Ethnic disparities in metabolic syndrome in malaysia: an analysis by risk factors

A multicentre study to determine the in vitro efficacy of flomoxef against extended-spectrum beta-lactamase producing Escherichia coli in Malaysia

Background

The high burden of extended-spectrum beta-lactamase-producing (ESBL)-producing Enterobacterales worldwide, especially in the densely populated South East Asia poses a significant threat to the global transmission of antibiotic resistance. Molecular surveillance of ESBL-producing pathogens in this region is vital for understanding the local epidemiology, informing treatment choices, and addressing the regional and global implications of antibiotic resistance.

Methods

Therefore, an inventory surveillance of the ESBL-Escherichia coli (ESBL-EC) isolates responsible for infections in Malaysian hospitals was conducted. Additionally, the in vitro efficacy of flomoxef and other established antibiotics against ESBL-EC was evaluated.

Results

A total of 127 non-repetitive ESBL-EC strains isolated from clinical samples were collected during a multicentre study performed in five representative Malaysian hospitals. Of all the isolates, 33.9% were isolated from surgical site infections and 85.8% were hospital-acquired infections. High rates of resistance to cefotaxime (100%), cefepime (100%), aztreonam (100%) and trimethoprim-sulfamethoxazole (100%) were observed based on the broth microdilution test. Carbapenems remained the most effective antibiotics against the ESBL-EC, followed by flomoxef. Antibiotic resistance genes were identified by PCR. The blaCTX-M-1 was the most prevalent ESBL gene, with 28 isolates (22%) harbouring blaCTX-M-1 only, 27 isolates (21.3%) co-harbouring blaCTX-M-1 and blaTEM, and ten isolates (7.9%) co-harbouring blaCTX-M-1, blaTEM and blaSHV. A generalised linear model showed significant antibacterial activity of imipenem against different types of infection. Besides carbapenems, this study also demonstrated a satisfactory antibacterial activity of flomoxef (81.9%) on ESBL-EC, regardless of the types of ESBL genes.

Association between pre-existing cardiometabolic comorbidities and the pathological profiles of breast cancer at initial diagnosis: a cross sectional study

The presence of comorbidities has been associated with later stages of breast cancer diagnosis. It is unclear whether biological mechanisms are partly responsible. We examined the association between the presence of pre-existing comorbidities and tumour profile at initial diagnosis with breast cancer. Data for the present analysis were derived from a prior inception cohort study comprising 2,501 multiethnic women, newly diagnosed with breast cancer between 2015 and 2017 in four hospitals across Klang Valley. At the inception of the cohort, medical and drug histories, height, weight and blood pressure were recorded. Blood samples were taken to measure serum lipid and glucose. Modified Charlson Comorbidity Index (CCI) was calculated using data extracted from medical records. The association of CCI as well as specific comorbidities, with pathological breast cancer profile was analysed. Higher comorbidity burden, namely cardiometabolic conditions were associated with unfavourable pathological features including larger tumours, involvement of >9 axillary lymph nodes, distant metastasis and human epidermal growth factor receptor 2 overexpression. These associations remained largely significant following multivariable analyses. Specifically, diabetes mellitus was independently associated with high nodal metastasis burden. Low level of high-density lipoprotein was associated with larger tumours (>5 cm), and distant metastasis. Evidence from this study seems to support the hypothesis that the later stages of breast cancer diagnosis in women with (cardiometabolic) comorbidities may be partially explained by underlying pathophysiological events.

Prevalence and predictors of metabolically healthy obesity in severely obese Asian children

BACKGROUND

Obese individuals who have little or no metabolic syndrome components are proposed to be "metabolically healthy obese (MHO)". This study aim to evaluate the prevalence of MHO and examine the predictors associated with MHO in a multi-ethnic Asian cohort of severely obese children.

METHODS

This study included a cross-sectional cohort of 406 Chinese, Malay and Indian children aged 5-20 years old with BMI for age ≥ 97th percentile. Metabolic syndrome (MS) and metabolic health (MH) definitions based on the presence or absence of metabolic abnormalities (High triglycerides, low HDL cholesterol, elevated blood pressure and high glucose) were used to define MHO in the cohort.

RESULTS

The prevalence of MHO is 63.5% by MS definition and 22.4% by MH definition. Maternal healthy metabolic status (OR: 2.47), age (OR: 0.83, 0.80), paternal obesity (OR: 0.48, 0.53), Malay (OR: 1.97) and Indian ethnicity (OR: 6.38, 3.21) (compared to Chinese ethnicity) are independent predictors for MHO phenotype based on different MHO definitions.

CONCLUSIONS

Adiposity measures are not associated with MHO phenotype, but instead younger age, maternal healthy metabolic status, absence of paternal obesity, Malay and Indian ethnicity are independent predictors for MHO phenotype in a multi-ethnic Asian cohort of severely obese children.

IMPACT

The prevalence of metabolically healthy obese (MHO) in our multi-ethnic Asian cohort of severely obese children is 63.5% and 22.4%, respectively, based on different MHO definitions. Adiposity measures are not associated with the MHO phenotype. There are other factors that contribute to the metabolic phenotype in obese individuals. Younger age, maternal healthy metabolic status, absence of paternal obesity, Malay and Indian ethnicity are independent predictors for MHO phenotype. Parental influence is important in predicting metabolic health in obese individuals.

Socio-demographic factors and healthy lifestyle behaviours among Malaysian adults: National Health and Morbidity Survey 2019

This study aimed to investigate the association between socio-demographic factors and designated healthy lifestyle behaviours in a nationally-representative sample of Malaysian adults aged 18 years and above. Secondary data involving 7388 participants aged 18-96 years from the National Health and Morbidity Survey 2019, a national cross-sectional survey, was used in this study. A healthy lifestyle score (0-5 points) was calculated based on five modifiable lifestyle factors: non-smoker, body mass index < 25 kg/m², physically active, moderate (or less) alcohol intake, and daily consumption of ≥ 5 servings of fruits and vegetables. Associations between socio-demographic factors and healthy lifestyle behaviours were examined using multinomial logistic regression adjusted for sampling design. About 30.6% of the participants met at least four out of the five healthy lifestyle factors. In multinomial model, subjects who were female (aOR = 3.26, 95%CI = 2.58, 4.12), of Chinese (aOR = 2.31, 95%CI = 1.62, 3.30 or other ethnicity (aOR = 1.44, 95%CI = 1.05, 1.98), and aged 18-30 years (aOR = 1.74, 95% CI = 1.12, 2.71) showed significant association with achieving healthy lifestyle compared to male, Malay and ≥ 61 years old as reference categories. Our results indicated that gender, age and ethnicity associated with healthy lifestyle behaviours. Information on the influence of socio-demographic factors on the prevalence of healthy lifestyles will facilitate the development of effective intervention strategies to improve the adaptation of healthy lifestyle practices.

Comprehending Nutrition and Lifestyle Behaviors of People with Metabolic Syndrome: A Focus Group Study

Demographically and socio-culturally appropriate care is critical for empowering people with metabolic syndrome (MetS) to self-manage their condition. This focus group study aimed to explore the understanding of nutrition and lifestyle behaviors (NLBs) of Malaysians with MetS. Adults with MetS (N = 21) participated in four focus groups at a university's research clinic in Malaysia. A thematic framework analysis approach was applied to the focus group data using an initial coding framework developed from the Health Belief Model. Six main themes were identified on perceived motivations, barriers, and threats toward healthy NLBs. Motivations to adopt healthy NLBs were body image, personal experience of adverse complications, and family and social support. The perception that healthcare is a business model, the idea that changes in NLBs are difficult and expensive, and cultural influence on food intake were identified as barriers to healthy NLBs. Inadequate knowledge of MetS was identified as a subtheme in this study. Health education and health promotion activities that aim to modify the NLBs of people with MetS should consider the community's perception of motivation and barriers to change. Addressing these aspects in the development of programs can potentially increase program adoption and adherence, ensuring the success of community-based lifestyle interventions.

Association between depressive symptoms, metabolic risk factors, and cognitive function: cross-sectional results from a community study in Quebec, Canada

OBJECTIVE

To investigate the cross-sectional association between depressive symptoms and metabolic risk factors with cognitive function in a middle-aged population.

METHODS

A stratified subsample of the CARTaGENE (CaG) cohort (n = 1991) was used to compare cognitive function outcomes between groups. The stratification was based on the presence of depressive symptoms and metabolic dysregulation (MetD): the presence of a) neither condition (reference group); b) MetD only; c) depressive symptoms only; and d) both depressive symptoms and MetD. Individuals with type 2 diabetes were excluded. Three cognitive domains were assessed: processing speed, episodic memory, and executive function. An overall cognitive function score, standardized for age and education, was computed. Poor cognitive function was defined as the lower quartile of the overall cognitive function distribution. Linear and logistic regression analyses were conducted.

RESULTS

The poorest cognitive performance was observed in the group with both depressive symptoms and MetD, followed by the group with depressive symptoms only, then the group with MetD only and the reference group. Mean (SD) overall cognition scores for the four groups were -0.25 (1.13), -0.13 (1.05), 0.11 (0.90), and 0.15 (0.93), respectively. Linear regression analyses suggested a linear increase in cognitive function across groups.In the logistic regression analyses, the highest risk of poor cognitive function was observed in the comorbid (depressive symptoms and MetD) group (adjusted OR = 1.99, 95% CI 1.46, 2.71).

CONCLUSION

Comorbidity of depressive symptoms and MetD was associated with reduced cognitive performance in middle-aged adults without diabetes.KEY POINTSPoor cognitive function is a major public health concern and can be potentially prevented by targeting its modifiable risk factors.Metabolic dysregulation and depression have both been independently associated with poor cognitive function.Comorbidity of metabolic dysregulation and depressive symptoms is associated with an increased risk of poor cognitive function in middle-aged individuals.Future health interventions might benefit by screening for comorbidity in patients with poor cognitive function and by targeting depression and metabolic dysregulation together.

Metabolic syndrome and its effect on the outcomes of rheumatoid arthritis in a multi-ethnic cohort in Singapore

INTRODUCTION

Over-expression of common inflammatory mediators in the metabolic syndrome (MetS) and in rheumatoid arthritis (RA) may lead to mutually adverse outcomes.

AIM

We investigate the prevalence of MetS in a multi-ethnic population of RA patients and its effect on clinical and patient-reported outcomes.

METHOD

Six hundred sixty RA (561 women) patients from a public-sector specialist clinic in a hospital in Singapore were assessed for MetS according to the 2009 Joint Consensus (JC) and the 2004 National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) definitions. Univariable and multivariable regression modelling were used to investigate the associations between patients' demographics with MetS and MetS with RA outcomes.

RESULTS

The prevalence of MetS in our RA cohort was 49.4% and 44.9% according to the JC and NCEP ATP III definitions, respectively. The diagnosis of MetS was largely due to hypertriglyceridemia, hypertension, and obesity. MetS was associated with older age (OR 1.06 [95% CI 1.04-1.08]), Malay ethnicity (OR 1.78 [95% CI 1.02-3.09]), or Indian ethnicity (OR 3.07 [95% CI 1.68-5.59]). No significant associations between MetS and RA outcomes were observed. RA patients with MetS are more likely to suffer from stroke and ischemic heart disease.

CONCLUSION

The prevalence of MetS in RA patients in Singapore was almost double that in the general population. MetS does not adversely affect RA outcomes but raises the risks of stroke and heart disease. RA patients, especially those older and of Indian and Malay ethnicities, should be routinely screened for MetS. Any MetS-defining condition should be actively controlled. Key Points • Approximately half of the RA sample from the Singapore RA population can be diagnosed with MetS. • Older patients, and patients of Malay and Indian ethnicities have higher odds of MetS. • MetS does not adversely affect RA outcomes but raises the risks of stroke and heart disease.

Metabolic syndrome and lifestyle-associated factors in the ethnically diverse population of Khuzestan, Iran: a cross-sectional study

Purpose

Metabolic syndrome (MetS) is a cluster of risk factors, mainly central obesity, insulin resistance, and dyslipidemia, leading to life-threatening cardiovascular diseases. The prevalence of MetS can vary based on different ethnicities and many cultural and lifestyle factors.

Aims

We aimed to evaluate the prevalence of MetS and possible correlations with lifestyle-associated factors among different ethnicities in Khuzestan, Iran.

Methods

This cross-sectional study was conducted in Khuzestan province of Iran, among 30,504 participants aged 20-65 years, between October 2016 and November 2019. Data was collected through questionnaires along with anthropometric and biological measurements. The National Cholesterol Education Program Adult Treatment Panel III definition was used to estimate MetS prevalence.

Results

Overall, 31.9% (95% CI 31.4-32.4) had MetS (34.2% [95% CI 33.3-35.1] among males; 30.7% [95% CI 30.0-31.3] among females [p < 0.001]). Central obesity, elevated fasting blood sugar levels, and dyslipidemia were the most common abnormalities among those with MetS. The risk of MetS was estimated to increase by age, male gender, residing in urban regions, lower educational levels, lower physical activity levels, lower sleep time, and a positive family history of diabetes mellitus (p < 0.001). Individuals of the Arab and Bakhtiary ethnicities had the highest and lowest risk of MetS, respectively.

Conclusion

MetS prevalence varied among different ethnicities. Aging and some lifestyle-associated factors such as physical activity and sleep time were related to the risk of MetS. Raising awareness about risk factors of MetS would be of great value in setting new health policies to manage the rising trend of MetS.

Associations between cognitive function, metabolic factors and depression: A prospective study in Quebec, Canada

BACKGROUND

Metabolic risk factors, low cognitive function and history of depression are known risk factors for future depressive episodes. This paper aims to evaluate the potential interactions between these factors on the risk of a major depressive episodes in middle-age.

METHODS

Baseline and follow-up data from a population-based study of Quebec, Canada were used. The sample consisted of 1788 adults between 40 and 69 years of age without diabetes. Cognitive function and metabolic risk factors were assessed at baseline. Three cognitive domains were assessed: processing speed, episodic memory and executive function. History of depression was assessed five years later by a clinical interview. Logistic regression analysis was conducted to evaluate interactions between individual metabolic factors, low cognitive function, and depression history.

RESULTS

Participants with a comorbidity of at least one metabolic factor, history of depression and low cognitive function had the highest risk of experiencing a depressive episode in middle age. The highest risk was observed in individuals with abdominal obesity, low cognitive function, and a history of depression (OR= 8.66, 95% CI 3.83-19.59). The risks for those with abdominal obesity only, depression history only, and low cognitive function were 1.20 (95%CI 0.71-2.02), 3.10 (95%CI 1.81-5.24), and 1.39 (95%CI 0.72-2.67), respectively.

LIMITATIONS

Depression was only assessed at follow-up.

CONCLUSION

Metabolic risk factors comorbid with low cognitive function in middle-aged individuals with a history of depression were associated with an increased risk of a future depressive episode. This study highlights the importance of screening for metabolic and cognitive comorbidities in patients with a history of depression.

Prevalence of metabolic syndrome among breast cancer survivors in East Coast of Peninsular Malaysia

Background

To date, limited data are available on metabolic syndrome prevalence among breast cancer survivors in Malaysia. Therefore, this study was conducted to determine the prevalence of metabolic syndrome and abnormal metabolic syndrome components among breast cancer survivors in East Coast of Peninsular Malaysia.

Methods

This cross-sectional study included 95 breast cancer survivors (age 53.7 ± 7.6 years) who have completed main cancer treatments for ≥6 months. Cancer survivors were recruited from two main government hospitals in Kelantan and Terengganu using a purposive sampling method.

Results

According to the Harmonized criteria, the metabolic syndrome prevalence was 50.5%. Among those with metabolic syndrome, the most prevalent abnormal metabolic components were triglycerides (91.2%), fasting blood glucose (79.6%) and HDL-c level (78.4%). Except for total cholesterol and LDL-c, all other metabolic syndrome components were significantly different (p < 0.05) between those with and without metabolic syndrome. Significant differences between metabolic syndrome and non-metabolic syndrome groups were found for weight, BMI, waist circumference, body fat percentage and cancer stages (p < 0.05). However, no significant relationship was reported between sociodemographic, clinical parameters and metabolic syndrome among breast cancer survivors in this study.

Conclusions

Metabolic syndrome was highly prevalent among breast cancer survivors. It is recommended for health care professionals to closely monitor and improve the triglycerides, blood glucose and HDL-c level of the breast cancer survivors under their care to control the detrimental effect of metabolic syndrome.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10288-9.

Prevalence, Associated Factors and Psychological Determinants of Obesity among Adults in Selangor, Malaysia

BACKGROUND

The pervasiveness of obesity is a growing concern in the world. This study aims to determine the prevalence of obesity among a segment of the Malaysian population, as well as investigate associated factors and psychological determinants of obesity.

METHODS

A cross-sectional study design was carried out in Selangor, Malaysia. A total of 1380 Malaysian adults (≥18 years old) participated in a structured and validated questionnaire survey. TANITA body scale and SECA 206 body meter were used to measure the respondents' weight and height, from which measurements of their body mass index (BMI) were calculated.

RESULTS

The overall prevalence of obesity (BMI ≥ 30 kg/m2) among adults in Selangor, Malaysia, was 18.6%. Factors significantly associated with increased risk of obesity were: being female (OR = 1.61, 95% CI [1.20-2.17]), aged between 30 to 39 years old (OR = 1.40, 95% CI [1.04-1.88]), being Indian (OR = 1.55, 95% CI [1.13-2.12]), married (OR = 1.37, 95% CI [1.03-1.83]), and having only primary school education (OR = 1.80, 95% CI [1.17-2.78] or secondary school education (OR = 1.37, 95% CI [1.04-1.81]). In the multiple linear regression analysis (stepwise method), perceived stress (B = -0.107, p = 0.041), suicidal ideation (B = -2.423, p = 0.003), and quality of life in the physical health domain (B = -0.350, p = 0.003) inversely and significantly contributed to BMI among males. Among females, stressful life events contributed positively to BMI (B = 0.711, p < 0.001, whereas quality of life in the psychological domain had a negative effect (B = -0.478, p < 0.001) in this respect.

CONCLUSION

There is an urgent need to integrate psychological approaches to enhance the effectiveness of obesity prevention strategies and weight-loss programs.

Cross-Sectional Study of Ethnicity and Chronic Heart Failure: Complex Interplay of Health and Wealth

Objectives: Extrapolating data from international and regional registries on chronic heart failure provides a challenge in Malaysia in view of it being a multicultural country. This study aimed to illustrate the chronic heart failure landscape within northern Kuala Lumpur and identify differences amongst major ethnic groups. Methods: A retrospective, single-centre study was conducted between the 1st January 2013 and 30th April 2016. Patients with left ventricular ejection fraction ≤45% were identified and information was collected on these individuals’ demographics, risk factors, and aetiology. Comparisons were made between three major ethnic groups within Malaysia, and between the author’s database and that of other international registries. Results: 1,181 patients were identified, the majority being Malays (67.3%) and male (81.2%). The mean age was 58.2±11.7 years. The majority had ischaemic risk factors, including previous and current smoking habits (56.7%), coronary artery disease (66.1%), hypertension (71.2%), diabetes (61.8%), and dyslipidaemia (47.9%). There were significant differences noted when looking at rates of dyslipidaemia, diabetes, atrial fibrillation, and chronic kidney disease amongst different ethnicities. The mean left ventricular ejection fraction in Malays was lower (33.1±9.6%) compared to that of Chinese (34.7±8.7%) and Indians (34.9±8.3%). There was marked differences seen in this study’s cohort, compared to three major Asian registries: The 2003 Chong et al. registry, Inter-CHF, and ASIAN-HF. Conclusion: There exists great disparity in chronic heart failure burden amongst populations, and therefore local registries are needed to narrow the gap in knowledge regarding chronic heart failure within Malaysia.

Dentition status among an ethnically diverse older urban Malaysian population

BACKGROUND

Poor oral health affects not only dietary choices but overall well-being. This study explores the influence of lifestyle, socio-demographics and utilization of dental services on the dentition status of an older urban Malaysian population.

METHODS

A total of 1210 participants 60 years and above, representing the three main ethnic groups were recruited from a larger cohort study. Weighted factors valued for comparison included socio demographics and health status. Knowledge of and attitude and behaviour towards personal oral health were also assessed. Dentition status, adapted from WHO oral health guidelines, was the dependent variable investigated. Data were analysed using descriptive chi square test and multivariate binary logistic regression.

RESULTS

Overall, 1187 respondents completed the study. The dentition status and oral health related knowledge, attitude and behaviour varied between the three ethnic groups. The Chinese were significantly less likely to have ≥13 missing teeth (OR = 0.698, 95% CI: 0.521-0.937) and ≥1 decayed teeth (0.653; 0.519-0.932) compared to the Malays, while the Indians were significantly less likely than the Malays to have ≥1 decayed teeth (0.695; 0.519-0.932) and ≥2 filled teeth (0.781; 0.540-1.128).

CONCLUSION

Ethnic differences in dentition outcome are related to oral health utilization highlighting the influence of cultural differences and the need for culturally sensitivity interventions.

Relationship of sociodemographic and lifestyle factors and diet habits with metabolic syndrome (MetS) among three ethnic groups of the Malaysian population

Objectives

Literature shows a high prevalence of MetS among Malaysians, varying across the major ethnicities. Since sociodemographic characteristics, lifestyle factors and diet habits of such communities have been reported to be diverse, the objective of this study was to investigate the association of various sociodemographic characteristics, lifestyle factors and diet habits with MetS overall, as well as with the three major ethnic communities in Malaysia, specifically.

Materials and methods

We conducted a cross-sectional study among 481 Malaysians of ages 18 years and above living in the state of Johor, Malaysia. Information on demographics, lifestyle and diet habits were collected using a structured questionnaire. Harmonized criteria were used to assess the status of MetS. Multiple logistic regression was employed to determine any associations between sociodemographic and lifestyle factors and dietary behaviours with MetS.

Results

MetS was found among 32.2% of the respondents and was more prevalent among the Indians (51.9%), followed by the Malays (36.7%) and the Chinese (20.2%). Overall, increasing age (AOR = 2.44[95%CI = 1.27–4.70] at 40–49 years vs. AOR = 4.14[95%CI = 1.97–8.69] at 60 years and above) and Indian ethnicity (AOR = 1.95[95%CI = 1.12–3.38)] increased the odds of MetS, while higher education (AOR = 0.44[95%CI = 0.20–0.94] decreased the odds of MetS in this population. Quick finishing of meals (AOR = 2.17[95%CI = 1.02–4.60]) and low physical activity (AOR = 4.76[95%CI = 1.49–15.26]) were associated with increased odds of MetS among the Malays and the Chinese, respectively.

Conclusion

The population of Johor depicts a diverse lifestyle and diet behaviour, and some of these factors are associated with MetS in certain ethnic groups. In the light of such differences, ethnic specific measures would be needed to reduce the prevalence of MetS among those in this population.

Prevalence and Correlation of Metabolic Syndrome: A Cross-Sectional Study of Nearly 10 Million Multi-Ethnic Chinese Adults

PURPOSE

This study aimed to examine the prevalence and correlates of metabolic syndrome (MetS) in multi-ethnic populations of Northwest China based on Large-scale provincial health checking data.

PATIENTS AND METHODS

A total of 9,745,640 Chinese aged ≥18 years in Xinjiang, the largest autonomous region of multi-ethnic in China, were enrolled from Feb. to Sep. 2019. MetS was defined by modified Adult Treatment Panel (ATP III) criteria.

RESULTS

The overall prevalence of MetS was 20.85% [Sex: 20.06% female, 21.56% male; Age: 39.22% 60-years and above, 26.32% 40- to 59-years and 9.56% 18- to 39-years; Ethnicity: 28.19% Hui followed by Han (26.39%), Uyghur (18.56%), Other (18.61%), Kazak (17.98%), Mongolian (17.87%), Kyrgyz (14.44%)]. People living in cities and towns (23.03%) or North (24.78%) had higher prevalence of MetS than rural (19.94%) and South (17.66%). Although the prevalence of hypertension, smoking, drinking and lack of physical activity were higher in Kyrgyz, Mongolian and Kazak than those of other ethnic groups, the risk of MetS was lower.

CONCLUSION

The results indicated that a high prevalence of MetS in Hui and Han groups and people living in cities and towns. Living in North Xinjiang and elder population tend to have higher prevalence of MetS. The prevention and management of MetS in these populations should be prioritized.

Risk factors and prevalence of urinary incontinence in mid-life Singaporean women: the Integrated Women's Health Program

INTRODUCTION AND HYPOTHESIS

The objective was to identify the prevalence and risk factors for urinary incontinence (UI) in healthy midlife Singaporean women.

METHODS

Healthy women, aged 45-69 years, were assessed for UI and sociodemographic characteristics, including ethnicity, menopausal status, parity, and body mass index (BMI). UI subtypes corresponding to stress (SUI) alone, urge (UUI) alone, mixed (MUI), and leakage (drops only) incontinence were classified using the Urinary Distress Inventory 6 (UDI-6). Risk factors were examined using Chi-squared tests, followed by sequential multivariate logistic regression to estimate adjusted odds ratios (aOR and 95% confidence intervals).

RESULTS

A total of 1,119 women (mean age 56.2 ± 5.2) completed the UDI-6. 52.3% reported any UI; MUI and SUI were the most common, each affecting 20% of women. Post-menopausal women had a lower risk (aOR 0.5 [0.3-0.9]) of SUI, but a higher risk (aOR 4.4 [1.0-19.9]) of UUI compared with premenopausal women. Higher education was negatively associated (aOR 0.3 [0.2-0.7]) with UUI, but positively associated with MUI (aOR 2.3 [1.3-4.0]). Parity (1-2 children) increased the risk of SUI (aOR 1.8 [1.0-3.1]), but reduced the risk of UUI (aOR 0.4 [0.2-0.9]). Obesity was associated with increased risk for MUI (aOR 2.2 [1.4-3.4]) and leakage (aOR 2.0 [1.0-4.1]). Malays and Indians had a higher risk of MUI, having (aOR 2.1 (1.2-3.7) and 1.7 (1.1-2.7) respectively compared with Chinese, a difference mediated by higher BMI.

CONCLUSION

Urinary incontinence is a major morbidity prevalent in healthy midlife Asian women. Post-menopausal status, education level, parity, BMI (and its link with ethnicity) are independent risk factors in this population, and should be incorporated into counseling and targeted interventions.

The self-care profiles and its determinants among adults with hypertension in primary health care clinics in Selangor, Malaysia

INTRODUCTION

Self-care has been shown to improve clinical outcome of hypertension. Gauging the level of self-care among patients with hypertension enables the design of their personalized care plans. This study aimed to determine the self-care profiles and its determinants among patients with hypertension in the Malaysian primary care setting.

METHODS

This was a cross sectional study conducted between 1 October 2016-30 April 2017 in three primary care clinics in the state of Selangor, Malaysia. All adults aged 18 years and above with hypertension for at least 6 months were recruited with a systematic random sampling of 1:2 ratio. The participants were assisted in the administration of the structured questionnaire, which included socio-demographic information, medical information and the Hypertension Self-Care Profile (HTN SCP) tool. Statistical analysis was done using SPSS version 20.0. Multiple linear regression was performed to determine the determinants for self-care.

RESULTS

The mean age of the participants was 59.5 (SD10.2) years old. There were more women (52.5%) and most were Malays (44.0%) follow by Chinese (34%) and Indians (21%). Majority (84.2%) had secondary or primary school level of education. A third (30.7%) had a family history of hypertension. The mean total HTN-SCP score was 124.2 (SD 22.8) out of 180. The significant determinants that influenced the HTN-SCP scores included being men (B-4.5, P-value0.008), Chinese ethnicity (B-14.7, P-value<0.001), primary level education/no formal school education level (B-15.7, P-value<0.001), secondary level education (B-9.2, P-value<0.001) and family history of hypertension (B 4.4, P-value 0.014).

CONCLUSIONS

The overall hypertension self-care profile among patients in this multi-ethnic country was moderate. Being men, Chinese, lower education level and without family history of hypertension were associated with lower hypertension self-care profile score. Healthcare intervention programmes to address self-care should target this group of patients.

Interaction of Dietary Linoleic Acid and α-Linolenic Acids with rs174547 in FADS1 Gene on Metabolic Syndrome Components among Vegetarians

Fatty acid desaturase 1 (FADS1) gene controls the fatty acid metabolism pathway in the human body. The lower intake of α-linolenic acid (ALA) than linoleic acid (LA) among vegetarians may disrupt the fatty acid metabolism and limit the conversion of ALA to anti-inflammatory products such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). This cross-sectional study aimed to determine the interaction of rs174547 in FADS1 gene with LA and ALA on metabolic syndrome (MetS) components. A total of 200 Chinese and Indian vegetarians in Kuala Lumpur and Selangor, Malaysia participated in the present study. The data on socio-demographic characteristics, vegetarianism practices, dietary practices, anthropometric measurements, blood pressure (BP), and overnight venous fasting blood samples were collected from the vegetarians. The rs174547 in FADS1 gene was significantly associated with MetS and its components such as waist circumference (WC) and fasting blood glucose (FBG). Multiple logistic regression analyses revealed that vegetarians with TT genotype of rs174547 in FADS1 gene had higher odds for MetS, larger WC, higher BP, and a lower level of HDL-c. Two-way ANOVA analysis showed that LA interacts with rs174547 in FADS1 gene to affect HDL-c (p < 0.05) among vegetarians. The present findings suggest the need to develop dietary guidelines for vegetarians in Malaysia. Prospective studies are also needed to affirm the interaction between LA and rs174547 in FADS1 gene on HDL-c among Malaysian vegetarians.

Socio-economics status and metabolic syndrome: A meta-analysis

OBJECTIVE

The metabolic syndrome (MetS) is responsible for an increased risk of type 2 diabetes, cardiovascular diseases and is associated with all-cause and cardiovascular mortality. Economic and social vulnerability is not an easy concept to grasp, but some studies investigate the association between MetS and socioeconomic and demographic factors, deprivation (more often correlations rather than causal one due to data). This work aims to assess the association between MetS and socio-economic gradient (SEG) in the literature by performing a meta-analysis.

DESIGN

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for systematic reviews were followed.

SETTING

The raw list of studies extracted from PubMed as regard to the inclusion/exclusion criteria was imported in Word. Studies were filed with regard to our three definitions of SEG and their title.

PARTICIPANTS

Subgroup analysis were performed considering several definitions of Mets: NCEP-ATPIII and IDF2006.

RESULTS

The overall multivariable-adjusted OR showed that the risk of MetS was significantly increased in association with SEG The results of the subgroup analysis showed an increased risk of MetS in association with SEG when IDF definition was considered.

CONCLUSIONS

Targeted interventions must be implemented in a specific way as prevention campaigns aimed at the general population are generally not adapted to this particular vulnerable population.

Correlates Between Health Beliefs and Health-Promoting Lifestyle Profiles in the Development of Metabolic Syndrome in Taiwan

Differences in sociodemographic variables, health beliefs, and a healthy lifestyle all contribute to the varied prevalence of metabolic syndrome (MetS). We investigated the associations among MetS-related risk factors and performed a cross-sectional study, recruiting 1741 Taiwanese residents aged ≥30 years, between August 2014 and August 2015. Data were obtained on sociodemographic factors, health beliefs, and health-promoting lifestyle profiles using questionnaires. Multivariate analysis revealed that age ≥65 years (odds ratio [OR] = 2.17), low educational level (OR = 1.46), body mass index ≥24 kg/m² (OR = 9.00), more health responsibility (OR = 1.08), and less exercise (OR = 0.924) were independent risk factors for MetS development. A correlation existed between health beliefs and health-promoting lifestyle profiles, suggesting that the establishment of an effective health-promoting program should consider participants' health beliefs.

Factors Influencing the Total Inpatient Pharmacy Cost at a Tertiary Hospital in Malaysia: A Retrospective Study

The steady growth of pharmaceutical expenditures is a major concern for health policy makers and health care managers in Malaysia. Our study examined the factors affecting the total inpatient pharmacy cost (TINPC) at the Universiti Kebangsaan Malaysia Medical Centre (UKMMC). In this retrospective study, we used 2011 administration electronic prescriptions records and casemix databases at UKMMC to examine the impact of sociodemographic, diagnostic, and drug variables on the TINPC. Bivariate and multivariate analyses of the factors associated with TINPC were conducted. The mean inpatient pharmacy cost per patient was USD 102.07 (SD = 24.76). In the multivariate analysis, length of stay (LOS; B = 0.349, P < .0005) and severity level III (B = 0.253, P < .0005) were the primary factors affecting the TINPC. For each day increase in the LOS and each increase of a case of severity level III, there was an increase of approximately USD 11.97 and USD 171.53 in the TINPC per year, respectively. Moreover, the number of prescribed items of drugs and supplies was positively associated with the TINPC (B = 0.081, P < .0005). Gender appears to have affected the TINPC; male patients seem to be associated with a higher TINPC than females (mean = 139.55, 95% confidence interval [CI]: 112.97-166.13, P < .001). Surgical procedures were associated with higher cost than medical cases (mean = 87.93, 95% CI: 61.00-114.85, P < .001). Malay (MYR 242.02, SD = 65.37) and Chinese (MYR 214.66, SD = 27.99) ethnicities contributed to a lower TINPC compared with Indian (MYR 613.93, SD = 98.41) and other ethnicities (MYR 578.47, SD = 144.51). A longer hospitalization period accompanied by major complications and comorbidities had the greatest influence on the TINPC.

Animal models of metabolic syndrome: a review

Metabolic syndrome (MetS) consists of several medical conditions that collectively predict the risk for cardiovascular disease better than the sum of individual conditions. The risk of developing MetS in human depends on synergy of both genetic and environmental factors. Being a multifactorial condition with alarming rate of prevalence nowadays, establishment of appropriate experimental animal models mimicking the disease state in humans is crucial in order to solve the difficulties in evaluating the pathophysiology of MetS in human. This review aims to summarize the underlying mechanisms involved in the pathophysiology of dietary, genetic, and pharmacological models of MetS. Furthermore, we will discuss the usefulness, suitability, pros and cons of these animal models. Even though numerous animal models of MetS have been established, further investigations on the invention of new animal model and clarification of plausible mechanisms are still necessary to confer a better understanding to researchers on the selection of animal models for their studies.

Screening of Peroxisome Proliferator-Activated Receptors (PPARs) α, γ and α Gene Polymorphisms for Obesity and Metabolic Syndrome Association in the Multi-Ethnic Malaysian Population

OBJECTIVE

This study aimed to investigate the association of peroxisome proliferator-activated receptor (PPAR) genes PPARα L162V, PPARγ2 C161T and PPARδ T294C single nucleotide polymorphisms (SNPs) with obesity and metabolic syndrome (Met-S) in a multi-ethnic population in Kampar, Malaysia.

METHODS

Socio-demographic data, anthropometric and biochemical measurements (plasma lipid profile, adiponectin and interleukin-6 [IL-6] levels) were taken from 307 participants (124 males; 180 obese; 249 Met-S; 97 Malays, 85 ethnic Chinese, 55 ethnic Indians).

RESULTS

The overall minor allele frequencies were .08, .22 and .30 for PPAR α L162V, γ C161T, δ T294C, respectively. All SNPs were not associated with obesity, Met-S and obesity with/without Met-S by χ(2) analysis, ethnicity-stratified and logistic regression analyses. Nevertheless, participants with V162 allele of PPARα had significantly higher IL-6, while those with T161 allele of PPARγ2 had significantly lower HOMA-IR.

CONCLUSIONS

All PPAR SNPs were not associated with obesity and Met-S in the suburban population of Kampar, Malaysia, where only PPARα V162 and PPARγ2 T161 alleles were associated with plasma IL-6 and HOMA-IR, respectively.

Investigating diet and physical activity in Malaysia: education and family history of diabetes relate to lower levels of physical activity

The National Health and Morbidity Survey (NHMS, 2011), estimates that the number of Malaysian adults suffering from type 2 diabetes has increased from 8.3 to 31.2% since 1996. This study is a preliminary investigation of possible factors contributing to this epidemic. Knowledge of diabetes, health locus of control, diet and exercise habits, as well as family history, education level and other demographic factors to better understand the correlates of risky and healthy behaviors. This was done as part of a larger initiative to improve prevention efforts. Questionnaires were completed by 770 individuals from three Malaysian states: Selangor, Penang, and Terengganu. Findings showed that people with better health knowledge and those who have a family history of type 2 diabetes were more likely to have healthy diets. Also, health knowledge related to lower alcohol consumption. Participants with diabetic family members, however, also reported higher levels of stress. Counterintuitively, higher educational levels, higher internal locus of control, better health knowledge, as well as a family history of diabetes all correlated with lower levels of physical activity. Thus, it is suggested that, while increasing health knowledge will be important in addressing the type 2 diabetes epidemic in Malaysia, especially in relation to diet, other cultural factors, specifically norms related to exercise and physical activity, also need to be addressed if the spread of type 2 diabetes is to be addressed over the long term.

Prevalence of obesity and its associated risk factors among Chinese adults in a Malaysian suburban village

INTRODUCTION

Obesity is a major modifiable risk factor associated with most chronic diseases. The aim of this study was to determine the prevalence of obesity, and its associated risk factors, among apparently healthy Chinese adults in a Malaysian suburban village.

METHODS

This was a cross-sectional study conducted among the Chinese residents in Seri Kembangan New Village, Klang Valley, Selangor, Malaysia. Convenience sampling was used for the selection of participants. Body weight, height, waist and hip circumferences, and blood pressure were measured. Fasting venous plasma was drawn for the measurement of fasting glucose level and lipid profile. Data on sociodemographic factors, dietary habits, physical activity, perceived stress level and sleep duration were collected using interviewer-administered, pretested and validated questionnaires.

RESULTS

Among the 258 Chinese residents (mean age 41.4 ± 10.0 years) recruited, the prevalence of obesity was 40%. The obese participants had significantly higher mean blood pressure, and triglyceride and fasting plasma glucose levels than the non-obese participants (p < 0.05). The obese participants also had a significantly lower high-density lipoprotein cholesterol level than the non-obese participants. Logistic regression analysis showed that drinking soy milk (adjusted odds ratio [OR] 0.447; 95% confidence interval [CI] 0.253-0.787; p < 0.05) and the perception that a balanced diet consists mainly of vegetables (adjusted OR 0.440; 95% CI 0.215-0.900; p < 0.05) were associated with a reduced risk of obesity. The risk of obesity was higher in younger participants (adjusted OR 2.714; 95% CI 1.225-6.011; p < 0.05).

CONCLUSION

The prevalence of obesity was high among the apparently healthy suburban Chinese. Our findings suggest that soy milk consumption and the perception that a balanced diet consists mainly of vegetables are associated with a lower risk of developing obesity in this population.

Are plasma thyroid-stimulating hormone levels associated with degree of obesity and metabolic syndrome in euthyroid obese patients? A Turkish cohort study

We aimed to observe the association between degree of obesity and metabolic syndrome and plasma thyrotropin levels in obese, euthyroid Turkish patients. 947 obese and overweight patients who admitted to our outpatient clinic were assessed retrospectively. 150 healthy euthyroid cases were also recruited as the control group. Cases with metabolic syndrome were determined. Patients were divided into various subgroups as overweight, obese, morbid obese, men, and women. No statistical significance was determined when all the patients' and subgroups' plasma thyrotropin levels were compared to normal weight control group. No association was shown between the presence of metabolic syndrome and plasma thyrotropin levels for both all patients and subgroups. Also there was not any association between each component of metabolic syndrome and plasma thyrotropin levels. In conclusion, we did not found any significant association between plasma thyrotropin levels and obesity and metabolic syndrome in our euthyroid subjects.

Ethnic differences in the prevalence of metabolic syndrome: results from a multi-ethnic population-based survey in Malaysia

Introduction

The prevalence of metabolic syndrome is increasing disproportionately among the different ethnicities in Asia compared to the rest of the world. This study aims to determine the differences in the prevalence of metabolic syndrome across ethnicities in Malaysia, a multi-ethnic country.

Methods

In 2004, we conducted a national cross-sectional population-based study using a stratified two-stage cluster sampling design (N = 17,211). Metabolic syndrome was defined according to the International Diabetes Federation/National Heart, Lung and Blood Institute/American Heart Association (IDF/NHLBI/AHA-2009) criteria. Multivariate models were used to study the independent association between ethnicity and the prevalence of the metabolic syndrome.

Results

The overall mean age was 36.9 years, and 50.0% participants were female. The ethnic distribution was 57.0% Malay, 28.5% Chinese, 8.9% Indian and 5.0% Indigenous Sarawakians. The overall prevalence of the metabolic syndrome was 27.5%, with a prevalence of central obesity, raised triglycerides, low high density lipoprotein cholesterol, raised blood pressure and raised fasting glucose of 36.9%, 29.3%, 37.2%, 38.0% and 29.1%, respectively. Among those <40 years, the adjusted prevalence ratios for metabolic syndrome for ethnic Chinese, Indians, and Indigenous Sarawakians compared to ethnic Malay were 0.81 (95% CI 0.67 to 0.96), 1.42 (95% CI 1.19 to 1.69) and 1.37 (95% CI 1.08 to 1.73), respectively. Among those aged ≥40 years, the corresponding prevalence ratios were 0.86 (95% CI 0.79 to 0.92), 1.25 (95% CI 1.15 to 1.36), and 0.94 (95% CI 0.80, 1.11). The P-value for the interaction of ethnicity by age was 0.001.

Conclusions

The overall prevalence of metabolic syndrome in Malaysia was high, with marked differences across ethnicities. Ethnic Chinese had the lowest prevalence of metabolic syndrome, while ethnic Indians had the highest. Indigenous Sarawakians showed a marked increase in metabolic syndrome at young ages.