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Ghamri R, Alsulami H. Intravenous Iron Versus Oral Iron Administration for the Treatment of Iron Deficiency Anemia: A Patient-Preference Study. Cureus 2024; 16:e65505. [PMID: 39188434 PMCID: PMC11346127 DOI: 10.7759/cureus.65505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Intravenous iron supplementation has been reported to provide a superior safety profile and effectiveness in the treatment of iron deficiency anemia (IDA) compared to traditional oral iron supplements. AIM To assess preference for intravenous iron versus oral iron among patients with IDA at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. METHODS This observational cross-sectional study included 267 adults diagnosed with IDA or on treatment for IDA at King Abdulaziz University Hospital between February 2023 and March 2024. A specially modified questionnaire was used for the collection of data, which included demographic and treatment-related data. The values of the variables are presented as mean and standard deviation or median and interquartile range. Differences with an asymptotic two-tailed P-value of less than 0.05 were considered to be statistically significant. RESULTS The majority of the included patients were women (95.5%), Saudi nationals (90.6%), and from the Western region (98.1%). About half of the included patients were receiving intravenous iron supplementation (51.7%), and the other half were receiving oral iron supplements (48.3%). However, the majority of the patients (74.9%) reported that they preferred intravenous iron treatment. With regard to factors that affected their preference, education level (P = 0.044), employment status (P = 0.009), and income level (P = 0.007) were identified as significant predictors. Among the patients who preferred oral iron therapy, the reason cited by the majority, that is, 79.1%, was that tablets were easier to adhere to than needles, while 50.7% stated that tablets had fewer side effects than needles and 64.2% reported a fear of needles. Among the patients who preferred intravenous iron therapy, the majority, that is, 82.4%, stated that intravenous administration was easier for them. Further, 73.5% were of the opinion that intravenous iron therapy had fewer side effects (73.5%), 27.7% reported that they were unable to swallow iron tablets, and 52.5% reported that they had difficulty remembering to take iron tablets. About a third of patients discontinued oral iron therapy due to changes in bowel habits (35%). Although 18.7% of the patients reported feeling pain with intravenous iron therapy, the majority were satisfied (79.4%) and recommended intravenous iron treatment for anemia to friends and family members (84.6%). In contrast, more than half of the patients on oral therapy were uncomfortable (56.2%) with the treatment. Further, 37.1% were not satisfied with their iron tablets, and 25.1% of patients stated that they would not recommend iron tablets for anemia treatment to their friends or family members. CONCLUSION The majority of the patients preferred intravenous iron therapy to correct IDA because oral therapy was associated with difficulties related to swallowing iron tablets and remembering to take the tablets. Although the results indicate that both therapies have similar effectiveness, patients receiving intravenous treatment appeared to be more satisfied with the treatment and recommended it to friends and family.
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Affiliation(s)
- Ranya Ghamri
- Family Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Hadeel Alsulami
- Family Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
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Hakami W, Dobie G, Alneami KA, Shaabi M, Essawi K, Saboor M, Madkhali AM, Nahari MH, Almasoudi HH, Akhter MS, Hakami FH, Zarbatan FA, Hakamy A, Chandika RM, Fageehi AA, Mobarki AA, Hamali HA. Assessing Nutritional Anemia Among University Students in Jazan, Saudi Arabia: A Public Health Perspective. J Blood Med 2024; 15:51-60. [PMID: 38352049 PMCID: PMC10863464 DOI: 10.2147/jbm.s436673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 01/29/2024] [Indexed: 02/16/2024] Open
Abstract
Background Nutritional anemia is a significant public health concern worldwide, particularly affecting young adults and children in Saudi Arabia, where inadequate nutrition is considered a primary contributing factor. This study aims to (i) examine the levels of serum iron, folate, and vitamin B12 in young adult students, with a focus on identifying any deficiencies and their association with anemia; (ii) explore the prevalence of mixed-deficiency anemia resulting from deficiencies in serum iron, folate, and vitamin B12 (iii) explore how sociodemographic characteristics and dietary habits influence serum iron, folate, and vitamin B12 levels. Materials and Methods This cross-sectional study encompassed 158 young adult students at Jazan University, Saudi Arabia. Blood samples were collected following a comprehensive questionnaire addressing sociodemographic and health characteristics. These samples were analyzed for complete blood count, serum iron, folate, and vitamin B12 levels. Results The findings of this study revealed a significant decrease in serum iron levels, with 70.6% of males and 88% in females exhibiting reduced level. Additionally, low levels of folate were observed in 4% of the study population, while deficiency in vitamin B12 was found in 2.2% of the study population. However, the simultaneous presence of low serum iron levels along with deficiencies in folate or vitamin B12 was not observed in the study participants. Conclusion The study indicates that there is a high incidence of low serum iron and ferritin levels among university students in Saudi Arabia, which poses a considerable public health concern. Conversely, the prevalence of folate and vitamin B12 deficiencies among the students was comparatively low, and notably, there were no cases where these deficiencies were observed alongside iron deficiency.
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Affiliation(s)
- Waleed Hakami
- Department of Medical Laboratory Technology, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Gasim Dobie
- Department of Medical Laboratory Technology, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Khadija A Alneami
- Department of Medical Laboratory Technology, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Misk Shaabi
- Department of Medical Laboratory Technology, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Khaled Essawi
- Department of Medical Laboratory Technology, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Muhammad Saboor
- Department of Medical Laboratory Sciences, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Aymen M Madkhali
- Department of Medical Laboratory Technology, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Mohammed H Nahari
- Department of Medical Laboratory Technology, Najran University, Najran, Saudi Arabia
| | - Hassan H Almasoudi
- Department of Medical Laboratory Technology, Najran University, Najran, Saudi Arabia
| | - Mohammad S Akhter
- Department of Medical Laboratory Technology, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Fasial H Hakami
- Department of Epidemiology, College of Public Health and Tropical Medicine, Jazan University, Jazan, Saudi Arabia
| | - Fatimah A Zarbatan
- Respiratory Care Department, King Fahad Central Hospital, Jazan, Ministry of Health, Jazan, Saudi Arabia
| | - Ali Hakamy
- Department of Respiratory Therapy, Faculty of Applied Medical Sciences, Jazan University, Gizan, Saudi Arabia
| | - Rama M Chandika
- Department of Clinical Nutrition, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Ali A Fageehi
- Department of Medical Laboratory Technology, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Abdullah A Mobarki
- Department of Medical Laboratory Technology, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Hassan A Hamali
- Department of Medical Laboratory Technology, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
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Almasmoum HA, Iqbal MS, Aljaadi A, Ghafouri K, Qasem AH, Azhar W, Qadhi A, Halawani AJ, Ezzat Abd El-Lateef A, Alharthi A, Khoja A. Prevalence of Undiagnosed Iron Deficiency Anemia and Associated Factors Among Female Undergraduate Medical Students in Makkah, Saudi Arabia. Cureus 2023; 15:e50046. [PMID: 38186469 PMCID: PMC10768742 DOI: 10.7759/cureus.50046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 01/09/2024] Open
Abstract
INTRODUCTION Iron deficiency anemia is the most common type of anemia according to the World Health Organization. Females are more likely to be affected than males. There are several factors causing iron deficiency anemia, such as increased loss of iron, decreased intake of iron, and increased utilization of iron. There are limited research studies evaluating the risk factors that cause anemia among female medical students in Saudi Arabia. For this, the study aimed to identify the prevalence of undiagnosed iron deficiency anemia (IDA) among young female university students and to identify if there is any correlation between IDA and several factors including dietary habits, psychological stress, anxiety status, and body mass index. MATERIALS AND METHODS A cross-sectional observational study was performed between October 2022 and December 2022 with a sample of 100 healthy female students aged between 19 and 23 years, who were studying at the medical colleges of Umm Al-Qura University, Saudi Arabia. Blood samples were collected to perform complete blood count and iron profile tests. Also, a survey was done to find correlation between iron deficiency anemia and dietary intake, drinks, stress, anxiety, and body mass index (BMI). Independent t-test or Mann-Whitney U test were used to compare values for non-anemic with anemic participants, and linear regression tests were used to analyze differences between non-anemic and anemic participants' dietary intake factors and stress and anxiety scores. The level of significance was set at p<0.05. RESULTS The findings represent an overall prevalence of iron deficiency anemia in female medical students based on the lab finding results. Thus, students were divided into two following groups: anemic (13%) with hemoglobin (Hb) concentration <12 g/dL and non-anemic (84%) with Hb concentration ≥12 g/dL. When comparing the two groups, results showed significant differences in the majority of RBC indices (hematocrit {HCT}, mean corpuscular volume {MCV}, mean corpuscular hemoglobin {MCH}, red cell distribution width {RDW}) and iron profiles, p-value was <0.05. On evaluation of the different types of food consumption, the mean iron intake was around 7 mg/day, and in 65% of the participants, it was below the estimated average requirement (EAR) of iron (8.1 mg/dL). The perceived stress scale (PSS) shows that 63% of the participants experienced moderate stress and 58% reported severe anxiety by the generalized anxiety disorder (GAD) scale. In multiple linear regression, iron was positively associated with hemoglobin concentrations, whereas stress scores were negatively associated with hemoglobin concentrations. CONCLUSION There is a relatively low prevalence of anemia and most of it was found of the microcytic type, indicating that this condition is a common health issue among local female college students. There was no independent association between stress or anxiety and hemoglobin levels.
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Affiliation(s)
- Hibah A Almasmoum
- Department of Clinical Laboratory Sciences, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, SAU
| | | | - Abeer Aljaadi
- Department of Clinical Nutrition, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, SAU
| | - Kholoud Ghafouri
- Department of Clinical Nutrition, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, SAU
| | - Ahmed H Qasem
- Department of Clinical Laboratory Sciences, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, SAU
| | - Wedad Azhar
- Department of Clinical Nutrition, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, SAU
| | - Alaa Qadhi
- Department of Clinical Nutrition, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, SAU
| | - Amr J Halawani
- Department of Clinical Laboratory Sciences, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, SAU
| | | | - Ashwaq Alharthi
- Department of Clinical Laboratory Sciences, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, SAU
| | - Athar Khoja
- Department of Clinical Laboratory Sciences, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, SAU
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Abbas G, Hussain A, Hussain A, Ahmed Z, Abbas Y, Nemat A. Geostatistical analysis for spatial distribution of anemia (Hb level) among women of reproductive age and determinant factors. Food Sci Nutr 2023; 11:4183-4190. [PMID: 37457163 PMCID: PMC10345706 DOI: 10.1002/fsn3.3408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 04/13/2023] [Accepted: 04/18/2023] [Indexed: 07/18/2023] Open
Abstract
The study was designed to assess the geostatistical spatial distribution of anemia and determinant factors among the women of reproductive age group (RAG) in Gilgit district, Pakistan. The Hb levels for 15-25 RAG, 26-35 RAG, and 36-45 group showed 10.22 g/dL, 10.41 g/dL, and 9.90 g/dL levels, respectively, while the Hb level showed a nugget/sill ratio of 0.21 inferring strong for the 15-25 group, weak for the 26-36, and moderate for 36-45 spatial dependence. Furthermore, 15-25 RAG showed 8% severe and 33.34% sufficient cases and 26-35 showed 12% severe and 29.33% sufficient results in their Hb level, whereas 36-45 had 9.34% severe and 29.33% sufficient.
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Affiliation(s)
- Ghulam Abbas
- Department of Biological SciencesKarakoram International UniversityGilgitPakistan
| | - Azhar Hussain
- Department of Agriculture and Food TechnologyKarakoram International UniversityGilgitPakistan
| | - Abid Hussain
- Department of Agriculture and Food TechnologyKarakoram International UniversityGilgitPakistan
| | - Zahoor Ahmed
- School of Food & Biological EngineeringJiangsu UniversityZhenjiangChina
- Department of Human Nutrition and Dietetics, School of Food and Agricultural SciencesUniversity of Management and Technology LahoreLahorePakistan
| | - Yasir Abbas
- Department of Agriculture and Food TechnologyKarakoram International UniversityGilgitPakistan
| | - Arash Nemat
- Kabul University of Medical SciencesKabulAfghanistan
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Vivek A, Kaushik RM, Kaushik R. Tobacco smoking-related risk for iron deficiency anemia: A case-control study. J Addict Dis 2023; 41:128-136. [PMID: 35699272 DOI: 10.1080/10550887.2022.2080627] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Globally, iron deficiency anemia (IDA) is a significant public health problem. Tobacco smoking as a risk factor for anemia is often ignored. AIMS To study the tobacco smoking-associated risk for IDA. This study was conducted in a tertiary care hospital in Dehradun, India from January 2019 to December 2020. One hundred ten patients having IDA (serum ferritin < 15 mcg/l) and an equal number of controls were randomly selected and assessed regarding their tobacco smoking status and type, quantity, and duration of tobacco used. RESULTS Seventy-six (69.1%) patients with IDA were tobacco smokers and were predominantly males (51cases, 67.1%) and beedi smokers (52 cases, 68.4%). The odds ratios (ORs) for the association of smoking tobacco (cigarette and beedi collectively), cigarette, and beedi with IDA were 7.60 (p < 0.0001), 2.79 (p = 0.01), and 5.68 (p < 0.0001), respectively. OR for developing IDA was more among light smokers (OR = 7.72, p < 0.0001) and increased with duration of smoking (p < 0.0001). IDA was not significantly associated with confounding risk factors like malnutrition (OR = 1.00, p = 1.00), low socioeconomic status (OR = 0.64, p = 0.21), dietary habits (OR = 1.43, p = 0.45), and place of residence (OR = 0.93, p = 0.88). CONCLUSIONS Tobacco smoking has a strong association with IDA. Both beedi smoking and cigarette smoking have a significant association with IDA. The risk of IDA is more among light smokers and is duration-dependent.
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Affiliation(s)
- Ankur Vivek
- Department of General Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Rajeev Mohan Kaushik
- Department of General Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Reshma Kaushik
- Department of General Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
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Singh RK, Kaushik RM, Goel D, Kaushik R. Association between iron deficiency anemia and chronic daily headache: A case-control study. Cephalalgia 2023; 43:3331024221143540. [PMID: 36739514 DOI: 10.1177/03331024221143540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE We aimed to determine the association between iron deficiency anemia and chronic daily headache. METHODS This case-control study was conducted in a tertiary care center in Dehradun, India. One hundred patients with chronic daily headache were randomly selected for the study with an equal number of controls. Subsets of chronic daily headache were diagnosed as per the 3rd edition of the International Classification of Headache Disorders. The study participants were assessed for iron deficiency anemia. RESULTS The mean age of the patients was 51.1 ± 22.1 years. Male: female ratio was 1:1.08. Chronic migraine was present in 62 (62%), tension-type headache in 23 (23%), and new daily persistent headache in 15 (15%) patients. The majority (96%) of patients had chronic daily headache of mild to moderate severity. Chronic daily headache was of long duration in all patients. Sixty-four (64%) patients had anemia of which 51 (51%) patients had iron deficiency anemia. Iron deficiency anemia showed a significant association with chronic daily headache (p < 0.001), but not with its type, subtype, and duration. Severe iron deficiency anemia had a significant association with the severity of chronic daily headache (p = 0.021). Serum iron, ferritin, total iron-binding capacity, and transferrin saturation also had a significant association with chronic daily headache (p < 0.05 for each), but not with its type, subtype, duration, and severity. Logistic regression analysis showed that iron deficiency anemia, total iron-binding capacity, and transferrin saturation had an independent association with chronic daily headache (p < 0.05 for each). CONCLUSIONS Iron deficiency anemia had an independent association with chronic daily headache. Severe iron deficiency anemia was related to the severity of chronic daily headache.
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Affiliation(s)
- Rohit Kumar Singh
- Department of General Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Rajeev Mohan Kaushik
- Department of General Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Deepak Goel
- Department of Neurology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Reshma Kaushik
- Department of General Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
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Belali TM. Iron deficiency anaemia: prevalence and associated factors among residents of northern Asir Region, Saudi Arabia. Sci Rep 2022; 12:19170. [PMID: 36357664 PMCID: PMC9649663 DOI: 10.1038/s41598-022-23969-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 11/08/2022] [Indexed: 11/11/2022] Open
Abstract
Iron deficiency anaemia is known to be one of the most common disorders that are associated with malnutrition. This study was conducted to form an understanding of the prevalence of Iron deficiency Anaemia (IDA) and evaluate its risk factors among the residents of the northern Asir Region, Saudi Arabia. Understanding the prevalence of IDA in different populations is important not only for therapeutic purposes but also for preventing the development of IDA in a given community. Moreover, this study was conducted to raise awareness about the significance of following iron-rich diet among high-risk groups such as women and children. This study collected data from 683 anaemic patients who are enrolled at the haematology unit in the Department of Internal Medicine at King Abdullah Hospital, Bisha Saudi Arabia. 398 participants who have IDA were included in this study where the collected data from the subjects included Age, gender, education, marital status, nationality, consanguinity, dietary habits and the clinical presentation of the participants. Our findings have shown that the prevalence of IDA among the participants is 58.27% where children under the age of 10 and females are the most affected individuals. Adults over 40, unmarried, and non-Saudis represented the second most affected portion of the subjects. IDA was prevalent among participants who shared the same ancestors and individuals with limited education. Moreover, participants did not consume sufficient iron and iron enhancing food or supplements. Inadequate iron intake is a major risk factor for anaemia. Low red fish and meat consumption contributed to the increase in ID. Findings highlight the need to raise awareness about the importance of a balanced diet and regular consumption of iron-containing food.
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Affiliation(s)
- Tareg M. Belali
- grid.494608.70000 0004 6027 4126Faculty of Applied Medical Sciences, University of Bisha, 255, Al Nakhil, Bisha, 67714 Saudi Arabia
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Khokhar J, Akbar A, Akhtar S, Layla A, Lazarte C, Abbas MA, Asif M, Shah ZA, Ismail T. Prevalence and determinants of anemia among resident female university students from Southern Punjab, Pakistan. Women Health 2022; 62:488-501. [DOI: 10.1080/03630242.2022.2085845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Javeria Khokhar
- Department of Statistics, Bahauddin Zakariya University, Multan, Pakistan
| | - Atif Akbar
- Department of Statistics, Bahauddin Zakariya University, Multan, Pakistan
| | - Saeed Akhtar
- Institute of Food Science & Nutrition, Bahauddin Zakariya University, Multan, Pakistan
| | - Anam Layla
- National Institute of Food Science & Technology, University of Agriculture, Faisalabad, Pakistan
| | - Claudia Lazarte
- Department of Food Technology, Engineering and Nutrition, Lund University, Lund, Sweden
| | - Muhammad Asif Abbas
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Muhammad Asif
- Department of Statistics, Bahauddin Zakariya University, Multan, Pakistan
| | - Zarnain Ali Shah
- Institute of Food Science & Nutrition, Bahauddin Zakariya University, Multan, Pakistan
| | - Tariq Ismail
- Institute of Food Science & Nutrition, Bahauddin Zakariya University, Multan, Pakistan
- Department of Food Technology, Engineering and Nutrition, Lund University, Lund, Sweden
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Evaluation of Predicting the Value of the Reticulocyte Hemoglobin Equivalent for Iron Deficiency in Chronic Kidney Disease Patients. Nephrourol Mon 2022. [DOI: 10.5812/numonthly-121289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background: Iron management is essential for anemia treatment in chronic kidney disease. The reticulocyte hemoglobin equivalent (RET-He) is a reticulocyte parameter that reflects hemoglobin synthesis of newly formed erythrocytes in the bone marrow in real-time. Objectives: This study aims to evaluate the role of reticulocyte hemoglobin equivalent (RET-He) in predicting iron deficiency in chronic kidney disease (CKD) patients. Methods: Following a descriptive cross-sectional observational design, this study was conducted on 131 adult patients with CKD stages 3 - 5. Laboratory indices, including complete blood count, some biochemical indices, iron status, and reticulocyte indices (including RET-He), were measured. Iron deficiency (ID) was defined as TSAT < 20%, where serum ferritin level > 100 ng/mL was defined as functional ID, while serum ferritin level
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Anemia Burden among Hospital Attendees in Makkah, Saudi Arabia. Anemia 2022; 2022:4709119. [PMID: 35495413 PMCID: PMC9054465 DOI: 10.1155/2022/4709119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/30/2022] [Accepted: 04/06/2022] [Indexed: 11/17/2022] Open
Abstract
Background Anemia is a major health problem in Saudi Arabia and has multiple etiologies. Many studies have been conducted in Saudi Arabia in specific population groups like school children, adolescents, university students, and females in the reproductive age group, and most have reported high prevalence of anemia. This study was conducted in a specialist hospital in Makkah city and includes all outpatients aged 15 years and above. Objective To study the burden of anemia among hospital attendees, its stratification based on gender and age, and its severity along with the morphological types of anemia. Methods This is a study conducted at a specialist hospital in Makkah city and one-month data were collected retrospectively from the laboratory database and include demographic and routine hematological results of complete blood count (CBC). Results A total of 21,524 patients were included, out of which 9444 (43.9%) were males and 12020 (56.1%) were females. The overall prevalence of anemia was 38.7% (8339). Prevalence was very high in females, accounting for 68.2% (5689), whereas it was 31.8% (2650) in males. There were 39.6% (3301), 43.9% (3657), and 16.6% (1381) cases of mild, moderate, and severe anemia, respectively. In females, anemia was more prevalent in the age group of 15 to 49, which is considered as the reproductive age group. Microcytic anemia was the most prevalent type observed in this age group, accounting for 40.7% of all anemia cases. Normocytic anemia was more prevalent in the males, accounting for 52%. Conclusion Our study showed high prevalence of anemia among the patients attending outpatient departments in a specialist hospital. Females have high prevalence of anemia when compared to male population. Microcytic anemia was the most common anemia type among females and was seen in the 15–49 age group. There is an increase in prevalence of anemia with age for males, whereas, in females, increased prevalence is observed in the reproductive age groups and the anemia prevalence maintained a steady decrease towards the 5th to the 9th decades. Normocytic anemia was more prevalent in the 5th to the 9th decades, indicating that there are more etiologies other than iron deficiency in the causation of anemia. Macrocytic anemia was the least reported anemia type. Anemia of mild and moderate severity was predominant in both genders, although severe anemia showed higher prevalence in females as compared to males. Conclusion Our study showed high prevalence of anemia among the patients attending outpatient departments in a specialist hospital. Females have high prevalence of anemia when compared to male population. Microcytic anemia was the most common anemia type among females and was seen in the 15–49 age group. There is an increase in prevalence of anemia with age for males, whereas, in females, increased prevalence is observed in the reproductive age groups and the anemia prevalence maintained a steady decrease towards the 5th to the 9th decades. Normocytic anemia was more prevalent in the 5th to the 9th decades, indicating that there are more etiologies other than iron deficiency in the causation of anemia. Macrocytic anemia was the least reported anemia type. Anemia of mild and moderate severity was predominant in both genders, although severe anemia showed higher prevalence in females as compared to males. Conclusion. Anemia is highly prevalent in adolescents, adults, and the elderly in Makkah region. The most common cause is thought to be iron deficiency, although other causes are not uncommon. The authorities need to address the problem of prevention and reduction in anemia prevalence by taking effective measures and interventions.
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Alsagaby SA. A comprehensive study on abnormalities associated with red blood cells in Saudi adult patients. Int J Health Sci (Qassim) 2022; 16:30-36. [PMID: 35024032 PMCID: PMC8721215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES The present work aimed to study red blood cells (RBCs) parameters data of Saudi patients to cover hematological patterns and evaluate abnormality prevalence. METHODS RBCs parameters data of adult Saudi patients who attended Prince Nasser bin Saad Al-Sudairy Hospital in Alghat province between January 1, 2019 and December 31 2019 were collected and studied. RESULTS The study included 1663 patients; 814 (49%) males and 849 (51%) females. The proportion of patients with anemia as defined by low levels of hemoglobin (Hb) was similar in males (20%) and females (21%) with a clear drop in the percentage of anemia among females aged 51-65 years. Data from Alghat province showed bigger proportion of patients with macrocytic anemia (high mean cell volume [MCV] = 35% in males and 25% in females) compared with microcytic anemia (low MCV = 7% in males and 19% in females). Microcytic hypochromic anemia was found to be common in women (18%) compared with men (6%), with the highest prevalence being detected in females (31%) at age 46-50. CONCLUSION This is the first study to shed light on RBCs data from Alghat province, and provide insights into anemia in adults. Anemia was seen in 20-21% of the patients, with macrocytic anemia being the most prevalent type of anemia in the studied population.
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Affiliation(s)
- Suliman A. Alsagaby
- Department of Medical Laboratories, College of Applied Medical Sciences, Majmaah University, Al-Majmaah, 11952, Saudi Arabia,Address for correspondence: Suliman A. Alsagaby, Department of Medical Laboratories, College of Applied Medical Sciences, Majmaah University, Al-Majmaah, 11952, Saudi Arabia. Mobile: +966-542552749. E-mail:
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Al-Amer OM, Oyouni AAA, Alshehri MA, Alasmari A, Alzahrani OR, Aljohani SAS, Alasmael N, Theyab A, Algahtani M, Al Sadoun H, Alsharif KF, Hamad A, Abdali WA, Hawasawi YM. Association of SNPs within TMPRSS6 and BMP2 genes with iron deficiency status in Saudi Arabia. PLoS One 2021; 16:e0257895. [PMID: 34780475 PMCID: PMC8592490 DOI: 10.1371/journal.pone.0257895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 09/13/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Globally, iron-deficiency anemia (IDA) remains a major health obstacle. This health condition has been identified in 47% of pre-school students (aged 0 to 5 years), 42% of pregnant females, and 30% of non-pregnant females (aged 15 to 50 years) worldwide according to the WHO. Environmental and genetic factors play a crucial role in the development of IDA; genetic testing has revealed the association of a number of polymorphisms with iron status and serum ferritin. AIM The current study aims to reveal the association of TMPRSS6 rs141312 and BMP2 rs235756 with the iron status of females in Saudi Arabia. METHODS A cohort of 108 female university students aged 18-25 years was randomly selected to participate: 50 healthy and 58 classified as iron deficient. A 3-5 mL sample of blood was collected from each one and analyzed based on hematological and biochemical iron status followed by genotyping by PCR. RESULTS The genotype distribution of TMPRSS6 rs141312 was 8% (TT), 88% (TC) and 4% (CC) in the healthy group compared with 3.45% (TT), 89.66% (TC) and 6.89% (CC) in the iron-deficient group (P = 0.492), an insignificant difference in the allelic distribution. The genotype distribution of BMP2 rs235756 was 8% (TT), 90% (TC) and 2% (CC) in the healthy group compared with 3.45% (TT), 82.76% (TC) and 13.79% (CC) in iron-deficient group (P = 0.050) and was significantly associated with decreased ferritin status (P = 0.050). In addition, TMPRSS6 rs141312 is significantly (P<0.001) associated with dominant genotypes (TC+CC) and increased risk of IDA while BMP2 rs235756 is significantly (P<0.026) associated with recessive homozygote CC genotypes and increased risk of IDA. CONCLUSION Our finding potentially helps in the early prediction of iron deficiency in females through the genetic testing.
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Affiliation(s)
- Osama M. Al-Amer
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk, Kingdom of Saudi Arabia
- Genome and Biotechnology Unit, Faculty of Sciences, University of Tabuk, Tabuk, Kingdom of Saudi Arabia
| | - Atif Abdulwahab A. Oyouni
- Genome and Biotechnology Unit, Faculty of Sciences, University of Tabuk, Tabuk, Kingdom of Saudi Arabia
- Department of Biology, Faculty of Sciences, University of Tabuk, Tabuk, Kingdom of Saudi Arabia
| | - Mohammed Ali Alshehri
- Genome and Biotechnology Unit, Faculty of Sciences, University of Tabuk, Tabuk, Kingdom of Saudi Arabia
- Department of Biology, Faculty of Sciences, University of Tabuk, Tabuk, Kingdom of Saudi Arabia
| | - Abdulrahman Alasmari
- Genome and Biotechnology Unit, Faculty of Sciences, University of Tabuk, Tabuk, Kingdom of Saudi Arabia
- Department of Biology, Faculty of Sciences, University of Tabuk, Tabuk, Kingdom of Saudi Arabia
| | - Othman R. Alzahrani
- Genome and Biotechnology Unit, Faculty of Sciences, University of Tabuk, Tabuk, Kingdom of Saudi Arabia
- Department of Biology, Faculty of Sciences, University of Tabuk, Tabuk, Kingdom of Saudi Arabia
| | - Saad Ali S. Aljohani
- Department of Basic Medical Sciences, Faculty of Medicine, Alrayan Colleges, Almadinah Almunawarah, Kingdom of Saudi Arabia
| | - Noura Alasmael
- King Abdullah University for Science and Technology, Thuwal, Kingdom of Saudi Arabia
| | - Abdulrahman Theyab
- Department of Laboratory Medicine, Security Forces Hospital, Mecca, Kingdom of Saudi Arabia
| | - Mohammad Algahtani
- Department of Laboratory Medicine, Security Forces Hospital, Mecca, Kingdom of Saudi Arabia
| | - Hadeel Al Sadoun
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Khalaf F. Alsharif
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, Taif, Kingdom of Saudi Arabia
| | - Abdullah Hamad
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk, Kingdom of Saudi Arabia
| | - Wed A. Abdali
- Research Center, King Faisal Specialist Hospital and Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Yousef MohammedRabaa Hawasawi
- Research Center, King Faisal Specialist Hospital and Research Center, Jeddah, Kingdom of Saudi Arabia
- College of Medicine, Al-Faisal University, Riyadh, Saudi Arabia
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13
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Vanié SC, Edjème-Aké A, Kouassi KN, Gbogouri GA, Djaman AJ. Nutritional and Obstetric Determinant of Iron Deficiency Anemia among Pregnant Women Attending Antenatal Care Services in Public Health Hospitals in Abidjan (Côte d'Ivoire): A Cross-Sectional Study. Ecol Food Nutr 2021; 61:250-270. [PMID: 34672848 DOI: 10.1080/03670244.2021.1987229] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Poorly diversified and micronutrient-deficient dietary intakes during pregnancy remain one of the major causes of nutritional anemia in developing countries. However, data on diet and its relation to anemia in pregnant women in Côte d'Ivoire are scarce. The objective of this study was to determine prevalence and iron deficiency anemia associated factors in pregnant women in Abidjan. A cross-sectional study was conducted among 389 pregnant women attending antenatal care services at public health hospitals in Abidjan. Sociodemographic, obstetrical, and dietary data were collected. Blood samples taken by venipuncture were analyzed for hemoglobin and iron biomarkers. Data were subjected to descriptive statistics and multivariate logistic regression. 47.8% of the pregnant women tested were anemic, 25.8% and 30.4% had iron deficiency and iron deficiency anemia, respectively. Based on AORs, the second and third trimesters of pregnancy (6.04 v 4.18, respectively), multiparity (13.18), skipping meals (3.05), inadequate energy (5.369), protein (2.74), and vitamin C (2.43) intakes and low dietary diversity (8.35) are the independent and significant determinants of iron deficiency anemia. The high prevalence of anemia among pregnant women in Abidjan reveals a real public health problem. Iron deficiency anemia is due to multiparity, gestational age, inadequate intake, low dietary diversity, and skipping meals.
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Affiliation(s)
- Stéphane Claver Vanié
- Training and Research Unit of Sciences and Food Technology, Laboratory of Nutrition and Food Safety, Nangui Abrogoua University, Abidjan, Côte d'Ivoire.,Department of Clinical and Fundamental Biochemistry, Pasteur Institute of Côte d'Ivoire (IPCI), Côte d'Ivoire
| | - Angèle Edjème-Aké
- Department of Clinical and Fundamental Biochemistry, Pasteur Institute of Côte d'Ivoire (IPCI), Côte d'Ivoire.,Training and Research Unit of Pharmaceutical and Biological Sciences, Félix Houphouët-Boigny University, Abidjan, Côte d'Ivoire
| | - Kouakou Nestor Kouassi
- Training and Research Unit of Sciences and Food Technology, Laboratory of Food Biochemistry and Tropical Products Technology, Nangui Abrogoua University, Abidjan, Côte d'Ivoire
| | - Grodji Albarin Gbogouri
- Training and Research Unit of Sciences and Food Technology, Laboratory of Nutrition and Food Safety, Nangui Abrogoua University, Abidjan, Côte d'Ivoire
| | - Allico Joseph Djaman
- Department of Clinical and Fundamental Biochemistry, Pasteur Institute of Côte d'Ivoire (IPCI), Côte d'Ivoire.,Training and Research Unit of Biosciences, Laboratory of Pharmacodynamics and Biochemistry, Félix Houphouët-Boigny University, Abidjan, Côte d'Ivoire
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14
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Rasheed Z, Shariq A, AlQefari GB, Alwahbi GS, Aljuaythin AI, Alsuhibani FS, Alotaibi DF, Aljohani SS, Alghasham R, Alsaeed T, Alharbi NA, Rugaie OA, Abdulmonem WA, Sharaf OF. Toxoplasmosis in immunocompetent Saudi women: Correlation with vitamin D. ACTA ACUST UNITED AC 2021; 17:17455065211043844. [PMID: 34541980 PMCID: PMC8451252 DOI: 10.1177/17455065211043844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective: Toxoplasma gondii (T. gondii) is a life-threatening parasite particularly infecting the immunocompromised women. Deficiency of vitamin D is well reported in several infectious disorders. This study was undertaken to investigate a correlation of vitamin D deficiency with the onset of T. gondii infection in immunocompetent women from the central of Saudi Arabia. Methods: Blood samples were collected from 304 Saudi women from the Qassim region of Saudi Arabia. Specific immunoassays were used to determine the levels of T. gondii immunoglobulin G and vitamin D. The SPSS and the Prism Graph Pad statistical software were used for the data analysis. Results: Out of 304 women, 18.8% were found to be positive for toxoplasmosis. Interestingly, the serum levels of vitamin D in toxoplasma positive cases were found to be significantly low as compared with the levels of vitamin D in toxoplasma negative cases. Moreover, sociodemographic risk factors such as age, residence location, and consumption of fruits/vegetables were also found to be associated with vitamin D deficiency and with the seroprevalence of toxoplasmosis. Conclusion: This study investigated a direct correlation of vitamin D deficiency with the severity of the toxoplasmosis in Saudi women. Therefore, it is predicted that vitamin D supplementation may provide protection against toxoplasma infection.
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Affiliation(s)
- Zafar Rasheed
- Department of Medical Biochemistry, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Ali Shariq
- Department of Microbiology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Ghaida B AlQefari
- Department of Pathology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Ghayda S Alwahbi
- Department of Pathology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Amal I Aljuaythin
- Department of Pathology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Fidaa S Alsuhibani
- Department of Pathology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Daliyah F Alotaibi
- Department of Pathology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Shahad S Aljohani
- Department of Pathology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Ruqiah Alghasham
- Department of Pathology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Thamir Alsaeed
- Department of Pathology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Nada A Alharbi
- Departments of Basic Medical Sciences, Pathology and Microbiology, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia
| | - Osamah Al Rugaie
- Department of Basic Medical Sciences, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia.,College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Waleed Al Abdulmonem
- Department of Pathology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Osama F Sharaf
- Department of Clinical and Molecular Parasitology, National Liver Institute, Menoufia University, Al Minufya, Egypt
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Hamali HA, Mobarki AA, Saboor M, Alfeel A, Madkhali AM, Akhter MS, Dobie G. Prevalence of Anemia Among Jazan University Students. Int J Gen Med 2020; 13:765-770. [PMID: 33116767 PMCID: PMC7547133 DOI: 10.2147/ijgm.s275702] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 09/09/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Anemia is one of the most common disorders affecting the population in both low-income and developing countries. This study aimed to determine the prevalence of anemia and iron deficiency in apparently normal male and female students of Jazan University, Saudi Arabia. Material and Methods This cross-sectional study was conducted at the Faculty of Applied Medical Sciences, Jazan University, Gizan, Saudi Arabia. One hundred thirty-four (85 males and 49 females) healthy students with no outward signs of illness were recruited. A specific questionnaire related to sociodemographic and health characteristics was designed and validated. The collected samples were analyzed for complete blood count, serum iron, and serum ferritin. Results In the male group, 81 participants (95.3%) were nonanemic with normal hemoglobin (14.99 ± 1.11g/dl), whereas only 4 males were anemic (hemoglobin <13.0 g/dl). On the other hand, anemia was more prevalent in female students, as 67.35% had hemoglobin values less than 12.0 g/dl. In addition, 26.54% of the anemic females had low serum iron and serum ferritin, indicating iron-deficiency anemia. Although the majority of male participants had normal hemoglobin levels, 37.6% of them had low mean cell volume (MCV), low mean cell hemoglobin (MCH), low mean cell hemoglobin concentration (MCHC), and high red blood cell (RBC) counts, suggesting thalassemia. Conclusion Anemia, in particular iron-deficiency anemia, was found to be highly prevalent in females, whereas more than one-third of the male participants might be carriers of alpha or beta thalassemia. Additionally, low dietary iron intake and irregular meal consumption could be two of the possible causes of anemia in the study population. Conducting this study on a large scale of male and female students from different faculties of Jazan University will provide in-depth details about the prevalence and types of anemia among them.
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Affiliation(s)
- Hassan A Hamali
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, Gizan, Saudi Arabia
| | - Abdullah A Mobarki
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, Gizan, Saudi Arabia
| | - Muhammad Saboor
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, Gizan, Saudi Arabia
| | - Aymen Alfeel
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, Gizan, Saudi Arabia
| | - Aymen M Madkhali
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, Gizan, Saudi Arabia
| | - Mohammad S Akhter
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, Gizan, Saudi Arabia
| | - Gasim Dobie
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, Gizan, Saudi Arabia
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16
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Chai ZF, Gan WY, Chin YS, Ching YK, Appukutty M. Factors associated with anemia among female adult vegetarians in Malaysia. Nutr Res Pract 2019; 13:23-31. [PMID: 30788053 PMCID: PMC6369109 DOI: 10.4162/nrp.2019.13.1.23] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 12/21/2018] [Accepted: 01/15/2018] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND/OBJECTIVES A large number of studies on anemia have focused mostly on pregnant women or children. The vegetarian population, which is another potential risk group for anemia, remains largely unexplored. Therefore, this cross-sectional study examined the associations of the sociodemographic, lifestyle, nutritional, and psychological factors with the anemia status among female adult vegetarians. SUBJECTS/METHODS A total of 177 female vegetarians were recruited from a Buddhist and Hindu organization in Selangor, Malaysia. The participants completed a self-administered questionnaire, which analyzed their sociodemographic characteristics, physical activity level, sleep quality, depression, anxiety, and stress. The body weight, height, waist circumference, and body fat percentage of the participants were also measured. A 3-day dietary recall was conducted to assess their dietary intake. Blood samples (3 ml) were withdrawn by a nurse from each participant to determine the hemoglobin (Hb) level. RESULTS The findings revealed 28.2% of the participants to be anemic. The age group (AOR = 2.46, 95% CI = 1.19-5.05), marital status (AOR = 2.69, 95% CI = 1.27-5.71), and percentage of energy from protein (AOR = 5.52, 95% CI = 1.41-21.65) were the significant predictors of anemia. CONCLUSIONS Anemia is a public health problem among female vegetarians in this study. Health promotion programs that target female adult vegetarians should be conducted to manage and prevent anemia, particularly among those who are married, aged 50 and below, and with an inadequate protein intake.
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Affiliation(s)
- Zi Fei Chai
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, University Putra Malaysia, 43400 Serdang, Selangor Darul Ehsan, Malaysia
| | - Wan Ying Gan
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, University Putra Malaysia, 43400 Serdang, Selangor Darul Ehsan, Malaysia
| | - Yit Siew Chin
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, University Putra Malaysia, 43400 Serdang, Selangor Darul Ehsan, Malaysia.,Research Centre of Excellence for Nutrition and Non-Communicable Diseases, Faculty of Medicine and Health Sciences, University Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - Yuan Kei Ching
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, University Putra Malaysia, 43400 Serdang, Selangor Darul Ehsan, Malaysia
| | - Mahenderan Appukutty
- Sports Science Programme, Faculty of Sport Science and Recreation, University Teknologi MARA, 40450 Shah Alam, Selangor, Malaysia
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