Characteristics associated with the consumption of malted drinks among Malaysian primary school children: findings from the MyBreakfast study

BACKGROUND

The consumption of beverages contributes to diet quality and overall nutrition. Studies on malted drinks, one of the widely consumed beverage choices among children in Asia, however, have received limited attention. This study aimed to examine the prevalence of malted drink consumption and explored associations of sociodemographic characteristics, nutrient intakes, weight status and physical activity levels with malted drink consumption among primary school children in Malaysia.

METHODS

Data for this analysis were from the MyBreakfast Study, a national cross-sectional study conducted from April to October 2013 throughout all regions in Malaysia. A total of 2065 primary school children aged 6 to 12 years were included in the present analysis. Data on two days 24-h dietary recall or record, anthropometry, physical activity and screen time were recorded. Associations between malted drink consumption and related factors were examined using binary logistic regression, adjusting for region, area, gender, ethnicity and household income.

RESULTS

Among children aged 6 to 12 years, 73.5% reported consuming malted drinks for at least once per week. Consumption of malted drinks was significantly associated with region (χ(2) = 45.64, p < 0.001), gender (χ(2) = 4.41, p = 0.036) and ethnicity (χ(2) = 13.74, p = 0.008). Malted drink consumers had similar total energy intake but higher micronutrient intakes compared to non-consumers. High physical activity level (OR = 1.77, 95% CI = 1.06, 2.99) and lower screen time during weekends (OR = 0.93, 95% CI = 0.86, 0.99) were independently associated with malted drink consumption among 6 to 9 year-old children, but not among 10 to 12 year-old children. No association was observed between malted drink consumption and weight status.

CONCLUSIONS

Malted drink consumption is prevalent among Malaysian primary school children, particularly higher among boys, indigenous children and those who lived in the East Coast region of Malaysia. Consuming malted drinks is associated with higher micronutrient intakes and higher levels of physical activity, but not with body weight status.

Whole Grain Intakes in the Diets Of Malaysian Children and Adolescents--Findings from the MyBreakfast Study

Background

Diets rich in whole grain are associated with several health benefits. Little is known however, about whole grain consumption patterns in Malaysia. The aim of this study was to assess whole grain intakes and dietary source in Malaysian children and adolescents.

Methods

This analysis is from the MyBreakfast study, a national cross sectional study investigating eating habits among primary and secondary school children throughout Malaysia, conducted in 2013. Children (n = 5,165) and adolescents (n = 2,947) who completed two days of dietary assessment using a food record or recall respectively were included. The whole grain content of foods was estimated mainly through the use of quantitative ingredient declarations on food labels. All wholegrain foods were considered irrespective of the amount of whole grain they contained.

Results

Overall, only 25% of children and 19% of adolescents were wholegrain consumers. Mean daily intakes in the total sample were 2.3g/d (SD 5.8g/d) in children and 1.7g/d (SD 4.7g/d) in adolescents and in the consumer’s only sample, mean intakes reached 9.1g/d (SD 8.6) and 9.2g/d (SD 7.1g/d) respectively. Wheat was the main grain source of whole grain while ready to eat breakfast cereals and hot cereals were the main food contributors. Less than 3% of the children and adolescents reached the US quantitative whole grain recommendation of 48g/day.

Conclusion

Whole grain is consumed by only a minority of Malaysian children and adolescents and even among consumers, intakes are well below recommendations. Efforts are needed to firstly understand the barriers to whole grain consumption among Malaysian children in order to design effective health promotion initiatives to promote an increase in whole grain consumption.

Prevalence of overweight among Malaysian adults from rural communities

Assessment of the nutritional status of 4054 households from rural communities in Peninsular Malaysia was undertaken from 1992 to 1995. Body mass index (BMI) and waist-to-hip ratio (WHR) were obtained from a self-selected sample of 1854 men and 2741 women aged >= 18 years. The BMI and WHR results are presented according to gender, age groups and type of community as defined by the main occupation, namely, fishing, rice farming, estate work, rubber and coconut small-holding. The mean BMI for men and women of all age groups are 22.5 kg/m2 and 23.8 kg/m2, respectively. The mean BMI for both genders increases with age between 18.0 and 49.9 years, after which the value declines. The prevalence of pre-obese (BMI >= 25.0-29.9 kg/m2) is 19.8% for men and 28.0% for women. The prevalence of obese men and women (>= 30.0 kg/m2) is 4.2% and 11.1%, respectively. The highest prevalence of pre-obese and obese men is found in the age groups of 30.0-49.9 years, while that for women is in the 40.0-49.9 years age group. The prevalence of pre-obesity and obesity is higher in women than in men for every age group. A similar result was indicated by WHR whereby a higher proportion of women (22.5%) than men (5%) for all ages was found to show central obesity. The prevalence of overweight adults is higher when compared with previous studies on subjects from almost similar rural communities. This study indicated that overweight is on the increase in rural communities, especially among female subjects.

Nutritional status, dietary intake patterns and nutrition knowledge of children aged 5-6 years attending kindergartens in the Klang Valley, Malaysia

INTRODUCTION

Early childhood is a period during which many factors influence the development of lifelong eating habits. This study aimed to assess the nutritional status of young children and to determine factors related to eating habits.

METHODS

A total of 992 children aged 5-6 years attending kindergartens that participated in the Bright Start Nutrition programme in the Klang Valley were included in the study. Anthropometric measurements were taken and body mass index (BMI) calculated. A questionnaire to assess the children's nutrition knowledge was administered through interviews, while their mothers self-administered another set of questionnaires regarding knowledge, attitude and practice on nutrition.

RESULTS

The mean BMI was 15.7 +/- 2.7 kg/m2 in boys and 15.4 +/- 2.4 kg/m2 in girls. Based on the WHO 2007 growth reference, the prevalence of overweight and obesity were 9.1% and 9.3%, respectively; while the prevalence of thinness and stunting were 5.8% and 3.9%, respectively. Most of the children consumed breakfast (86.4%), lunch (94.1%) and dinner (93.4%) daily. The majority liked fruits (95.1%), snacks (93.8%), Western fast food (93.3%) and milk (90.8%), while less than two-thirds (65.1%) liked vegetables. The mean nutrition knowledge scores for the children and mothers were 73.2 +/- 9.8% and 60.2 +/- 18.8%, respectively. Maternal nutrition knowledge was correlated positively with children's vegetable intake (r=0.111, p<0.05) and negatively with snack intake (r = -0.134, p<0.05).

CONCLUSION

These results showed a higher prevalence of overweight and obesity than underweight and thinness among the urban young children studied. As mother's nutrition knowledge was found to exert a positive influence on children's eating habits, it is important to provide nutrition education to both mothers and children when conducting intervention programmes.

Consumer understanding and preferences for different nutrition information panel formats

The study was conducted to assess the level of understanding and the ability to extract information from a nutrition information panel (NIP) among women (n = 232, 20-59 years) in the Klang Valley, an urban area in Malaysia. The study involved the currently used format in Malaysia and three other formats, namely (i) based on Guideline Daily Amount (GDA), (ii) Multiple Traffic Light (MTL) and (iii) combination of GDA/MTL. Four hypermarkets were chosen for the face-to-face interview using a questionnaire. Subjects were selected using a convenient sampling method. The mean score for level of understanding was the highest for the current format (3.46 ± 1.12) compared to the other three tested formats (GDA = 3.09 ± 1.03, MTL = 2.72 ± 0.97, GDA/MTL combination 3.09 ± 1.36). However, most of the respondents (68.1%) would prefer the current NIP format to be changed due to difficulty in understanding (43.1%) and perceived the nutrition information to be insufficient (23.3%) and over simplified (21.6%). When other NIP formats were introduced, GDA format was the most preferred (mean score 3.52 ± 0.84) compared to the other formats (MTL = 3.41 ± 0.98; GDA/ MTL combination = 3.29 ± 0.91), including the current format used in Malaysia (3.16 ± 0.85). These findings suggest that the preferred NIP format does not necessarily lead to correct interpretation of the nutrition information. The current format should be further promoted and explained to the public to improve its usage and consumer understanding.

Abbreviated report of the WHO Western Pacific Region Workshop on National Plans of Action for Nutrition: key elements for success, constraints and future plans

A workshop on National Plans of Action for Nutrition: Constraints, Key Elements for Success, and Future Plans was convened and organized by the WHO Regional Office for the Western Pacific in collaboration with the Institute for Medical Research Malaysia and co-sponsored with FAO and UNICEF from 25-29 October 1999. It was attended by representatives of 25 countries in the region and resource persons, representatives from WHO and other international agencies. The objectives of the workshop were to review the progress of countries in developing, implementing and monitoring national plans of action for nutrition (NPANs) in the Western Pacific Region and to identify constraints and key elements of success in these efforts. Most of the countries have NPANs, either approved and implemented or awaiting official endorsement. The Plan formulation is usually multisectotal, involving several government ministries, non-governmental organizations, and international agencies. Often official adoption or endorsement of the Plan comes from the head of state and cabinet or the minister of health, one to six years from the start of its formulation. The NPAN has stimulated support for the development and implementation of nutrition projects and activities, with comparatively greater involvement of and more support from government ministries, UN agencies and non-governmental agencies compared to local communities, bilateral and private sectors and research and academic institutions. Monitoring and evaluation are important components of NPANs. They are, however, not given high priority and often not built into the plan. The role of an intersectoral coordinating body is considered crucial to a country's nutrition program. Most countries have an intersectoral structure or coordinating body to ensure the proper implementation, monitoring and evaluation of their NPANs. The workshop identified the constraints and key elements of success in each of the four stages of the NPAN process: development, operationalization, implementation, and monitoring and evaluation. Constraints to the NPAN process relate to the political and socioeconomic environment, resource scarcity, control and management processes, and factors related to sustainability. The group's review of NPAN identified successful NPANs as those based on recent, adequate and good quality information on the nutritional situation of the country, and on the selection of strategies, priorities and interventions that are relevant to the country and backed up by adequate resources. Continued high level political commitment, a multisectoral approach, and adequate participation of local communities are other key elements for success. The participants agreed on future actions and support needed from various sources for the further development, implementation, monitoring and evaluation of their NPANs. The recommendations for future actions were categorized into actions pertaining to countries with working NPAN, actions for countries without working NPAN and actions relevant to all countries. There was also a set of suggested actions at the regional level, such as holding of regular regional NPAN evaluation meetings, inclusion of NPAN on the agenda of regional fora by the regional organizations, and strengthening of regional nutrition networks.

Southeast Asian perspectives on nutrition needs for the new millennium

Over the last three decades, there has been significant changes in the lifestyles of commmunities, including food habits, and food purchasing and consumption patterns in the Southeast Asian region. As a result, there is a definite change in the food and nutrition issues in the region. Nutritional deficiencies in many of these countries are slowly being decreased in magnitude. On the other hand, the significant proportions of the population are now faced with the other facet of the malnutrition problem, namely diet-related chronic diseases. However, because of the different stages of socio-economic development, the extent of each of these extremes of the malnutrition problems varies considerably between the different countries in Southeast Asia. Nutrition needs in the new millennium would necessarily differ somewhat among these countries while at the same time, there would be a considerable amount of similarities. This presentation highlights several macro issues that countries in the region may focus on in the near future. Various intervention programmes have been undertaken by authorities to tackle the co-existence of twin faces of malnutrition in many developing countries. It would be desirable to have a blue print of such programmes and activities in the National Plans of Action for Nutrition (NPANs) . The NPAN should be more than a framework or a descriptive document. It should be a tool for action, an operational plan that sets out priorities; identifies projects and activities, with details of implementation such as what, how and when; designates responsibilities and accountability for the activities; identifies resource requirements and their source; and sets out the plan for monitoring and evaluation. One of the main obstacles in the formulation and effective implementation of intervention programmes in developing countries is the lack of comprehensive data on the extent of the problems in many cases and the causes of such problems specificy to the communities concerned. It is thus imperative to identify appropriate research priorities and conduct relevant studies. It is also important to have basic baseline data collected at regular intervals such as nutritional status of communities and dietary intake. To conduct all these activities, it is vital to ensure adequate funding, preferably through establishing a dedicated fund for research. There should be closer collaboration between countries in the region in all nutrition activities to enable sharing of resources, experiences and learn from the mistakes of others. One existing mechanism is through the ASEAN structure. The other existing mechanisms are through WHO and FAO. One other mechanism is through the International Life Sciences Institute (ILSI) Southeast Asian Branch. Closely related to this need for networking is the need for continuing harmonization of approaches to nutrition activities in the region. Current efforts in harmonisation include RDA, nutritional status assessment methodologies and dietary guidelines. Other areas of harmonisation in the near future include nutrition labelling and claims.

School-administered weekly iron-folate supplements improve hemoglobin and ferritin concentrations in Malaysian adolescent girls

BACKGROUND

Iron deficiency and its consequent anemia constitute the commonest micronutrient deficiency in the world.

OBJECTIVE

We investigated whether long-term, weekly iron-folate supplements administered at school would improve hemoglobin and ferritin concentrations in adolescent girls, including those with mild-to-moderate anemia and hemoglobin concentrations indicating borderline anemia.

DESIGN

Subjects were 266 girls with hemoglobin concentrations of 80-119.9 g/L (group A) and 358 girls with hemoglobin concentrations of 120-130 g/L (group B) who were otherwise healthy. Two hundred sixty-six girls in group A and 268 girls in group B were randomly assigned to receive either 60 or 120 mg Fe plus 3.5 mg folic acid weekly for 22 wk. Ninety of the girls in group B were randomly assigned to receive only 5 mg folic acid weekly. Capillary hemoglobin and plasma ferritin were measured at baseline and after 12 and 22 wk of supplementation.

RESULTS

By the end of the study, 2% of the girls had dropped out and > 96% had taken > or = 20 of the 22 tablets; side effects were minimal. Mean plasma ferritin increased significantly in all iron-supplemented groups, independently of initial hemoglobin values and iron doses. Ferritin concentrations decreased in the girls supplemented with folic acid only. As expected, hemoglobin responses to iron were higher in group A than in group B and increases were positively correlated with initial plasma ferritin. Hemoglobin failed to respond to folate supplementation if initial plasma ferritin concentrations were low. Mean hemoglobin increased significantly and consistently in relation to the length of treatment.

CONCLUSION

Long-term, weekly iron-folate supplementation was found to be a practical, safe, effective, and inexpensive method for improving iron nutrition in adolescent schoolgirls.

The role of unsaponifiable components in the lipidemic property of olive oil

Pure olive oil triglycerides (POLO), free from all unsaponifiable matter, were isolated from Virgin Spanish olive oil (COLO) by alumina-charcoal column chromatography. COLO and POLO were used as sources of dietary fat in two animal studies. The responses of serum and liver lipids to the two types of dietary fat were examined. Our results show that animals fed POLO-diet gave somewhat higher serum total and LDL cholesterol levels as compared to those on COLO-diet. The increase in serum cholesterol level is followed by a parallel increase in liver cholesterol content. These results indicate that the hypocholesterolemic effect of olive oil was partly due to the presence of the unsaponifiable matter. Supplement of the POLO-diet separately with a-tocopherol and squalene resulted in serum lipid responses similar to that observed with the COLO-diet. The serum and liver triglyceride levels are not affected by the removal of unsaponifiable components but addition of a--T and squalene to the POLO-diet appeared to lower both the cholesterol and triglyceride levels in the serum but increased only the liver cholesterol content. These results show that the unsaponifiable components modulate the hypocholesterolemic effect of olive oil.

Replacing coconut santan with palm oil santan: impact on dietary C12-16 saturated fatty acids, serum total cholesterol and cardiovascular risk

The theoretical impact of the use of coconut cream (santan) powder and palm oil santan powder on the dietary levels of C12-16 saturated fatty acids (SFAs) and linoleic acid (18:2), and on serum total cholesterol (TC), was evaluated holding non-santan dietary variables constant. The prediction was based on a 2,300-kcal hypothetical diet, containing one santan-based dish or snack in each of the 5 daily meals with fat contributing 30% of total calories, while the santan contributed a total of 14% kcal (36g). Replacing coconut santan with palm oil santan reduced the overall dietary C12-16 SFAs from 10.8% kcal to 4.8% kcal (i.e. 6.0% kcal) and the virtual removal of lauric (12:0) + myristic (14:0) acids, while palmitic acid (16:0) rose by 3.3% kcal, and the polyunsaturated linoleic acid (18:2) increased by 1.13% kcal. Applying the Hegsted equation to these dietary fatty acid (FA) changes, predicted a serum TC reduction of 24 -31 mg/dL (0.62- 0.80 mM/L), with the hypocholesterolemic effect being influenced by the low-density lipoprotein receptor (LDLr) set-point of the individual(s) concerned. Thus, the prediction indicated that replacing coconut santan with palm oil santan in santan-based Malaysian dishes or snacks would have a significant beneficial impact on serum TC and hence, cardiovascular risk.

Nutritional assessment of rural villages and estates in Peninsular Malaysia*. III. Prevalence of anaemia

As a part of the recent UPM-IMR collaborative study on the nutritional status of communities in rural villages and estates in Peninsular Malaysia from 1992-1995, this report presents findings on the haemoglobin levels and the prevalence of anaemia amongst these rural dwellers. A total of 69 villages and 7 estates located in 9 states in Peninsular Malaysia were studied. Results of the study on the 5 communities (total n=8024), namely fishing, padi, rubber, coconut and estate communities, are presented according to five age groups, namely less than 7 years (n=1418), 7-12.9 years (n=1778), 13-17.9 years (n=701), 18-59.9 years (n=3241) and 60 years (n=886). The extent of the anaemia problem varied considerably amongst the various age groups and community types. The prevalence of anaemia and mean Hb level (g/dl) for subjects of both sexes were respectively 24% and 12.1 for those < 7 years; 21.9% and 13.0 for the 7-12.9 years old; 17.8% and 13.7 for the 13-17.9 years; 21.0% and 13.8 for 18-59.9 years; and 22.7% and 13.6 for those 60 years of age and above. While the female adults (18-59.9 years) had a significantly higher prevalence rate for anaemia of 25% compared to 14% found in the male adults, no significant difference in the prevalence rates were found between the sexes for the other age groups. The problem was most serious among adult women, young children and the elderly. Amongst the various community types, the fishing community had the highest prevalence of anaemia at an overall rate of 50%, taking into consideration both sexes and all age groups. The rubber smallholders, in contrast, had the lowest prevalence of anaemia, at an overall rate of about 10%. Intervention and preventive health programmes should therefore be continued to be focussed on the above groups of rural subjects, particularly those in the fishing community.

Nutritional assessment of rural villages and estates in Peninsular Malaysia: I Socio-economic profile of households

A nutritional study was carried out on six (five rural and one urban) low income groups in Peninsular Malaysia from 1992-1995. In this paper, the socio-economic data for the five rural groups - padi farmers, rubber smallholders, coconut smallholders, estate workers, and fishermen - are presented. With the exception of the estate workers, the sample was predominantly Malay, with an overall mean household size of 5.30. Household incomes were generally low, and 47% of all households had incomes that were below the poverty line income (PLI) of RM405. Based on this PLI, the prevalence of poverty was above 50% among the padi, rubber, coconut, and fishing households. Nevertheless, the study population appeared to be better off in terms of the other indicators examined. Poultry rearing, for example, was widespread in the padi, rubber, and coconut villages; 65% of all households owned at least one motorised vehicle, 53% owned a refrigerator, and 83% owned a television set. Furthermore, over 80% of all households had access to piped water, 96% had electricity supply, and over 90% had a flush or pour-flush latrine. In comparison to the 1979-1983 poverty villages study (Chong et al., 1984), the households in the current study enjoyed better living conditions. Strict comparisons between the two studies, however, is difficult owing to the different criteria adopted in the selection of the study villages.

Nutritional assessment of rural villages and estates in Peninsular Malaysia II. Nutritional status of children aged 18 years and below

This paper presents the results of anthropometric assessment of 2,364 boys and 2,415 girls aged 18 years and below drawn from the estates and rural community groups engaged in padi farming, rubber planting, coconut cultivation and fishing. The children were mainly Malay, however in the estates, Indians predominated. The results showed that the percentage of boys who have normal weight-for-age, height-for-age and weight-for-height were respectively 69.4%, 68.3% and 88.8%. Among girls, the percentage with normal values for weight-for-age, height-for-age and weight-for-height were 73.8%, 72.6% and 89.5% respectively. This study also showed the persistence of underweight, stunting and wasting amongst children in the study communities. Overall, the prevalence of underweight among boys was 29.8% and for girls 25.5%. The prevalence of stunting was 31.3% for boys and 26.9% for girls, while wasting was found in 9.3% boys and 8.5% girls. By age groups, the prevalence of underweight was lowest among the infants (16.8% for boys and 13.3% for girls), and highest among children aged above 1 to 6 years old (32.6% and 35.9% for boys and girls respectively). Children from the fishing, rubber and padi villages showed a higher prevalence of acute and chronic undernutrition than those from the coconut and the estate communities. In contrast, the mean prevalence of overweight in the five community groups did not exceed 2%. When compared with another peninsula-wide nutritional assessment of poverty villages undertaken in 1979-1983, it is found, over the past decade, that the prevalence of underweight in rural communities appeared to have decreased somewhat while that of stunting showed a more substantial decline. The persistence of current undernutrition has led to the manifestation of children who were too thin for their "non-stunted" height, thus giving rise to an apparently higher prevalence of wasting as found in this study. The implications of these results are discussed.

Simultaneous determination of B-vitamins and ascorbic acid in multi-vitamin preparations by reversed-phase HPLC

The tedious and time consuming methods employed for the analysis of individual B-vitamins can now be replaced by ion-pair reversed-phase high-performance liquid chromatographic (HPLC) methods. This laboratory has previously reported the simultaneous determination of eight water-soluble vitamin standards that is, B1, B2, B6, B12, C, niacin, niacinamide and folic acid. The proposed isocratic HPLC method, employing 3 channels of detection, adequately separated all eight vitamins in less than 20 minutes. This study reports another phase of the project whereby the method was employed for the analysis of pharmaceutical preparations. Different extraction procedures were first evaluated, namely acid, acid plus enzyme and alkaline hydrolysis methods, using vitamin standards, individual vitamin tablets and multivitamin preparations. The amounts obtained from the analysis were compared with the declared values. Recovery studies were also carried out. The method of acid hydrolysis with 0.1N sulphuric acid was found suitable for use and was thus adopted as the extraction procedure for the analysis of 10 multivitamin preparations obtained from various pharmaceutical outlets. For most of these preparations, the amount obtained were close to the declared values, except for folic acid and cyanocobalamin. Further trials on folic acid showed that the problem could be resolved by omitting the filtration step in the final extract after acid hydrolysis and diluting with 0.01N sodium hydroxide before processing for chromatography. Vitamin B12 was not detectable using the present chromatography system probably because of its low concentration in the samples studied.

Development of a HPLC method for the simultaneous determination of several B-vitamins and ascorbic acid

In cognizance of the difficulties involved in the colorimetric and titrimetric methods for the determination of individual vitamins, this laboratory has been carrying out a series of studies into the use of HPLC for improved analysis of these nutrients. Preliminary studies have been carried out for the determination of four B-vitamins. The present paper reports on further improvements made to enable the simultaneous determination of eight vitamins i.e. B1, B2, B6, B12, C, niacin, niacinamide and folic acid. Trials were carried out to determine the most suitable chromatographic system include changing the proportion of methanol in the mobile phase, the use of different ion-pairing reagents and other additives such as triethylamine and ammonia. Three sets of HPLC mobile phase systems are proposed to enable successful separation of all eight vitamins in less than 20 minutes, varying slightly with the type of ion-pairing reagent and mobile phase additive. This laboratory is currently carrying out trials to determine if the developed methods could be used for the determination of pharmaceutical products and food samples.

Rural communities in nutritional transition: emergence of obesity, hypertension and hypercholesterolemia as public health problems in three kampungs in Bagan Datoh, Perak

This paper highlights the marked presence of nutritional disorders in a sample (190 males, 237 females, aged 18-80 years) obtained from the adult population in three kampungs i.e. Pasang Api, Sungai Nipah Baroh and Sungai Balai Darat, in the Mukim of Bagan Datoh, Perak in 1992. All subjects (except pregnant females) were measured for blood pressure, weight, height, waist circumference, and hip circumference from which the body mass index (BMI) and waist-hip ratios (WHR) were calculated. A random blood sample was obtained by finger-prick from each subject and analysed for total cholesterol (TC) and glucose, using the Reflotron compact analyser. Elevated means for BMI and WHR indicated that obesity (BMI ≥30.0) was a serious public health problem in these three kampungs, affecting about 5% of males and 14% of females. Another 24% of males and 46% of females had an overweight problem (BMI 25.0-29.9), indicating that on the average, about half the adult population in these kampungs were either overweight or obese. This contrasted with the situation a decade ago in similar-type kampungs in the Peninsula where underweight was the major nutritional disorder in adults, especially males. Overall, there was a shift of an underweight problem to one of overweight, as exemplified by increments of 2.0 to 3.0 BMI units in the adult population, with the phenomenon being more marked in the females. Hypertension (21%) and hyperglycaemia (6.5%) affected the males and females approximately equally. Female adults had higher mean plasma TC compared to males (204 versus 199 mg/dl); these means were some 20 mg/dl (0.52 mmol/L) higher than the corresponding means for adults in similar rural communitites in the early eighties, and approximate the corresponding means for present-day urban adults. The above findings serve to emphasise the nutritional transition undergoing in the rural communities in the Peninsula, viz, the marked emergence in these rural communities of nutritional disorders normally associated with affluent populations.

Simultaneous determination of retinol, carotenoids and tocopherols in human serum by high pressure liquid chromatography

The determination of serum vitamins having antioxidant properties has gained in importance in recent years. This is mainly due to the observation that an inverse correlation exists between blood levels of these vitamins, including retinol, carotenoids and tocopherol, and diet-related chronic diseases such as coronary heart disease and cancers. This laboratory has been carrying out a series of studies into the nutritional and analytical aspects of retinol and carotenoids. A simple reversed-phase HPLC method has been developed in an effort to improve methodologies for the separation and quantitation of carotenoids and retinol in foods and biological specimens, especially blood serum. As an extension to these studies, trials were carried out to determine the feasibility of analysing tocopherols using the same chromatographic procedure. With the addition of another detector wavelength, the same procedure detected and quantitated 3 major tocopherols simultaneously with retinol and five carotenoids. Within-day and between-day precision of the procedure was satisfactory. Trials carried out were able to improve recovery of the vitamins. Experiments conducted also showed that the addition of ascorbic acid to the extracting ethanol was beneficial for the analytical procedure. The presence of peroxide in ethyl acetate used in the chromatography mobile phase caused drastic destruction to the vitamins analysed. The addition of ascorbic acid during sample preparation was able to inhibit this destruction. The method was used for the analysis of sera from 65 apparently healthy Malaysians with a mean age of 52.8 years (range 24-76 years). Mean retinol concentration of the group was 69.8 ± 18.8 mg/dl. The mean β-carotene concentration of the subjects studied was 33.8 ± 24.3 mg/dl, while the mean total carotenoid concentration was 180.2 ± 3.0 mg/dl. The most abundant carotenoid in the serum samples studied was lutein, comprising about one-third of all carotenoids quantitated. The concentrations of δ- and γ-tocopherols in the serum samples studied were too low to be identified with certainty and quantitated accurately. The mean α-tocopherol level was 1840 ± 528 μg/dl. For retinol, α-tocopherol and most of the carotenoids determined, there was no statistically significant difference in the mean levels between male and female subjects as well as among the three different ethnic groups. Results obtained in this study were very similar to those previously reported by this laboratory. It is hoped that more data on the serum concentrations of these vitamins can become available for various population groups, including during various disease conditions.

The medical importance of vitamin A and carotenoids (with particular reference to developing countries) and their determination

Vitamin A, or retinol, is an essential nutrient for man and all mammalian species since it cannot be synthesised within the body. Deficiency of the vitamin results in adverse effects on growth, reproduction and resistance to infection. The most important manifestation of severe vitamin A deficiency (VAD) is xerophthalmia, and irreversible blindness may eventually occur in one or both eyes. VAD is still an important micronutrient deficiency problem in many developing countries, afflicting large numbers of pre-school children. It is often associated with protein-energy malnutrition, parasitic infestation and diarrhoeal disease. For many communities in developing countries, the major source of vitamin A in the diet is carotenoids. These compounds are synthesised only by photosynthetic microorganisms and by members of the plant kingdom where they serve important functions in metabolism, including participating in the photosynthetic process. These pigments also provide aesthetic qualities as colourants in the plant and animal kingdoms. Most importantly, the carotenoids serve the animal kingdom as sources of vitamin A activity. Major advances have occurred in understanding the role and mechanisms of action of carotenoids. They are now thought to play specific roles in mammalian tissues related to their function in plants. Carotenoids, with their highly reactive conjugated double bonds, act as free radical traps or antioxidants and may play an important role in the prevention of cancers. In view of the wide medical importance of carotenoids, much attention has been given to the determination of these pigments in foods as well as blood. Carotenoids in foods have conventionally been analysed using the open-column chromatography technique, but the high-pressure liquid chromatographic (HPLC) method is now gaining in importance as well. The classical method for the determination of carotenoids in blood is by the spectrophotometric method while the HPLC method is also recommended for use. An example of an HPLC method developed for the simultaneous determination of retinol and carotenoids in food and blood is given. The determination of retinol and carotenoids should be further developed in view of the wide importance of carotenoids in health and disease.

Carotenoid composition and content of legumes, tubers and roots by HPLC

As part of a series of studies on the analytical and nutritional aspects of carotenoids and retinoids in foods, seventeen types of legumes and their products and 9 tubers and starchy roots were studied for their carotenoid composition and content by HPLC. All samples were saponified and subsequently chromatographed using a reverse-phase HPLC method previously developed in this laboratory in which carotenoids were separated isocratically on an octadecylsilane (C18) column using a ternary mixture of acetonitrile, methanol and ethyl acetate (88:10:2) as the mobile phase. Carotenoid peaks obtained were tentatively identified using 6 reference standards similarly chromatographed. The HPLC method used enabled the separation and quantitation of the major carotenoids present, namely, lutein, cryptoxanthin, lycopene, g-, a- and b-carotenes. For most of the legumes, the major carotenoids detected were b-carotene, lutein and cryptoxanthin. Lutein was found in all the legumes studied, and was clearly the major carotenoid in most of the legumes, followed by unidentified carotenoids, b-carotene and cryptoxanthi. The other carotenoids were encountered infrequently and at low levels. The starchy roots and tubers gave a different carotenoid composition from those obtained for the legumes: lycopene and b-carotene were detected in all the samples except in sago. There was no clear pattern of carotenoids present in the samples studied. Compared with the vegetables and fruits, the carotenoid concentration in legumes, tubers and roots were found to be much lower. None of the items studied can be said to be good sources of vitamin A. Nevertheless, they are still of nutritional import flee, if consumed in significant amounts.

Carotenoids and retinoids in human nutrition

Since the discovery of vitamin A as a fat-soluble growth factor in the early part of the century, research into carotenoids and retinoids has attracted the attention of many scientists. These two groups of compounds are still being actively studied all over the world since many gaps in knowledge exist and new frontiers are being pursued. Recent developments in studies into the possible roles of carotenoids and retinoids beyond their classical functions in vision have created a great deal of excitement in the biomedical community. This review covers a wide range of topics pertaining to these two closely related compounds. Particular emphasis is given to the functions of these compounds and their roles in human nutrition. Various aspects of vitamin A deficiency and studies on carotenoids and retinoids in cancer development and prevention are reviewed in some detail.