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The effect of dietary intake changes on nutritional status in acute leukaemia patients after first induction chemotherapy

Malihi Z, Kandiah M, Chan YM, Esfandbod M, Vakili M, Hosseinzadeh M, et al.

Eur J Cancer Care (Engl), 2015 Jul;24(4):542-52.
PMID: 25355468 DOI: 10.1111/ecc.12262

This study aimed to evaluate how changes in dietary intake among acute lymphoblastic and acute myeloid leukaemia (ALL and AML) patients affect nutritional status after the first induction chemotherapy. Dietary intake was assessed using 24-h recall and a 136-item food frequency questionnaire. Nutritional status was assessed by Patients Subjective Global Assessment questionnaire before starting induction therapy and again after 1 month. All newly diagnosed acute leukaemia patients aged 15 years old and older who attended three referral hospitals for initiation of their induction chemotherapy were included in the sample selection provided that they gave informed consent. A total of 30 AML and 33 ALL patients participated in the study. Dietary intake and nutritional status worsened after the chemotherapy treatment. Dietary intake in terms of macronutrients, micronutrients, food variety and diet diversity score changed significantly after the induction chemotherapy. No significant relationship was found between the changes in dietary indices and nutritional status. Chemotherapy-related side effects as an additional factor to cancer itself could affect dietary intake of leukaemia patients. The effectiveness of an early assessment of nutritional status and dietary intake should be further investigated in order to deter further deterioration.
Nutritional status and quality of life in patients with acute leukaemia prior to and after induction chemotherapy in three hospitals in Tehran, Iran: a prospective study

Malihi Z, Kandiah M, Chan YM, Hosseinzadeh M, Sohanaki Azad M, Zarif Yeganeh M

J Hum Nutr Diet, 2013 Jul;26 Suppl 1:123-31.
PMID: 23627676 DOI: 10.1111/jhn.12043

The primary objective of the present study was to assess changes in the nutritional status and quality of life in acute leukaemia patients, aged ≥15 years, who had undergone induction chemotherapy.
Fulltext Knowledge and behavior regarding breast cancer screening among female teachers in Selangor, Malaysia

Parsa P, Kandiah M, Mohd Zulkefli NA, Rahman HA

Asian Pac J Cancer Prev, 2008 Apr-Jun;9(2):221-7.
PMID: 18712963

A cross-sectional study was carried out to determine the knowledge and practices of 425 female secondary school teachers from 20 selected secondary schools in Selangor, Malaysia on breast cancer screening (BCS). A self-administered, structured questionnaire was used for data collection. This study showed moderate to low knowledge on breast cancer (BC) and BCS among teachers. Only 19%, 25% and 13.6% eligible women performed breast self-examination (BSE), clinical breast examination (CBE) and mammography respectively, on a regular basis. Level of breast cancer knowledge was significantly associated with BSE (p<0.001). Having heard/ read about BCS, and regular visit with a physician were associated with BCS behaviors (P<0.05). There was no association between BCS behaviors (P>0.05) and age, family history of breast cancer, marital status or having health insurance. Efforts are needed to increase knowledge and remove misconceptions about breast cancer and screening practices among Malaysian women.
Fulltext Dietary patterns and risk of colorectal cancer in Tehran Province: a case-control study

Safari A, Shariff ZM, Kandiah M, Rashidkhani B, Fereidooni F

BMC Public Health, 2013;13:222.
PMID: 23497250 DOI: 10.1186/1471-2458-13-222

Colorectal cancer is the third and fourth leading cause of cancer incidence and mortality among men and women, respectively in Iran. However, the role of dietary factors that could contribute to this high cancer incidence remains unclear. The aim of this study was to determine major dietary patterns and its relationship with colorectal cancer.
Fulltext A Qualitative Study on Coping Strategies among Women from Food Insecurity Households in Selangor and Negeri Sembilan

Norhasmah S, Zalilah MS, Mohd Nasir MT, Kandiah M, Asnarulkhadi AS

Malays J Nutr, 2010 Apr;16(1):39-54.
PMID: 22691852 MyJurnal

Understanding the experiences of household food insecurity is essential for better measurement and assessment of its nutritional, physical and psychological consequences. This qualitative study explored coping strategies and their perceived severity in relation to household food insecurity. Women (n=57; 20-50 years old) from rural and urban areas in Selangor and Negeri Sembilan participated in this study. These women were interviewed using a semi-structured questionnaire. The questionnaire was divided into two parts, that is, demographic and socio-economic information and women's experiences of coping with household food insecurity. Women were chosen since they were primarily responsible for food acquisition and preparation for the all household members. Thematic analysis was utilized in data analysis. Thematic analysis is a method for identifying, analysing and reporting patterns and themes of the qualitative data. Themes capture something important related to the study objectives and describe an integrating as well as relational idea from the data. Results showed that households displayed a variety of non-food related coping strategies and food-related coping strategies. Women's descriptions of non-food related coping strategies to food insecurity were categorised into five themes i.e. cloth purchasing behaviors, reduce school-going children's expenditure, delay the payment of bills, adjust lifestyle and increase cash and income earning. Food related coping strategies were categorised into four themes i.e. food stretching, food rationing, food seeking and food anxiety. Food stretching is a strategy of food insecurity that affects the quality of diet. Food rationing comprises coping strategies of food insecurity related to the quantity of food available for household's consumption. Food seeking is a strategy of acquiring food through socially unacceptable ways and food anxiety is a strategy that indicates households allocating money to buy staple food in order to prevent food insecurity. Each coping strategy showed a different level of perceived severity, that is, less severe, quite severe, severe and very severe. In conclusion, the qualitative data provide valuable information for understanding the experiences of food insecurity that can be used as a basis to develop direct indicators that can capture the core behaviours and their level of severity to measure household food insecurity.
Fulltext Obesity and risk of colorectal adenomatous polyps: a case-control study in hospital kuala lumpur

Ramadas A, Kandiah M, Zarida H, Yunus Gul AG, Faizal JA

Malays J Nutr, 2009 Mar;15(1):1-10.
PMID: 22691799 MyJurnal

Colorectal adenomas are precursor lesions of colorectal cancer. Several studies have proposed that obesity is a risk factor for colorectal adenoma. This case-control study examined the relationship between body mass index (BMI), waist circumference, waistto-hip ratio (WHR), body fat percentage and colorectal adenomatous polyps (CRA) in patients who have had a colonoscopy at the Hospital Kuala Lumpur (HKL). Fifty-nine patients (42 males and 17 females) positively identified as having CRA and 59 polypfree subjects were recruited as controls (33 males and 26 females). A pre-tested questionnaire was used to collect socio-economic information, while anthropometric measurements were determined directly by established methods. The mean BMI of female case subjects was significantly higher than control females (25.63 + 4.87 kg/m2 vs. 23.86 + 3.70 kg/m2, p<0.05) but the difference in BMI was not significant in men. The mean WHR of male subjects was significantly higher in the case group (0.92 + 0.07 vs. 0.90 + 0.06, p<0.05). After adjusting for confounders, waist circumference was the only indicator that was found to significantly increase the risk for CRA in women (OR = 6.349, 95% CI = 1.063 - 37.919). Higher BMI, WHR and body fat percentage showed a non-significant risk in female subjects. In men, none of the obesity indicators were found to be significant risk factors for CRA. These findings suggest that abdominal obesity may be a contributing factor to CRA risk particularly in women. A prospective study is needed to confirm the role of obesity in the development of CRA in Malaysians.
Fulltext Socio-demographic and psychosocial factors associated with physical activity of working woman in Petaling Jaya, Malaysia

Siti Affira K, Mohd Nasir MT, Hazizi AS, Kandiah M

Malays J Nutr, 2011 Dec;17(3):315-24.
PMID: 22655453

This study was conducted on 215 working women from four private corporate companies in a suburb in Malaysia to determine the factors related to their physical activity levels.
Fulltext Stages of change to increase fruit and vegetable intake and its relationships with fruit and vegetable intake and related psychosocial factors

Chee Yen W, Mohd Shariff Z, Kandiah M, Mohd Taib MN

Nutr Res Pract, 2014 Jun;8(3):297-303.
PMID: 24944775 DOI: 10.4162/nrp.2014.8.3.297

BACKGROUND/OBJECTIVES: Understanding individual's intention, action and maintenance to increase fruit and vegetable intake is an initial step in designing nutrition or health promotion programs. This study aimed to determine stages of change to increase fruit and vegetable intake and its relationships with fruit and vegetable intake, self-efficacy, perceived benefits and perceived barriers.
SUBJECTS/METHODS: This cross-sectional study was conducted among 348 public university staff in Universiti Putra Malaysia. A pre-tested self-administered questionnaire and two days 24-hour diet recall were used.
RESULTS: Half of the respondents (50%) were in preparation stage, followed by 43% in action/maintenance, 7% in pre-contemplation/contemplation stages. Respondents in action/maintenance stages had significantly higher self-efficacy (F = 9.17, P < 0.001) and perceived benefits (F = 5.07, P < 0.01) while respondents in pre-contemplation/contemplation and preparation stages had significantly higher perceived barriers (F = 4.83, P < 0.05). Perceived benefits tend to outweigh perceived barriers pre-ceding to taking action. Self-efficacy is important in motivating individuals to increase fruit and vegetable intake as self-efficacy and perceived barriers crossed over between preparation and action/maintenance. Respondents in action/maintenance stages had the highest adjusted mean serving of fruit and vegetable intake (F = 4.52, P < 0.05) but the intake did not meet recommendation.
CONCLUSION: Intervention strategies should emphasize on increasing perceived benefits and building self-efficacy by providing knowledge and skills to consume a diet high in fruits and vegetables in order to promote healthy changes in having high fruit and vegetable intake.
Socioeconomic profile and nutritional status of children in rubber smallholdings

Marjan ZM, Kandiah M, Lin KG, Siong TE

Asia Pac J Clin Nutr, 2002;11(2):133-41.
PMID: 12074180

This paper will present the socioeconomic profile and nutritional status of children aged 1-6 years in the rubber smallholdings of Peninsula Malaysia. A total of 323 households were involved in this study. The sociodemographic data were obtained through interviews with heads of households using a set of questionnaires. Anthropometric measurements were taken from 506 children aged 1-6 years from these households. The weight and height of the children were compared with the reference values of the National Center for Health Statistics (NCHS) and the nutritional status was classified based on the recommendations of WHO. The average age of the fathers was 39.9+/-8.6 years and 34.4+/-7.0 years for the mothers. The mean household size was 6.67+/-2.27. The majority (49.7%) of the heads of households received 4-6 years of formal education and 7.9% received no formal education. Based on the monthly per capita income, 24.0% were found to be in the hardcore poor category, 38.3% fall into the poor category and 37.7% in the above poverty income group. The prevalence of stunting and underweight among children between the ages of 1-6 years were highest among children from the hardcore poor, followed by the poor category and above the poverty line income group. Wasting was present in all income groups, with a prevalence of 4.2% found among the hardcore poor, 9.4% among the poor group and 8.4% in the above poverty income group. The Pearson Product Moment Correlation showed significant relationships between household total income and height-for-age (r = 0.131, P = 0.05) and weight-for-age (r = 0.127, P = 0.05). There were also significant correlations between monthly per capita income with height-for-age (r = 0.16, P < 0.01) and weight-for-age (r = 0.13, P < 0.05). The acreage of land utilised was correlated with height-for-age (r = 0.11, P < 0.05), weight-for-age (r = 0.17, P < 0.05) and weight-for-height (r = 0.16, P < 0.05). However, stepwise multiple regression analysis indicated that the predictor of height-for-age was monthly per capita income (R2 = 0.03, P < 0.01) and acreage of land utilised was a predictor for weight-for-age (R2 = 0.03, P < 0.01) and weight-for-height (R2 = 0.01, P < 0.01). Because income and acreage of land utilised have been shown to be associated with nutritional status, it is recommended that intervention programs that focus on generation of income and diversification of land utilisation should be undertaken. A multidiscipline approach involving the family, community and government agencies should be applied to any type of intervention program.
Diet and physical activity in relation to weight change among breast cancer patients

Yaw YH, Shariff ZM, Kandiah M, Weay YH, Saibul N, Sariman S, et al.

Asian Pac J Cancer Prev, 2014;15(1):39-44.
PMID: 24528062

BACKGROUND: This study aimed to provide an overview of lifestyle changes after breast cancer diagnosis and to examine the relationship between dietary and physical activity changes with weight changes in breast cancer patients. Women with breast carcinomas (n=368) were recruited from eight hospitals and four breast cancer support groups in peninsular Malaysia. Dietary and physical activity changes were measured from a year preceding breast cancer diagnosis to study entry. Mean duration since diagnosis was 4.86±3.46 years. Dietary changes showed that majority of the respondents had decreased their intake of high fat foods (18.8-65.5%), added fat foods (28.3-48.9%), low fat foods (46.8-80.7%), red meat (39.7%), pork and poultry (20.1-39.7%) and high sugar foods (42.1-60.9%) but increased their intake of fish (42.7%), fruits and vegetables (62.8%) and whole grains (28.5%). Intake of other food groups remained unchanged. Only a small percentage of the women (22.6%) had increased their physical activity since diagnosis where most of them (16.0%) had increased recreational activities. Age at diagnosis (β= -0.20, p= 0.001), and change in whole grain (β= -0.15, p= 0.003) and fish intakes (β= 0.13, p= 0.013) were associated with weight changes after breast cancer diagnosis. In summary, the majority of the women with breast cancer had changed their diets to a healthier one. However, many did not increase their physical activity levels which could improve their health and lower risk of breast cancer recurrence.
Validation of the Malaysian Coping Strategy Instrument to measure household food insecurity in Kelantan, Malaysia

Sulaiman N, Shariff ZM, Jalil RA, Taib MN, Kandiah M, Samah AA

Food Nutr Bull, 2011 Dec;32(4):354-64.
PMID: 22590969

Food insecurity occurs whenever people are not able to access enough food at all times for an active and healthy life or when adequate and safe food acquired by socially acceptable ways is not available.
Colorectal cancer and its association with the metabolic syndrome: a Malaysian multi-centric case-control study

Ulaganathan V, Kandiah M, Zalilah MS, Faizal JA, Fijeraid H, Normayah K, et al.

Asian Pac J Cancer Prev, 2012;13(8):3873-7.
PMID: 23098486

OBJECTIVE: Colorectal cancer (CRC) and the metabolic syndrome (MetS) are both on the rise in Malaysia. A multi-centric case-control study was conducted from December 2009 to January 2011 to determine any relationship between the two.
METHODS: Patients with confirmed CRC based on colonoscopy findings and cancer free controls from five local hospitals were assessed for MetS according to the International Diabetes Federation (IDF) definition. Each index case was matched for age, gender and ethnicity with two controls (140: 280).
RESULTS: MetS among cases was highly prevalent (70.7%), especially among women (68.7%). MetS as an entity increased CRC risk by almost three fold independently (OR=2.61, 95%CI=1.53-4.47). In men MetS increased the risk of CRC by two fold (OR=2.01, 95%CI, 1.43-4.56), demonstrating an increasing trend in risk with the number of Mets components observed.
CONCLUSION: This study provides evidence for a positive association between the metabolic syndrome and colorectal cancer. A prospective study on the Malaysian population is a high priority to confirm these findings.
Fulltext Contribution of diet and major depression to incidence of acute myocardial infarction (AMI)

Yary T, Soleimannejad K, Abd Rahim F, Kandiah M, Aazami S, Poor SJ, et al.

Lipids Health Dis, 2010;9:133.
PMID: 21087475 DOI: 10.1186/1476-511X-9-133

BACKGROUND: Despite significant improvements in the treatment of coronary heart disease (CHD), it is still a major cause of mortality and morbidity among the Iranian population. Epidemiological studies have documented that risk factors including smoking and the biochemical profile are responsible for the development of acute myocardial infarction (AMI). Psychological factors have been discussed as potential risk factors for coronary heart disease. Among emotional factors, depression correlates with coronary heart disease, particularly myocardial infarction.
METHODS: This case-control study was conducted on 120 cases (69 males and 51 females) of acute myocardial infarction (AMI) and 120 controls, with a mean age of 62.48 ± 15.39 years. Cases and controls were matched by age, residence and sex.
RESULTS: The results revealed that severe depression was independently associated with the risk of AMI (P = 0.025, OR = 2.6, 95% CI 1.1-5.8). The analysis of variables indicated that risk factors for developing depression were unmarried, low levels of polyunsaturated fatty acids (PUFAs), total dietary fiber (TDF) and carbohydrates. The levels of these dietary factors were lowest in severely depressed patients compared to those categorised as moderate or mild cases. Furthermore, severely depressed subjects were associated with higher levels of total cholesterol, high systolic blood pressure (SBP) and WHR. Age, income, a family history of coronary heart disease, education level, sex, employment and smoking were not associated with severe depression.
CONCLUSION: The present study demonstrated that severe depression symptoms are independent risk factors for AMI. Furthermore, severe depression was associated with an unhealthy diet and AMI risk factors.
Study site: Mostafa Hospital, Ilam Province, Iran
Prevalence of obesity and factors associated with it in a worksite setting in Malaysia

Cheong SM, Kandiah M, Chinna K, Chan YM, Saad HA

J Community Health, 2010 Dec;35(6):698-705.
PMID: 20458526 DOI: 10.1007/s10900-010-9274-1

Socio-economic status, lifestyle behaviors, and psychosocial factors have been implicated in the development of overweight and obesity. This study aims to observe the prevalence of overweight and obesity in an academic worksite and to examine the possible association between variables such as socio-economic characteristics, work factors, psychosocial factors, and weight control behaviors and obesity. In this study, the target population were full-time academic and non-academic staff. Body mass index (BMI) and waist circumference (WC) were computed to determine obesity. A pretested self-administered questionnaire was used to obtain information on socio-demographic factors, work related factors, psychosocial factors, and weight control behaviors. Data were obtained on 367 adults of whom 39.2% were males and 60.8% females. Overweight was seen in 31.9% of males and 26.5% of females while 16.1% of them were obese, irrespective of gender. Central obesity was noted in about 37% of males and 39% of females. The results showed that socio-demographic factors (age, gender, and education) and psychosocial factors (perceived health status, body weight perception, and weight-control goals) were significantly associated with BMI. Working hours were also significantly associated with BMI. However, weight control practices (diet-control practices and physical activity practices) were not significantly associated with BMI. In conclusion, this study found a higher prevalence of overweight and obesity among employees of a selected public university in comparison to the general population. Socio-demographic, psychosocial factors, and working hours were found to contribute to obesity in this sample of adults.
Fulltext Diet and lifestyle intervention among patients with colorectal adenomas: rationale and design of a Malaysian study

Kandiah M, Ramadas A, Shariff ZM, Yusof RM, Gul YG

Asian Pac J Cancer Prev, 2005 Oct-Dec;6(4):553-60.
PMID: 16436011

Comprehensive evaluation of the large body of consistent evidence from laboratory, epidemiologic and clinical studies has led to the conclusion that modification of the dietary and lifestyle patterns of populations has considerable potential for reducing cancer risk. This paper describes a randomized-controlled trial involving a diet and lifestyle intervention for patients with history of colorectal adenomas. The primary aim of this trial is to evaluate the effectiveness of the intervention with reference to recurrence of adenomatous polyps over a two year period--the first year being the intervention period and the second year of the study allowing for post-intervention follow-up. Subjects found to fit the inclusion criteria are recruited and randomized to two groups: the intervention group and the control group. The intervention group subjects will attend a monthly lecture-discussion session for 10 months and small group counseling on modification of lifestyle behavior and diet as well as receive educational materials which were adapted from the WCRF Diet and Health Recommendations for Cancer Prevention. Control subjects will be provided with the usual care given to such patients. One hundred and sixteen patients who were diagnosed with colorectal adenomatous polyps in the previous twelve months at the Hospital Kuala Lumpur have already been enrolled in this trial. Baseline data collection is on-going.
Fulltext Dietary and other factors associated with overweight among women workers in two electronics factories in selangor

Lim HM, Chee H, Kandiah M, Shamsuddin K, Jamaluddin J, Nordin N, et al.

Malays J Nutr, 2003 Sep;9(2):105-24.
PMID: 22691732 MyJurnal

This study was a cross-sectional survey conducted among 122 women workers employed in the electronics factories in the Ulu Klang Free Trade Zone (FTZ) and the Bangi FTZ, Selangor, Peninsular Malaysia. The purpose of the study was to examine the problem of overweight (>25.0 kg/m2) among this group of women, and factors (socio-demographic, work, exercise, and dietary) associated with overweight, and, to study the food intake pattern of the women in both the overweight and non-overweight groups. Data was collected using a set of questionnaires, while anthropometric measurements were obtained to calculate body mass index (BMI) and waist hip ratio (WHR). The results of the study indicated that 64.0% of the women were overweight (29.5% pre-obese, 34.5% obese). About one-tenth of the women (11.5%) had a WHR of above 0.85. From the bivariate analysis, it was found that women who were older, ever married, had lower educational level, had higher salary, not living in the hostel, involved in shiftwork, and trying to lose weight were more likely to be overweight. After adjusting for age, each of the above factors, except for educational level, remained significantly associated with overweight. Women's diet was found to be monotonous and lacking in variety as accessibility to and availability of a variety of food was a problem for them due to the nature of their work. They also had a sedentary lifestyle. Therefore, further research focusing on changing the poor dietary habits and sedentary lifestyle of the women workers is necessary to address the problem of overweight.
Fulltext Nutritional anemia in pregnancy: a study at the maternity hospital, Kuala Lumpur

Tee ES, Kandiah M, Ali J, Kandiah V, Zahari MR, Kuladevan R, et al.

Malays J Reprod Health, 1984 Jun;2(1):32-50.
PMID: 12267519

The study presents recent data on the prevalence and pattern of nutritional anemia in the Maternity Hospital, Kuala Lumpur. A total of 309 pregnant women in their third trimester, of Malay, Chinese and Indian origin from the lower socio-economic strata were randomly selected for the study. Hematological indices (including Hb, PCV, MCHC, and TRBC), serum iron, transferrin saturation and ferritin, serum folate as well as protein and albumin were determined. Based on Hb and PCV values, 30-40 percent of the women could be considered anemic; approximately 50 percent of them presented with unsatisfactory serum iron, transferrin saturation and ferritin values; 60.9 percent had low serum folate levels; and about 30 percent may be considered to be of poor protein nutriture. Anemia in the study population was seen to be related mostly to iron and to a lesser extent, folate deficiency. Hematological, iron, folate and protein status was observed to be the poorest amongst the Indian women, better in the Malay group and generally the best amongst the Chinese women. Birth records of 169 of these women revealed that all of them had live births. Nearly all the infants were delivered by normal vaginal delivery (NVD) The mean gestational age was 38.6 weeks. One of the infants had a birth weight of <2.0 kg; incidence of low birth weight, <2.5 kg, was 8.3 percent. Although there was a trend of deteriorating hematological, iron and protein status of women from the 0, 1 -3 and >=4 parity groups, these differences were not statlstlcally significant.
Fulltext Reliability and validity of Champion's Health Belief Model Scale for breast cancer screening among Malaysian women

Parsa P, Kandiah M, Mohd Nasir MT, Hejar AR, Nor Afiah MZ

Singapore Med J, 2008 Nov;49(11):897-903.
PMID: 19037556

Breast cancer is the leading cause of cancer deaths in Malaysian women, and the use of breast self-examination (BSE), clinical breast examination (CBE) and mammography remain low in Malaysia. Therefore, there is a need to develop a valid and reliable tool to measure the beliefs that influence breast cancer screening practices. The Champion's Health Belief Model Scale (CHBMS) is a valid and reliable tool to measure beliefs about breast cancer and screening methods in the Western culture. The purpose of this study was to translate the use of CHBMS into the Malaysian context and validate the scale among Malaysian women.
Fulltext School-administered weekly iron-folate supplements improve hemoglobin and ferritin concentrations in Malaysian adolescent girls

Tee ES, Kandiah M, Awin N, Chong SM, Satgunasingam N, Kamarudin L, et al.

Am J Clin Nutr, 1999 Jun;69(6):1249-56.
PMID: 10357747 DOI: 10.1093/ajcn/69.6.1249

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.

Comment in: Picciano MF. Iron and folate supplementation: an effective intervention in
adolescent females. Am J Clin Nutr. 1999 Jun;69(6):1069-70. PubMed PMID:
10357724. https://academic.oup.com/ajcn/article/69/6/1069/4714856

Study site: 3 secondary schools, Samarahan district, Sarawak, Malaysia
Fulltext Prevalence of overweight among Malaysian adults from rural communities

Khor GL, Yusof AM, Tee ES, Kandiah M, Lee Huang MS

Asia Pac J Clin Nutr, 1999 Dec;8(4):272-9.
PMID: 24394228

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.

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