Enhancing diabetic care in the community in Malaysia: need for a paradigm shift

Efforts towards improving the management of diabetes mellitus has grown and progressed. Clinical studies and new drug discoveries have led to better treatment for patients. Most healthcare budgets devote an enormous amount of expenditure for the treatment of diabetes. However, despite all these efforts, the disease continues to grow and has been predicted to be unmanageable in the near future. Thus, there is a dire need to relook the current approaches and policies. “Prevention is better than cure” is definitely the precise solution to this catastrophe. A paradigm shift in strategies for the prevention of diabetes and treatment of its risk factors is an imperative

Prevalence, awareness, treatment and control of hypertension in Malaysia: A national study of 16,440 subjects.

Study design: A cross-sectional study was conducted in all states of Malaysia to determine the prevalence, awareness, treatment and control of hypertension. A stratified two-stage cluster sampling design with proportional allocation was used. Methods: Trained nurses obtained two blood pressure measurements from each subject. Hypertension was defined as mean systolic blood pressure 4140 mmHg, diastolic blood pressure490 mmHg, or a self-reported diagnosis of hypertension and taking antihypertensive medication. All data were analysed using Stata 9.2 software and took the complex survey design into account. A two-sided P-value of o0.05 was considered to be statistically significant. Results: The overall prevalence of hypertension for subjects aged X15 years was 27.8% (95% confidence interval (CI) 26.9–28.8). The prevalence of hypertension was significantly higher in males (29.6%, 95% CI 28.3–31.0) compared with females (26.0%, 95% CI 25.0–27.1). Multivariate logistic regression showed that the odds of having hypertension increased with increasing age, in males, in subjects with a family history of hypertension, with increasing body mass index, in non-smokers and with decreasing levels of education. Only 34.6% of the subjects with hypertension were aware of their hypertensive status, and 32.4 were taking antihypertensive medication. Amongst the latter group, only 26.8% had their blood pressure under control. The prevalence of hypertension amongst those aged X30 years has increased from 32.9% in 1996 to 40.5% in 2004. Conclusion: In Malaysia, the prevalence of hypertension is high, but levels of awareness, treatment and control are low. There is an urgent need for a comprehensive integrated population-based intervention programme to ameliorate the growing problem of hypertension in Malaysians

A community-based study on the prevalence and factors affecting smoking in Terengganu state, Malaysia, 2004

Introduction: It is estimated that 4.9 million people worldwide died in 2000 as a result of their addiction to nicotine, about half of them prematurely. This huge death toll is rising rapidly, especially in low and middle income countries where most of the world’s 1.2 billion tobacco users live. Objectives: This study aimed to determine (i) the prevalence of smoking among the community aged 18 and above in Terengganu state, and (ii) the relationship between smoking and age, sex, educational level, family and peer influence. Methods: A cross-sectional study design was used in this study and data was collected using a standardised pre-tested structured questionnaire. Results: The overall mean age of the respondents was 38.9 (95% CI= 37.7 – 40.2) years. The majority of the respondents were Malays (99.1%). Of the 653 respondents, 32.2% and 23.6% were ever and current smokers respectively. Of this, 211 ever smokers, 199 (94.3%) were males and only 12 (5.7%) were females. The prevalence of ever and current smokers for males was 73.2% and 53.7% respectively compared to the females (3.1% and 2.1% respectively). There was a significant association between smoking status and sex (p<0.001). The prevalence of ever smokers was lowest amongst respondents with college or university educational level. However, for current smokers, those with college or university education had the highest prevalence. The overall mean initiation age of ever smokers was 19.7 years (95% CI = 18.8 – 20.7). The mean initiation age for the males (19. 1 years) was significantly lower compared to 29.8 years for the females (p<0.001). The mean duration of smoking for the current smokers was 21.6 (95% CI= 19.1 – 24) years. There was also no significant difference in the mean duration of current smoking for males compared to the females (p = 0.5). The majority (93.4%) of the ever smokers started either because their friends asked them to try or they were trying for fun. The quit ratio was 27%. Conclusion : The prevalence of ever and current smokers in males is very high (73.2% and 53.7% respectively) compared with the females (3.1% and 2.1% respectively). The mean initiation age for the males (19. 1 years) was significantly lower compared to 29.8 years for the females (p<0.001)

KOREAN DIETARY PATTERNS AND THE PREVALENCE OF DIABETES, METABOLIC SYNDROME, AND SUBCLINICAL ATHEROSCLEROSIS

This dissertation investigates the associations between dietary patterns, diabetes, metabolic syndrome, and subclinical atherosclerosis. The literature on Asian dietary patterns and cardiovascular health is limited. For the first aim, we used a cross sectional design to identify and describe the major dietary patterns in 269,266 adult men and women who underwent a screening examination between January 2011 and December 2013 at the Kangbuk Samsung Total Healthcare Center in Seoul and Suwon, South Korea. Diet was assessed using a validated 103-item food frequency questionnaire. We used principal component analysis to derive three major dietary patterns. These patterns labelled as traditional Korean, modern Korean, and Western Korean, explained 20.7%, 11.4%, and 10.1%, of the total variation in daily dietary intakes. Traditional Korean dietary pattern was characterized by higher intakes of fruits, vegetables, soya and other beans, and fish. Modern Korean dietary pattern was characterized by higher intakes of noodles, raw or salted fish, shellfish, red meat, processed meat, poultry, soda, and alcohol. Western Korean dietary pattern was characterized by higher intakes of bread and cereals, milk and dairy products, snacks, and pizza, and lower intakes of alcohol, rice, and preserved vegetables. For the second aim, we evaluated the associations between the major Korean dietary patterns and the prevalence of diabetes and metabolic syndrome in 220,979 screening participants without any histories of cardiovascular disease, cancer, diabetes, hypertension, and dyslipidemia. We did not find any significant associations between the traditional Korean pattern and the prevalence of diabetes and metabolic syndrome (both P>0.05). Higher adherence to modern Korean dietary patterns was significantly associated with 32% and 76% increase in odds of diabetes (adjusted odds ratio, aOR, P90 vs P10 = 1.32; 95% CI 1.13, 1.55) and metabolic syndrome (aOR P90 vs P10=1.76; 95% CI 1.64, 1.88), respectively. Higher adherence to Western Korean dietary patterns was significantly associated with 22% and 27% decrease in odds of diabetes (aOR P90 vs P10 = 0.78; 95% CI 0.67, 0.91) and metabolic syndrome (aOR P90 vs P10=0.73; 95% CI 0.69, 0.78), respectively. Using those with no metabolic syndrome criteria as the base group, the prevalence ratio of three to five metabolic syndrome criteria comparing the 90th to the 10th percentiles of modern and Western Korean dietary pattern scores was 2.14 (95%CI 2.00, 2.30) and 0.67 (0.63, 0.72), respectively. For the third aim, we evaluated the association between the major Korean dietary patterns and prevalent subclinical atherosclerosis. The study population consisted of screening participants who had coronary artery calcium score and diet measured during the same screening visit. We included 27,028 screening participants without any histories of cardiovascular disease, cancer, diabetes, hypertension, and dyslipidemia. We failed to find any significant associations between the three major Korean dietary patterns and the prevalence of subclinical atherosclerosis (all P>0.05)

A population-based study on the prevalence and factors associated with obesity in Selangor

Objective: This study was conducted to determine prevalence and factors associated with obesity in Selangor, Malaysia. Methods: A population-based cross-sectional study was conducted in all districts of Selangor State. All individuals, 15 years and above in the selected households, were included. A pre-tested structured questionnaire was used to collect the data. Weight was recorded using TANITA model HD-309 and height was measured using SECA Body meter Model 208. Statistical analysis was performed using Stata 8.2 taking into account the complex survey design. Results: The overall mean age of the 2219 respondents was 36.6(95% CI 35.7 – 37.6) years. There was no significant difference in the mean age of the males and females (p=0.697). The majority of the respondents were Malays (52.9%), followed by Chinese (30.9%), Indians (15.4%) and other races (0.9%). The overall mean BMI was 24.1 kg/m2 (95% CI=23.8- 24.4). The overall prevalence of obesity was 12.2% (95% CI 10.6%, 14.0%). There was no significant difference in the prevalence of obesity in the males compared to females (p>0.05). The prevalence of obesity increased with age up to the ages of 40-59 years and then decreased after 60 years. The highest prevalence of obesity was in the 40-59 years age groups in both sexes. The overall prevalence of obesity was significantly higher amongst the Malays (15.2%) compared to the Indians (11.6%) and Chinese (7.3%). Multivariate logistic regression analysis showed that only age and ethnicity were associated with obesity. Sex and educational level were not associated with obesity

A national study on the prevalence and factors associated with smoking amongst Malaysians aged 18 years and above

A cross-sectional study was conducted in Malaysia with the objectives of determining the prevalence of smoking in Malaysia, reasons for starting to smoke, age first started to smoke, duration of smoking and to determine the relationship between smoking and age, sex, race, education level, peer influence and parental smoking status. Methods: All residents aged 18 years and above from selected households were included in this study. A standardised pre-tested structured questionnaire was used in this study. Results: The results showed that the overall mean age of the 17, 246 respondents was 38.8 (95% CI= 38.5 - 39.2) years with a range of 18 - 100 years. The majority were Malays (55.5%) followed by Chinese (21.2%) and Indians (11.2%). The age, sex and ethnicity adjusted prevalence of ever and current smokers were 32.0% and 24.9% respectively. The prevalence of ever and current smokers for males was 59.3% and 47.2% respectively. For the females, the prevalence of ever and CUlTentsmokers was 4.8% and 2.7% respectively. The highest ethnicity adjusted prevalence of current smokers was in Malays (28.9%), followed by the Chinese (18.7%). The lowest prevalence was amongst the Indians (16.8%). The highest prevalence of current smokers was found in Kelantan (30.2%), Terengganu (29.7%), Pahang (28.7%) and Kedah (26.9%); the lowest prevalence was in Kuala Lumpur, Federal Teritory (20.4%). The overall mean initiation age of current smokers was 19.2 years (95% CI = 19.1, 19.4 years). The mean initiation age of male current smokers was significantly lower (18.9 years) compared to female current smokers (24.1 years). The mean duration of smoking amongst the current smokers was 18.6 years. Males smoked significantly more cigarettes than the females ( p < 0.00 I). D isc u ssio n : Multivariate logistic regression analysis showed that smoking was significantly associated with age, sex, ethnicity, educational level and peer and family influence

A national study on the prevalence of obesity among 16,127 Malaysians

A population-based cross-sectional study was conducted in all states of Malaysia with the aim to determine the prevalence of obesity among Malaysians aged fifteen years and above and factors associated. A stratified two stage cluster sampling design with proportional allocation was used. Trained interviewers using a standardized protocol obtained the weight and height measurements and other relevant information. Subjects with a body mass index ≥ 30 kg/m2 were labelled as obese. The results show that the overall national prevalence of obesity among Malaysians aged 15 years old and above was 11.7% (95% CI = 11.1 - 12.4%). The prevalence of obesity was significantly higher in females (13.8%) as compared to 9.6% in males (p< 0.0001). Prevalence of obesity was highest amongst the Malays (13.6%) and Indians (13.5%) followed by the indigenous group of "Sarawak Bumiputra" (10.8%) and the Chinese (8.5%). The indigenous group of "Sabah Bumiputra" had the lowest prevalence of 7.3%. These differences are statistically significant (p< 0.0001). Logistic regression analysis results show that there was a significant association between obesity and age, gender, ethnicity urban/rural status and smoking status. The prevalence of obesity amongst those aged ≥ 18 years old has markedly increased by 280% since the last National Health and Morbidity Survey in 1996. Conclusion: The overall prevalence of obesity in Malaysia is very high as compared to 1996. There is an urgent need for a comprehensive integrated population-based intervention program to ameliorate the growing problem of obesity in Malaysians

Health poverty among people with type 2 diabetes mellitus (T2DM) in Malaysia

In the context of the escalating burden of diabetes in low and middle-income countries (LMICs), there is a pressing concern about the widening disparities in care and outcomes across socioeconomic groups. This paper estimates health poverty measures among individuals with type 2 diabetes mellitus (T2DM) in Malaysia. Using data from the National Diabetes Registry between 2009 and 2018, the study linked 932,855 people with T2DM aged 40–75 to death records. Cox proportional hazards models were used to estimate the 5-year survival probabilities for each patient, stratified by age and sex, while controlling for comorbidities and area-based indicators of socio-economic status (SES), such as district-level asset-based indices and night-time luminosity. Measures of health poverty, based on the Foster-Greer-Thorbecke (FGT) measures, were employed to capture excessive risk of premature mortality. Two poverty line thresholds were used, namely a 5% and 10% reduction in survival probability compared to age and sex-adjusted survival probability of the general population. Counterfactual simulations estimated the extent to which comorbidities contribute to health poverty. 43.5% of the sample experienced health poverty using the 5% threshold, and 8.9% were health poor using the 10% threshold. Comorbidities contribute 2.9% for males and 5.4% for females, at the 5% threshold. At the 10% threshold, they contribute 7.4% for males and 3.4% for females. If all patients lived in areas of highest night-light intensity, poverty would fall by 5.8% for males and 4.6% for females at the 5% threshold, and 4.1% for males and 0.8% for females at the 10% threshold. In Malaysia, there is a high incidence of health poverty among people with diabetes, and it is strongly associated with comorbidities and area-based measures of SES. Expanding the application of health poverty measurement, through a combination of clinical registries and open spatial data, can facilitate simulations for health poverty alleviation.</p

Anemia in pregnancy in Malaysia: a cross-sectional survey

Anemia is the most prevalent nutritional deficiency during pregnancy. Except for a study conducted 10 years ago in Kelantan, Malaysia's available statistics are based on isolated small urban maternity hospital studies from the 1980s. There was therefore, a need for a large study at national level to estimate the magnitude of the problem in the country as well as to understand its epidemiology. This multi-center, cross-sectional study was conducted from February to March 2005, to assess the prevalence of anemia. Multistage stratified random sampling technique was used and 59 Ministry of Health (MOH) primary health care clinics were selected. Our final dataset consisted of 1,072 antenatal mothers from 56 clinics. The overall prevalence of anemia in this population was 35 % (SE 0.02) if the cut off level is 11 g/dL and 11 % (SE 0.03) if the cut-off level is 10 g/dL. The majority was of the mild type. The prevalence was higher in the teenage group, Indians followed by Malays and Chinese being the least, grandmultiparas, the third trimester and from urban residence. After multiple linear regression analysis, only gestational age remained significant. These findings are useful for our Maternal Health program planners and implementers to target and evaluate interventions. Work is in progress for outcomes and cost-effectiveness studies to best tackle this problem. In conclusion, the prevalence of anemia is 35% and mostly of the mild type and more prevalent in the Indian and Malays

Metabolically-Healthy Obesity and Coronary Artery Calcification

ObjectivesThe purpose of this study was to compare the coronary artery calcium (CAC) scores of metabolically-healthy obese (MHO) and metabolically healthy normal-weight individuals in a large sample of apparently healthy men and women.BackgroundThe risk of cardiovascular disease among obese individuals without obesity-related metabolic abnormalities, referred to as MHO, is controversial.MethodsWe conducted a cross-sectional study of 14,828 metabolically-healthy adults with no known cardiovascular disease who underwent a health checkup examination that included estimation of CAC scores by cardiac tomography. Being metabolically healthy was defined as not having any metabolic syndrome component and having a homeostasis model assessment of insulin resistance <2.5.ResultsMHO individuals had a higher prevalence of coronary calcification than normal weight subjects. In multivariable-adjusted models, the CAC score ratio comparing MHO with normal-weight participants was 2.26 (95% confidence interval: 1.48 to 3.43). In mediation analyses, further adjustment for metabolic risk factors markedly attenuated this association, which was no longer statistically significant (CAC score ratio 1.24; 95% confidence interval: 0.79 to 1.96). These associations did not differ by clinically-relevant subgroups.ConclusionsMHO participants had a higher prevalence of subclinical coronary atherosclerosis than metabolically-healthy normal-weight participants, which supports the idea that MHO is not a harmless condition. This association, however, was mediated by metabolic risk factors at levels below those considered abnormal, which suggests that the label of metabolically healthy for obese subjects may be an artifact of the cutoff levels used in the definition of metabolic health