. Stress level and constipation were assessed using the Cohen’s Perceived Stress Scale and Agachan’s Constipation Score System Questionnaire, respectively. Data were analysed using IBM SPSS Statistics version 23. Multivariate linear regression analysis was done to determine factors that were associated with constipation. Results: Mean age of the participants was 20.9±1.5 years old and majority were third year students (32.1%). Mean intakes of energy, dietary fibre, and fluids per day were 1567±438kcal, 5.6±3.5g, and 2301±946ml, respectively. The median score for physical activity was 1135.5 METminutes/week. Most of the participants (77.1%) had a high or a very high stress level and 64.3% had slight constipation. Age, dietary fibre, fluid, energy, and perceived stress scale explained a significant amount of the variance in the occurrence of constipation [F(6.133)=16.373, p<0.001, R2=0.425, R2 Adjusted=0.399]. Conclusion: Age, energy, fluid and fibre intakes, as well as perceived stress were factors that were associated with constipation among undergraduate students. Therefore, undergraduate students should be encouraged to practise a healthy lifestyle to modify these identified risk factors

Management responsibilities among dietitians: what is the level of job satisfaction and skills involved? a scoping review

The role of dietitians involves not solely on clinical responsibilities. Additionally, operation management responsibilities such as managing human labor, financial resources, and problem solver are the tasks that a dietitian look after. It is reported to be challenging and stressful and could affect job satisfaction levels in the working environment. This scoping review aimed to explore the job satisfaction level and skills needed among dietitians to assume management responsibilities at their workplace. This study was completed using PRISMA guidelines. Online databases (Scopus and Science Direct) were used to identify papers published from 2000 to 2019. We selected English publications from the United States, Australia, South Africa, Korea, and the United Kingdom that used job satisfaction as a primary or secondary outcome. Studies were included if they addressed dietitians who were involved in clinical work, food service, and management in their dietetic practices. Findings on existing skills, including managerial skills, communication, teamwork, and time management among dietitians with management responsibilities, have helped to enhance the job satisfaction and work quality of the dietetic profession. The findings would be useful for human resource management in the organisation, preserving the professional identity of a dietitian

Factors associated with quality of life among hemodialysis patients in Malaysia.

Although hemodialysis treatment has greatly increased the life expectancy of end stage renal disease patients, low quality of life among hemodialysis patients is frequently reported. This cross-sectional study aimed to determine the relationship between medical history, hemodialysis treatment and nutritional status with the mental and physical components of quality of life in hemodialysis patients. Respondents (n=90) were recruited from Hospital Kuala Lumpur and dialysis centres of the National Kidney Foundation of Malaysia. Data obtained included socio-demography, medical history, hemodialysis treatment and nutritional status. Mental and physical quality of life were measured using the Mental Composite Summary (MCS) and Physical Composite Summary (PCS) of the Short-Form Health Survey 36-items, a generic core of the Kidney Disease Quality of Life Short Form. Two summary measures and total SF-36 was scored as 0-100, with a higher score indicating better quality of life. Approximately 26 (30%) of respondents achieved the body mass index (24 kg/m(2)) and more than 80% (n=77) achieved serum albumin level (>35.0 mg/dL) recommended for hemodialysis patients. The majority of respondents did not meet the energy (n=72, 80%) and protein (n=68,75%) recommendations. The total score of SF-36 was 54.1 ± 19.2, while the score for the mental and physical components were 45.0 ± 8.6 and 39.6 ± 8.6, respectively. Factors associated with a higher MCS score were absence of diabetes mellitus (p=0.000) and lower serum calcium (p=0.004), while higher blood flow (p=0.000), higher serum creatinine (p=0.000) and lower protein intake (p=0.006) were associated with a higher PCS score. To improve the overall quality of life of hemodialysis patients, a multidisciplinary intervention that includes medical, dietetic and psychosocial strategies that address factors associated with mental and physical quality of life are warranted to reduce further health complications and to improve quality of life