Weighing the Facts of Malaysia’s Battle Against Obesogenic Environments

WORDS UMI ATIKAH MOHD HASHIM & ASSOCIATE PROFESSOR DR ZAHARA ABDUL MANAF

FEATURED EXPERTS

UMI ATIKAH BT MOHD HASHIM
BSc Nutrition and Community Health UPM
Student of Master Clinical Nutrition
Universiti Kebangsaan Malaysia
ASSOCIATE PROFESSOR DR ZAHARA ABDUL MANAF
Senior Lecturer
Centre for Healthy Ageing and Wellness (H-CARE)
Faculty of Health Sciences
Universiti Kebangsaan Malaysia

The Malaysian lifestyle has been undergoing changes over time. With improved socio-economic conditions, Malaysians tend to consume more food today than they did previously. Excessive intake of high-calorie foods combined with little daily physical activity has led to increased numbers of overweight and obese people in the population.

Malaysia has the second highest in the number of overweight and obese people in the Southeast Asian region. Furthermore, the rate of increase in overweight and obese individuals in Malaysia was found to be the highest in the region. Since the percentage of overweight and obese people increased consistently from 2010 to 2014, there is a high possibility that this trend will continue in the coming years.

The root of this issue lies not just in personal choices but in what experts term an “obesogenic environment.”

WHAT IS AN OBESOGENIC ENVIRONMENT?

An obesogenic environment is characterized by conditions that promote obesity among populations.

In Malaysia, this includes a combination of the following factors.

  • Readily available high-calorie foods, exacerbated by the proliferation of fast-food outlets and online food delivery service.
  • Notable scarcity of outlets offering fresh and nutritious foods in urban areas that makes healthy eating more challenging and often more expensive, steering individuals towards less healthy but more accessible and affordable options.
  • Sedentary lifestyle. Increased screen time, whether for work, education, or leisure, reduces the time spent on physical activities. The convenience of smartphones and other devices has made it easier for individuals to order food online, play video games, or consume digital content for hours, thereby limiting physical movement.
  • Urban planning that discourages physical activity. Urban infrastructure often lacks safe, accessible spaces for physical exercise, further contributing to sedentary behavior. Parks and recreational facilities are often too few or inadequately maintained, especially in lower-income areas.
  • Social and economic pressures. People in lower socioeconomic brackets may prioritize cheaper food options, which are often processed and high in calories, due to budget constraints. Furthermore, individuals working multiple jobs or long hours may have less time and energy to prepare healthy meals or engage in physical exercise.
  • Cultural factors. Food plays a significant role in Malaysian culture, with social events often centered around eating. The emphasis on food abundance can sometimes overshadow the importance of food quality.
IMPLICATIONS FOR THE PEOPLE AND THE NATION

The implications of this obesogenic landscape are profound, impacting not only the physical health of individuals but also the nation’s healthcare system.

  • Public health crisis. Rising obesity rates increase the prevalence of non-communicable diseases (NCDs) such as diabetes, heart disease, and certain cancers, straining the healthcare system.
  • Economic burden. The rise in obesity-related diseases, such as diabetes, hypertension, and heart disease, places an increased burden on healthcare resources.
  • Social and emotional toll. Obesity can lead to psychological issues, including low self-esteem and depression, affecting individuals’ quality of life and productivity. Furthermore, obese people often encounter stigma and discrimination.
TACKLING THE CHALLENGE OF OBESOGENIC ENVIRONMENT WITH A MULTIFACETED APPROACH

Addressing the challenge of obesogenic environments requires a broad, collaborative approach that involves public policy changes, community engagement, and individual action.

  • Enhance urban planning and infrastructure. Prioritize the development of pedestrian-friendly infrastructure, safe cycling paths, and more green spaces within urban areas.
  • Improve economic accessibility to healthy foods. Implement policies aimed at reducing the cost of fresh produce and healthy goods while potentially taxing high-calorie, nutrient-poor foods.
  • Promote cultural shift towards healthy living. Launch public health campaigns that educate about healthy eating and celebrate it as part of the national culture.
  • Leverage technology for health promotion. Harness technology to encourage physical activity and healthy eating through apps and virtual services.
  • Strengthen public health policies. Implement comprehensive policies that tackle the availability and marketing of unhealthy food options, especially those aimed at children.
  • Launch education and public awareness campaigns. Encourage employers to create wellness programmes that promote physical activity and healthy eating. Invest in educational programmes that start from early childhood and extend into adulthood to build lifelong habits of healthy eating and regular physical activity.
  • Improve access to healthcare and nutritional guidance. Ensure individuals have access to regular health check-ups and consultations with nutritionists and dietitians to help prevent and manage obesity.

The battle against obesogenic environments in Malaysia is complex, involving an intricate web of societal, economic, and individual factors. However, by understanding these challenges and adopting a collective approach to address them, Malaysia can pave the way toward a healthier future. It requires commitment from all sectors of society—from government and industry to schools and families—to create an environment where healthy choices are easy, affordable, and valued.

Probiotics: Gut-Friendly Allies or Overhyped Foes?

WORDS MARAM T.M. BESAISO & DR SHANTHI KRISHNASAMY

FEATURED EXPERTS

MARAM T.M. BESAISO
Master’s Student in Clinical Nutrition
Faculty of Health Sciences
Universiti Kebangsaan Malaysia
DR SHANTHI KRISHNASAMY
Senior Lecturer and Coordinator of the Master of Clinical Nutrition Dietetics Programme
Universiti Kebangsaan Malaysia

Probiotics are living organisms that confer health advantages when ingested or used on the body and can be discovered in various sources.

These include fermented foods like yoghurt, as well as dietary supplements.

While some may think that probiotics are only beneficial for gut health or specific conditions like diarrhoea, the research delves deeper to reveal that they are crucial for our overall well-being, extending from gut health to the immune system and beyond.

THE BENEFITS OF PROBIOTICS
  • Eases digestion by breaking down complex carbohydrates, dietary fibres, and certain sugars that our bodies can’t digest on their own.
  • Produce short-chain fatty acids (SCFAs) that nourish gut cells and contribute to overall gut health.
  • Compete with harmful bacteria, thus preventing these harmful bacteria from causing digestive issues like diarrhoea, constipation, irritable bowel syndrome, and inflammatory bowel diseases.
  • Contribute to immunity and may have anti-cancer properties.
  • There is growing evidence that probiotics positively impact eczema management in children and reduce the risk of urinary tract infections, particularly among women.

However, ongoing research continues to explore their effects, especially in healthy individuals, and further investigation is needed to provide a clearer understanding.

IF YOU ARE INTERESTING IN TAKING PROBIOTICS, HERE IS HOW YOU CAN CHOOSE THE RIGHT ONE FOR YOU

The market for probiotic supplements has expanded significantly, offering various forms such as tablets, pills, chewable gummies, liquids, powders, and fortified foods. These options cater to different age groups and vary in price and claimed health benefits.

According to pharmacists, the powder form is popular due to its ease of consumption as it can be easily mixed with food.

When planning to purchase probiotics, consider the following factors:

Look at the CFU

Ensure that it contains living and active microorganisms. The potency of probiotics is measured in colony-forming units (CFU), and a higher CFU count often indicates a more potent product.

Consider the Type of Probiotic Strains Present

Various probiotic strains are like a squad of superheroes, each with unique power to tackle different health issues.

Mixing and matching probiotics, especially Lactobacilli and Bifidobacteria, can be the secret weapon against eczema in tiny tots. In addition, when calming down inflammation in urinary tract infections, trust Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 to save the day. (Anukam et al .2009).

Remember, there’s no one-size-fits-all hero here. Every health concern might need its special probiotic warrior or a dream team. So, grab your cape and give these friendly bacteria a whirl for 12 weeks to see if they’re your perfect sidekicks.

Probiotics in Foods May be a More Affordable Option 

Probiotic supplements can be expensive.

Those on a tight budget can still obtain probiotics through natural sources. Consider incorporating yoghurt, kefir, sauerkraut, miso, sourdough bread, kimchi, tempeh, kombucha and pickles into your diet.

DON’T JUST RELY ON SUPPLEMENTATION, HOWEVER!

The debate over whether to obtain probiotics from food or supplements remains controversial.

Some argue that a healthy, balanced diet rich in probiotic foods is sufficient for most individuals. To support the growth of beneficial gut bacteria, consider consuming foods that promote their proliferation.

However, while incorporating these nutritious whole foods into your diet is beneficial, they should not be seen as a cure-all for all health conditions.

Last but not least, a holistic approach to health, including a balanced diet and lifestyle modifications, should be your primary focus.

References:

  1. Anukam, K. C., Hayes, K., Summers, K., & Reid, G. (2009). Probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 may help downregulate TNF-Alpha, IL-6, IL-8, IL-10 and IL-12 (p70) in the neurogenic bladder of spinal cord injured patient with urinary tract infections: a two-case study. Advances in urology, 2009, 680363. https://doi.org/10.1155/2009/680363
  2. Garzon Mora, N., & Jaramillo, A. P. (2024). Effectiveness of probiotics in patients with constipation: A systematic review and meta-analysis. Cureus, 16(1), e52013. https://doi.org/10.7759/cureus.52013
  3. Hemarajata, P., & Versalovic, J. (2013). Effects of probiotics on gut microbiota: mechanisms of intestinal immunomodulation and neuromodulation. Therapeutic advances in gastroenterology, 6(1), 39–51. https://doi.org/10.1177/1756283X12459294
  4. McFarland, L. V., & Goh, S. (2019). Are probiotics and prebiotics effective in the prevention of travellers’ diarrhea: A systematic review and meta-analysis. Travel medicine and infectious disease, 27, 11–19. https://doi.org/10.1016/j.tmaid.2018.09.007
  5. Tsai, Y. T., Cheng, P. C., & Pan, T. M. (2012). The immunomodulatory effects of lactic acid bacteria for improving immune functions and benefits. Applied microbiology and biotechnology, 96(4), 853–862. https://doi.org/10.1007/s00253-012-4407-3
  6. Vasant, D. H., Paine, P. A., Black, C. J., Houghton, L. A., Everitt, H. A., Corsetti, M., Agrawal, A., Aziz, I., Farmer, A. D., Eugenicos, M. P., Moss-Morris, R., Yiannakou, Y., & Ford, A. C. (2021). British Society of Gastroenterology guidelines on the management of irritable bowel syndrome. Gut, 70(7), 1214–1240. https://doi.org/10.1136/gutjnl-2021-324598
  7. Zuccotti, G., Meneghin, F., Aceti, A., Barone, G., Callegari, M. L., Di Mauro, A., Fantini, M. P., Gori, D., Indrio, F., Maggio, L., Morelli, L., Corvaglia, L., & Italian Society of Neonatology (2015). Probiotics for prevention of atopic diseases in infants: systematic review and meta-analysis. Allergy, 70(11), 1356–1371. https://doi.org/10.1111/all.12700

Gut Health Revolution: How Probiotics Could Be a Key to Weight Loss

WORDS LIYANA TAN ABDULLAH & DR NURUL HUDA RAZALLI

FEATURED EXPERTS

LIYANA TAN ABDULLAH
BSc Applied Chemistry UM
Student of Master Clinical Nutrition
Universiti Kebangsaan Malaysia
DR NURUL HUDA RAZALLI
Senior Lecturer
Dietetic Programme
Centre for Healthy Ageing and Wellness (H-CARE)
Faculty of Health Sciences
Universiti Kebangsaan Malaysia (UKM)
GETTING TO KNOW PROBIOTICS BETTER
  • Probiotics are live bacteria and yeasts that are beneficial for your health, especially your digestive system. Often referred to as ‘good’ or ‘helpful’ bacteria, they help keep your gut healthy.
  • Probiotics are naturally found in your body, but they can also be ingested through certain foods and supplements.
  • Probiotic products contain selective, beneficial types of microbes to add to the populations already living in your body.
  • They are crucial in maintaining a balanced gut microbiota, the community of microorganisms living in the intestines. The human gut is home to trillions of bacteria, a complex ecosystem that plays a vital role in digesting food, synthesizing nutrients, and defending against pathogens. Probiotics contribute to this ecosystem by enhancing its function and restoring its natural balance when it has been disrupted.
  • Some studies suggest that certain probiotics may aid in weight loss by influencing metabolism and fat storage.
PROBIOTIC PRODUCTS IN THE MARKET
  • Many probiotics are oral supplements designed to be ingested into your gastrointestinal tract.
  • Others are topical products that you can apply to your skin or to the mucous membranes inside your body cavities, like your nose or genitals. These are all places where beneficial microbes commonly live.
  • You can also obtain probiotics from your natural food. Yes, tempeh, yogurt, kefir, kimchi, sourdough bread, and other usually fermented foods are probiotic-rich.
THE LINK BETWEEN PROBIOTICS & OBESITY

Variation in the composition of the gut microbiota results in health deterioration due to the mechanisms they employ to maintain appropriate homeostasis, including immune system modification, metabolic signaling, endocrine signaling, neuronal signaling, and epigenetics.

The condition is closely linked to various metabolic disorders, including elevated cholesterol levels, type 2 diabetes, heart and vascular diseases, and osteoporosis.

Consequently, addressing obesity through prevention and treatment is crucial, more so with the integration of innovative scientific approaches and technologies like artificial intelligence.

Probiotics, regarded by the WHO and FAO in 2002 as beneficial live microorganisms that confer health benefits when consumed in adequate amounts, are a testament to this.

They positively affect the host by establishing themselves within the human body and altering the microbial composition at specific sites. By modulating the mucosal and systemic immune functions or adjusting the intestinal microbiota balance, they facilitate nutrient absorption and intestinal health, offering health-promoting effects whether as single or mixed microorganisms with a defined composition.

The connection between gut health and obesity has become a focal point of modern medical research. Studies suggest that the composition of gut microbiota in obese individuals differs significantly from that of healthy individuals, indicating a potential link between gut microbes and obesity.

Probiotics interact with the host through pattern recognition receptors in intestinal cells, such as Toll-like receptors, and these can play multiple roles in the individual’s body.

The mechanisms of action of probiotics associated with obesity control may be modulation of endogenous microbiota functions that affect interaction with the host, competitive exclusion of pathogens, improved epithelial barrier function and other innate immune responses, modulation of fat absorption and excretion, reduced endotoxemia and inflammation, and modulation of numerous genes involved in hepatic lipogenesis or lipolysis in adipose tissue.

Gut Microbiota and Body Weight Regulation

Research shows that certain strains of gut bacteria are more prevalent in individuals who are obese compared to those who are not. These bacteria may influence weight by affecting the body’s metabolism, increasing energy extraction from food, and altering the way fat is stored in the body.

Probiotics and Weight Loss

Research indicates that specific probiotic strains could be effective for weight loss in obese individuals.

Some studies have found that introducing specific probiotic strains such as Hafnia alvei can help reduce body weight and body mass index (BMI) in obese individuals.

Probiotics may aid weight loss by improving the balance of the gut microbiota, reducing inflammation, and influencing hormones and proteins related to appetite and fat storage.

Prebiotics and Synergistic Effects

Prebiotics, non-digestible fibers that feed beneficial gut bacteria, can also play a role in managing obesity. When combined with probiotics, prebiotics can enhance the growth and activity of healthy gut bacteria, leading to improved gut health and potentially contributing to weight loss.

HOW CAN OUR GUT MICROBIOTA BECOME UNBALANCED?
External Factors

Diet, drug intake, and lifestyle habits—smoking, alcohol intake, and disrupted sleeping habits—which can easily influence the bacterial communities in the gut.

Bacterial Metabolites from the Gut

These metabolites, such as SCFAs, gamma-aminobutyric acid (GABA), and tryptophan, have a substantial influence on the regulation of the gut-brain axis.

For example, even a short-term (5-days) consumption of diets composed entirely of animal or plant products alters the microbial community structure, affecting microbial gene expression among individuals.

Fermentable dietary fibre, prebiotics, and probiotic-based diets contribute to the proliferation of SCFA-producing bacteria, which might influence gut-brain communication and brain function directly or indirectly through immune, endocrine, vagal, and other humoral pathways.

THE CHALLENGES IN USING DIET AS A MEANS TO ACHIEVE & MAINTAIN BALANCED GUT MICROBIOTA

Firstly, individual variability plays a significant role. The gut microbiota is highly personal and can be influenced by genetics, age, diet, lifestyle, and even antibiotic use.

This variability means that what works for one person may not work for another, making personalized nutrition and probiotic supplementation strategies necessary.

Furthermore, modern lifestyles and diets often work against the maintenance of a healthy gut microbiota. Processed foods, high sugar consumption, and the overuse of antibiotics can disrupt the delicate balance of gut bacteria, making it difficult to restore or maintain a healthy gut environment.

Additionally, stress and lack of sleep can also negatively affect gut health, adding another layer of complexity to managing gut microbiota.

Lastly, the current regulatory environment regarding probiotics and dietary supplements can be a challenge for consumers. The market is flooded with products claiming to support gut health, but not all of these products are effective or safe. The lack of stringent regulation and standardized testing protocols makes it challenging for individuals to make informed choices about the probiotics and prebiotics they choose to incorporate into their diets.

WHAT CAN WE DO TO MAINTAIN A HEALTHY GUT MICROBIOTA?

Beyond diet and supplementation, holistic approaches that encompass emotional well-being and physical activities play a crucial role in maintaining a balanced gut microbiota.

Healthy Food and Physical Activities

Use the Malaysian Healthy Plate as simple yet effective guide to help you balance your meals on a 10-inch plate.

Imagine dividing your plate into 4 parts.

  • One quarter is dedicated to carbohydrates like rice, noodles, bread, grains, or tubers, ensuring you have the energy to power through your day.
  • The next quarter is reserved for proteins such as fish, poultry, meat, or legumes, supporting muscle repair and growth.
  • The remaining half is where colourful vegetables and fruits come in, flooding your body with essential vitamins, minerals, and fiber.
Healthy Emotional Well-being
  • Practice activites that promote emotional well-being, such as mindfulness, meditation, adequate sleep, and stress management techniques.

Through a comprehensive approach that includes healthy eating, exercise, and stress reduction, individuals can support their gut microbiota’s balance, thereby enhancing their overall health and well-being.

References:

  1. Coradduzza, D., Sedda, S., Cruciani, S., De Miglio, M. R., Ventura, C., Nivoli, A., & Maioli, M. (2023). Age-related cognitive decline, focus on microbiome: A systematic review and meta-analysis. International journal of molecular sciences, 24(4), 3756. https://doi.org/10.3390/ijms24043756
  2. Dalile, B., Van Oudenhove, L., Vervliet, B., & Verbeke, K. (2019). The role of short-chain fatty acids in microbiota-gut-brain communication. Nature reviews gastroenterology & hepatology, 16(8), 461-478. https://doi.org/10.1038/s41575-019-0157-3
  3. Déchelotte, P., Breton, J., Trotin-Picolo, C., Grube, B., Erlenbeck, C., Bothe, G., Fetissov, S. O., & Lambert, G. (2021). The probiotic strain H. alvei HA4597® improves weight loss in overweight subjects under moderate hypocaloric diet: A proof-of-concept, multicenter randomized, double-blind placebo-controlled study. Nutrients, 13(6), 1902. https://doi.org/10.3390/nu13061902
  4. Jokela, M., Virtanen, M., Batty, G. D., & Kivimäki, M. (2016). Inflammation and specific symptoms of depression. JAMA Psychiatry, 73(1), 87-88. https://doi.org/10.1001/jamapsychiatry.2015.1977
  5. Luoto, R., Kalliomäki, M., Laitinen, K., & Isolauri, E. (2010). The impact of perinatal probiotic intervention on the development of overweight and obesity: Follow-up study from birth to 10 years. International journal of obesity, 34(10), 1531-1537. https://doi.org/10.1038/ijo.2010.50
  6. National Center for Complementary and Integrative Health. (2019, August). Probiotics: What you need to know. https://www.nccih.nih.gov/health/probiotics-what-you-need-to-know
  7. Zhang, J., Mu, J., Li, X., & Zhao, X. (2022). Relationship between probiotics and obesity: A review of recent research. Food science and technology, 42, e47621. https://doi.org/10.1590/fst.47621

Uncovering the Secret Connection Between Hormones and Your Weight

WORDS ANAS ALMASWARY & PROFESSOR DR SUZANA SHAHAR

FEATURED EXPERTS

ANAS ALMASWARY
Master’s Student in Clinical Nutrition
Faculty of Health Sciences
Universiti Kebangsaan Malaysia (UKM)
PROFESSOR DR SUZANA SHAHAR
Dietetic Program
Centre for Healthy Aging and Wellness
Faculty of Health Sciences
Universiti Kebangsaan Malaysia (UKM)

Are you tired of struggling with weight loss or weight gain despite your best efforts at diet and exercise? Do you find yourself constantly wondering why your body refuses to cooperate, leaving you feeling frustrated and defeated?

HOW HORMONES IMPACT YOUR WEIGHT

Hormones regulate our activity in many ways, not just as simple ‘on and off’ switches that determine if we feel like exercising.

They also influence weight gain and loss by controlling energy intake, appetite, and metabolic balance.

Ghrelin

A hormone produced mainly in the gut, ghrelin has been implicated in the regulation of food intake and meal frequency as well as energy balance.

High levels of ghrelin before meals and during fasting act to stimulate appetite by signaling hunger.

The levels of this hormone revert back to normal values after meals, to help regulate appetite and satiety.

Leptin

When you are overweight, your levels of leptin go up to tell your brain you have plenty of energy.

However, people with obesity can develop a resistance to leptin. Even when their leptin levels increase, their brain no longer recognizes the satiety signal, and they continue to overeat.

Weight loss helps to improve leptin sensitivity, making it easier to lose weight.

Insulin

This is another hormone associated with weight management.

It regulates blood sugar levels after meals, and is influenced by how often and what you eat.

Endurance exercises increase insulin sensitivity. This allows the body to better process carbohydrates and store less fat.

Thyroid hormones

Moreover, thyroid hormones (T4 and T3) also help to regulate your metabolism.

If your thyroid hormone levels lower, such as due to an underactive thyroid or hypothyroidism, your digestive system may act at a slower pace, bringing about weight gain.

When your thyroid is overactive (hyperthyroidism), your metabolism speeds up, and you may lose weight.

Cortisol

The stress hormone cortisol has also been shown to play a role in weight control and affects eating behavior by increasing motivation and consumption of junk foods.

Likewise, chronically stressed people may prefer more energy-dense comfort foods, leading to weight gain over time.

KNOWLEDGE LEADS TO UNDERSTANDING

It is important to understand how hormones like ghrelin, leptin, insulin, thyroid hormones, and cortisol interact with lifestyle behaviors such as diet, exercise, sleep, and stress.

This understanding enables the design of personalized weight control strategies. These strategies can help correct hormonal imbalances and support long-term, successful weight manage.

YOU MAY HAVE HORMONAL IMBALANCE & SHOULD SEE A DOCTOR IF YOU:
  • Experience unusual weight gain or loss.
  • Develop increased sensitivity to cold or heat.
  • Have Increased thirst and urination.
  • Experience insomnia or have difficulties in sleeping.
  • Have irregular or heavy periods, missed periods, or painful periods.
  • Experience mood changes such mood swings, anxiety, depression.
  • Experience fatigue or low energy.
  • Are infertile or have difficulties in getting pregnant.
HOW OTHER FACTORS CAN LEAD TO HORMONE IMBALANCES

Several factors can cause hormone imbalances, including genetics, lifestyle choices, stress and anxiety levels, sleep patterns, and diet.

The balance of these factors can affect the hormonal control of ghrelin, cortisol, insulin, GLP-1, and leptin, which are important for appetite control and body weight balance.

For instance, increased psychological stress can affect hormone levels such as cortisol and ghrelin, changing eating behaviors.

Additionally, lack of sleep, poor dietary habits, and a sedentary lifestyle can contribute to hormonal imbalances, which may compromise weight control and metabolism.

Overall, a combination of genetic predisposition and environmental influences can lead to hormonal imbalances, potentially contributing to issues like obesity and difficulties in weight control.

NATURAL STRATEGIES FOR BALANCING YOUR HORMONES
  1. Increasing your water intake
  2. Adjust the macronutrient composition of meals.
  3. Eat more frequent smaller meals with moderate proteins and limited fats.
  4. Ensure that you have adequate sleep
  5. Take steps to reduce stress levels
  6. Incorporate at least 30 minutes of exercise a day into your daily routine.

Addressing these lifestyle factors and their impact on hormone levels can help many people achieve better hormonal balance and support effective weight control

Additionally, working with a team of professionals, including physicians, psychologists, dietitians, nutritionists, and exercise physiologists, for personalized strategies can further enhance hormonal balance and overall weight management.

References:

  1. Monalisa, R. (2015). Role of leptin in obesity. Research journal of pharmacy and technology, 8(8), 1073-1076. http://dx.doi.org/10.5958/0974-360X.2015.00185.7
  2. Schwarz, N. A., Rigby, B. R., La Bounty, P., Shelmadine, B., & Bowden, R. G. (2011). A review of weight control strategies and their effects on the regulation of hormonal balance. Journal of nutrition and metabolism, 2011, 237932. https://doi.org/10.1155/2011/237932
  3. Severo, J. S., Morais, J. B. S., de Freitas, T. E. C., Andrade, A. L. P., Feitosa, M. M., Fontenelle, L. C., de Oliveira, A. R. S., Cruz, K. J. C., & do Nascimento Marreiro, D. (2019). The role of zinc in thyroid hrmones metabolism. International journal for vitamin and nutrition research. Internationale Zeitschrift fur Vitamin- und Ernahrungsforschung. Journal international de vitaminologie et de nutrition, 89(1-2), 80–88. https://doi.org/10.1024/0300-9831/a000262
  4. Treasure, N.-O., Johnkennedy, N., Chinyere, O., Amarachi, I. P., & Chioma, N. (2022). The perspective of hormonal imbalance in humans: A review. Acta Scientific Clinical Case Reports, 3(11). https://www.researchgate.net/publication/368720563_Acta_Scientific_Clinical_Case_Reports_The_Perspective_of_Hormonal_Imbalance_in_Humans_A_Review_Case_Report

Concerned about Food Additives & Food Safety? You Should Read This!

WORDS TI MEI JUN & DR NURUL HUDA RAZALLI

FEATURED EXPERTS

TI MEI JUN
Student of Master Clinical Nutrition
Faculty of Health Sciences
Universiti Kebangsaan Malaysia (UKM)
DR NURUL HUDA RAZALLI
Senior Lecturer
Dietetic Programme
Centre for Healthy Ageing and Wellness (H-CARE)
Faculty of Health Sciences
Universiti Kebangsaan Malaysia (UKM)

More than 200 diseases, ranging from cancer to diarrhoea, are brought on by contaminated food that contains dangerous bacteria, viruses, parasites or chemical.

Malaysia had an incidence of 60 cases of food and water borne disease per 100,000 people, with 56% being food poisoning.

Hence, food safety is crucial to ensure that food, when prepared or consumed in accordance with its intended usage, would not harm consumers.

4 FACTS THAT WE SHOULD KNOW ABOUT FOOD ADDITIVES
  1. According to Codex Alimentarius Commission—also known as the ‘Food Code’ published by the Food and Agriculture Organization of the United Nations (FAO) and World Health Organization—any substance that is not typically used as an ingredient in food or consumed as food on its own is considered a food additives, regardless of its nutritional value.
  2. Food additives are added to processed foods to serve several functions, most prominently the prevention of food spoilage, improvements in flavour or texture and other desired qualities, and the provision of certain colours and flavours.
  3. Food additives are applied in the production and processing of almost all food types.
  4. Only specific foods may have food additives added to them, and only to the extent allowed by the Food Regulations of 1985.
EXAMPLES OF COMMON FOOD ADDITIVES
Soybean To maintain food consistency
Beet A colouring agent
Tartazine A colouring agent
Aspartame An artificial sweetener
Monosodium glutamate (MSG) A flavour enhancer
Lecithin Thickening and stabilizing agent
Guar gum Thickening and stabilizing agent
Benzoic acid A preservative
Sorbic acid A preservative
5 TIPS FOR CONSUMERS TO REDUCE EXPOSURE TO HARMFUL ADDITIVES
  1. People with allergies or sensitivity to certain food ingredients should closely read labels when shopping for processed foods.
  2. Buy fresh and whole food to minimize exposure of food additives and contaminants.
  3. Proper storage and handling of food materials are crucial to prevent contamination. Wash and peel foods, such as apples and eggs, to remove dirt and pesticides.
  4. Purchase food from stalls that demonstrate good hygiene practices, such as covering and properly packaging their food.
  5. Buy food that is prepared fresh upon ordering, rather than food that was cooked earlier and not maintained at the appropriate temperature.

References:

  1.  Halim, N. R. A., Mutalib, S. A., Ghani, M. A., & Hashim, H. (2024). Food safety regulations implementation and their impact on food security level in Malaysia: A review. International food research journal, 31(1), 20-31. https://doi.org/10.47836/ifrj.31.1.02
  2. Laganà, P., Avventuroso, E., Romano, G., Gioffré, M. E., Patanè, P., Parisi, S., Moscato, U., & Delia, S. (2017). The Codex Alimentarius and the European legislation on food additives. In P. Laganà, E. Avventuroso, G. Romano, M. E. Gioffré, P. Patanè, S. Parisi, U. Moscato, & S. Delia (Eds.), Chemistry and hygiene of food additives (pp. 23-32). Springer International Publishing.
  3. Lalani, A., Pouyani, N., Askari, A., Tavajohi, S., Akbari, S., & Jafarzadeh, E. (2024). Food additives, benefits, and side effects: A review article. Journal of chemical health risks, 1(1), 1. https://doi.org/10.22034/jchr.2023.1967340.1619
  4. Liang, X. (2023). Impact of food additives in ultra-processed food on human health. Theoretical and natural science, 6, 437-444. http://dx.doi.org/10.54254/2753-8818/6/20230321
  5. Ukwo, S., Udo, I., & Ndaeyo, N. (2022). Food additives: Overview of related safety concerns. Food science & nutrition research, 5(1), 1-10. http://dx.doi.org/10.33425/2641-4295.1052

MADSA Calls for More Efforts to Safeguard Dietary Supplements in Malaysia

WORDS DR RAJENDRAN MANICKAVASAGAM

FEATURED EXPERT
DR RAJENDRAN MANICKAVASAGAM
Malaysian Dietary Supplement Association (MADSA)

Since the onset of COVID-19, Malaysians have been taking extra care of their health.

In fact, there has been a steady demand for dietary supplements propelled by this new collective awareness towards our overall wellbeing.

However, recent price hikes have raised the average living costs in Malaysia. For some, they may have to cut back on added expenses, which includes dietary supplements.

This situation opens doors for devious, illegal activities to take place within the market, especially through e-commerce websites where counterfeit supplements are sold at absurdly low prices.

For instance, a single joint support supplement may cost RM120 to RM180 at pharmacies, but some unscrupulous sellers offer the same product for only RM38.

Additionally, certain platforms and sellers may take advantage of unassuming consumers by offering attractive discounts and vouchers, further expanding this perpetual market of deceit in terms of people’s health and wellbeing.

VERY CHEAP SUPPLEMENTS: WHAT’S THE CATCH?

The allure of a good bargain can be extremely compelling, especially when one only needs to pay a fraction of the original price. However, the consequences of purchasing from unverified vendors or websites can be severe.

Counterfeits

A multitude of these sellers often operate without the necessary quality control measures.

Without proper scrutiny, these unscrupulous vendors can easily pass off fake supplements as genuine, putting consumers at risk of ingesting unknown and possibly harmful substances.

These products also may not follow proper standards of procedures, leading to higher chances of improper handling and contamination.

Effects on the Local Supplement Market

In addition to the health risks, these unverified sources also undermine the integrity of Malaysia’s legitimate nutritional supplements market, which is valued at USD $644.88 million in 2023.

Certified brands are finding it increasingly harder to earn customers’ trust who have been victims to disingenuous sellers.

THE NEED FOR REGULATORY RECOGNITION TO PROTECT CONSUMERS

In spite of these malicious activities, Malaysia upholds strict laws and regulations to govern the manufacturing and labelling of dietary supplements.

This includes mandatory registration of documented evidence and stringent timelines for health supplements. While some counterfeit products may slip through the cracks, the Ministry of Health, via the National Pharmaceutical Regulatory Agency (NPRA), has laid out various safeguarding measures to help consumers identify the legitimacy of a product.

The Ministry of Health has also mandated that all certified health supplements must be marked with the holographic sticker called the FarmaTag, which is extremely hard for counterfeit producers to replicate. The sticker also includes an MOH-issued QR Code, a gradient design, and holographic serial and pin numbers.

Additionally, the Health Ministry has released a mobile app called FarmaChecker to help consumers confirm a product’s certification status online by scanning its QR code or typing in its serial number.

At the same time, the NPRA continues to ensure the safety and efficacy of dietary supplements, mandating safety data for supplements with new or innovative ingredients. Similarly, the Malaysian Dietary Supplement Association (MADSA) has also worked hand-in-hand with the government to promote and increase awareness of health supplements and its benefits to all Malaysians.

With the collective effort by both the government and consumers alike, we can work towards a future where all our nutritional supplements are safeguarded from the unethical practices of counterfeit producers.

By being mindful of the sources of our purchases, especially when the products involve our health and wellbeing, we can nurture a safe and healthy supplements market in Malaysia.

After all, bargaining our health for cheaper costs will never be worth the price.

MADSA CALLS MALAYSIANS TO BE VIGILANT

MADSA advises Malaysian consumers to always make sure that online supplements have been registered by the NPRA.

Check if the product has an MAL number, which verifies that it has been approved by the NPRA.

If the product that’s delivered doesn’t have such identification, return and request for a refund and report this matter to the Ministry of Health.

Human Clinical Trial Shows That Tocotrienol-Incorporated Oats Can Benefit People With Metabolic Syndrome (Mets)

This pioneering clinical trial, led by Dr Lee Lai Kuan from Universiti Sains Malaysia, involved 81 MetS patients that consumed two sachets (equivalent of 60 g) of Bioley Toco Oats daily for up to 12 weeks.

RESULTS
Improved Key MetS Parameters
√ 5.5% reduction in fasting blood sugar.
√ 4.3% reduction in diastolic blood pressure.
√ 23% increase in HDL (good) cholesterol.
√ 11.8% reduction in blood triglycerides.

Enhanced Antioxidant Levels
√ Significantly elevated total antioxidant capacity (TAC) and superoxide dismutase (SOD) levels.
√ Reduced protein carbonyl concentration, a marker of oxidative stress.

Anti-Inflammatory Effects
Lowered concentrations of multiple inflammatory biomarkers such as tumour necrosis factor-α (TNF-α), histidine-sensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6), and matrix metalloproteinase-3 (MMP-3). Tolerance Participants did not show any gastrointestinal side effects after prolonged consumption of Bioley Toco Oats.

Tolerance
Participants did not show any gastrointestinal side effects after prolonged consumption of Bioley Toco Oats.

CONCLUSION
The clinical trial findings demonstrate the potential of Bioley Toco Oats in improving metabolic parameters, enhancing antioxidant capacity, and reducing inflammation in individuals with metabolic syndrome.

IMPORTANT NOTE
This product is not intended to diagnose, treat, cure, or prevent any disease. Individual results may vary. A balanced diet and regular exercise are essential for good health. This product should not replace conventional treatments or consultations with qualified healthcare professionals for any medical condition.
Always seek proper medical advice for diagnosis and treatment.

 

This is an educational article brought to you by

References:

1.    Tan, D. T., Khor, H. T., Low, W. H., Ali, A., & Gapor, A. (1991). Effect of a palm-oil-vitamin E concentrate on the serum and lipoprotein lipids in humans. The American journal of clinical nutrition, 53(4 Suppl), 1027S–1030S.
https://doi.org/10.1093/ajcn/53.4.1027S
2.    Ajuluchukwu, J. N., Okubadejo, N. U., Mabayoje, M., Ojini, F. I., Okwudiafor, R. N., Mbakwem, A. C., Fasanmade, O. A., & Oke, D. A. (2007). Comparative study of the effect of tocotrienols and -tocopherol on fasting serum lipid profiles in patients with mild hypercholesterolaemia: a preliminary report. The Nigerian postgraduate medical journal, 14(1), 30–33.
https://pubmed.ncbi.nlm.nih.gov/17356586/
3.    Mottram, P., Shige, H., & Nestel, P. (1999). Vitamin E improves arterial compliance in middle-aged men and women. Atherosclerosis, 145(2), 399–404. https://doi.org/10.1016/s0021-9150(99)00073-8
4.    Khanna, S., Roy, S., Parinandi, N. L., Maurer, M., & Sen, C. K. (2006). Characterization of the potent neuroprotective properties of the natural vitamin E alpha-tocotrienol. Journal of neurochemistry, 98(5), 1474–1486.
https://doi.org/10.1111/j.1471-4159.2006.04000.x
5.    Mangialasche, F., Kivipelto, M., Mecocci, P., Rizzuto, D., Palmer, K., Winblad, B., & Fratiglioni, L. (2010). High plasma levels of vitamin E forms and reduced Alzheimer’s disease risk in advanced age. Journal of Alzheimer’s disease : JAD, 20(4), 1029–1037.
https://doi.org/10.3233/JAD-2010-091450

Students from the UTAR Faculty of Arts and Social Sciences (FAS) Brings the Love Canteen to Ipoh and Kampar

WORDS LIM TECK CHOON

Food insufficiency, also known as food scarcity and food insecurity, describes a lack of adequate food and nutrition to meet dietary needs.

It’s a global crisis affecting millions, with adverse impacts on health, productivity, and human potential.

According to a paper published in 2021, the prevalence of household food insecurity in Malaysia was “unexpectedly high”. Chief affected demographics are the Orang Asli, low-income household or welfare-recipient households, university students, and the elderly.

UTAR STUDENTS PLAY THEIR PART IN HELPING OUT PEOPLE EXPERIENCING FOOD INSUFFICIENCY

To raise awareness about food insufficiency in underprivileged communities, 16 students from the Universiti Tunku Abdul Rahman (UTAR) Faculty of Arts and Social Sciences (FAS) brought the Love Canteen campaign in Ipoh and Kampar.

These are final-year Bachelor of Communication (Honours) Public Relations students that have previously successfully conducted two food distribution activities under the Love Canteen campaign.

DESTINATION: IPOH

In late February, the team effectively distributed 1,000 food packs throughout the city of Ipoh to individuals in need, including the elderly and those facing financial hardships. This was made possible with close collaboration with Pertubuhan Amal Ai Xin Fan Tong.

The volunteers were divided into two teams that, between them, diligently worked to prepare a large quantity of ingredients while ensuring that the nutritional values in these food packs were able to help meet the recipient’s recommended nutritional intake.

According to student volunteer Tay Yong Qi, “This programme taught me that some people can’t access food easily. It made me realize how important it is to appreciate the food we have.”

Kuan Chu Yie, the treasurer of the Love Canteen campaign, added: “It was heart-wrenching to see elderly people living alone, especially in homes falling apart.”

Pertubuhan Amal Ai Xin Fan Tong Coordinator Assistant Adele Siew Li Me praised the effort. “The onset of a substantial number of individuals facing financial distress due to the Movement Control Order (MCO) has prompted us to extend our support during this challenging period,” she says.

She elaborates further: “Consequently, Pertubuhan Amal Ai Xin Fan Tong initiated a comprehensive aid programme, which encompasses not only distributing freshly prepared meals but also delivering essential goods and vegetables to low-income communities. This effort aims to alleviate their financial strain and uphold the mission of ensuring ‘A full stomach for all’.”

DESTINATION: KAMPAR

During early March, the Love Canteen campaign headed over to Kampar, where approximately 100 elderly individuals were able to enjoy meals provided by Pertubuhan Amal Ai Xin Fan Tong.

Following this, the group devoted the remaining half of the day to distributing food to various other charity organizations, including Beautiful Gate for the Disabled Foundation, I Care Center, Pusat Jagaan Kasih Sayang Kampar and Rumah Orang Tua Gopeng.

A PROGRAMME TO RAISE AWARENESS ON FOOD SCARCITY

Leong Kah Ding, Secretary II of the Love Canteen campaign, expressed his belief that the Love Canteen volunteering programme and the upcoming on-campus exhibition would help raise awareness among university students and the public regarding the importance of achieving food sufficiency.

To achieve this aim, the Love Canteen project also hosted an exhibition on 26 and 27 March 2024 to showcase their journey and knowledge, with the aim of educating the public on achieving food sufficiency. The exhibition was held in the foyer of Dewan Tun Dr Ling Liong Sik, Kampar.

To find out more about Love Canteen, please visit www.linktr.ee/lovecanteenutar (link opens in a new tab).

Reference: Sulaiman, N., Yeatman, H., Russell, J., & Law, L. S. (2021). A food insecurity systematic review: Experience from Malaysia. Nutrients, 13(3), 945. https://doi.org/10.3390/nu13030945

 

Is Mycoprotein the Sustainable Protein Solution We’ve Been Searching for?

WORDS ALFRED C CHEUNG

FEATURED EXPERT
ALFRED C CHEUNG
Certified Food Scientist
Co-Founder of Ultimeat
SUSTAINABLE, ALTERNATIVE OPTIONS FOR PROTEIN ARE SOARING IN POPULARITY

In fact, according to the strategic consulting firm EY-Parthenon, the alternative protein market is projected to reach US$17.4 billion in 2027!

Locally, leading data and analytics company GlobalData reports that the Malaysian meat substitutes market is set to expand at a value compound annual growth rate or CAGR of 7.4% throughout 2023 to 2027.

BUT WHAT ARE THE OPTIONS FOR ALTERNATIVE PROTEIN IN THE MALAYSIAN MARKET?

Typically, the average Malaysian supermarket will carry a range of plant-based proteins like soy-based tofu or wheat-based seitan, and many of these products are great choices. Not only do they have a lower environmental impact in comparison to animal agriculture, but they also make up an essential part of vegetarian and vegan diets, with the necessary amino acids for building and repairing tissues in the body.

However, Malaysians love trying new and interesting foods—and there is a lesser known and potentially more suitable alternative protein out there!

Let me introduce you to the wonderful world of mycoprotein, a fungi-derived product, and how it’s an underrated, viable, and eco-friendly alternative to traditional animal proteins.

THE FUNDAMENTALS OF FUNGI

Mycoprotein is created through a process known as biomass fermentation.

Basically, this process utilizes the high-protein content and rapid growth of fungi to efficiently make large amounts of protein-rich food.

Since fermentation is a natural process, this has the added benefit of being much cheaper than other methods of creating alternative protein products.

Take extrusion, for example, which uses moisture, high heat and mechanical energy to produce meat substitutes in a matter of seconds. While the extrusion process is quicker, it is significantly more expensive. In contrast, fermentation uses less energy and utilizes carbon and nitrogen sources, which as a bonus is better for the environment!

RESEMBLES TRADITIONAL MEAT IN TASTE & TEXTURE

The use of fungi to produce mycoproteins also allows for a closer approximation of taste and texture in comparison to meat.

In fact, the mycelium, the network of threads throughout fungi, branches and develops in a surprisingly similar pattern to real meat muscles during the fermentation process.

This elevates the authenticity of mycoprotein as well as give mycoprotein a closer resemblance to traditional meat in terms of texture and taste. This distinguishes it from other plant-based proteins that often lack such genuine resemblance.

THE NUTRITIONAL MERITS OF MYCOPROTEIN

Mycoprotein provides high levels of protein and fibre while containing low fat, low sodium, and zero cholesterol.

Additionally, its protein quality surpasses that of some conventional meats. When mycoprotein-based products are cultivated from mushrooms specifically, they can boast high levels of glutamic acid, an amino acid that helps with metabolism, brain, and cardiac functions.

FROM FUNGI TO FEAST

At the heart of it all, choosing mycoprotein doesn’t just offer a sustainable and nutritious option but a cost-effective solution, as well.

In this sense, mycoprotein products provide Malaysians with a high-quality alternative protein at a reasonable price, paving a path towards a meat-free future.

Strengthen Your Defence Against Illnesses with a Hidden Ally

WORDS ANAS ALMASWARY & PROFESSOR DR SUZANA SHAHAR

FEATURED EXPERTS

ANAS ALMASWARY
Master’s Student in Clinical Nutrition
Faculty of Health Sciences
Universiti Kebangsaan Malaysia (UKM)
PROFESSOR DR SUZANA SHAHAR
Dietetic Program
Centre for Healthy Aging and Wellness
Faculty of Health Sciences
Universiti Kebangsaan Malaysia (UKM)

When we feel a scratchy throat or struggle to breathe, our first thought is usually hospitals. But what if I told
you there’s a simple remedy in your kitchen?

Let’s explore how the anti-inflammatory diet can actually boost our immune system, especially when it comes to respiratory health.

THE TROUBLE WITH PRO-INFLAMMATORY DIETS

Our body’s immune system is like a superhero that fights off infections and heals injuries, and inflammation is its natural power.

But here’s the twist: if not kept in check, inflammation can turn into a villain that causes chronic diseases. Hence, the foods we consume can either be a superhero sidekick or a troublemaker!

A pro-inflammatory diet influences our immune system’s balance in bad way, increasing the inflammation in our body.

Such a diet, measured by the Adapted Dietary Inflammatory Index (ADII), is associated with systemic inflammation and reduced kidney function in older adults. Chronic low-grade inflammation is believed to be one possible pathway linking this dietary pattern to kidney dysfunction.

EXAMPLES TO PRO-INFLAMMATORY FOODS

  • Red and processed meats
  • Refined sugars
  • Fried foods
  • Margarine or shortening
  • Alcohol
  • Sodas

Researchers found that a higher ADII is related to higher levels of C-reactive protein (CRP), a marker of inflammation, and lower estimated glomerular filtration rates (eGFR), an indicator of kidney function.

Hence, a proinflammatory diet can lead to both systemic inflammation and reduced kidney function.

THE BENEFITS OF AN ANTI-INFLAMMATORY DIET

Generally, an anti-inflammatory diet should include sources of low-fat protein, colourful no- starchy carbohydrates, healthy fats like extra virgin olive oil, supplementation of omega 3 fatty acids, and foods rich in polyphenols.

An anti-inflammatory diet keeps insulin levels stable and cuts down on omega 6-fatty acids, which is crucial for beating silent inflammation.

Found in vibrant non-starchy veggies and fruits, polyphenols included in this diet put the brakes on inflammation by targeting a key player called nuclear factor (NF-κB). These polyphenols activate AMP kinase, a central switch controlling metabolism, including blood sugar levels.

The anti-inflammatory diet goes the extra mile by reducing chronic inflammation at the cellular level and tweaking gene expression. The result is lower risk of chronic diseases like obesity, metabolic syndrome, and diabetes.

NUTRIENTS EXAMPLES OF FOODS TIPS
Lean sources of proteins Chicken, fish, or protein-rich vegetarian sources like tofu
or legumes.		 Consume approximately the size and thickness of the palm of your
hand.
Colourful carbohydrates Vegetables like broccoli, spinach, carrots, bell peppers; fruits like guava and dragon fruits. Fill two-thirds of your plate with
non-starchy vegetables and
substantial amounts of fruits
These foods will help maintain a
low glycemic load and provide adequate levels of polyphenols.
Healthy fats Vegetable oils. Use in cooking or drizzle over salads and vegetables.
Omega-3 fatty acids Fatty fish such as salmon, mackerel, tuna, and sardines. Avoid deep frying; omega-3 fatty acids will be lost if you do this.

References:

  1. Bikman, B. (2020). Why we get sick: The hidden epidemic at the root of most chronic disease–and how to fight it. BenBella Books.
  2. Eleazu C. O. (2016). The concept of low glycemic index and glycemic load foods as panacea for type 2 diabetes mellitus; prospects, challenges and solutions. African health sciences, 16(2), 468–479. https://doi.org/10.4314/ahs.v16i2.15
  3. Estruch R. (2010). Anti-inflammatory effects of the Mediterranean diet: The experience of the PREDIMED study. The proceedings of the Nutrition Society, 69(3), 333–340. https://doi.org/10.1017/S0029665110001539
  4. Galland L. (2010). Diet and inflammation. Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition, 25(6), 634–640. https://doi.org/10.1177/0884533610385703
  5. Grimes, K. (2011). The everything anti-inflammation diet book: The easy-to-follow, scientifically-proven plan to reverse and prevent disease lose weight and increase energy slow signs of aging live pain-free. Simon and Schuster.
  6. Lyons, C. L., & Roche, H. M. (2018). Nutritional Modulation of AMPK-Impact upon Metabolic-Inflammation. International journal of molecular sciences, 19(10), 3092. https://doi.org/10.3390/ijms19103092
  7. O’Neil, A., Shivappa, N., Jacka, F. N., Kotowicz, M. A., Kibbey, K., Hebert, J. R., & Pasco, J. A. (2015). Pro-inflammatory dietary intake as a risk factor for CVD in men: A 5-year longitudinal study. The British journal of nutrition, 114(12), 2074–2082. https://doi.org/10.1017/S0007114515003815
  8. Oprea, E. (2021). The power plate diet: Discover the ultimate anti-inflammatory meals to fat-proof your body and restore your health. Rodale Books.
  9. Rudnicka, E., Suchta, K., Grymowicz, M., Calik-Ksepka, A., Smolarczyk, K., Duszewska, A. M., Smolarczyk, R., & Meczekalski, B. (2021). Chronic low grade inflammation in pathogenesis of PCOS. International journal of molecular sciences, 22(7), 3789. https://doi.org/10.3390/ijms22073789
  10. Sears B. (2015). Anti-inflammatory diets. Journal of the American College of Nutrition, 34 Suppl 1, 14–21. https://doi.org/10.1080/07315724.2015.1080105
  11. Shivappa, N., Bonaccio, M., Hebert, J. R., Di Castelnuovo, A., Costanzo, S., Ruggiero, E., Pounis, G., Donati, M. B., de Gaetano, G., Iacoviello, L., & Moli-sani study Investigators (2018). Association of proinflammatory diet with low-grade inflammation: results from the Moli-sani study. Nutrition (Burbank, Los Angeles County, Calif.), 54, 182–188. https://doi.org/10.1016/j.nut.2018.04.004
  12. Xu, H., Sjögren, P., Ärnlöv, J., Banerjee, T., Cederholm, T., Risérus, U., Lindholm, B., Lind, L., & Carrero, J. J. (2015). A proinflammatory diet is associated with systemic inflammation and reduced kidney function in elderly adults. The journal of nutrition, 145(4), 729–735. https://doi.org/10.3945/jn.114.205187