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Raman P, Sagadevan Y, Dhanapalan S, Fernandez BJ, Tan SY, Appalasamy JR, Ramadas A. Lifestyle-Related Risk Factors and Primary Prevention Strategies for Cardiovascular Diseases in a Middle-Income Country: A Scoping Review and Implication for Future Research. JOURNAL OF PREVENTION (2022) 2024; 45:579-609. [PMID: 38839738 PMCID: PMC11271377 DOI: 10.1007/s10935-024-00782-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/04/2024] [Indexed: 06/07/2024]
Abstract
Cardiovascular diseases are the leading cause of death in middle-income countries such as Malaysia. There is a significant gap in knowledge between cardiovascular disease-related risk assessments and interventions in the Malaysian population. In this scoping review, we have determined the status of cardiovascular research in Malaysia by prioritising lifestyle-related risk assessments and interventions. We searched five electronic databases (Ovid MEDLINE, Cochrane Central Register of Controlled Trials, APA PsychINFO, Embase and Scopus) to identify relevant research articles that had been published. The Joanna Briggs Institute and the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews served as a guide for the scoping review. Study selection was made using the Covidence platform, screened, and extracted. Thirty-one studies were included in this review. Studies reviewed reported a significant positive association between physical inactivity, smoking, poor dietary patterns, working hours, clustering of lifestyle risk, and cardiovascular disease risk. Most interventions focused on physical activity and a multimodal lifestyle approach, significantly improving primary and secondary cardiovascular disease-related outcomes. The findings suggest improving lifestyle-related risk assessments and interventions to prevent cardiovascular diseases in this population. It is unclear if these outcomes can translate to higher effectiveness in preventing cardiovascular disease. Nevertheless, intervention using the multifaceted lifestyle approach can improve cardiovascular disease-related outcomes.
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Affiliation(s)
- Pragashini Raman
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Sunway City, Malaysia
| | - Yoganishalini Sagadevan
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Sunway City, Malaysia
| | - Sornavalli Dhanapalan
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Sunway City, Malaysia
| | - Brandon J Fernandez
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Sunway City, Malaysia
| | - Sheng Yew Tan
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Sunway City, Malaysia
| | - Jamuna Rani Appalasamy
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Sunway City, Malaysia
| | - Amutha Ramadas
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Sunway City, Malaysia.
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Hasbullah FY, Mohd Yusof BN, Shyam S, Abdul Ghani R, Mohamed Khir HI. Dietary Patterns Associated with Abnormal Glucose Tolerance following Gestational Diabetes Mellitus: The MyNutritype Study. Nutrients 2023; 15:2819. [PMID: 37375723 DOI: 10.3390/nu15122819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/14/2023] [Accepted: 06/18/2023] [Indexed: 06/29/2023] Open
Abstract
Abnormal glucose tolerance (AGT), which includes type 2 diabetes and pre-diabetes, is highly prevalent in women post gestational diabetes mellitus (post-GDM). Dietary patterns have been associated with the risk of developing AGT in women post-GDM, but evidence in Asian populations is sparse. This study aimed to determine the association between a posteriori dietary patterns and AGT in women post-GDM. This cross-sectional study recruited 157 women post-GDM (mean age 34.8 years) from Seri Kembangan Health Clinic and Universiti Putra Malaysia. AGT was diagnosed according to the Malaysian Clinical Practice Guidelines using a 75 g 2 h oral glucose tolerance test or HbA1c. Food intake was assessed using the 2014 Malaysian Adult Nutrition Survey food frequency questionnaire. Five dietary patterns were derived using principal component analysis: 'Unhealthy', 'Fish-eggs-fruits-vegetables', 'Cereals-confectionaries', 'Legumes-dairy', and 'Meat-sugar-sweetened-beverages'. After adjusting for sociodemographic characteristics and total energy intake, the 'Cereals-confectionaries' dietary pattern was significantly associated with AGT (adjusted odds ratio 1.536, p = 0.049). Targeted lifestyle modification, including dietary intervention, for women post-GDM is warranted to reduce their risk of AGT and its complications.
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Affiliation(s)
- Farah Yasmin Hasbullah
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Barakatun-Nisak Mohd Yusof
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
- Diabetes Research Unit, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
- Institute for Social Science Studies, Putra Infoport, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Sangeetha Shyam
- Unitat de Nutrició Humana, Departament de Bioquímica i Biotecnologia, Universitat Rovira i Virgili, 43204 Reus, Spain
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Hospital Universitari Sant Joan de Reus, 43204 Reus, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Centre for Translational Research, IMU Institute for Research and Development (IRDI), International Medical University (IMU), Kuala Lumpur 57000, Malaysia
| | - Rohana Abdul Ghani
- Department of Internal Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh 47000, Selangor, Malaysia
- The Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Sungai Buloh 47000, Selangor, Malaysia
| | - Hannah Izzati Mohamed Khir
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
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Hasbullah FY, Mohd Yusof BN, Abdul Ghani R, Mat Daud Z‘A, Appannah G, Abas F, Shyam S. Maternal and Dietary Factors Are Associated with Metabolic Syndrome in Women with a Previous History of Gestational Diabetes Mellitus. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16797. [PMID: 36554678 PMCID: PMC9779785 DOI: 10.3390/ijerph192416797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/06/2022] [Accepted: 12/11/2022] [Indexed: 06/17/2023]
Abstract
While it is known that women with a previous history of gestational diabetes mellitus (post-GDM) have a higher risk of metabolic syndrome (MetS), evidence of lifestyle practices from low- and middle-income countries (LMICs) is still scarce. This study aimed to determine the factors associated with MetS in women post-GDM. This cross-sectional study involved 157 women post-GDM (mean age 34.8 ± 5.6 years) sampled from Selangor, Malaysia. We collected data on sociodemographic characteristics and obstetric history. Food intake was assessed using a food frequency questionnaire, and dietary patterns were derived from principal component analysis. MetS was diagnosed according to the 2009 Harmonized criteria. The prevalence of MetS in this study was 22.3%. Western dietary pattern consumption was correlated with MetS, body mass index (BMI), waist circumference, and triglyceride levels. Independent factors associated with MetS were lower education level (odds ratio, OR 4.017, p = 0.007), pre-pregnancy BMI (OR 1.192, p = 0.002), and Caesarean delivery (OR 3.798, p = 0.009). The study identified the maternal and dietary factors associated with MetS in women post-GDM in Malaysia. Community-based interventions that include dietary modification are warranted to prevent MetS and its complications, thus helping to reduce the overall disease burden.
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Affiliation(s)
- Farah Yasmin Hasbullah
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Barakatun-Nisak Mohd Yusof
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
- Diabetes Research Unit, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
- Institute for Social Science Studies, Putra Infoport, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Rohana Abdul Ghani
- Department of Internal Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh 47000, Selangor, Malaysia
| | - Zulfitri ‘Azuan Mat Daud
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Geeta Appannah
- Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Faridah Abas
- Department of Food Science, Faculty of Food Science and Technology, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Sangeetha Shyam
- Unitat de Nutrició Humana, Departament de Bioquímica i Biotecnologia, Universitat Rovira i Virgili, 43201 Reus, Spain
- Institut d’Investigació Sanitària Pere Virgili (IISPV), Hospital Universitari Sant Joan de Reus, 43204 Reus, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Centre for Translational Research, IMU Institute for Research and Development (IRDI), International Medical University (IMU), Kuala Lumpur 57000, Malaysia
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Kocher E, Wood D, Lim SC, Jackson-Morris A, Kataria I, Ngongo C, Sham Z, Chandran A, Nugent R, Mustapha FI. Community priorities for obesity prevention among low-income adults in Kuala Lumpur: a discrete choice experiment. Health Promot Int 2022; 37:6823575. [PMID: 36367424 PMCID: PMC9651037 DOI: 10.1093/heapro/daac156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Non-communicable diseases and associated risk factors, such as obesity, are prevalent and increasing in Malaysia. To address this burden and the heightened vulnerability of low-income communities to these risk factors, the Better Health Programme Malaysia conducted a partial-profile discrete choice experiment (DCE) to inform the design of a community-based obesity-prevention programme. The DCE survey was conducted with community members (n = 1453) from three publicly supported low-cost, high-rise flat complexes in urban Kuala Lumpur. In the survey, community members were asked to choose between different sets of potential evidence-based interventions for obesity prevention. Their responses to these choice tasks were analysed to quantify preferences for these different health interventions using a random utility maximization model. Based on these results, we determined participants’ relative prioritization of the different options. The most preferred interventions were those that reduced the price of fruit and vegetables; altered cooking practices at restaurants and food vendors to reduce salt, sugar and oil; and offered reward incentives for completing online educational activities. Community members did not prioritize several evidence-based interventions, including changes to product placement or product labelling, suggesting that these effective approaches may be less familiar or simply not preferred by respondents. The DCE enabled the clear articulation of these community priorities for evidence-based interventions that focus on the supply and promotion of affordable healthy foods within the local food environment, as well as community demand for healthier food options.
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Affiliation(s)
- Erica Kocher
- Global Health Division, Center for Global Noncommunicable Diseases, RTI International , 3040 East Cornwallis Road, Research Triangle Park, NC 27709 , USA
| | - Dallas Wood
- Center for Applied Economics and Strategy , 3040 East Cornwallis Road, Research Triangle Park, NC 27709 , USA
| | - Shiang-Cheng Lim
- RTI International, Global Health Division, Suite 5.2 & 5.3, Level 5, Nucleus Tower, Jalan PJU 7/2 Mutiara Damansara, 47820, Petaling Jaya, Selangor , Malaysia
| | - Angie Jackson-Morris
- Center for Applied Economics and Strategy , 3040 East Cornwallis Road, Research Triangle Park, NC 27709 , USA
| | - Ishu Kataria
- Global Health Division, RTI International, 6th Floor, Commercial Tower, Pullman Hotel, Aerocity New Delhi 100037 , India
| | - Carrie Ngongo
- Center for Applied Economics and Strategy , 3040 East Cornwallis Road, Research Triangle Park, NC 27709 , USA
| | - Zhi Sham
- RTI International, Global Health Division, Suite 5.2 & 5.3, Level 5, Nucleus Tower, Jalan PJU 7/2 Mutiara Damansara, 47820, Petaling Jaya, Selangor , Malaysia
| | - Arunah Chandran
- Non-Communicable Disease (NCD) Section, Disease Control Division, Ministry of Health , Level 2, Block E2, Complex E, Federal Government Administration Centre, 62590 Putrajaya , Malaysia
| | - Rachel Nugent
- Center for Applied Economics and Strategy , 3040 East Cornwallis Road, Research Triangle Park, NC 27709 , USA
| | - Feisul Idzwan Mustapha
- Non-Communicable Disease (NCD) Section, Disease Control Division, Ministry of Health , Level 2, Block E2, Complex E, Federal Government Administration Centre, 62590 Putrajaya , Malaysia
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Landais E, Miotto-Plessis M, Bene C, Maitre d’Hotel E, Truong MT, Somé JW, Verger EO. Consumption of food away from home in low- and middle-income countries: a systematic scoping review. Nutr Rev 2022; 81:727-754. [PMCID: PMC10170323 DOI: 10.1093/nutrit/nuac085] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023] Open
Abstract
Context Consumption of food away from home represents an increasing share of people’s food consumption worldwide, although the percentage of food intake that is consumed away from home varies among countries and among individuals. Previous systematic reviews have reported that, overall, consumption away from home negatively affects an individual’s diet and nutritional status. However, these reviews have mainly focused on high-income countries, leaving a gap in knowledge and data for people in low- and middle-income countries (LMICs). Objective The present review aimed to describe trends in the consumption of food away from home in an apparently healthy population in low- and middle-income countries (LMICs) and to investigate any associations between this behavior and diet quality, nutritional status, and health outcomes. Data Sources A structured search strategy was developed for retrieving (from MEDLINE [via PubMed], Web of Science, and Scopus) peer-reviewed articles published in English from March 2011 until May 2021. Data Extraction Forty studies were included, and from them information was obtained based on data from 12 different countries. A qualitative and descriptive approach was used to review the evidence. Data Analysis It was found that there was large heterogeneity in the definition of food consumed away from home and the methods used to measure it, making comparisons and syntheses difficult. Consumption of food away from home in LMICs was relatively common and was positively driven by factors such as being a male, being young, having a high socio-economic status, being educated, and living in urban areas. As in high-income countries, consumption of food away from home in LMICs had unfavorable effects on an individual’s diet quality, nutritional status, and health. Conclusion There is a need to develop harmonized surveillance systems for better monitoring of the phenomenon of food consumption away from home in LMICs, including a need for a standardized definition for food consumed away from home, to enable the design of effective regulatory policies.
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Affiliation(s)
- Edwige Landais
- are with the MoISA, University of Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD, Montpellier, France
| | - Mathilda Miotto-Plessis
- are with the MoISA, University of Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD, Montpellier, France
| | - Chris Bene
- is with the International Center for Tropical Agriculture, Cali, Colombia
- is with the Wageningen Economic Research Group, Wageningen University, The Netherlands
| | - Elodie Maitre d’Hotel
- are with the MoISA, University of Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD, Montpellier, France
- is with the CIRAD, UMR MOISA, Montpellier, France
| | - Mai Tuyet Truong
- is with the Nutrition-Network Department, National Institute of Nutrition, Hanoi, Vietnam
| | - Jérome W Somé
- is with the Département Biomédical et Santé Publique, Centre National de la Recherche Scientifique et Technologique, Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso
| | - Eric O Verger
- are with the MoISA, University of Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD, Montpellier, France
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Association between a dietary pattern high in saturated fatty acids, dietary energy density, and sodium with coronary heart disease. Sci Rep 2022; 12:13049. [PMID: 35906378 PMCID: PMC9336144 DOI: 10.1038/s41598-022-17388-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/25/2022] [Indexed: 11/08/2022] Open
Abstract
This study aimed to determine the association between dietary pattern (DP) and coronary heart disease (CHD) among high-risk adults as determined by metabolic syndrome (MetS) criteria in Malaysia. This cross-sectional study involved 365 participants with (CHD = 178; non-CHD = 187) who were recruited from selected health clinics. Dietary intake was measured using a 189-item semi-quantitative foods frequency questionnaire (FFQ) whilst anthropometry and clinical data were measured by trained researcher and biochemical data were obtained from medical records. The reduced rank regression (RRR) method was used to derive DPs scores and binary logistic regression was used to assess the associations between identified DPs and CHD. The main DP found in this study was characterised by “high saturated fatty acid (SFA), high dietary energy density (DED), high sodium”. This DP, which is attributed to high consumption of coconut-based dishes, fast foods and snacks, rice dishes, fat spread, seasoning sauces, salted and processed foods, and low intake of fruits, green leafy vegetables, white rice and other vegetables were associated with CHD (OR:1.32, 95% CI:1.03, 1.69) p value = 0.026 when, adjusted for age, sex, race, education level, household income, family history of CHD, marital status, smoking status, physical activity, stress level and BMI. This study suggests that individuals with a DP of high SFA, high DED, and high sodium have a significantly increased likelihood of having CHD compared to those who do not practice this DP.
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de Quadros VP, Balcerzak A, Allemand P, de Sousa RF, Bevere T, Arsenault J, Deitchler M, Holmes BA. Global Trends in the Availability of Dietary Data in Low and Middle-Income Countries. Nutrients 2022; 14:nu14142987. [PMID: 35889943 PMCID: PMC9324857 DOI: 10.3390/nu14142987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/06/2022] [Accepted: 07/12/2022] [Indexed: 02/05/2023] Open
Abstract
Individual-level quantitative dietary data can provide suitably disaggregated information to identify the needs of all population sub-groups, which can in turn inform agricultural, nutrition, food safety, and environmental policies and programs. The purpose of this discussion paper is to provide an overview of dietary surveys conducted in low- and middle-income countries (LMICs) from 1980 to 2019, analyzing their key characteristics to understand the trends in dietary data collection across time. The present study analyzes the information gathered by the Food and Agriculture Organization of the United Nations/World Health Organization Global Individual Food consumption data Tool (FAO/WHO GIFT). FAO/WHO GIFT is a growing repository of individual-level dietary data and contains information about dietary surveys from around the world, collected through published survey results, literature reviews, and direct contact with data owners. The analysis indicates an important increase in the number of dietary surveys conducted in LMICs in the past four decades and a notable increase in the number of national dietary surveys. It is hoped that this trend continues, together with associated efforts to validate and standardize the dietary methods used. The regular implementation of dietary surveys in LMICs is key to support evidence-based policies for improved nutrition.
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Affiliation(s)
- Victoria Padula de Quadros
- Food and Agriculture Organization of the United Nations (FAO), 00153 Rome, Italy; (A.B.); (P.A.); (R.F.d.S.); (T.B.); (B.A.H.)
- Correspondence:
| | - Agnieszka Balcerzak
- Food and Agriculture Organization of the United Nations (FAO), 00153 Rome, Italy; (A.B.); (P.A.); (R.F.d.S.); (T.B.); (B.A.H.)
| | - Pauline Allemand
- Food and Agriculture Organization of the United Nations (FAO), 00153 Rome, Italy; (A.B.); (P.A.); (R.F.d.S.); (T.B.); (B.A.H.)
| | - Rita Ferreira de Sousa
- Food and Agriculture Organization of the United Nations (FAO), 00153 Rome, Italy; (A.B.); (P.A.); (R.F.d.S.); (T.B.); (B.A.H.)
| | - Teresa Bevere
- Food and Agriculture Organization of the United Nations (FAO), 00153 Rome, Italy; (A.B.); (P.A.); (R.F.d.S.); (T.B.); (B.A.H.)
| | - Joanne Arsenault
- Intake—Center for Dietary Assessment, FHI Solutions, Washington, DC 20009, USA; (J.A.); (M.D.)
| | - Megan Deitchler
- Intake—Center for Dietary Assessment, FHI Solutions, Washington, DC 20009, USA; (J.A.); (M.D.)
| | - Bridget Anna Holmes
- Food and Agriculture Organization of the United Nations (FAO), 00153 Rome, Italy; (A.B.); (P.A.); (R.F.d.S.); (T.B.); (B.A.H.)
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Sualeheen A, Khor BH, Balasubramaniam GV, Sahathevan S, Chinna K, Mat Daud ZA, Khosla P, Abdul Gafor AH, Karupaiah T. Benchmarking Diet Quality to Assess Nutritional Risk in Hemodialysis Patients: Applying Adequacy and Moderation Metrics of the Hemodialysis-Healthy Eating Index. J Ren Nutr 2022; 32:726-738. [PMID: 35182714 DOI: 10.1053/j.jrn.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 02/01/2022] [Accepted: 02/06/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES This study modified Healthy Eating Index (HEI) based on hemodialysis (HD) specific guidelines and investigated associations between the diet quality (DQ) and nutritional risk in HD patients. METHODS The HD-HEI tool adapted the XXX Dietary Guidelines 2010 framework according to HD-specific nutrition guidelines. This HD-HEI was applied to 3-day dietary records of 382 HD patients. Relationships between HD-HEI scores and nutritional parameters were tested by partial correlations. Binary logistic regression models adjusted with confounders were used to determine adjusted odds ratio (adjOR) with 95% confidence interval (CI) for nutritional risk based on HD-HEI scores categorization. RESULTS The total HD-HEI score (51.3 ± 10.2) for this study population was affected by ethnicity (Ptrend<0.001) and sex (P=0.003). No patient achieved "good" DQ (score: 81-100), while DQ of 54.5% patients were classified as "needs improvement" (score: 51-80) and remaining as "poor" (score: 0-51). Total HD-HEI scores were positively associated with dietary energy intake (DEI) and dietary protein intakes (DPI), dry weight and handgrip strength, but inversely associated with Dietary Monotony Index (DMI) (all P<0.05). Individually, scores for refined grain, total protein, and animal protein were positively associated with DEI (all P< 0.05), whilst total, animal, fish and vegetable proteins indicated positive associations with DPI (all P< 0.05). Moderating metrics for convenience meals, saturated fats, sodium, and fluid negatively correlated towards DEI with similar trends for DPI excepting convenience meals and fluids. "Poor" DQ was associated with DMI ≥ 29.2 (adjOR: 18.83, 95% CI: 9.36-37.86, P<0.001), Malnutrition Inflammation Score (MIS) ≥ 5 (adjOR: 1.78, 95% CI: 1.01-3.15, P=0.045), and Protein Energy Wasting (PEW) (adjOR: 1.96, 95% CI: 1.14-3.34, P=0.031), but became nullified with covariate adjustments. "Poor" DQ was also associated with low lean tissue mass (< 32.6 kg) in men (adjOR: 2.38, 95% CI: 1.01-5.58, P=0.046) but not women. CONCLUSIONS "Poor" DQ was associated with poor nutritional status in XXX HD patients, who should be targeted for nutritional counselling.
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Affiliation(s)
- Ayesha Sualeheen
- Dietetics Program, Faculty of Health Sciences, University Kebangsaan Malaysia, 50300, Kuala Lumpur, Malaysia
| | - Ban-Hock Khor
- Faculty of Food Science and Nutrition, University Malaysia Sabah, 88400, Kota Kinabalu, Malaysia
| | | | - Sharmela Sahathevan
- Dietetics Program, Faculty of Health Sciences, University Kebangsaan Malaysia, 50300, Kuala Lumpur, Malaysia
| | - Karuthan Chinna
- School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor 47500, Malaysia
| | - Zulfitri Azuan Mat Daud
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor 43400, Malaysia
| | - Pramod Khosla
- Department of Nutrition and Food Science, Wayne State University, Detroit, MI 48202, USA
| | - Abdul Halim Abdul Gafor
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, 56000, Kuala Lumpur, Malaysia
| | - Tilakavati Karupaiah
- School of Biosciences, Faculty of Health & Medical Science, Taylor's University Lakeside Campus, Jalan Taylor's, 47500, Subang Jaya, Selangor, Malaysia.
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