Salt content of instant noodles in Malaysia: a cross-sectional study

Salt reduction policy for out of home sectors: a supplementary document for the salt reduction strategy to prevent and control non-communicable diseases (NCDS) in Malaysia 2021-2025

Cardiovascular diseases (CVDs) are the major cause of death among Malaysians. Reduction of salt intake in populations is one of the most cost-effective strategies in the prevention of CVDs. It is very feasible as it requires low cost for implementation and yet could produce a positive impact on health. Thus, salt reduction initiatives have been initiated since 2010, and two series of strategies have been launched. However, there are issues on its delivery and outreach to the target audience. Further, strategies targeting out of home sectors are yet to be emphasized. Our recent findings on the perceptions, barriers and enablers towards salt reduction among various stakeholders including policy-makers, food industries, food operators, consumers and schools showed that eating outside of the home contributed to high salt intake. Foods sold outside the home generally contain a high amount of salt. Thus, this supplementary document is being proposed to strengthen the Salt Reduction Strategy to Prevent and Control Non-communicable Diseases (NCDs) for Malaysia 2021-2025 by focussing on the strategy for the out-of-home sectors. In this supplementary document, the Monitoring, Awareness and Product (M-A-P) strategies being used by the Ministry of Health (MOH) are adopted with a defined outline of the plan of action and indicators to ensure that targets could be achieved. The strategies will involve inter-sectoral and multi-disciplinary approaches, including monitoring of salt intake and educating consumers, strengthening the current enforcement of legislation on salt/sodium labelling and promoting research on reformulation. Other strategies included in this supplementary document included reformulation through proposing maximum salt targets for 14 food categories. It is hoped that this supplementary document could strengthen the current the Salt Reduction Strategy to Prevent and Control NCDs for Malaysia 2021-2025 particularly, for the out-of-home sector, to achieve a reduction in mean salt intake of the population to 6.0 g per day by 2025.

Occurrence of Perfluoroalkyl and Polyfluoroalkyl Substances in Ice Cream, Instant Noodles, and Bubble Tea

Food consumption is a significant exposure route to perfluoroalkyl and polyfluoroalkyl substances (PFAS). The concentrations of 27 PFAS in fast food were determined by ultrahigh-performance liquid chromatography-high resolution mass spectrometry. In ice cream, instant noodles, and bubble tea, some PFAS were detected, among which perfluorooctanoic acid, perfluoro-n-butanoic acid, and 6:2 polyfluoroalkyl phosphate monoester showed relatively high concentrations. PFAS migrating from bubble tea cups to the food simulant of 50% ethanol aqueous solution showed a difference compared with those migrating into bubble tea matrices. The migration of 27 PFAS to bubble tea samples indicated that long storage time increased PFAS levels (up to 4.8 times) and so did high storage temperature (up to 7.3 times). The hazard ratio, defined as the ratio of the estimated daily intake and the reference dose, was calculated, and it suggests that the total PFAS exposure risk due to consumption of bubble tea should be of concern.

Developing a policy to reduce the salt content of food consumed outside the home in Malaysia: protocol of a qualitative study

INTRODUCTION

Current salt intake in Malaysia is high. The existing national salt reduction policy has faced slow progress and does not yet include measures to address the out of home sector. Dishes consumed in the out of home sector are a known leading contributor to daily salt intake. This study aims to develop a salt reduction strategy, tailored to the out of home sector in Malaysia.

METHODS AND ANALYSIS

This study is a qualitative analysis of stakeholder views towards salt reduction. Participants will be recruited from five zones of Malaysia (Western, Northern, Eastern and Southern regions and East Malaysia), including policy-makers, non-governmental organisations, food industries, school canteen operators, street food vendors and consumers, to participate in focus group discussions or in-depth interviews. Interviews will be transcribed and analysed using thematic analysis. Barriers will be identified and used to develop a tailored salt reduction strategy.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from the Universiti Kebangsaan Malaysia Medical Research Ethics Committee (UKM PPI/1118/JEP-2020-524), the Malaysian National Medical Research Ethics Committee (NMRR-20-1387-55481 (IIR)) and Queen Mary University of London Research Ethics Committee (QMERC2020/37) . Results will be presented orally and in report form and made available to the relevant ministries for example, Ministry of Health, Ministry of Education and Ministry of Trade to encourage adoption of strategy as policy. The findings of this study will be disseminated through conference presentations, peer-reviewed publications and webinars.

The Clinicopathological Features and Staging at Presentation of Gastric Cancer: A Single-Center Retrospective Study

Introduction Gastric cancer (GC) is the third leading cause of cancer death, with most patients diagnosed at a later stage, with distant metastasis at the time of presentation, contributing to poor prognosis. GC has been associated with nonspecific clinical presentations, which cause a time delay for patients to seek for medical advice. This study aims to identify the clinicopathological features of GC patients and correlate time delay of the diagnosis to the staging of the disease.

Materials and Methods This is a single-center retrospective study of GC patients diagnosed from January 2012 to December 2018. All relevant data of GC patient diagnosed during this time period were extracted from the patients’ case notes.

Results A total of 69 GC patients were included in this study, with male preponderance and mean age of 62 years old. The top three symptoms presented are dyspepsia or ingestion (47.8%), weight loss (43.5%), and nausea or vomiting (33.3%). The mean time delay was 3.7 months. Patients presented with weight loss have a significantly longer average time delay of 4.88 months. Most tumor lesion was found at the distal stomach (43.5%), while 74.5% tested negative for Helicobacter pylori. Most patients were diagnosed at Stage IV (52.6%) and Stage III (36.8%) of the disease, with poorly differentiated (67.7%) histological features which have poor prognosis.

Discussion and Conclusion No evidence of specific symptom or combination of symptoms predicts higher risk of GC. Regardless of the number of symptoms presented or the time delay, most GC patients were diagnosed at later stage of the disease. The study shows the importance of GC screening in Malaysia to ensure early detection, even before a symptom presented.

Selected Predictors of the Importance Attached to Salt Content Information on the Food Packaging (a Study among Polish Consumers)

This paper aims to identify selected antecedents of the importance attached to salt content information (ISCI) placed on food labels, on the basis of a representative survey of 1051 Polish consumers. The study was conducted with the use of the CAWI (Computer Assisted Web Interviews) method in 2018. Quota sampling was applied with reference to the following five criteria: sex, age, education, place of living (urban and rural areas), and region. In a multiple regression model, ISCI depends on the respondent’s: sex, age, evaluation of the quantity of nutrition claims, importance attached to nutrition claims, willingness to pay a price premium for products with nutrition claims, attention paid to health and nutrition claims, agreeing with the opinion that unreliable nutrition claims are a serious problem, evaluation of healthiness of one’s diet, self-rated knowledge about healthy nutrition, buying organic food, and reading front-of-package (FOP) labels during and after the purchase. The strongest effects on the importance attached to salt content information on the food packaging were displayed by the importance of nutrition claims, attention paid to nutrition and health claims, respondent’s age, FOP label reading at home, and agreeing that the use of unreliable nutrition claims is a serious problem.