Nutrition in diabetes

Medical nutrition therapy (MNT) is a key component of diabetes management. The importance of balancing macronutrients, reducing carbohydrate load, lowering glycemic index, and implementing an overall healthy dietary pattern are emerging as better approaches for MNT in diabetes. Recent research points to improved glycemic control, reduction in body weight, and improvement in many cardiovascular risk factors when these approaches are provided by registered dietitians or health care providers. This review article discusses the current evidence about the role of sensible nutrition in diabetes management. Specific eating plans for weight reduction and for patients with type 1 diabetes are also discussed

Physico-chemical characteristics of watermelon in Malaysia

Watermelon (Citrullus lanatus) is a popular fruit among Malaysians. Red-fleshed seeded and seedless, and yellow-fleshed watermelons are mostly selected as a dessert and available throughout the year in local markets. Therefore, this study was focused to determine the nutritional and physico-chemical characteristics of these watermelons. Red-fleshed seedless watermelon contained 89.7 ± 4.3% moisture, while red-fleshed seeded and yellow-fleshed watermelon had 87.5 ± 2.6% and 87.0 ± 2.7% respectively. No significant differences were observed for most nutritional and physico-chemical analysis between samples. However, there were significant differences for colour determination (L*, a* and b*) and amount of sucrose among the samples. Yellow-fleshed watermelon showed L* = 50.0 ± 6.9, a* = 5.8 ± 2.0, b* = 32.6 ± 8.8, red-fleshed seedless showed L* = 43.4 ± 3.5, a* = 25.1 ± 4.4, b* = 15.2 ± 4.1 and red-fleshed seeded showed L* = 38.2 ± 5.1, a* = 19.4 ± 7.3, b* = 15.3 ± 6.6. Total sugar contents determined by high performance liquid chromatography (HPLC) showed that red-fleshed seedless, red-fleshed seeded and yellow-fleshed watermelon consisted of glucose, fructose and sucrose. Amount of total sugar for red-fleshed seedless, red-fleshed seeded and yellow-fleshed watermelon were 95.0 ± 25.2 mg/g, 113.8 ± 31.6 mg/g and 100.6 ± 25.5 mg/g respectively.There was positive and strong correlation between total soluble solid with total sugar (r2 = 0.75). The results indicated that different varieties of watermelon had different nutritional contents and physico-chemical characteristics

Relationship of energy and protein adequacy with 60-day mortality in mechanically ventilated critically ill patients: a prospective observational study

Background & aims: The effect of provision of full feeding or permissive underfeeding on mortality in mechanically ventilated critically ill patients in the intensive care unit (ICU) is still controversial. This study investigated the relationship of energy and protein intakes with 60-day mortality, and the extent to which ICU length of stay and nutritional risk status influenced this relationship. Methods: This is a prospective observational study conducted among critically ill patients aged ≥18 years, intubated and mechanically ventilated within 48 h of ICU admission and stayed in the ICU for at least 72 h. Information on baseline characteristics and nutritional risk status (the modified Nutrition Risk in Critically ill [NUTRIC] score) was collected on day 1. Nutritional intake was recorded daily until death, discharge, or until the twelfth evaluable days. Mortality status was assessed on day 60 based on the patient's hospital record. Patients were divided into 3 groups a) received <2/3 of prescribed energy and protein (both <2/3), b) received ≥2/3 of prescribed energy and protein (both ≥2/3) and c) either energy or protein received were ≥2/3 of prescribed (either ≥2/3). The relationship between the three groups with 60-day mortality was examined by using logistic regression with adjustment for potential confounders. Sensitivity analysis was performed to examine the influence of ICU length of stay (≥7 days) and nutritional risk status. Results: Data were collected from 154 mechanically ventilated patients (age, 51.3 ± 15.7 years; body mass index, 26.5 ± 6.7 kg/m2; 54% male). The mean modified NUTRIC score was 5.7 ± 1.9, with 56% of the patients at high nutritional risk. The patients received 64.5 ± 21.6% of the amount of energy and 56.4 ± 20.6% of the amount of protein prescribed. Provision of energy and protein at ≥2/3 compared with <2/3 of the prescribed amounts was associated with a trend towards increased 60-day mortality (Adjusted odds ratio [Adj OR] 2.23; 95% confidence interval [CI], 0.92-5.38; p = 0.074). No difference in mortality status was found between energy and protein provision at either ≥2/3 compared with <2/3 of the prescribed amounts (Adj OR 1.61, 95% CI, 0.58-4.45; p = 0.357). Nutritional risk status, not ICU length of stay, influenced the relationship between nutritional adequacy and 60-day mortality. Conclusions: Energy and protein adequacy of ≥2/3 of the prescribed amounts were associated with a trend towards increased 60-day mortality among mechanically ventilated critically ill patients. However, neither energy nor protein adequacy alone at ≥ or <2/3 adequacy affect 60-day mortality. Increased mortality was associated with provision of energy and protein at ≥2/3 of the prescribed amounts, which only affected patients with low nutritional risk

Prevalence and duration of reasons for enteral nutrition feeding interruption in a tertiary intensive care unit

Objectives: Intensive care unit (ICU) enteral nutrition (EN) can involve frequent feeding interruption (FI). The prevalence, causes, and duration of such interruption were investigated. Methods: Reasons for EN FI identified from extensive literature review were prospectively collected in adult mechanically ventilated critically ill patients. Results were reported by descriptive statistics. Baseline and nutritional characteristics between patients who died and those alive at day 60 were compared. Results: A total of 148 patients receiving ≥1 day of EN for the full 12-day observational period were included in the analysis. About 332 episodes of EN FI were recorded and contributed to 12.8% (4190 hours) of the total 1367 evaluable nutrition days. For each patient, FI occurred for a median of 3 days and the total duration of FI for the entire ICU stay was 24.5 hours. Median energy and protein deficits per patient due to FI for the entire ICU stay were -1780.23 kcal and -100.58 g, respectively. Duration of FI, days with FI, and the amount of energy and protein deficits due to FI were not different between patients who had died and those who were still alive at day 60 (all P > 0.05). About 72% of the total duration of EN FI was due to procedural-related and potentially avoidable causes (primarily human factors), while only about 20% was due to feeding intolerances. Conclusions: EN FI occurred primarily due to human factors, which may be minimized by adherence to an evidence-based feeding protocol as determined by a nutrition support team

Determinants of metabolic syndrome among Malaysian government employees

Introduction: The metabolic syndrome comprises a collection of cardiovascular disease risks, which has been demonstrated to predict type 2 diabetes mellitus and cardiovascular disease. Metabolic syndrome is a crucial health concern in Malaysia, with a prevalence of about 42.5% in the general population based on the ‘Harmonized’ definition. The aim of this study was to ascertain the association between socioeconomic status among Malaysian government employees with metabolic syndrome, compared with those without metabolic syndrome. Furthermore, this study also aimed to ascertain the associated obesity indicators for metabolic syndrome among employees—explicitly body mass index, waist circumference, waist-to-hip ratio, body fat percentage, fat mass index, and waist-to-height ratio. Methods: This cross-sectional study was undertaken at government agencies in Putrajaya, Malaysia, via multi-stage random sampling. A total of 675 government employees were randomly sampled from a list of 3,173 government employees working in five government agencies under five geographical areas. Data on socioeconomic status, anthropometric, biochemical, and clinical assessments were collected. Results: Employees who were males had higher metabolic syndrome prevalence compared to their counterparts (p=0.019). In addition, employees aged between 20 to younger than 30 years had lowest metabolic syndrome prevalence (p=0.002). The risk of having metabolic syndrome was almost 10 times more likely in men with a waist-to-hip ratio of ≥0.90 compared to men with a waist-to-hip ratio of <0.90 (p<0.001). Women with a waist-to-hip ratio of ≥0.85 were approximately 33 times more likely to have metabolic syndrome as compared to women with waist-to-hip ratios of <0.85 (p<0.001). Men with a waist circumference of ≥90 cm were approximately twice as likely to have metabolic syndrome, compared to men with waist circumferences of <90 cm (p=0.030). The risk of having metabolic syndrome was almost three times more likely in women with a waist circumference of ≥80 cm compared to women with waist circumferences of <80 cm (p<0.001). Furthermore, the risk of having metabolic syndrome was almost five times more likely in women with fat mass indexes in Quartile 4 (≥7.93), compared to women with fat mass indexes in Quartile 1 (<5.25) [p<0.001]. On the other hand, men with waist-to-height ratios of <0.445 were 75% less likely to have metabolic syndrome as compared to men with waist-to-height ratios of ≥0.625 (p=0.020). Women with waist-to-height ratios of 0.445 to <0.525 were 95% less likely to have metabolic syndrome as compared to women with waist-to-height ratios of ≥0.625 (p<0.001). In addition, women with waist-to-height ratios of 0.525 to <0.625 were 77% less likely to have metabolic syndrome as compared to women with waist-to-height ratios of ≥0.625 (p<0.001). Conclusion: Gender and age were associated with metabolic syndrome prevalence. Waist-to-hip ratio, waist circumference, and waist-to-height ratio seems to be the better obesity indicators to predict the presence of metabolic syndrome than body mass index and body fat percentage in both men and women

Glycemic index of selected watermelon (Citrullus lanatus)

The glycemic index (GI) was conducted on 14 healthy subjects who have consumed 25 g of available carbohydrate portions of glucose (standard food) and four test foods (red-fleshed seedless watermelon, red-fleshed seeded watermelon and yellow-fleshed watermelon, as well as a glass of red-fleshed seedless watermelon juice) in random order after an overnight fast. Red-fleshed seedless watermelon was usually processed as juice than red-fleshed seeded and yellow-fleshed watermelon. Blood glucose was measured at 0, 15, 30, 45, 60, 90 and 120 mins after intake of the foods. Incremental areas under the curve were calculated, whereas the glycemic index was determined by expressing the area under the curve after the test foods, as a percentage of the mean area under the curve after consuming standard food, was carried out. The results showed that the area under the curve for a portion of red-fleshed seedless was 98.17±6.39, red-fleshed seeded (94.10±7.45), yellow-fleshed (92.95±8.73), and a juice of redfleshed seedless (98.89±6.38) did not have any significant difference (p < 0.05). The GI of a portion fruit and the juice of red-fleshed seedless watermelon were 51, while red-fleshed seeded watermelon was 48 and yellow-fleshed watermelon was 47. The study showed red-fleshed watermelon and yellow-fleshed watermelon could be classified as low GI food (GI value below 51) with strong influenced by the fructose content and no significant difference from GI value among red and yellow watermelons. This research will help the experts to explore more based of GI value and also be used as a database reference

Preliminary findings of malnutrition risk factors among older adults in a care home

Background: Older adults are at risk of nutrient deficiencies. They face many barriers to have an adequate intake that leads to malnutrition Among Malaysian institutionalized elderly aged 60 years and above, the prevalence of malnutrition was 17.4% and it was associated with eating half of the food served in the institution. Materials and Methods: This cross-sectional study aimed to determine the association between adequacy of nutrition provision and plate wastage with risk of malnutrition among elderly aged ≥ 60 years in Rumah Seri Kenangan, Cheras (RSK) (N=46). The study used Mini Nutritional Assessment (MNA) to assess malnutrition risk, weighing method for adequacy and plate waste study. Mean of energy and protein (served, consumed and wasted) were compared with the Malaysian Recommended Nutrient Intake (RNI). Results: Majority of the subjects were male (65%; n=30) and 35% were females (n=16). Mean age of the subjects was 71.35±7.21 years. Majority of the subjects were classified as well-nourished (50%) and 13% as malnourished. Total energy served in one-lunch time was inadequate (82.67±12.93% of RNI) but total protein served was adequate (108.59±19.63 % of RNI). Total energy and protein consumption were inadequate with the mean percentage of RNI for energy and protein was 47.09±26.39% and 73.50±32.07% respectively. Surprisingly, energy and protein served, consumed and wasted were not associated with risk of malnutrition. Conclusion: Energy provision and intake and protein intake did not meet the RNI for Malaysians among older adults in RSK Cheras, Selangor. However, the adequacy of nutrition provision and plate wastage during the one-lunch time were not associated with the risk of malnutrition

Nutritional status, glycemic control and its associated risk factors among a sample of type 2 diabetic individuals, a pilot study

Background: The prevalence of type 2 diabetes is increasing in Malaysia, with most patients poorly controlled. Hence, this study aimed to determine nutritional and metabolic status as well as blood pressure of Malaysian patients with type 2 diabetes mellitus and identify associated risk factors for poor glycemic control. Materials and Methods: A total of 104 type 2 diabetic patients were recruited and completed a questionnaire covering socio-demographic status, 3-day diet records, and physical activity. Anthropometry and glycemic control parameters, lipid profile and blood pressure were also measured. Results: Subjects were on average 56.7±9.9 years old with a mean duration of diabetes of 6.5 ± 5.0 years. The mean hemoglobin A1c of the subjects was 7.6% ± 1.4%, with only 20.2% achieving the target goal of <6.5% with no significant differences between genders. The mean body mass index was 26.9 ± 4.7 kg/m2, with 86.5% either were overweight or obese. Only 10.6% of the subjects exercised daily. The proportions of macronutrients relative to total energy intake were consistent with the recommendations of most diabetes associations. The adjusted odds of having poor glycemic control were 3.235 (1.043-10.397) (P < 0.05) higher among those who had high density lipoprotein cholesterol levels below the normal range. Those taking one or two types of oral anti-diabetic drugs had 19.9 (2.959-87.391) (P < 0.01) and 14.3 (2.647-77.500) (P < 0.01) higher odds of poor glycemic control respectively compared to those who were being treated by diet alone. Conclusion: Poor glycemic control was prevalent among Malaysian diabetic patients, and this could be associated with low levels of HDL and being treated with oral anti-diabetes agents

How different is the dietary intake of individuals with metabolic syndrome?

Background: Metabolic syndrome has turned out to be a chief public health concern, but the role of diet in the etiology of metabolic syndrome is not well understood. Aims: This study aimed at assessing whether individuals with metabolic syndrome had a specific dietary intake and how it compared with the Recommended Nutrient Intakes for Malaysia and the Medical Nutrition Therapy Guidelines by the Malaysian Dietitians’ Association. Study Design: Cross-sectional study. Place of Study: Putrajaya, Malaysia. Duration of Study: Eight weeks. Methodology: Waist circumference, systolic blood pressure, diastolic blood pressure, triglycerides, HDL cholesterol and fasting plasma glucose were collected in 659 randomly selected subjects. A total of 275 out of 322 subjects with metabolic syndrome completed the self-administered three-day food record. Data were analysed with Nutritionist Pro, and were compared with the Recommended Nutrient Intakes for Malaysia (2010), based on age and gender. Metabolic syndrome was defined according to the ‘Harmonized’ criteria. Results: Subjects’ mean age was 34.51±8.30 years, 202 Females: 73 Males. Comparison of subjects’ food records with the Recommended Nutrient Intakes for Malaysia revealed that protein consumption was significantly higher among study subjects compared to the Recommended Nutrient Intakes for Malaysia (62 g/day for males; 55 g/day for females), P<.001. All subjects (100%) had low fibre (<20 g/day) intake. Conversely, most subjects (72.0%) had high sodium intake (≥2400 mg/day). Conclusion: This study highlights the importance of assessing the dietary intake of each individual with metabolic syndrome. There is a discrepancy between the dietary intake among individuals with metabolic syndrome and the Recommended Nutrient Intakes for Malaysia or Medical Nutrition Therapy Guidelines by the Malaysian Dietitians’ Association. Notwithstanding, our study cannot declare that diet induces the disease, yet it definitely sheds more light on the need for appropriate and professional dietary measures to be integrated in the management of individuals with metabolic syndrome

Effectiveness of traditional Malaysian vegetables (ulam) in modulating blood glucose levels

Ulam refers to a group of traditional Malaysian plants commonly consumed as a part of a meal, either in the raw form or after a short blanching process. Many types of ulam are thought to possess blood glucose-lowering properties, but relatively little is known on the effectiveness of ulam in modulating blood glucose levels in humans. This review aims to systematically evaluate the effectiveness of ulam in modulating blood glucose levels in humans. A literature review was conducted using multiple databases with no time restriction. Eleven studies were retrieved based on a priori inclusion and exclusion criteria. In these 11 studies, only Momordica charantia, locally known as "peria katak", was extensively studied, followed by Centella asiatica, locally known as "daun pegaga", and Alternanthera sessilis, locally known as "kermak putih". Of the 11 studies, 9 evaluated the effectiveness of M. charantia on blood glucose parameters, and 7 of which showed significant improvement in at least one parameter of blood glucose concentration. The remaining 2 studies reported nonsignificant improvements in blood glucose parameters, despite having high-quality study design according to Jadad scale. None of the studies related to C. asiatica and A. sessilis showed significant improvement in blood glucose-related parameters. Current clinical evidence does not support the popular claim that ulam has glucose-lowering effects, not even for M. charantia. Hence, further clinical investigation is needed to verify the glucose modulation effect of M. charantia, C. asiatica, and A. sessilis