Introduction: Dietitians play an essential role in the management of childhood obesity and consistency in dietetic practices is required to ensure the effectiveness of treatment. This study assessed dietitians’ current practices in the management of childhood obesity, compared the practices with nutrition practice guidelines used by dietitians in other countries and identified practice components for the development of nutrition practice guidelines for the management of childhood obesity in Malaysia.
Methods: A cross-sectional study was conducted among 40 dietitians in 16 Ministry of Health hospitals and three teaching hospitals. Information on current dietetic practices in the management of childhood obesity was obtained through a mailed survey questionnaire. The practices included nutritional assessment, determination of energy requirement, dietary prescription and physical activity modification. Emails were sent to 31 dietetic associations in other countries to obtain information on practice guidelines used by dietitians.
Results: Frequently used dietary intervention and physical activity modification approaches were high fibre diet (65%), low fat diet (40%), reduction of sedentary pursuits and screen times (67.5%) and an increase in duration of current physical activities (60%). In comparison to other dietetic practice guidelines, the current dietetic practices in Malaysia do not usually include waist circumference, biochemical and blood pressure data. However, similar to other guidelines, the current dietetic practices included low dietary fat, high fibre diet, decreased sedentary activity and increased physical activity level.
Conclusions: The dietetic practices in the management of childhood obesity in Malaysia are diverse. A comprehensive nutrition practice guideline for management of childhood obesity is urgently needed for standardisation of dietetic practices in Malaysia.
Introduction: Demand for dietary fibre-enriched and low sugar bakery products is rapidly increasing due to the current high incidence of Type 2 diabetes mellitus. Cinnamon, a spice which acts as a natural sweetener and insulin mimetic is believed to have health benefits. The objective of this study was to determine the properties of butter biscuits containing cinnamon powder (CP) that partially replaced sucrose at levels of 0 (control), 2, 4 or 6%. Methods: Nutritional composition, physical properties and sensory acceptability of the biscuits were analysed using AOAC methods, texture profile analyser and 7-point hedonic scaling method, respectively. Results: Protein, ash and dietary fibre contents of the biscuits increased significantly (P < 0.05) whereas the moisture and sucrose contents were reduced significantly, proportionately to the increasing levels of CP. In texture profile analyses, increment of firmness and reduction of crispiness of the biscuits were detected with increasing levels of CP, but not significantly. The sensory scores for control and 2% CP biscuits were not significantly different for all the sensory attributes. Biscuits with 4% CP received lower scores only for aroma and appearance whereas the scores for colour, crispiness and flavour showed no significant differences compared to the control and 2% CP biscuit. Conclusion: The addition of 4% CP in biscuit could be an effective way to produce nutritious butter biscuits without any apparent change to its desirable physical properties and sensory acceptability.
Introduction: Hypercholesterolemia is an important modifiable risk factor for coronary heart disease. Lifestyle changes in diet and physical activity can improve cholesterol levels. This study aimed to compare the fruits and vegetables (FV) intake and physical activity (PA) between hypercholesterolemic adults and non- hypercholesterolemic adults in Malaysia, and to investigate factors associated with meeting the recommended levels of FV intake and PA in a hyper- cholesterolemic population. Methods: This study was based on 17,988 participants (response rate 98.7%) aged 18 years and above who responded to the hypercholesterolemia questionnaire in the 2011 Malaysian National Health and Morbidity Survey (NHMS), a cross-sectional study with two-stage stratified sampling design. Data were obtained by trained enumerators via face-to-face interviews and were analysed by descriptive analysis, chi-square test, and univariable and multivariable logistic regression. Results: Out of the total population assessed, 39.0% had hypercholesterolemia. The prevalence of consuming five or more servings of FV per day is low (7.8%) while 36.0% were physically inactive among the hypercholesterolemic adults. No significant differences were observed in FV intake and PA between hypercholesterolemic and non-hypercholesterolemic populations. Gender, age and educational levels were associated with FV intake and PA among hypercholesterolemic adults. Hypercholesterolemic adults who were underweight or obese were less likely to consume FV, while those who were former smokers and those who had diabetes and heart disease were less likely to be physically active. Conclusion: These findings are relevant for future health promotion strategies, suggesting that more intensive interventions are needed to increase FV intake and PA level in hypercholesterolemic population and in the general population.
Study name: National Health and Morbidity Survey (NHMS-2011)
MeSH terms: Adult; Cholesterol; Coronary Disease; Cross-Sectional Studies; Diabetes Mellitus; Diet; Food Habits; Fruit; Health Promotion; Health Surveys; Heart Diseases; Humans; Hypercholesterolemia; Life Style; Malaysia; Motor Activity; Obesity; Risk Factors; Thinness; Vegetables; Prevalence; Logistic Models
Introduction: Nutrition screening is recommended as a first step of nutrition care to allow early identification and intervention of malnourished patients. The present study determined the validities and reliabilities of two malnutrition screening tools namely, the Malnutrition Universal Screening Tool (MUST) and Malnutrition Screening Tool (MST) among adult patients at the Hospital Kuala Lumpur. Methods: The sensitivity, specificity and predictive value of MUST and MST were conducted against the Subjective Global Assessment (SGA), anthropometric parameters including body mass index (BMI), calf circumference (CC), mid-upper arm circumference (MUAC) and energy intake. Inter-rater reliability was evaluated using kappa value (κ) to determine the level of agreement between raters. Results: A total of 151 subjects with mean age of 45.2 ± 13.7 years participated in this study. Prevalence of malnutrition according to MUST, MST and SGA was 34.4%, 33.8% and 19.9%, respectively. As compared to SGA, MUST and MST had a sensitivity of 96.6% and 93.3% respectively, whereas the specificity was 80.9% for both tools. The sensitivity and specificity of MUST against the anthropometric parameters (BMI, CC and MUAC) were between 53.8% to 88.8% and 67.4% to 69.9%, respectively. The sensitivity values for MST were between 46.1% to 63.6% and specificity values were between 64.4% to 67.6%. The inter-rater reliability of MUST was higher (substantial, mean (κ) = 0.78) than for MST (moderate, mean (κ) = 0.52). Conclusions: In conclusion, MUST was found to have similar validity levels but higher reliability result than MST. Based on our result, MUST is recommended for use in identifying adult patients who are at high risk of malnutrition. It can be used as a malnutrition screening tool but there is a need to evaluate the cost effectiveness of its implementation.
MeSH terms: Adult; Animals; Anthropometry; Arm; Energy Intake; Cattle; Cost-Benefit Analysis; Humans; Nutritional Status; Sensitivity and Specificity; Reproducibility of Results; Body Mass Index; Prevalence; Malnutrition
Introduction: This study aimed to assess the nutritional status of children below 24 months in the district of Pekan, Pahang, and identify the contributing factors. Methods: Using a cross-sectional methodology, a total of 910 children was selected by random sampling from four public health clinics. Anthropometric measurements were taken and weight-for-age, height-for-age, and weight-for- height were calculated in Z scores. Immediate caregivers of children were interviewed by using a pretested validated questionnaire to assess their socio- economic, demographic, educational and occupational status. Results: Of the 910 children who participated in the study, the majority were Malay (70.1%), while the remaining comprised indigenous or Orang-Asli (OA) children. Prevalence of wasting, stunting and underweight were 28.7 %, 15.6 % and 19.0% respectively. There were more underweight males than females. Wasting was most common among children aged below 6 months. Stunting was more prevalent in children between 12 to 24 months. Obesity was seen in 7.3% of the sample. Maternal education, employment and socio-economic status had a significant influence on wasting and underweight. Children were vulnerable to stunting as age advanced, whereas prevalence of wasting tended to decrease. Conclusion: Malnutrition exists in significant proportions among children below 24 months in the Pekan district. This study identified low birth weight along with age, race, gender, large family size and socio-economic status as important risk factors of malnutrition.
MeSH terms: Ambulatory Care Facilities; Body Weight; Cachexia; Child; Cross-Sectional Studies; Employment; Female; Growth Disorders; Humans; Infant, Low Birth Weight; Malaysia; Malaysia/ethnology; Male; Nutritional Status; Obesity; Surveys and Questionnaires; Risk Factors; Thinness; Prevalence; Caregivers; Malnutrition; Continental Population Groups
Introduction: This study aimed to ascertain the effects of a Facebook-based physical activity intervention on improvements in step counts and metabolic syndrome. Methods: Government employees with metabolic syndrome were randomly assigned by cluster to the Facebook group (n = 44) or the control group (n = 103). All participants were asked to complete self-administered questionnaires at baseline, after the first and second phases. Data from anthropometric (weight, body mass index, fat mass, body fat percentage, waist circumference, hip circumference and waist-to-hip ratio), biochemical (total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides and fasting glucose) and clinical examinations (systolic blood pressure and diastolic blood pressure) were collected. The number of steps per day was determined by a Lifecorder e- STEP accelerometer. Results: A significant difference in the number of steps per day between the baseline and the first phase (p
MeSH terms: Adipose Tissue; Anthropometry; Blood Pressure; Body Weight; Cholesterol; Fasting; Glucose; Government; Cholesterol, HDL; Cholesterol, LDL; Motor Activity; Surveys and Questionnaires; Triglycerides; Body Mass Index; Metabolic Syndrome X; Control Groups; Waist-Hip Ratio; Waist Circumference; Social Media
Introduction: This study aimed to determine the prevalence of malnutrition and factors influencing malnutrition among children aged five years and below in Serian District of Sarawak, a district where the majority of people are indigenous. Methods: Using a cross-sectional method, a total of 177 children were randomly selected and assessed, and their mothers or caregivers were interviewed. Data were collected using a pretested questionnaire; anthropometric measurements were also taken. Data were analysed using SPSS version 17.0. Results: The prevalence of underweight, stunting and wasting in children aged five years and below was 20.9%, 11.9% and 10.2% respectively. The results suggest that the significant factors contributing to underweight are birth weight, frequency of child visit to the clinic, and individual insecurity. Only age, when complementary diet was introduced, was found to be significantly associated with stunting. For wasting, individual insecurity, duration of family planning and met recommended protein intake per day were found to be significant factors. Conclusion: The prevalence of malnutrition in children 5 years and below in Serian District of Sarawak is high compared to state figures. The major contributing factors were found to be manifested at the individual and family level. There is a need for appropriate public health promotion and socio- economic improvement interventions towards improving the nutritional status and health of children in Serian District.
The modelling of a three-dimensional (3-D) molten carbonate fuel cell (MCFC) was developed to study the effects of gas flow direction (co-flow and counter-flow) in anode and cathode on the generated power density by solving the mass and momentum conservation equations, electrochemical reaction and heat transfer. The simulation result of the co-flow temperature distribution was compared with the experimental data obtained from open literature. The molar fraction distribution of gases in the anode and cathode gas channels and temperature distribution across the cell were compared between two different flow directions. Furthermore, the performance of MCFC, which operates in the temperature range of 823 - 1023 K, was analysed by comparing the generated power density. The results showed that MCFC with co-flow attained higher power density compared to that of counter-flow at 873 K. However, at higher temperature of 1023 K, the generated power density was the same for both gas flow directions.
Current ethanol production processes utilizing crops such as sugar cane and corn starch have been well established over the decade. Other crop such as cassava is a potential candidate in producing ethanol. However, thermal processes are required to hydrolyze starch for the production of fermentable sugars. The processes are energy intensive and could lead to undesirable by-products generation. In this work, the hydrolysis of cassava starch is studied following an experimental design as a statistical problem solving approach. Central composite design (CCD) is used in order to select the most important variables from the simultaneous study on the effect and influence of operating conditions of bioreactor utilized, namely, pH, temperature and substrate concentration, as well as to optimize the process of cassava starch hydrolysis. From the results obtained, it can be concluded that the cassava starch hydrolysis is enhanced by pH and temperature. Model validations show good agreement between experimental results and the predicted responses.
MeSH terms: Ethanol; Manihot; Zea mays; Hydrolysis; Problem Solving; Research Design; Starch; Temperature; Cohort Studies; Crops, Agricultural; Bioreactors; Saccharum
The aim of this study is to investigate the effects of Palm Oil Clinker (POC) added as a stabilizer for improving the strength of peat. Cement and POC are added into peat up to 50% of the maximum dry unit weight. Treated peat achieved higher dry unit weight, almost 2.5 times as compared to untreated peat. Unconfined compressive strength (UCS) of treated peat is also investigated for soaked and unsoaked conditions. The results show that curing time improved the unconfined compressive strength of treated sample and increased by a factor of 20 and 11 for unsoaked and soaked conditions after 28 days of curing, respectively. The treated samples added with POC can be related to an increase in unconfined compressive strength for long time curing.
This paper presents a two-staged, pilot-scale vertical flow engineered wetland-based septage treatment system (VFEWs), which was designed and constructed in Curtin University Sarawak Campus to determine the system efficiency in treatment of septage. The treatment system consists of storage tanks, vertical flow wetlands, and a network of influent and effluent distribution pipes. The first stage of the VFEWs treatment system consists of three vertical flow wetlands placed in parallel to provide pre-treatment to raw septage to reduce solids and organic matters mainly by physical filtration and sedimentation processes. The percolate from the first stage is then further treated in the second stage, with four vertical flow wetlands, each with variation in operational regime and substrate (filter) type. The influences of various system and application-related parameters such as substrate material, presence of plants and plant types, and septage feeding practices (solid loading rate (SLR), batch and intermittent loading, and frequency of daily feeding) on pollutant removal efficiency were studied. Results from the first stage wetlands indicate that the removal of total solids and organic matter (BOD and COD) from the raw septage is promising (> 80%) at both SLR of 100 kg TS/m2 .yr and 250 kg TS/m2 .yr, respectively. However, a higher SLR decreased the average NH3-N removal efficiency. The findings on bed clogging assessment during the study period are also presented in this paper. Validation and expansion of these results are carried out with ongoing assessments on the system performance.
In this paper, stormwater runoff from a residential catchment located in Miri, Sarawak, was characterized to determine the pollutant concentrations and loading. The observed average event mean concentrations were 116 mg/L for TSS, 115 mg/L for COD, 1.5 mg/L for NH3-N, and 0.23 mg/L for Pb. Based on Interim National Water Quality Standards (INWQS) for Malaysia, the average event mean concentration, EMC value for TSS exceeded class II (50 mg/L), exceeded class V (>100 mg/L) for COD, and exceeded class III (0.9 mg/L) for NH3-N. All four water quality parameters exhibited first flush characteristic but to varying magnitude which was influenced by the storm characteristics.
MeSH terms: Malaysia; Paper; Rain; Water Movements; Hazardous Substances; Water Quality
A major source of contemporary power is a Coal-fired Power Plant. These power plants have the capacity to continuously supply electricity to almost 500,000 residential and business units. An essential component of a Coal-fired Power plant is automation. A feature of this automation is an Intelligent System developed for the Power Plant. These Intelligent Systems have different configurations and design. This research studies the various Intelligent Monitoring Interfaces developed for Coal-fired Power Plant Trips, their advantages, disadvantages and proposes a new Intelligent Monitoring Interface that would alleviate the disadvantages of the existing systems. Current systems that use Neural Network models are investigated. The improved Intelligent Monitoring Interface as proposed in this paper is a modification of the existing monitoring system for the Coal-fired Power Plant Boiler Trips. It is expected to improve the overall system by implementing remote accessibility and interactability between the plant operator and the control system interface. The interface will also assist the operator by providing guidelines to troubleshoot the identified trips and the remote server application will allow data collected to be viewed anytime, anywhere.
MeSH terms: Automation; Coal; Electricity; Power Plants; Neural Networks (Computer)
This case report highlights delay in the diagnosis of adenoma carcinoma of the lung in a female patient who has never smoked. It took three months to reach the diagnosis of stage IV lung carcinoma despite the presence of symptoms and an abnormal chest radiograph finding from the beginning. The clinical characteristics and predictors of missed opportunities for an early diagnosis of lung cancer are discussed. In this case, patient and doctor factors contributed to the delay in diagnosis. Thus, early suspicions of lung cancer in a woman with the presence of respiratory symptoms despite being a non-smoker are important in primary care setting.
MeSH terms: Adult; Female; Humans; Lung Neoplasms; Malaysia; Primary Health Care; Early Detection of Cancer
This study is an attempt to investigate the adsorption of petroleum hydrocarbon (toluene) from aqueous solutions using granular activated carbon (GAC) synthesized from oil palm shell (OPS) (referred as OPSbased GAC). This study involved a series of batch experiments to determine the adsorption equilibrium and kinetics. The batch experiments were conducted by shaking 200 mL toluene solution containing 0.4 g GAC (initial concentrations of 5, 15, 25 and 30 mg/L) at 180 rpm at 30°C. The OPS-based GAC achieved more than 80% toluene removal in all the experiments. The adsorption capacity of the OPSbased GAC estimated using Freundlich isotherm was 6.039 mg/g (L/mg)1/n. The adsorption kinetic study showed that the adsorption of toluene was of chemisorption as the experimental data fitted better to the pseudo-second-order kinetic model than the pseudo-first-order kinetic model.
The source of gastrointestinal bleeding (GIB) remains uncertain in patients presenting without hematemesis. This paper aims at studying the accuracy, specificity and sensitivity of the Naive Bayesian Classifier (NBC) in identifying the source of GIB in the absence of hematemesis. Data of 325 patients admitted via the emergency department (ED) for GIB without hematemesis and who underwent confirmatory testing were analysed. Six attributes related to demography and their presenting signs were chosen. NBC was used to calculate the conditional probability of an individual being assigned to Upper Gastrointestinal bleeding (UGIB) or Lower Gastrointestinal bleeding (LGIB). High classification accuracy (87.3 %), specificity (0.85) and sensitivity (0.88) were achieved. NBC is a useful tool to support the identification of the source of gastrointestinal bleeding in patients without hematemesis.
This study was conducted using crab shells as a biosorbent to remove Cu and Cd with different initial concentrations of 1, 5, 10, 15, and 20 mg/L in a biosorption treatment process. Crab shells were selected as biosorbents due to their abundance in the environment and ready availability as waste products from the market place. This study aimed to determine the ability of Scylla Serrata shells to remove Cu and Cd in an aqueous solution, as well as to provide a comparison of the removal rate between the two metals. The data were incorporated into hydrochemical software, PHREEQC, to investigate the chemical speciation distribution of each heavy metal. The shells of S. serrata were found to have a significant (p< 0.05) ability to remove Cu and Cd following the treatment. After six hours of treatment, the crab shells had removed 60 to 80% of both metals. However, the highest removal percentage was achieved for Cu with up to 94.7% removal rate in 5 mg/L initial Cu concentration, while 85.1% of Cd was removed in 1 mg/L initial solution, respectively. It can be concluded that the shells of S. serrata could remove Cu and Cd better with significant results (p
A multivariate control chart is a common tool used for monitoring and controlling a process whose quality is determined by several related variables. The objective of this study is to compare the performances of the multivariate exponentially weighted moving average (MEWMA) and the multivariate synthetic T2 control charts, for the case of a multivariate normally distributed process. A comparative study is made based on the average run length (ARL) performances of the control charts, using the simulation method, in order to identify the chart having the best performance in monitoring the process mean vector. The performances of the two charts, for different sample sizes and correlation coefficients, are presented in this paper. It was found that the MEWMA chart outperformed synthetic T2 chart for small shifts but the latter prevailed for moderate shifts. Both charts performed equally well for larger shifts. In addition, the performances of both MEWMA and synthetic T2 charts were found to be influenced by sample size and correlation coefficient. The two charts’ performances improved as the sample size and correlation coefficient increased for small and moderate shifts, but the charts’ performances did not depend on sample size and correlation coefficient when the shift was large.
MeSH terms: Paper; Normal Distribution; Sample Size
Lansium domesticum Corr. is a fruit tree of the Meliaceae family, which is commonly found in SouthEast Asia with a wide range of varieties. This study investigated three varieties of L. domesticum; Duku, Langsat and Dokong for the phytochemical screening and antimicrobial activity. Seeds from the matured fruits were extracted using hexane, methanol and water. The crude extracts were screened for antimicrobial activities toward three bacteria, namely, Pseudomonas aeruginosa, Bacillus subtilis, and Staphylococcus aureus. The findings showed that Langsat seed extracts contained more groups of compounds compared with the other two varieties, and its methanol extract demonstrated the highest inhibition zones against the three bacteria. The crude methanol extract of Duku seeds showed inhibition zones only towards Bacillus subtilis at a high concentration (1.0 mgL-1), whilst the seed extracts of Dokong showed no inhibition zones towards any of the tested bacteria.
Detailed geophysical investigations have been carried out using integrated geophysical methods with a view to characterising the subsurface lithologic features that might indicate suitable places for structural developments. An overview of the subsurface resistivity distribution has been achieved employing 8Vertical Electrical Soundings with the Schlumberger array and 4 2D resistivity imaging using Wenner array. In order to constrain the results of the electrical resistivity methods, we carried out a ground magnetic survey along E-W direction using the Proton precession magnetometer at 1m sampling interval. Analysis of well logs data available and VES results showed 4 to 5 geoelectric layers corresponding to sand, clayey sand, clay, silty sand and sandy clay. The 2D resistivity imaging sections showed relative decrease of apparent resistivity with depth implying a geological transition from sand with high resistivity value of about 508Ωm to clay with low resistivity value 16Ωm at depths of 0-20m and 25-50m respectively. The magnetic profiles showed that the study area was characterised by short wavelengths and amplitudes ranging from –3800 to 700 nT. The highs and lows of the magnetic responses occasioned by lithological variations and structural features were magnetically resolved. In view of the identified subsurface structures, the suggested depth to the competent layer is about 20m for low to medium structures while above 50m would be suitable for heavy or massive engineering structures. The use of integrated geophysical methods for the delineation, identification and imaging of the subsurface geological structures which could provide clues to the nature and type of foundation suitable for the development of the study area has been successfully achieved.