Predictors of Overweight and Obesity and Its Consequences among Senoi Orang Asli (Indigenous People) Women in Perak, Malaysia

Identifying obesogenic environment through spatial clustering of body mass index among adults

BACKGROUND

The escalating trend of obesity in Malaysia is surmounting, and the lack of evidence on the environmental influence on obesity is untenable. Obesogenic environmental factors often emerge as a result of shared environmental, demographic, or cultural effects among neighbouring regions that impact lifestyle. Employing spatial clustering can effectively elucidate the geographical distribution of obesity and pinpoint regions with potential obesogenic environments, thereby informing public health interventions and further exploration on the local environments. This study aimed to determine the spatial clustering of body mass index (BMI) among adults in Malaysia.

METHOD

This study utilized information of respondents aged 18 to 59 years old from the National Health and Morbidity Survey (NHMS) 2014 and 2015 at Peninsular Malaysia and East Malaysia. Fast food restaurant proximity, district population density, and district median household income were determined from other sources. The analysis was conducted for total respondents and stratified by sex. Multilevel regression was used to produce the BMI estimates on a set of variables, adjusted for data clustering at enumeration blocks. Global Moran's I and Local Indicator of Spatial Association statistics were applied to assess the general clustering and location of spatial clusters of BMI, respectively using point locations of respondents and spatial weights of 8 km Euclidean radius or 5 nearest neighbours.

RESULTS

Spatial clustering of BMI independent of individual sociodemographic was significant (p < 0.001) in Peninsular and East Malaysia with Global Moran's index of 0.12 and 0.15, respectively. High-BMI clusters (hotspots) were in suburban districts, whilst the urban districts were low-BMI clusters (cold spots). Spatial clustering was greater among males with hotspots located closer to urban areas, whereas hotspots for females were in less urbanized areas.

CONCLUSION

Obesogenic environment was identified in suburban districts, where spatial clusters differ between males and females in certain districts. Future studies and interventions on creating a healthier environment should be geographically targeted and consider gender differences.

Diseases among Orang Asli community in Malaysia: a systematic review

Orang Asli, the indigenous people of Peninsular Malaysia, is a minority population and placed behind in terms of socioeconomy, education and health. The Malaysian government has supported Orang Asli since the second Malaysia Plan in the 1970s, resulting in changes in their living standard, access to health, education and occupation. Hence, this review aims to assess the recent prevalence of diseases among Orang Asli in Peninsular Malaysia. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) review protocol guided this systematic review. The research question was formulated based on Population, Interest, Comparison and Outcome (PICO). The selected databases include Web of Science, Scopus, Ovid and EBSCOhost. The process of identification, screening and inclusion identified 33 articles. The mixed methods appraisal tool (MMAT) was then used to rank the quality of the articles. Selangor is the most frequent state involved in this review (12 studies), followed by Perak (10 studies), Pahang (10 studies) and Kedah (one study). We categorised into four categories of diseases, namely neglected tropical disease (n = 20), non-communicable disease (n = 6), nutritional status (n = 5), and hepatic disease (n = 2). The prevalence of diseases among Orang Asli is higher than in the general population, especially for soil-transmitted helminth (STH) and malnutrition. There is increasing research on non-communicable diseases due to an increasing trend in the socioeconomic status and lifestyle of the Orang Asli. Government agencies and private organisations must work together to empower Orang Asli with a healthy lifestyle, improve their socioeconomic status, and enhance food security, all of which will improve Orang Asli's health and reduce the prevalence of diseases.

Orang Asli Health and Lifeways Project (OA HeLP): a cross-sectional cohort study protocol

INTRODUCTION

Non-communicable disease (NCD) risk is influenced by environmental factors that are highly variable worldwide, yet prior research has focused mainly on high-income countries where most people are exposed to relatively homogeneous and static environments. Understanding the scope and complexity of environmental influences on NCD risk around the globe requires more data from people living in diverse and changing environments. Our project will investigate the prevalence and environmental causes of NCDs among the indigenous peoples of Peninsular Malaysia, known collectively as the Orang Asli, who are currently undergoing varying degrees of lifestyle and sociocultural changes that are predicted to increase vulnerability to NCDs, particularly metabolic disorders and musculoskeletal degenerative diseases.

METHODS AND ANALYSIS

Biospecimen sampling and screening for a suite of NCDs (eg, cardiovascular disease, type II diabetes, osteoarthritis and osteoporosis), combined with detailed ethnographic work to assess key lifestyle and sociocultural variables (eg, diet, physical activity and wealth), will take place in Orang Asli communities spanning a gradient from remote, traditional villages to acculturated, market-integrated urban areas. Analyses will first test for relationships between environmental variables, NCD risk factors and NCD occurrence to investigate how environmental changes are affecting NCD susceptibility among the Orang Asli. Second, we will examine potential molecular and physiological mechanisms (eg, epigenetics and systemic inflammation) that mediate environmental effects on health. Third, we will identify intrinsic (eg, age and sex) and extrinsic (eg, early-life experiences) factors that predispose certain people to NCDs in the face of environmental change to better understand which Orang Asli are at greatest risk of NCDs.

ETHICS AND DISSEMINATION

Approval was obtained from multiple ethical review boards including the Malaysian Ministry of Health. This study follows established principles for ethical biomedical research among vulnerable indigenous communities, including fostering collaboration, building cultural competency, enhancing transparency, supporting capacity building and disseminating research findings.

Impact of Malaysian palm oil on sustainable development goals: co-benefits and trade-offs across mitigation strategies

Palm oil (PO) is an important source of livelihood, but unsustainable practices and widespread consumption may threaten human and planetary health. We reviewed 234 articles and summarized evidence on the impact of PO on health, social and economic aspects, environment, and biodiversity in the Malaysian context, and discuss mitigation strategies based on the sustainable development goals (SDGs). The evidence on health impact of PO is equivocal, with knowledge gaps on whether moderate consumption elevates risk for chronic diseases, but the benefits of phytonutrients (SDG2) and sensory characteristics of PO seem offset by its high proportion of saturated fat (SDG3). While PO contributes to economic growth (SDG9, 12), poverty alleviation (SDG1, 8, 10), enhanced food security (SDG2), alternative energy (SDG9), and long-term employment opportunities (SDG1), human rights issues and inequities attributed to PO production persist (SDG8). Environmental impacts arise through large-scale expansion of monoculture plantations associated with increased greenhouse gas emissions (SDG13), especially from converted carbon-rich peat lands, which can cause forest fires and annual trans-boundary haze; changes in microclimate properties and soil nutrient content (SDG6, 13); increased sedimentation and change of hydrological properties of streams near slopes (SDG6); and increased human wildlife conflicts, increase of invasive species occurrence, and reduced biodiversity (SDG14, 15). Practices such as biological pest control, circular waste management, multi-cropping and certification may mitigate negative impacts on environmental SDGs, without hampering progress of socioeconomic SDGs. While strategies focusing on improving practices within and surrounding plantations offer co-benefits for socioeconomic, environment and biodiversity-related SDGs, several challenges in achieving scalable solutions must be addressed to ensure holistic sustainability of PO in Malaysia for various stakeholders.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s11625-021-01052-4.

Genetic and Environmental Factors Contributing to Visceral Adiposity in Asian Populations

Obesity-associated metabolic illnesses are increasing at an alarming rate in Asian countries. A common feature observed in the Asian population is a higher incidence of abdominal obesity-the "skinny-fat" Asian syndrome. In this review, we critically evaluate the relative roles of genetics and environmental factors on fat distribution in Asian populations. While there is an upward trend in obesity among most Asian countries, it appears particularly conspicuous in Malaysia. We propose a novel theory, the Malaysian gene-environment multiplier hypothesis, which explains how ancestral variations in feast-and-famine cycles contribute to inherited genetic predispositions that, when acted on by modern-day stressors-most notably, urbanization, westernization, lifestyle changes, dietary transitions, cultural pressures, and stress-contribute to increased visceral adiposity in Asian populations. At present, the major determinants contributing to visceral adiposity in Asians are far from conclusive, but we seek to highlight critical areas for further research.