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Harun Z, Shahar S, You YX, Manaf ZA, Majid HA, Chia YC, Haron H, Michael V, Sukiman NS, Taib AFM, He FJ, Brown MK. Perceptions, barriers and enablers of salt reduction in Malaysian out-of-home sectors (MySaltOH): from the point of view of policy-makers and food industries. Health Res Policy Syst 2023; 21:17. [PMID: 36759869 PMCID: PMC9910255 DOI: 10.1186/s12961-023-00965-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 01/20/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND High salt intake is a major cause of hypertension and cardiovascular diseases. The out-of-home sectors have been identified as one of the contributors of high salt intake in the population. The National Salt Reduction Policy of Malaysia was initiated in 2015; however, out-of-home sectors are yet to be emphasized and perception by policy-makers and the food industries towards salt reduction are yet unknown. This study aimed to determine the perceptions, barriers and enablers towards salt reduction in the out-of-home sector in Malaysia, as well as among policy-makers and the food industries. METHODS This is a qualitative study via semi-structured in-depth interviews (IDI) and focus group discussions (FGD) involving several stakeholders consisting of policy-makers from five ministries, five nongovernment organizations (NGOs) and food science/food technology researchers from five regions (West, North, East, and South Peninsular and East Malaysia/Borneo), as well as the food industries. The IDI and FGD sessions were recorded, transcribed verbatim and analysed thematically using Nvivo software version 12. RESULTS All participants agreed that salt intake in Malaysia is high and leads to hypertension and cardiovascular diseases. Lack of awareness, poor eating culture and behaviour and frequent eating out were among the causes of high salt intake. Awareness campaigns and education, sodium content labelling and product reformulation were strategies that have been implemented by the government; whilst for the food industries, some of them have tried to reduce salt and labelled the sodium content on their food products. However, there were several barriers including perceived poor consumer acceptance, lack of knowledge and resources, and challenges in reformulation, as well as unavailability of guidelines and salt targets. Hence, several enablers have been suggested, which include prioritizing the salt reduction strategy, creating more awareness, collaboration and engagement, research and technology particularly for reformulation and shelf-life stability, incentives and salt tax. CONCLUSIONS Salt reduction efforts of the out-of-home sector in Malaysia could be achieved through several measures or enablers that can overcome the barriers currently faced by stakeholders, especially policy-makers, food industries and the consumers themselves. This study will benefit the policy-makers to improve the salt reduction policy of out-of-home sectors and highlight the concerns among the food industries on the policy.
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Affiliation(s)
- Zaliha Harun
- Dietetic Programme, Centre for Healthy Ageing and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Suzana Shahar
- Dietetic Programme, Centre for Healthy Ageing and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia.
| | - Yee Xing You
- Dietetic Programme, Centre for Healthy Ageing and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Zahara Abdul Manaf
- Dietetic Programme, Centre for Healthy Ageing and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Hazreen Abdul Majid
- Centre for Population Health, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
- School of Chiropractor, AECC University College, Parkwood Campus, Parkwood Road, Bournemouth, Dorset, BH5 2DF, United Kingdom
| | - Yook Chin Chia
- Department of Medical Sciences, School of Medical and Life Sciences, Sunway University, 47500, Bandar Sunway, Selangor Darul Ehsan, Malaysia
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Hasnah Haron
- Nutritional Sciences Programme, Centre for Healthy Ageing and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Viola Michael
- Allied Health Sciences Division, Ministry of Health Malaysia, Level 2, Block A, Chancery Place Main Building, Jalan Diplomatik 2, Precinct Diplomatik, Precinct 15, 62050, Putrajaya, Malaysia
| | - Noor Shahida Sukiman
- Dietetic Programme, Centre for Healthy Ageing and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Aida Farzana Mohamad Taib
- Nutritional Sciences Programme, Centre for Healthy Ageing and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Feng J He
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, EC1M 6BQ, United Kingdom
| | - Mhairi K Brown
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, EC1M 6BQ, United Kingdom
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Tayyem R, Hamdan A, Alhmmadi K, Eissa Y, Al-Adwi M, Al-Haswsa Z, Bawadi H, Shi Z. Association of Glycemic Control With Different Diets Followed by Patients With Type 2 Diabetes: Findings From Qatar Biobank Data. Front Nutr 2022; 9:813880. [PMID: 35619957 PMCID: PMC9127728 DOI: 10.3389/fnut.2022.813880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background Diabetes mellitus type 2 (T2DM) is one of the most common diseases worldwide. Unhealthy dietary habits may lead to T2DM, which is also influenced by the extent of education and knowledge of appropriate diets for this disease. Aim This study aims to highlight the possible association between following different types of diet (low-fat diet, low-calorie diet, low-salt diet, and more than one diet) and glycemic control among Qatari and long-term resident patients with T2DM. Methods This study is secondary data analysis. Qatar Biobank (QBB) data on 2448 T2DM patients aged 18-60 years were obtained. The first group included participants with HbA1C <7%, while the second included those with HbA1c ≥ 7%. Results The results of the association of glycemic control with different diets followed by patients with type 2 diabetes were adjusted in four models. In the 4th model (adjusted for gender, age, sociodemographic, anthropometric, dietary habits, comorbidities, and medications), results showed that poor patients with poor glycemic control have higher odds [OR 1.90; CI (1-3.63)] of following a low-salt diet. The same observation was found in the low-fat diet [OR 1.73; CI (1.06-3.07)]. However, patients following more than one diet showed lower odds of having poor glycemic control for about 32% [OR.69; CI (0.48-0.98)]. Conclusion Diet and lifestyle are vital factors that can affect HbA1C levels. The findings of this secondary analysis showed that better glycemic control of the patients was observed in patients following more than diet from the studied diets.
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Affiliation(s)
- Reema Tayyem
- Department of Human Nutrition, College of Health Sciences, Qatar University, Doha, Qatar
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Anual ZF, Mohammad Sham N, Ambak R, Othman F, Shaharudin R. Urinary Concentrations of Metals and Metalloids in Malaysian Adults. EXPOSURE AND HEALTH 2021; 13:391-401. [PMID: 34722950 PMCID: PMC8550151 DOI: 10.1007/s12403-021-00390-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 02/03/2021] [Accepted: 03/10/2021] [Indexed: 06/13/2023]
Abstract
Exposure to environmental pollutants in humans can be conducted through direct measurement of biological media such as blood, urine or hair. Assessment studies of metals and metalloids in Malaysia is very scarce although cross-sectional nationwide human biomonitoring surveys have been established by the USA, Canada, Germany, Spain, France, and Korea. This study aims to assess urinary metal levels namely cadmium (Cd), nickel (Ni), lead (Pb) and arsenic (As) among Malaysian adults. This was a cross-sectional study involving 1440 adults between the age of 18 and 88 years old. After excluding those with 24 h urine samples of less than 500 ml, urine creatinine levels < 0.3 or > 3.0 g/L and those who refuse to participate in the study, a total of 817 respondents were included for analysis. A questionnaire with socio-demographic information such as age, gender, occupation, ethnic, academic qualification and medical history was administered to the respondents. Twenty-four-hour urine samples were collected in a container before being transported at 4 °C to the laboratory. Samples were then aliquoted into 15 ml tubes and kept at - 80 °C until further analysis. Urine was diluted ten-fold with ultrapure water, filtered and analysed for metals and metalloids using Inductively Coupled Plasma-Mass Spectrometry (ICP-MS). The geometric mean of urinary As, Ni, Cd and Pb concentrations among adults in Malaysia was 48.21, 4.37, 0.32, and 0.80 µg/L, respectively. Males showed significantly higher urinary metal concentrations compared to females for As, Cd and Pb except for Ni. Those who resided in rural areas exhibited significantly higher As, Cd and Pb urinary concentrations than those who resided in urban areas. As there are no nationwide data on urinary metals, findings from this study could be used to identify high exposure groups, thus enabling policy makers to improve public health strategically.
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Affiliation(s)
- Zurahanim Fasha Anual
- Environmental Health Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health, Shah Alam, 40170 Malaysia
| | - Noraishah Mohammad Sham
- Environmental Health Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health, Shah Alam, 40170 Malaysia
| | - Rashidah Ambak
- Centre for Nutrition Epidemiology Research, Institute for Public Health, National Institutes of Health, Ministry of Health, Shah Alam, 40170 Malaysia
| | - Fatimah Othman
- Dietetic and Food Service Department, Hospital Sultanah Aminah, Ministry of Health, Johor Bahru, 80000 Malaysia
| | - Rafiza Shaharudin
- Environmental Health Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health, Shah Alam, 40170 Malaysia
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