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Mohamad MS, Abdul Maulud KN, Faes C. A practical illustration of spatial smoothing methods for disconnected regions with INLA: spatial survey on overweight and obesity in Malaysia. Int J Health Geogr 2023; 22:14. [PMID: 37344913 DOI: 10.1186/s12942-023-00336-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 06/01/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND National prevalence could mask subnational heterogeneity in disease occurrence, and disease mapping is an important tool to illustrate the spatial pattern of disease. However, there is limited information on techniques for the specification of conditional autoregressive models in disease mapping involving disconnected regions. This study explores available techniques for producing district-level prevalence estimates for disconnected regions, using as an example childhood overweight in Malaysia, which consists of the Peninsular and Borneo regions separated by the South China Sea. We used data from Malaysia National Health and Morbidity Survey conducted in 2015. We adopted Bayesian hierarchical modelling using the integrated nested Laplace approximation (INLA) program in R-software to model the spatial distribution of overweight among 6301 children aged 5-17 years across 144 districts located in two disconnected regions. We illustrate different types of spatial models for prevalence mapping across disconnected regions, taking into account the survey design and adjusting for district-level demographic and socioeconomic covariates. RESULTS The spatial model with split random effects and a common intercept has the lowest Deviance and Watanabe Information Criteria. There was evidence of a spatial pattern in the prevalence of childhood overweight across districts. An increasing trend in smoothed prevalence of overweight was observed when moving from the east to the west of the Peninsular and Borneo regions. The proportion of Bumiputera ethnicity in the district had a significant negative association with childhood overweight: the higher the proportion of Bumiputera ethnicity in the district, the lower the prevalence of childhood overweight. CONCLUSION This study illustrates different available techniques for mapping prevalence across districts in disconnected regions using survey data. These techniques can be utilized to produce reliable subnational estimates for any areas that comprise of disconnected regions. Through the example, we learned that the best-fit model was the one that considered the separate variations of the individual regions. We discovered that the occurrence of childhood overweight in Malaysia followed a spatial pattern with an east-west gradient trend, and we identified districts with high prevalence of overweight. This information could help policy makers in making informed decisions for targeted public health interventions in high-risk areas.
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Affiliation(s)
- Maria Safura Mohamad
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Arvo Ylpön Katu 34, 33520, Tampere, Finland.
| | - Khairul Nizam Abdul Maulud
- Department of Civil Engineering, Faculty of Engineering & Built Environment, National University of Malaysia, 43600, Bangi, Selangor, Malaysia
- Earth Observation Centre, Institute of Climate Change, National University of Malaysia, 43600, Bangi, Selangor, Malaysia
| | - Christel Faes
- Data Science Institute, I-BioStat, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium
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Mohamad MS, Mahadir Naidu B, Virtanen SM, Lehtinen-Jacks S, Abdul Maulud KN. Relationships of Local Food and Physical Activity Environments With Overweight in 5- to 17-Year-Old Malaysian Children. Asia Pac J Public Health 2023; 35:34-41. [PMID: 36321506 DOI: 10.1177/10105395221135407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Evidence on the associations between built environment and overweight in children outside developed countries is scarce. We examined associations between access to local food and physical activity environments and overweight in 5- to 17-year-old Malaysians in two states with differing overweight levels. Information on children was measured in the National Health and Morbidity Survey 2015 and combined with Geographic Information System-derived data on local food and physical activity environments. Access to the built environment was measured by presence and distance from child's residence. Complete data were available for 880 children. Access to local food outlets and parks was higher and associated with higher occurrence of overweight in children living in the state with higher overweight prevalence. When adjusted for sociodemographic factors, higher presence of and shorter distance to convenience stores and parks were associated with overweight. Both built environment and children's sociodemographic backgrounds should be considered when planning interventions to curb the overweight epidemic in Malaysia.
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Affiliation(s)
- Maria Safura Mohamad
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Balkish Mahadir Naidu
- Research and Methodology Unit, Department of Statistics Malaysia, Putrajaya, Malaysia
| | - Suvi M Virtanen
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland.,Health and Well-Being Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.,Centre for Child Health Research, Tampere University and Tampere University Hospital, Tampere, Finland.,The Science Centre of Pirkanmaa Hospital District, Tampere, Finland
| | - Susanna Lehtinen-Jacks
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland.,Division of Public Health Sciences, School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Khairul Nizam Abdul Maulud
- Earth Observation Centre, Institute of Climate Change, National University of Malaysia, Bangi, Malaysia.,Department of Civil Engineering, Faculty of Engineering and Built Environment, National University of Malaysia, Bangi, Malaysia
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Wong SF, Yap PS, Mak JW, Chan WLE, Khor GL, Ambu S, Chu WL, Mohamad MS, Ibrahim Wong N, Ab Majid NL, Abd Hamid HA, Rodzlan Hasani WS, Mohd Yussoff MFB, Aris HTB, Ab Rahman EB, M Rashid ZB. Association between long-term exposure to ambient air pollution and prevalence of diabetes mellitus among Malaysian adults. Environ Health 2020; 19:37. [PMID: 32245482 PMCID: PMC7119016 DOI: 10.1186/s12940-020-00579-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 02/18/2020] [Indexed: 02/16/2023]
Abstract
Background Malaysia has the highest rate of diabetes mellitus (DM) in the Southeast Asian region, and has ongoing air pollution and periodic haze exposure. Methods Diabetes data were derived from the Malaysian National Health and Morbidity Surveys conducted in 2006, 2011 and 2015. The air pollution data (NOx, NO2, SO2, O3 and PM10) were obtained from the Department of Environment Malaysia. Using multiple logistic and linear regression models, the association between long-term exposure to these pollutants and prevalence of diabetes among Malaysian adults was evaluated. Results The PM10 concentration decreased from 2006 to 2014, followed by an increase in 2015. Levels of NOx decreased while O3 increased annually. The air pollutant levels based on individual modelled air pollution exposure as measured by the nearest monitoring station were higher than the annual averages of the five pollutants present in the ambient air. The prevalence of overall diabetes increased from 11.4% in 2006 to 21.2% in 2015. The prevalence of known diabetes, underdiagnosed diabetes, overweight and obesity also increased over these years. There were significant positive effect estimates of known diabetes at 1.125 (95% CI, 1.042, 1.213) for PM10, 1.553 (95% CI, 1.328, 1.816) for O3, 1.271 (95% CI, 1.088, 1.486) for SO2, 1.124 (95% CI, 1.048, 1.207) for NO2, and 1.087 (95% CI, 1.024, 1.153) for NOx for NHMS 2006. The adjusted annual average levels of PM10 [1.187 (95% CI, 1.088, 1.294)], O3 [1.701 (95% CI, 1.387, 2.086)], NO2 [1.120 (95% CI, 1.026, 1.222)] and NOx [1.110 (95% CI, 1.028, 1.199)] increased significantly from NHMS 2006 to NHMS 2011 for overall diabetes. This was followed by a significant decreasing trend from NHMS 2011 to 2015 [0.911 for NO2, and 0.910 for NOx]. Conclusion The findings of this study suggest that long-term exposure to O3 is an important associated factor of underdiagnosed DM risk in Malaysia. PM10, NO2 and NOx may have mixed effect estimates towards the risk of DM, and their roles should be further investigated with other interaction models. Policy and intervention measures should be taken to reduce air pollution in Malaysia.
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Affiliation(s)
- Shew Fung Wong
- Institute for Research, Development and Innovation (IRDI), International Medical University, 57000, Kuala Lumpur, Malaysia. .,School of Medicine, International Medical University, 57000, Kuala Lumpur, Malaysia.
| | - Poh Sin Yap
- Institute for Research, Development and Innovation (IRDI), International Medical University, 57000, Kuala Lumpur, Malaysia.,School of Postgraduate Studies, International Medical University, 57000, Kuala Lumpur, Malaysia
| | - Joon Wah Mak
- Institute for Research, Development and Innovation (IRDI), International Medical University, 57000, Kuala Lumpur, Malaysia.,School of Medicine, International Medical University, 57000, Kuala Lumpur, Malaysia.,School of Postgraduate Studies, International Medical University, 57000, Kuala Lumpur, Malaysia
| | - Wan Ling Elaine Chan
- Institute for Research, Development and Innovation (IRDI), International Medical University, 57000, Kuala Lumpur, Malaysia
| | - Geok Lin Khor
- School of Postgraduate Studies, International Medical University, 57000, Kuala Lumpur, Malaysia
| | - Stephen Ambu
- Institute for Research, Development and Innovation (IRDI), International Medical University, 57000, Kuala Lumpur, Malaysia.,School of Medicine, International Medical University, 57000, Kuala Lumpur, Malaysia.,School of Postgraduate Studies, International Medical University, 57000, Kuala Lumpur, Malaysia
| | - Wan Loy Chu
- Institute for Research, Development and Innovation (IRDI), International Medical University, 57000, Kuala Lumpur, Malaysia.,School of Medicine, International Medical University, 57000, Kuala Lumpur, Malaysia.,School of Postgraduate Studies, International Medical University, 57000, Kuala Lumpur, Malaysia
| | - Maria Safura Mohamad
- Institute for Public Health, Ministry of Health, 40170, Shah Alam, Selangor, Malaysia
| | | | - Nur Liana Ab Majid
- Institute for Public Health, Ministry of Health, 40170, Shah Alam, Selangor, Malaysia
| | | | | | | | - Hj Tahir Bin Aris
- Institute for Public Health, Ministry of Health, 40170, Shah Alam, Selangor, Malaysia
| | - Ezahtulsyahreen Bt Ab Rahman
- Department of Environment, Ministry of Energy, Technology, Science, Environment and Climate Change, 62662, Putrajaya, Malaysia
| | - Zaleha Bt M Rashid
- Department of Environment, Ministry of Energy, Technology, Science, Environment and Climate Change, 62662, Putrajaya, Malaysia
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Ab Rahman J, Mohd Yusoff MF, Nik Mohamed MH, Mahadir Naidu B, Lim KH, Tee GH, Mohamad MS, Kartiwi M, Draman S, Ab Rahman NS, Aris T. The Prevalence of E-Cigarette Use Among Adults in Malaysia. Asia Pac J Public Health 2019; 31:9S-21S. [DOI: 10.1177/1010539519834735] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Electronic cigarettes (e-cigarettes) are a new method for the consumption of nicotine. A nationwide survey among 4288 Malaysian adults was conducted in 2016 to measure the prevalence and to describe the population characteristics of e-cigarette users. A complex sampling design was used, and data were collected using a face-to-face questionnaire. The overall prevalence of current, ever, former, and dual users of e-cigarettes in Malaysia were 3.2% (95% confidence interval [CI] = 2.5-4.1), 11.9% (95% CI = 10.5-13.5), 8.6% (95% CI = 7.5-9.8), and 2.3% (95% CI = 1.8-3.1), respectively. The prevalence of all type of e-cigarette use was higher in urban than in rural areas. Current e-cigarette users were likely to be younger, males, and with higher education level. Among current e-cigarette users, 74% (95% CI = 64-82) also smoked conventional cigarettes (dual user). E-cigarette use is prevalent in Malaysia. It is common among younger adults, males, and cigarette smokers.
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Affiliation(s)
| | | | | | | | - Kuang Hock Lim
- Institute for Medical Research, Ministry of Health, Kuala Lumpur, Malaysia
| | - Guat Hiong Tee
- Institute for Public Health, Ministry of Health, Kuala Lumpur, Malaysia
| | | | - Mira Kartiwi
- International Islamic University Malaysia, Kuantan, Malaysia
| | - Samsul Draman
- International Islamic University Malaysia, Kuantan, Malaysia
| | | | - Tahir Aris
- Institute for Public Health, Ministry of Health, Kuala Lumpur, Malaysia
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Gazola VAFG, Garcia RF, Curi R, Pithon-Curi TC, Mohamad MS, Hartmann EM, Barrena HC, Bazotte RB. Acute effects of isolated and combinedL-alanine andL-glutamine on hepatic gluconeogenesis, ureagenesis and glycaemic recovery in experimental short-term insulin induced hypoglycaemia. Cell Biochem Funct 2007; 25:211-6. [PMID: 16397910 DOI: 10.1002/cbf.1319] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The acute effects of isolated and combined L-alanine (L-Ala) and L-glutamine (L-Gln) on liver gluconeogenesis, ureagenesis and glycaemic recovery during short-term insulin-induced hypoglycaemia (IIH) were investigated. For this purpose, 24-h fasted rats that received intraperitoneal injection of regular insulin (1.0 U/Kg) were investigated. The control group (COG group) were represented by rats which received saline. The studies were performed 30 min after insulin (IIH group) or saline (COG group) injection. Livers from IIH and COG groups were perfused with basal or saturating levels of L-Ala, L-Gln or L-Gln + L-Ala (L-G + L-A). The production of glucose, urea, L-lactate and pyruvate in livers from IIH and COG group were markedly increased (p < 0.001) when perfused with saturating levels of L-Ala, L-Gln or L-G + L-A compared with basal levels of the same substrates. In addition, livers from IIH rats showed greater ability in producing glucose and urea from saturating levels of L-Ala compared with L-Gln or L-G + L-A. In agreement with these results, the oral administration of L-Ala (100 mg/kg) promoted better glycaemic recovery than L-Gln (100 mg/kg) or the combination of L-G (50 mg/kg) + L-A (50 mg/kg). It can be concluded that L-Ala, but not L-Gln or L-G + L-A could help glycaemic recovery by a mechanism mediated, partly at least, by the increased gluconeogenic and ureagenic efficiency of L-Ala.
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Affiliation(s)
- V A F G Gazola
- Department of Morphophysiological Sciences, State University of Maringá, 87020-900, Maringá, PR, Brazil
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