Displaying publications 21 - 35 of 35 in total

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  1. Mazri FH, Manaf ZA, Shahar S, Mat Ludin AF, Karim NA
    Chronobiol Int, 2023 Mar;40(3):272-283.
    PMID: 36803265 DOI: 10.1080/07420528.2023.2165092
    Previously we had demonstrated the development and feasibility of an integrated chrono-nutrition weight reduction program among non-shift workers with morning and evening chronotypes. In this current paper, we described the association between the changes in chrono-nutrition practice and weight loss outcomes upon completing the weight reduction program. A total of 91 overweight/obese non-shift workers participated in the 12-week integrated chrono-nutrition weight reduction program (Age: 39.6 ± 6.3 y; 74.7% women; BMI: 31.2 ± 4.5 kg/m2). All the assessments including anthropometry, dietary, sleep habits, physical activity, and process of change were measured during pre- and post-intervention. Participants who had lost ≥3% of their body weight were categorized as satisfactory weight loss outcome, and those who did not achieve 3% weight loss were categorized as unsatisfactory weight loss. The satisfactory weight loss had greater daily percent energy intake during earlier in the day from protein (Mean difference (MD): +3.2%, 95% CI: 1.6, 4.9, p
  2. Teng NI, Shahar S, Manaf ZA, Das SK, Taha CS, Ngah WZ
    Physiol Behav, 2011 Oct 24;104(5):1059-64.
    PMID: 21781980 DOI: 10.1016/j.physbeh.2011.07.007
    Calorie restriction (CR) has been promoted to increase longevity. Previous studies have indicated that CR can negatively affect mood and therefore the effect of CR on mood and quality of life (QOL) becomes crucial when considering the feasibility of CR in humans. We conducted a three month clinical trial on CR (reduction of 300 to 500 kcal/day) combined with two days/week of Muslim sunnah fasting (FCR) to determine the effectiveness of FCR on QOL among aging men in Klang Valley, Malaysia. A total of 25 healthy Malay men (age 58.8±5.1 years), with no chronic diseases and a BMI of 23.0 to 29.9 kg/m2 were randomized to FCR (n=12) and control (n=13) groups. Body composition measurements and QOL questionnaires were ascertained at baseline, week 6 and week 12. QOL was measured using the Short-Form 36, sleep quality was determined using the Pittsburgh Sleep Quality Index, the Beck Depression Inventory II was used to measure mood and the Perceived Stress Scale was used to measure depression. The FCR group had a significant reduction in body weight, BMI, body fat percentage and depression (P<0.05). The energy component of QOL was significantly increased in FCR group (p<0.05). There were no significant changes in sleep quality and stress level between the groups as a result of the intervention. In conclusion, FCR resulted in body weight and fat loss and alleviated depression with some improvement in the QOL in our study and has the potential to be implemented on a wider scale.
  3. Manaf ZA, Rosli MHM, Noor NM, Jamil NA, Mazri FH, Shahar S
    Nutr Res Pract, 2024 Apr;18(2):294-307.
    PMID: 38584814 DOI: 10.4162/nrp.2024.18.2.294
    BACKGROUND/OBJECTIVES: Dietitians frequently use nutrition education tools to facilitate dietary counselling sessions. Nevertheless, these tools may require adaptation to keep pace with technological advancements. This study had a 2-fold purpose: first, to identify the types of nutrition education tools currently in use, identify their limitations, and explore dietitians' perspectives on the importance of these tools; second, to investigate the features that dietitians prefer in digital nutrition education tools.

    SUBJECTS/METHODS: A semi-structured face-to-face interview was conducted among 15 dietitians from selected public hospitals, primary care clinics, and teaching hospitals in Malaysia. Inductive thematic analysis of the responses was conducted using NVivo version 12 software.

    RESULTS: Most dietitians used physical education tools including the healthy plate model, pamphlets, food models, and flip charts. These tools were perceived as important as they facilitate the nutrition assessment process, deliver nutrition intervention, and are time efficient. However, dietitians described the current educational tools as impersonal, outdated, limited in availability due to financial constraints, unhandy, and difficult to visualise. Alternatively, they strongly favoured digital education tools that provided instant feedback, utilised an automated system, included a local food database, were user-friendly, developed by experts in the field, and seamlessly integrated into the healthcare system.

    CONCLUSION: Presently, although dietitians have a preference for digital educational tools, they heavily rely on physical nutrition education tools due to their availability despite the perception that these tools are outdated, impersonal, and inconvenient. Transitioning to digital dietary education tools could potentially address these issues.

  4. Juliana N, Shahar S, Sahar MA, Ghazali AR, Manaf ZA, Noah RM
    Asia Pac J Clin Nutr, 2017 Mar;26(2):278-286.
    PMID: 28244706 DOI: 10.6133/apjcn.122015.05
    BACKGROUND AND OBJECTIVES: Nutrition and physical activity interventions is beneficial in reversing obesity. However far too little attention has been paid to the effect of these interventions on breast tissues. Thus, the aim of this study was to explore the effect of a home-based dietary and physical activity intervention (the Her Shape Program) on metabolic parameters, blood biomarkers and adiposity at the breast.

    METHODS AND STUDY DESIGN: A randomized controlled study was conducted on obese women with high breast adiposity (<0.1 Sm-1), aged 40-60 years in Klang Valley, Malaysia. Subjects were assigned to intervention (n=16) and control group (n=15). Intervention group received a home based health education package with close monitoring weekly, personal diet consultation and physical training in group. Assessment was ascertained at three time points; baseline, weeks 8 and 16. Outcome measures were the energy intake, physical activity, body composition, blood tests, blood biomarkers and electrical impedance tomography (EIT) quantitative values. Analyses were done using 2-way repeated measures ANOVA.

    RESULTS AND CONCLUSIONS: All subjects completed the program without any drop-out. The HSI group had 100% compliance towards the intervention program; their energy intake was reduced for approximately 35% and their activity score was increased for approximately 11%. A significant interaction effect was found in body weight, body mass index (BMI), total cholesterol/HDL, vitamin C intake and matrix metallopeptidase 9 (MMP-9) (p<0.05). Interestingly, their EIT extremum values were also significantly increased indicating a reduction of breast adiposity. The intervention program was successful in improving body composition, physical activities, MMP9 and breast adipose tissue composition.

  5. Won H, Singh DK, Din NC, Badrasawi M, Manaf ZA, Tan ST, et al.
    Clin Epidemiol, 2014;6:343-50.
    PMID: 25328418 DOI: 10.2147/CLEP.S62392
    Cognitive impairment is correlated with physical function. However, the results in the literature are inconsistent with cognitive and physical performance measures. Thus, the aim of this study was to determine the association between cognitive performance and physical function among older adults.
  6. Mazri FH, Manaf ZA, Shahar S, Mat Ludin AF, Karim NA, Ban AY, et al.
    Chronobiol Int, 2021 05;38(5):659-665.
    PMID: 33733959 DOI: 10.1080/07420528.2021.1887209
    The Munich Chronotype Questionnaire (MCTQ) has been widely validated among various types of populations. However, determination of chronotype among individuals who have a split sleep pattern with short intervals between the first and second sleep bouts on free days has not yet been reported. This study aimed to validate the MCTQ modified for this purpose by assessing the actual sleep-wake timing against the Morningness-Eveningness Questionnaire (MEQ). The modified calculation for the midpoint of sleep on free days (MSF) of the split sleep pattern considers the second sleep bout as the total sleep duration on free days. We recruited 161 participants (mean age: 38.7 ± 7.8 years; 73% females, 29% with split sleep pattern) were recruited to administer the modified version of the MCTQ and MEQ. All of the MCTQ original parameters: midpoint of sleep on work days (MSW, r = -0.575), midpoint of sleep on free days (MSF, r = -0.568), and midpoint of sleep on free days corrected for sleep debt (MSFsc,r = -0.566) were significantly correlated with MEQ. The MEQ was further tested against MSF in four conditions of the split sleep pattern. The MSF modified for split sleep within 60 minutes after the first awakening showed highest correlation (r = -0.576) against MEQ score. The results demonstrate the modified version of MCTQ is valid to determine the chronotype in participants who practice consolidated and split sleep patterns.
  7. Ahmad NA, Mat Ludin AF, Vanoh D, Tohit NM, Manaf ZA, Mohd Noah SA, et al.
    Digit Health, 2024;10:20552076241297213.
    PMID: 39600385 DOI: 10.1177/20552076241297213
    BACKGROUND: Technology advancement along with the increase in the older adults' population leads to the creation of health applications. The combination of exercise, nutrition, and cognition should be studied carefully in improving older adults' health.

    OBJECTIVE: The purpose of this study is to develop a health application, WeFit contains these three components and to determine its content validity, acceptability, and usability.

    METHODOLOGY: This study is a design and development study involving three phases. The first phase is the need analysis involving a review on 16 mobile applications available in Google play and iTunes App store as well as a review of six articles for identifying the perception of older adults in using mobile applications. Second phase is mobile application development and content validity. The content validity was determined using the Content Validity Index for Individual Items (I-CVI). Phase 3 evaluated the acceptance of the WeFit mobile application among older adults and health practitioners.

    RESULTS: Phase 1 indicated that half of the applications reviewed (50.0%) had physical activity component and the other half (50.0%) had a cognitive component, and none on nutrition. No application is reported to have all three components. In Phase 2, WeFit health application containing the three components was developed where users can view exercise and food recommendations and play cognitive games. WeFit had an I-CVI value of 0.98. With respect to acceptability, majority of the study participants (93.3%) understood the WeFit's content and the graphics used were appropriate. The usability study found that the majority of the older adults were satisfied with the interface and content. All health practitioners (100%) agreed WeFit is easy to use and agreed that it can guide them in giving medical advices.

    CONCLUSION: WeFit mobile app has been successfully developed, validated, and tested for acceptance among the older adults and health practitioners.

  8. Michael V, You YX, Shahar S, Manaf ZA, Haron H, Shahrir SN, et al.
    PMID: 34360392 DOI: 10.3390/ijerph18158099
    In this review, we have investigated the perceptions, barriers, and enabling factors that were responsible for a dietary salt reduction in the out-of-home sectors. For this purpose, we examined different knowledge databases such as Google Scholar, Ebscohost, MEDLINE (PubMed), Ovid, and Cochrane Library for research articles from September to December 2020. The inclusion criteria for the research articles were that they had to be published in English and had to be a qualitative or quantitative study that was conducted after 2010. These studies also had to report the various enablers, barriers, and perceptions regarding salt reduction in the out-of-home sectors. After implementing the inclusion criteria, we successfully screened a total of 440 studies, out of which 65 articles fulfilled all the criteria. The perceived barriers that hindered salt reduction among the out-of-home sectors included lack of menu and food variabilities, loss of sales due to salt reduction, lack of technical skills for implementing the salt reduction processes for cooking or reformulation, and an absence of environmental and systemic support for reducing the salt concentration. Furthermore, the enablers for salt reduction included the intervention programs, easy accessibility to salt substitutes, salt intake measurement, educational availability, and a gradual reduction in the salt levels. With regards to the behavior or perceptions, the effect of organizational and individual characteristics on their salt intake were reported. The majority of the people were not aware of their salt intake or the effect of salt on their health. These people also believed that low salt food was recognized as tasteless. In conclusion, the enablers, barriers, and perceptions regarding salt reduction in the out-of-home sectors were multifaceted. Therefore, for the implementation of the strategies, policies, and initiatives for addressing the barriers, the policymakers need to encourage a multisectoral collaboration for reducing the salt intake in the population.
  9. Brown MK, Shahar S, You YX, Michael V, Majid HA, Manaf ZA, et al.
    BMJ Open, 2021 07 23;11(7):e044628.
    PMID: 34301647 DOI: 10.1136/bmjopen-2020-044628
    INTRODUCTION: Current salt intake in Malaysia is high. The existing national salt reduction policy has faced slow progress and does not yet include measures to address the out of home sector. Dishes consumed in the out of home sector are a known leading contributor to daily salt intake. This study aims to develop a salt reduction strategy, tailored to the out of home sector in Malaysia.

    METHODS AND ANALYSIS: This study is a qualitative analysis of stakeholder views towards salt reduction. Participants will be recruited from five zones of Malaysia (Western, Northern, Eastern and Southern regions and East Malaysia), including policy-makers, non-governmental organisations, food industries, school canteen operators, street food vendors and consumers, to participate in focus group discussions or in-depth interviews. Interviews will be transcribed and analysed using thematic analysis. Barriers will be identified and used to develop a tailored salt reduction strategy.

    ETHICS AND DISSEMINATION: Ethical approval has been obtained from the Universiti Kebangsaan Malaysia Medical Research Ethics Committee (UKM PPI/1118/JEP-2020-524), the Malaysian National Medical Research Ethics Committee (NMRR-20-1387-55481 (IIR)) and Queen Mary University of London Research Ethics Committee (QMERC2020/37) . Results will be presented orally and in report form and made available to the relevant ministries for example, Ministry of Health, Ministry of Education and Ministry of Trade to encourage adoption of strategy as policy. The findings of this study will be disseminated through conference presentations, peer-reviewed publications and webinars.

  10. Mazri FH, Manaf ZA, Shahar S, Mat Ludin AF, Karim NA, Hazwari NDD, et al.
    Nutrients, 2021 Nov 17;13(11).
    PMID: 34836375 DOI: 10.3390/nu13114121
    This study examined whether the temporal patterns of energy and macronutrient intake in early and late eating windows were associated with metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO) among non-shift workers. A total of 299 overweight/obese non-shift workers (Age: 40.3 ± 6.9 years; 73.6% women; BMI: 31.7 ± 5.0 kg/m2) were recruited in the Klang Valley area of Malaysia. The biochemical parameters were determined from fasting blood samples, whereas information on dietary intake and timing was obtained from a 7-day diet history questionnaire. The midpoint of eating was used to determine the early and late windows. Compared to MHO non-shift workers (n = 173), MUO non-shift workers (n = 126) had lower energy intake from carbohydrates and protein during the early window. In contrast, MUO participants had greater energy intake from carbohydrates and fat during the late window. Participants with unhealthy metabolic status (regardless of their chronotypes) had similar temporal patterns of energy intake characterized by smaller energy intake during the early window and greater energy intake during the late window compared with participants with healthier metabolic status. Overall, the lowest percentile of energy intake during the early window was associated with an increased risk of MUO, after adjustment for potential confounders [odds ratio (OR) = 4.30, 95% confidence interval (CI) 1.41-13.11]. The greater the energy intake during the late window, the greater the risk of MUO (OR = 2.38, 95% CI 1.11-5.13) (OR = 2.33, 95% CI 1.03-5.32) (OR = 4.45, 95% CI 1.71-11.56). In summary, consuming less energy earlier in the day and more energy and carbohydrate later in the day was associated with a greater risk of MUO. Thus, a prospective study is needed to explore the potential role of chrono-nutrition practices in modifying risk factors to delay the transition of MHO to MUO.
  11. Zainal Arifen ZN, Haron H, Shahar S, Harun Z, Michael V, You YX, et al.
    Public Health Nutr, 2023 Dec 15;27(1):e12.
    PMID: 38098442 DOI: 10.1017/S136898002300277X
    OBJECTIVE: To explore the perspectives, barriers and enablers on salt reduction in out-of-home sectors in Malaysia among street food vendors, caterers and consumers.

    DESIGN: A qualitative study involving twenty-two focus group discussions and six in-depth interviews was conducted, recorded and transcribed verbatim. An inductive thematic analysis approach was employed to analyse the data.

    SETTING: Two in-depth interviews and twenty-two focus group discussions were conducted face-to-face. Four in-depth interviews were conducted online.

    PARTICIPANTS: Focus group discussions were conducted among twenty-three street food vendors, twenty-one caterers and seventy-six consumers of various eateries. In-depth interviews were conducted among two street food vendors and four caterers, individually.

    RESULTS: Consumers and food operators perceived a high-salt intake within Malaysia's out-of-home food sectors. Food operators emphasised the necessity for a comprehensive salt reduction policy in the out-of-home sector involving all stakeholders. Consumers faced limited awareness and knowledge, counterproductive practices among food operators and challenges in accessing affordable low-Na food products, whereas food operators faced the lack of standardised guidelines and effective enforcement mechanisms and uncooperative consumer practices. Both groups expressed that food quality and price of salt were also the barriers, and they advocated for awareness promotion, enhanced regulation of manufactured food products and stricter enforcement targeting vendors. Consumers also suggested promoting and recognising health-conscious food premises, whereas food operators suggested on knowledge enhancement tailored to them, strategies for gaining consumers acceptance and maintaining food quality.

    CONCLUSIONS: These findings provide valuable insights that serve as foundational evidence for developing and implementing salt reduction policies within Malaysia's out-of-home sectors.

  12. Manaf ZA, Lee MT, Ali NH, Samynathan S, Jie YP, Ismail NH, et al.
    Malays J Med Sci, 2012 Apr;19(2):56-66.
    PMID: 22973138 MyJurnal
    BACKGROUND: Tooth erosion is a growing dental problem; however, the role of diet in the aetiology of tooth erosion is unclear. A cross-sectional study was conducted to determine the association between tooth erosion occurrence and the consumption of acidic foods and drinks among undergraduate university students.

    METHODS: A total of 150 undergraduate students (33 males and 117 females) aged 19 to 24 years at Universiti Kebangsaan Malaysia participated in this study. The Basic Erosive Wear Examination was used to assess the occurrence of tooth erosion. Information regarding dental hygiene practices, usual dietary habits, and consumption of acidic foods and drinks was obtained through a structured questionnaire.

    RESULTS: In all, 68% of subjects had tooth erosion. Subjects who reported having received information about healthy eating were less likely to have tooth erosion (χ(2) [1, N = 150] = 7.328, P = 0.007). The frequencies of milk (OR = 0.29, 95% CI = 0.13-0.67) and tea/coffee (adjusted OR = 0.42, 95% CI = 0.19-0.95) consumption were negatively associated with tooth erosion. Dental hygiene practice, the frequency and amount of acidic food and drink intake, and body mass index classification were not significantly associated with the risk of tooth erosion (P > 0.05).

    CONCLUSION: A high prevalence of tooth erosion was observed among this group of students. Preventive measures, such as dietary advice and increased consumption of milk at a younger age, may reduce the occurrence of tooth erosion among this age group.

  13. Lau H, Shahar S, Hussin N, Kamarudin MZ, Hamid TA, Mukari SZ, et al.
    Geriatr Gerontol Int, 2019 Mar;19(3):233-239.
    PMID: 30618211 DOI: 10.1111/ggi.13598
    AIM: The 36-month Long-Term Research Grant Scheme project: Towards Usual Aging - Neuroprotective Model for Healthy Longevity among Malaysian Elderly was designed to address multidimensional aspects including psychosocial, biophysical health, nutrition and dietary pattern, and auditory and visual function to highlight the magnitude of these associations in a single study.

    METHODS: A total of 2322 respondents aged ≥60 years were recruited at baseline using the multistage sampling method, followed up at 18 months and 36 months.

    RESULTS: Response rates at baseline, 18 months and 36 months were 87.8%, 77.3% and 67.1%, respectively. At baseline, the prevalence of successful aging, usual aging and mild cognitive impairment was 11%, 73% and 16%, respectively. The prevalence of single and multimorbidity at baseline were 25.9% and 50.3%, respectively. The incidence rates of mild cognitive impairment at 18 months and 36 months were 6.5 and 5.6 per 100 person-years. The incidence rates of multimorbidity at 18 months and 36 months were 23.7 and 21.5 per 100 person-years, respectively.

    CONCLUSIONS: The Long-Term Research Grant Scheme project: Towards Usual Aging study provides an opportunity to investigate the interactions between wide ranges of aspects of the older population in a nationally representative sample of the older population. Geriatr Gerontol Int 2019; 19: 233-239.

  14. Manaf MRA, Shaharuddin MA, Nawi AM, Tauhid NM, Othman H, Rahman MRA, et al.
    Int J Environ Res Public Health, 2021 Nov 12;18(22).
    PMID: 34831628 DOI: 10.3390/ijerph182211874
    Mental health conditions are a major part of workers' health that predisposes to poor self-motivation for sustaining productivity. This study was aimed to determine the prevalence of depression, anxiety, and stress among staff in a Malaysian public university and its associated factors. A cross-sectional study was conducted among 459 staff from the Universiti Kebangsaan Malaysia (UKM) between April and June 2019. A questionnaire that consisted of items on socio-demographic and socioeconomic characteristics, employment description, lifestyle risk behaviors, personal medical history, and symptoms of depression, anxiety, and stress was administered to participants. Descriptive and inferential statistics were conducted using SPSS version 22.0. The prevalence of perceived symptoms of depression, anxiety, and stress among the respondents was 28.7%, 50.1%, and 14.8%, respectively. Over one-quarter (26.5%) of the participants presented symptoms of two or more mental disorders. Women, those aged less than 40 years old, and non-academic professionals were more likely to exhibit depressive symptoms, while those with medical conditions that required hospitalizations sustained anxiety symptoms. Perceived stress was more likely to be prevalent among staff with secondary education or less and smokers. Proactive support for staff needs to be offered in sustaining their emotional well-being.
  15. Manaf MRA, Nawi AM, Tauhid NM, Othman H, Rahman MRA, Yusoff HM, et al.
    Sci Rep, 2021 Apr 14;11(1):8132.
    PMID: 33854087 DOI: 10.1038/s41598-021-87248-1
    Public health systems are concerned with the commensurate rise of metabolic syndrome (MetS) incidence across populations worldwide, due to its tendency to amplify greater risk of diabetes and cardiovascular diseases within communities. This study aimed to determine the prevalence of MetS and its associated risk factors among staffs in a Malaysian public university. A cross-sectional study was conducted among 538 staffs from the Universiti Kebangsaan Malaysia (UKM) between April and June 2019. MetS was defined according to JIS "Harmonized" criteria. A questionnaire that consisted of items on socio-demographics, lifestyle risk behaviors and personal medical history information was administered to participants. Subsequently, a series of physical examination and biochemical assessment was conducted at the hall or foyer of selected faculties in the university. Descriptive and inferential statistics were conducted using SPSS version 22.0. Multivariate models were yielded to determine the risk factors associated with MetS. Statistical significance was set at P 
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