Cultivating Better Immunity: Nutrition Strategies for Children Under Five

WORDS ANAS ALMASWARY

FEATURED EXPERT
ANAS ALMASWARY
Master’s Student in Clinical Nutrition
Faculty of Health Sciences
Universiti Kebangsaan Malaysia (UKM)

The role of nutrition in the first phase of a child’s life, especially in the first thousand days, is huge and influences the immune response system and later health.

THE IMPACT OF EARLY NUTRITION

Nutrition during the first 1000 days, including the intrauterine period, is crucial for a child’s development, affecting the gut microbiota composition and immune system.

The immune system receives benefits from dietary omega-3 long-chain fatty acids, prebiotics, and micronutrients.

There is an intricate relationship among diet, microbiome, and epigenetic elements influencing this interaction. Numerous non-communicable diseases (NCDs) linked with dysbiosis begin their ‘programming’ in childhood.

Nutrition also plays a significant role in shaping the composition and development of children’s microbiota, thus exerting a powerful influence on the development of NCDs.

STRATEGIES TO STRENGTHEN IMMUNITY IN KIDS BELOW 5
Breastfeed

In the first 2 years of a child’s life, breastfeeding plays a crucial role in providing essential nutrients and immune support for infants.

Breast milk offers a unique blend of antibodies and nutrients that help strengthen a baby’s immune system and overall health. Introducing a variety of nutrient-rich foods after breastfeeding can further enhance a child’s immune health.

Diversify Nutrient Intake

Enhance your child’s immune system by incorporating a variety of colorful fruits, vegetables, whole grains, and lean proteins into their diet. These foods provide essential nutrients crucial for building strength and immunity.

Citrus Fruits for Immune Support

Include vitamin C-rich citrus fruits such as oranges and lemons in your child’s diet. These fruits act as natural immune boosters, safeguarding your child’s health.

Promote Gut Health with Probiotics

Opt for probiotic-rich yoghurt to support a healthy gut environment, which plays a significant role in overall immunity. A balanced gut ensures a robust defense system against illnesses.

Harness the Power of Antioxidants

Incorporate antioxidant-rich berries like blueberries and strawberries into your child’s meals to enhance their immunity. These berries provide a powerful boost to your child’s health and immune function.

Essential Vitamins from Leafy Greens

Ensure your child consumes leafy greens such as spinach and kale to benefit from vitamins A, C, and E, which are essential for strengthening the immune system.

Prioritize Hydration

Encourage your child to stay hydrated by drinking plenty of water and natural fruit juices. Proper hydration helps flush out toxins from the body, supporting overall health and immunity.

Healthy Swaps for Immunity

Replace sugary treats with wholesome options like fresh fruits and natural sweeteners to boost immunity in a healthier way.

References:

  1. Cunha, A. J. L. A., Leite, Á. J. M., & Almeida, I. S. D. (2015). The pediatrician’s role in the first thousand days of the child: The pursuit of healthy nutrition and development. Jornal de Pediatria, 91, S44-S51. https://doi.org/10.1016/j.jped.2015.07.002
  2. Kong, X., Zhuang, L., Wang, M., Zhang, S., Peng, J., & Feng, Z. (2020). Effect of bovine lactoferrin supplementation on intestinal inflammatory factor expression in premature rats model of necrotizing enterocolitis. Chinese journal of applied clinical pediatrics, 35(2), 151-155.
  3. Fragkou, P. C., Karaviti, D., Zemlin, M., & Skevaki, C. (2021). Impact of early life nutrition on children’s immune system and noncommunicable diseases through its effects on the bacterial microbiome, virome and mycobiome. Frontiers in immunology, 12, Article 644269. https://doi.org/10.3389/fimmu.2021.644269
  4. Camacho-Morales, A., Caba, M., García-Juárez, M., Caba-Flores, M. D., Viveros-Contreras, R., & Martínez-Valenzuela, C. (2021). Breastfeeding contributes to physiological immune programming in the newborn. Frontiers in pediatrics, 9, Article 744104. https://doi.org/10.3389/fped.2021.744104
  5. Shao, T., Verma, H. K., Pande, B., Costanzo, V., Ye, W., & Bhaskar, L. (2021). Physical activity and nutritional influence on immune function: An important strategy to improve immunity and health status. Frontiers in physiology, 12, Article 751374. https://doi.org/10.3389/fphys.2021.751374
  6. Miles, E. A., & Calder, P. C. (2021). Effects of citrus fruit juices and their bioactive components on inflammation and immunity: A narrative review. Frontiers in immunology, 12, Article 712608. https://doi.org/10.3389/fimmu.2021.712608
  7. Pagnini, C., Saeed, R., Bamias, G., Arseneau, K. O., Pizarro, T. T., & Cominelli, F. (2010). Probiotics promote gut health through stimulation of epithelial innate immunity. Proceedings of the National Academy of Sciences, 107(1), 454-459. https://doi.org/10.1073/pnas.0910307107
  8. Tomovska, J., & Vllasaku, I. (2021). Review of antioxidants in fruit berries and its impact in immune system. Asian journal of plant and soil sciences, 6(1), 136-147. https://www.researchgate.net/publication/355192320_Asian_Journal_of_Plant_and_Soil_Sciences_REVIEW_OF_ANTIOXIDANTS_IN_FRUIT_BERRIES_AND_ITS_IMPACT_IN_IMMUNE_SYSTEM
  9. Faber, M., Phungula, M. A., Venter, S. L., Dhansay, M. A., & Benadé, A. S. (2002). Home gardens focusing on the production of yellow and dark-green leafy vegetables increase the serum retinol concentrations of 2–5-y-old children in South Africa. The American journal of clinical nutrition, 76(5), 1048-1054. https://doi.org/10.1093/ajcn/76.5.1048
  10. Benelam, B., & Wyness, L. (2010). Hydration and health: A review. Nutrition bulletin, 35(1), 3-25. https://doi.org/10.1111/j.1467-3010.2009.01795.x
  11. Arshad, S., Rehman, T., Saif, S., Rajoka, M. S. R., Ranjha, M. M. A. N., Hassoun, A., Cropotova, J., Trif, M., Younas, A., & Aadil, R. M. (2022). Replacement of refined sugar by natural sweeteners: Focus on potential health benefits. Heliyon, 8(9), e10711. https://doi.org/10.1016/j.heliyon.2022.e10711

UKM & AMM Organized Liver Cancer Awareness Day in Conjunction with World Cancer Day

WORDS LIM TECK CHOON

February 4 was World Cancer Day. In conjunction with World Cancer Day 2024, the Gastroenterology and Hepatology Unit, Department of Medicine and the Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM) collaborated the Academy of Medicine Malaysia (AMM) organized a Liver Cancer Awareness Day event at Komune Living & Wellness, Bandar Tun Razak, Cheras, Kuala Lumpur.

THE MINISTER OF HEALTH CALLS FOR REMOVAL OF GREATER AWARENESS OF CANCER AMONG MALAYSIANS

The event was officiated by YB Datuk Seri Dr Dzulkefly Ahmad, our Minister of Health, and witnessed by the residents of Bandar Tun Razak.

In his speech, Datuk Seri Dr Dzulkefly congratulated the UKM Faculty of Medicine for organizing a community program that has the community closer to the university.

“Approximately 48,639 new cancer cases and 29,530 cancer deaths were reported in 2020 in Malaysia. And more worryingly, experts have predicted that the incidence of cancer in Malaysia will increase 2 times by 2040,” he shared.

He further stated: “There is no doubt that cancer is on the rise. I strongly believe that, as a community, we should learn what cancer is and most importantly to remove the taboo behind the word ‘cancer’.”

LIVER CANCER IS ONE OF THE TOP 5 MOST COMMON CANCERS IN MALAYSIA

“Currently, liver cancer is one of the 5 most common cancers in Malaysia; others are breast cancer, colorectal cancer, lung cancer and nasopharyngeal cancer,” Datuk Seri Dr Dzulkefly revealed. “Primary liver cancer, which starts from within the liver itself, unfortunately, has one of the worst prognoses because it is often diagnosed at a late stage when symptoms appear.”

Our Minister of Health also added that obesity is often associated with an increased risk of fatty liver disease known as metabolic dysfunction associated fatty liver disease (MAFLD), which is becoming the main cause of liver cancer.

However, liver cancer can be prevented either through hepatitis B immunization or early treatment of liver disease detected in patients with known hepatitis or cirrhosis.

LIVER CANCER DAY OFFERED EDUCATIONAL EVENTS & HEALTH SCREENING FOR ALL ATTENDANTS

The objective of the Liver Cancer Awareness Day event was to increase community awareness of liver cancer in addition to knowing more about liver cancer, its symptoms, risk factors, detection, and prevention.

A public forum on liver cancer was held during the event. This forum became a platform for liver cancer patients to share their experiences. Additionally, a group of panelists from the Ministry of Health Malaysia, University Hospitals, agencies and medical associations discussed the issue of public access to affordable cancer medicine in an effort to bridge the gap between the rich and the needy when it comes to cancer care.

In addition to public forums, the Liver Cancer Awareness Day event also provided attendants with screening services such as mammograms by Majlis Kanser Nasional (MAKNA), metabolic disease screening, hepatitis B and C screening, and fatty liver screening as well as consultation by experts, health fairs, quizzes, and lucky draws.

Meanwhile, the Malaysian Relief Agency (MRA) donated food packs to 90 residents of Bandar Tun Razak, Cheras. The participation of residents in this area was made via a community network between the UKM Faculty of Medicine and the residents of Bandar Tun Razak, Kuala Lumpur.

AUSPICIOUS GUESTS ADDED IMPACT TO THE EVENT

In addition to the gracious presence of the esteemed Minister of Health, the Liver Cancer Awareness Day event was attended by: Professor Dato’ Dr. Hanafiah Harunarashid (Pro Vice Canselor Kuala Lumpur Campus UKM), Professor Dr. Abdul Halim Abdul Gafor (Dean of the Faculty of Medicine UKM), Professor Datin Dr Marina Mat Baki (Deputy Dean of Industry Community and Partnerships Affairs), Professor Dato’ Dr Razman Jarmin (Director of Hospital Canselor Tuanku Muhriz UKM), Professor Dato’ Dr Ismail Sagap (Director of Hospital Pakar Kanak-Kanak UKM), Professor Dr Rosmawati Mohamed from the Academy of Medicine Malaysia, as well as various hospital directors and heads of department.

This program was made possible by the efforts of the Dean of the UKM Faculty of Medicine, Professor Dr Abdul Halim Abdul Gafor, and members of the faculty’s top management.

 

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

Mealtime Strategies to Transform the Lives of People with Type 2 Diabetes

WORDS LIYANA TAN ABDULLAH, DR HARVINDER KAUR GILCHARAN SINGH & DR KANIMOLLI ARASU

FEATURED EXPERTS

LIYANA TAN ABDULLAH
BSc Applied Chemistry UM
Student of Master Clinical Nutrition
Universiti Kebangsaan Malaysia
DR HARVINDER KAUR GILCHARAN SINGH
Senior Lecturer
Centre for Community Health Studies (ReaCH) Faculty of Health Sciences
Universiti Kebangsaan Malaysia (UKM)
DR KANIMOLLI ARASU
Dietitian and Senior Lecturer
IMU Division of Nutrition & Dietetics
International Medical University (IMU)

Type 2 diabetes mellitus (T2DM) poses a significant public health challenge in Malaysia, mirroring a global trend of increasing prevalence.

According to the International Diabetes Federation (IDF), there are almost 463 million people suffering from T2DM worldwide. In Malaysia, this chronic condition is on the rise, with approximately 1 in 5 adults living with diabetes according to 2019 National Health and Morbidity Survey.

THE COST OF TREATING T2DM IN MALAYSIA IS INCREASING DAY BY DAY

Globally, total annual cost for treating diabetes in 2022 was estimated to be USD412.9 billion, which include USD306.6 billion for direct medical costs and $106.3 billion for indirect costs attributable to diabetes.

T2DM has a huge socioeconomic implication with an estimated cost of RM 4.38 billion in 2017 to treat T2DM and its complications, according to a report published by the Malaysian Ministry of Health (MOH) and the World Health Organization (WHO).

Additionally, people with T2DM suffer from complications such as heart disease, chronic kidney disease, nerve damage, vision and/or hearing problems, and mental health issues when the disease is poorly managed. Consequently, it leads to poor quality of life among Malaysians living with T2DM.

There is a need for public awareness and caution when managing T2DM. This article aims to provide comprehensive insights of the risk factors associated with T2DM and lifestyle strategies for effective diabetes management.

WHAT IS TYPE 2 DIABETES?

T2DM is a chronic health condition characterized by increased sugar (glucose) levels in the blood.

An overview of T2DM. Click on the image for a larger and clearer version.

Following a meal, our body processes the ingested food, generating sugar, specifically glucose molecules. Glucose molecules are then released into the blood stream.

Concurrently, the pancreas secretes insulin hormone to control and maintain our blood glucose level. Insulin helps our cells to utilize sugars as a source of energy for the body.

In people with T2DM, their body cannot produce sufficient insulin or there is a problem in the effective utilization of insulin. Thus, blood glucose level remains high, causing multiple complications.

RISK FACTORS OF T2DM

Various risk factors, including overweight and obesity, have been identified in association with T2DM.

Overweight and obesity

The mechanisms that link obesity with insulin resistance are still uncertain. However, some studies suggest that people with obesity have fewer insulin receptors, especially in the skeletal muscle, liver and adipose tissue, than lean people.

Excessive weight gain is posited as a potential factor contributing to the impairment of insulin function, possibly linked to the detrimental effects of fat accumulation in tissues such as the muscles and liver.

Other risk factors

Besides obesity, other risk factors for T2DM includes combination of environmental and genetic risk factors. Even though strong correlation between genetic risk factors and T2DM are found in many studies, environmental risk factors remain as crucial in the development of T2DM.

Therefore, specific strategies such as promotion of physical activity, healthy lifestyle and healthy dietary patterns combined with interventions to reduce the rate of obesity could reduce increasing number of T2DM incidences in near future.

MEALTIME STRATEGIES FOR PEOPLE WITH T2DM

Here are some important strategies recommended by Ministry of Health Malaysia.

Portion control is crucial.

People with T2DM are recommended to have:

  • 2 servings of carbohydrates for breakfast.
  • 2 to 3 servings for lunch and dinner, respectively.
  • 1 to 2 servings of snack.

You can use your hand as a visual guide to determine portion sizes of your foods.

NUTRIENTS EXAMPLES SIZE OF 1 PORTION
Carbohydrates Rice The size of your fist.
Protein Tenggiri fish The size of your palm.
Fats Butter The size of the tip of your thumb.
Dietary fibre Green vegetables 2 hands full.

Additionally, you can also adhere to their specific recommended portions by following the Malaysian healthy plate such as the quarter, quarter half concept.

  1. Pick a dinner plate of 9-inch or 23-cm diameter.
  2. Fill half the plate with non-starchy vegetables, such as salad, green beans, broccoli, cauliflower, cabbage, or carrot.
  3. Fill one quarter with a lean protein, such as chicken, fish, turkey, beans, tempeh, tofu, or eggs.
  4. Fill the remaining quarter with carbohydrate-rich foods such as rice, pasta, noodles, corn, or other wholegrains. Note that a cup of milk counts as carbohydrate.
  5. Choose water or a low-calorie drink such as unsweetened fruit juice or tea to go with your meal.
  6. You can also add 2 serving of fruits per day as part of your diet.
Consume high-fibre food such as fresh fruits and vegetables.

Foods containing high amounts of soluble fibres such as apples, citrus fruits, barley, and beans help to prevent sugar spikes as they slow down the digestion process.

However, these foods also contain carbohydrates and thus, you need to watch the portion sizes.

Choose wholegrains instead of simple carbohydrates.
EXAMPLES OF SIMPLE CARBS EXAMPLES OF COMPLEX CARBS
  • White bread
  • White pasta
  • White rice
  • Cakes
  • Cookies
  • Candy
  • Ice cream
  • Non-diet sodas
  • Sugar cereals
  • Sweetened drinks
  • Whole wheat bread
  • Brown rice
  • Starchy vegetables
  • Fruit
  • Beans
  • Lentils
  • Quinoa
  • Oats
  • Sweet potatoes
  • Chia seeds
Avoid or limit intake of foods high in sodium as these foods may lead to high blood pressure.

Examples of high sodium foods include salty snacks, fast food, pickles, and gravies.

Low sodium foods include whole foods such as fresh fruits and vegetables, unsalted foods or snacks, herbs and spices.

Consume healthy fats such as foods rich in unsaturated fatty acids.

Examples of fgood sources of unsaturated fatty acids include fish, nuts and seeds.

Avoid or limit intake foods high in saturated fats such as processed meat, cheese, and fatty meat.

Avoid or limit sugar sweetened beverages such as canned drinks or carbonated drinks.

These beverages add to your total calorie intake and lead to increased blood glucose levels.

People with T2DM can opt for unsweetened coffee or tea.

Avoid or limit alcohol drinks and cigarettes smoking.
Lead an active lifestyle by doing exercises.

Perform moderate-intensity exercises such as cycling less than 20km/hour, water aerobics, mowing the lawn, actively playing with children for 150 minutes per week.

Perform for at least 90 minutes per week vigorous exercise such as race walking, hiking uphill, aerobics, swimming, and cycling uphill.

Additionally, aim for at least 2 sessions per week of muscle strengthening exercises such as push-ups, squats and abdominal crunches.

Consult a healthcare professional on the appropriate types and frequency of exercise. as some individuals may need personalized exercise regime—especially the older adults, elderly and those with chronic conditions.

It is also recommended to check blood glucose levels before engaging in vigorous exercise regimes.

Consume adequate fluids to maintain good hydration status during exercise.

OTHER USEFUL TIPS
Monitoring carbohydrates intake is essential.

A dietitian can provide guidance on estimating carbohydrates intake through techniques such as carbohydrates counting or maintaining a food diary. These approaches enable people with T2DM to understand how different foods impact their blood sugar levels. It is important to pair carbohydrates counting with the blood glucose levels and medication intake.

Always monitor at home the blood sugar level for those who are at risk of hypo- or hyperglycaemia, using a blood glucose meter.

Self-monitoring of blood glucose level is important to ensure blood glucose stays within the recommended levels and it helps to prevent hypo- or hypoglycemia.

It can be done in a fasting state before and/or 2 hours after a meal.

People with T2DM should adhere to anti-diabetic medications dosage intake and insulin injection regimen to help improve blood glucose control.

Always seek guidance from healthcare professionals to manage your diabetes effectively.

Keeping a close watch on overall carbohydrates and sugar consumption remains a fundamental strategy for achieving optimal blood sugar control in people with T2DM.

Besides, people with T2DM should possess awareness and understanding of all the recommendations and guidelines provided by their healthcare professionals.

References:

  1. CPG Secretariat, Health Technology Assessment Section. (2020). Clinical practice guidelines: Management of type 2 diabetes mellitus (6th ed.). Ministry of Health Malaysia. https://www2.moh.gov.my/moh/resources/Penerbitan/CPG/Endocrine/CPG_T2DM_6th_Edition_2020_13042021.pdf
  2. Nasir, B.M., Abd. Aziz A., Abdullah, M.R., & Mohd Noor, N. (2012). Waist height ratio compared to body mass index and waist circumference in relation to glycemic control in Malay type 2 diabetes mellitus patients, Hospital Universiti Sains Malaysia. International journal of collaborative research on internal medicine & public health (IJCRIMPH), 4, 406. https://www.researchgate.net/publication/281629114_Waist_height_ratio_compared_to_body_mass_index_and_waist_circumference_in_relation_to_glycemic_control_in_Malay_type_2_diabetes_mellitus_patients_Hospital_Universiti_Sains_Malaysia
  3. Bener, A., Zirie, M., & Al-Rikabi, A. (2005). Genetics, obesity, and environmental risk factors associated with type 2 diabetes. Croatian medical journal, 46(2), 302–307.
  4. Ganasegeran, K., Hor, C. P., Jamil, M. F. A., Loh, H. C., Noor, J. M., Hamid, N. A., Suppiah, P. D., Abdul Manaf, M. R., Ch’ng, A. S. H., & Looi, I. (2020). A systematic review of the economic burden of type 2 diabetes in Malaysia. International journal of environmental research and public health, 17(16), 5723. https://doi.org/10.3390/ijerph17165723
  5. Gardner, C. D., Trepanowski, J. F., Del Gobbo, L. C., Hauser, M. E., Rigdon, J., Ioannidis, J. P. A., Desai, M., & King, A. C. (2018). Effect of low-fat vs low-carbohydrate diet on 12-month weight loss in overweight adults and the association with genotype pattern or insulin secretion: The DIETFITS randomized clinical trial. JAMA, 319(7), 667–679. https://doi.org/10.1001/jama.2018.0245
  6. Kojta, I., Chacińska, M., & Błachnio-Zabielska, A. (2020). Obesity, bioactive lipids, and adipose tissue inflammation in insulin resistance. Nutrients, 12(5), 1305. https://doi.org/10.3390/nu12051305
  7. Feisul, I. M., Azmi, S., Mohd Rizal, A. M., Zanariah, H., Nik Mahir, N. J., Fatanah, I., Aizuddin, A. N., & Goh, A. (2017). What are the direct medical costs of managing type 2 diabetes mellitus in Malaysia?. The medical journal of Malaysia, 72(5), 271–277.
  8. Shafie, A., & Ng, C.H. (2020). Estimating the costs of managing complications of type 2 diabetes mellitus in Malaysia. Malaysian journal of pharmaceutical sciences, 18, 15-32. 10.21315/mjps2020.18.2.2
  9. Goossens G. H. (2008). The role of adipose tissue dysfunction in the pathogenesis of obesity-related insulin resistance. Physiology & behavior, 94(2), 206–218. https://doi.org/10.1016/j.physbeh.2007.10.010
  10. Parker, E. D., Lin, J., Mahoney, T., Ume, N., Yang, G., Gabbay, R. A., ElSayed, N. A., & Bannuru, R. R. (2024). Economic costs of diabetes in the U.S. in 2022. Diabetes care, 47(1), 26–43. https://doi.org/10.2337/dci23-0085

Tame the IBS Beast: Your Guide to a Happy Gut

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

Have you ever woken up feeling like your stomach was about to explode? Or experienced that nagging discomfort after eating certain foods? If so, you’re not alone.

Irritable bowel syndrome (IBS), a common gastrointestinal disorder, affects 1 in 10 people worldwide.

UNMASKING IBS: A PERSONAL JOURNEY

My teenage years, already burdened by academic pressure, took a painful turn when I developed IBS.

The unpredictable digestive woes—rumbling stomachs, embarrassing episodes, and constant discomfort—cast a shadow over my social life and amplified my anxieties.

Shame and isolation became my unwelcome companions.

Seeking medical help finally brought the diagnosis: IBS.

While the condition persisted, understanding it became the first step towards managing it.

Now, on the flip side of this journey, I offer my story not for pity, but for hope. To anyone wrestling with IBS, know this: you’re not alone. Let’s navigate this together, sharing strategies, finding support, and reclaiming control. Together, we can turn the tables on IBS and discover a life brimming with delicious possibilities and digestive joys.


An overview of IBS. Click on the image for a larger, clearer version.

NAVIGATING THE COMPLEXITIES OF IBS

This can be a daunting task, as this common gastrointestinal disorder can significantly impact your quality of life.

While not life-threatening, IBS can manifest in a range of distressing symptoms. It is a common condition characterized by frequent tummy troubles, bloating, cramps, and bathroom emergencies.

It not only affects the gut but also causes social anxiety, worry about finding a bathroom, and a decline in productivity due to doctor visits, tests, and medications.

GUT OFFENDERS

Living with IBS means your gut can flip its lid over certain foods. Here are some of my worst offenders.

  • Spicy foods: capsaicin in chili peppers lights up pain receptors in your sensitive gut, leading to gut pain, bloating, and diarrhoea.
  • Caffeine revs up your gut, potentially worsening diarrhoea and anxiety. Plus, it acts like a sneaky thief, steals fluids (causing dehydration) and makes constipation worse.
  • Alcohol, research suggests alcohol disrupts gut barrier integrity, which can worsen IBS symptoms. Also, alcohol disrupts digestion, which may slow down bowel movements and contribute to constipation. It irritates gut, triggering inflammation and worsening discomfort.
LIFESTYLE HACKS TO EMPOWER YOUR LIFE IN SPITE OF IBS

IBS can rumble your confidence and hijack your life. Fear not! Conquer IBS and reclaim your freedom with simple dietary tweaks and lifestyle hacks.

Regularity and consistency are key. To ease your IBS symptoms, eat slowly and regularly in a relaxing environment, and be mindful of how your food affects your gut.

Small and frequent wins. Smaller portions, more often, can be your gastrointestinal allies, embrace bite-sized snacks throughout the day to keep your digestion humming smoothly.

Small changes as a starter. To avoid losing motivation, make gradual changes and observe their effects. This will help you maintain consistency and find what works best for you.

Start recording. Keep a diary of your foods and symptoms as you are making changes, so that you can see what have helped (and haven’t).

Hydration is your hero. Water is your gut’s best friend! Aim for 8 glasses daily.

Caffeine and fizz, the troublemakers. Limit yourself to 3 cups of coffee and/or tea a day and keep the fizzy drinks at bay – your gut will thank you!

Alcohol? Not the best buddy. Moderation is key, so if you do imbibe, choose wisely and drink plenty of water alongside.

Fibre matters but choose wisely. If your IBS involves frequent trips to the loo, steer clear of whole grains, brown rice, bran, and fruit and veggie peels. However, don’t ditch fibre altogether!

To conquer constipation: embrace soluble fibres in moderation. Apples, pears, bananas, flaxseeds, chia seeds, and oats can be your constipation-busting friend.

Sorbitol, the sweet deceiver. If diarrhoea is your IBS partner, avoid the artificial sweetener sorbitol found in sugar‑free sweets, including chewing gum, and drinks, and in some diabetic and slimming products.

Trigger foods. Fatty foods and spices might be it’s not your best choice.

Stress, the IBS enemy. Exercise, meditation, and yoga are your stress-busting maestros, helping your gut find its happy rhythm again.

Sleep. Aim for eight hours of uninterrupted sleep. A well-rested you translates to a well-rested gut, ready to face the day with digestive harmony.

Probiotics: The gut’s new best buds. Consult your doctor about incorporating these into your routine. They’re friendly bacteria, keeping your gut’s ecosystem in balance and preventing IBS from crashing your day

Seek expert guidance. Consult your doctor or a registered dietitian for personalized advice and support.

Remember, IBS is yours to manage, and with these empowering strategies, you can reclaim control, say goodbye to gut chaos, and embrace a life brimming with delicious possibilities and happy digestion!

References:

  1. UK National Institute for Health and Care Excellence (NICE). (2008, February 23). Irritable bowel syndrome in adults: diagnosis and management. https://www.nice.org.uk/guidance/cg61
  2. Werlang, M. E., Palmer, W. C., & Lacy, B. E. (2019). Irritable bowel syndrome and dietary interventions. Gastroenterology & hepatology, 15(1), 16–26.
  3. Koochakpoor, G., Salari-Moghaddam, A., Keshteli, A. H., Esmaillzadeh, A., & Adibi, P. (2021). Association of coffee and caffeine intake with irritable bowel syndrome in adults. Frontiers in nutrition, 8, 632469. https://doi.org/10.3389/fnut.2021.632469

A Breath of Fresh Hope For Women Against Lung Cancer

A panel discussion titled ‘A Breath of Fresh Hope’ was held on 7 December 2023. This was a collaboration between the pharmaceutical division of Roche (Malaysia) Sdn Bhd and the Lung Cancer Network Malaysia (LCNM).

This panel discussion highlighted the alarming prevalence of lung cancer in non-smoking Malaysian women, the related medical implications of this prevalence, and the social stigma surrounding this cancer.

“Over 2.2 million lung cancer cases were reported in 2020 globally, and more than 770,000 of them were in women. Lung cancer is the third top malignancies seen in the global female population, after breast and colorectal cancers,” said Ms Deepti Saraf.

SHIFTING PUBLIC PERCEPTION OF LUNG CANCER
FEATURED EXPERT
DR ANAND SACHITHANANDAN
Consultant Cardiothoracic Surgeon and Co-Founder of Lung Cancer Network
Malaysia

“The majority of lung cancer cases affect smokers. Having said that, we are now starting to see increasing numbers of cases of lung cancer in non-smokers, of whom women are overrepresented,” said Dr Anand.

Lung cancer does not affect smokers only; there are other risk factors that could put one could be at risk.

Dr Anand Sachithanadan revealed that fewer than 2% of Malaysian women smoke, but lung cancer is one of the main cancers that affect women in Malaysia.

Thus, contrary to popular perception, lung cancer does affect people that do not smoke, as outlined below.

Common lung cancer risk factors. Click on the image for a larger, clearer version.

BE AWARE OF THE SYMPTOMS OF LUNG CANCER—EVEN IF YOU DO NOT SMOKE
FEATURED EXPERT
DR JENNIFER LEONG
Consultant Clinical Oncologist
Sunway Medical Centre

Dr Jennifer Leong told us, “Many women harbour the preconceived notion that because they don’t smoke, they are not at risk of lung cancer. At times, even when displaying typical symptoms, they can easily miss out on these symptoms and do not get the required medical attention in the earlier stages of disease, affecting their chances at longer survival.”

“While I wouldn’t say that lung cancer is preventable, it’s very much a curable disease provided that you can detect it early on,” she added.

On the other hand, ignoring or overlooking the early symptoms of lung cancer would lead one to seek medical treatment only when the cancer has advanced to a late stage, during which the chances of a positive outcome are far more diminished.

Dr Anand concurred with Dr Jennifer’s statement. He stated: “Lung cancer care has been revolutionized in the last four or five years, leading to significantly better outcomes for our patients as well as overall survival. Despite all these tremendous promises, the fact remains most patients are still being diagnosed late in stage.”

Common symptoms of lung cancer. Click on the image for a larger, clearer version.

WOMEN SHOULD PRIORITISE THEIR OWN HEALTH AS WELL AS THAT OF THEIR LOVED ONES
FEATURED EXPERT
ASSOCIATE PROFESSOR DR CARYN CHAN MEI HSIEN
Consultant Health Psychologist
Faculty of Health Sciences
Universiti Kebangsaan Malaysia

“Many women are expected to and are taught to prioritise the health of family, sometimes at the expense of their own health. Consequently, some women would ignore or dismiss their symptoms, or feel guilty when their medical treatments become a significant expense to the family,” said Associate Professor Dr Caryn Chan.

One unfortunate consequence of women putting the needs and well-being of others over their own is that they often neglect their own health.

Often, Associate Professor Dr Caryn Chan pointed out, they overlooked symptoms such as those of lung cancer, and seek medical attention only when their illness had deteriorated to an advanced stage.

This attitude on both the parts of women and society need to change. “Taking care of your health does not mean you are burdening the rest of the family,” Dr Caryn stated.

She also called for the family to come together to distribute caregiving and support responsibilities, typically delegated to a woman, across all capable family members. This way, a woman would have ample opportunity to also tend to her own needs and well-being.

BE MORE PROACTIVE IN DETECTING LUNG CANCER EARLY!
FEATURED EXPERT
MS. DEEPTI SARAF
General Manager
Roche Malaysia Sdn Bhd

“All of us have a part to play in raising awareness of lung cancer,” Ms Deepti Saraf reiterated while closing the panel discussion.

Be alert for symptoms.

If you, your loved ones, or your friends have symptoms, seek medical help.

If you are at high risk of lung cancer, consult your doctor.

The doctor can arrange for you to undergo regular screening to detect early the presence of cancer or other issues with your lungs.

This is an educational article brought to you by

Expert Advice for Moms That Are Juggling Breastfeeding and Work

WORDS MAS AMIRAH MOHMAD AZHAR & DR HASLINA ABDUL HAMID

FEATURED EXPERTS

MAS AMIRAH MOHMAD AZHAR
Student of Master’s in Clinical Nutrition
Faculty of Health Sciences
Universiti Kebangsaan Malaysia (UKM)
DR HASLINA ABDUL HAMID
Lecturer and Registered Dietitian Nutritionist
Centre for Community Health Studies (ReaCH)
Faculty of Health Sciences
Universiti Kebangsaan Malaysia (UKM)

Exclusive breastfeeding is recommended for infants from birth until at least 6 months of age.

This is defined as providing an infant with just breast milk—no other foods or liquids.

For the first six months of life, the World Health Organization (WHO) and other health organizations highly advise this practice, as it can contribute to many advantages for both mother and baby.

THE BENEFITS OF BREASTFEEDING

In addition to its balanced nutritional composition, breast milk contains important substances such as immunoglobulin A or Ig A, lactoferrin, cytokines, enzymes, growth factors and leucocytes. These substances provide the baby with protection against infections while also promoting intestinal adaptation and maturation.

Breast milk also contains numerous prebiotic substances such as human milk oligosaccharides (HMO), which support the growth of non-pathogenic probiotic microorganisms, primarily lactobacilli and bifidobacteria, while removing the potentially pathogenic bacteria. This high concentration of HMO is unique to humans, and studies have shown that breastfed infant has a more stable and constant population of oligosaccharides compared with infants fed with formula milk.

Furthermore, the composition of breast milk is unique, as the concentration of both energy and protein in expressed breast milk is highly variable throughout lactation stages, between mothers, and even from the same mother.

Breast milk feeding also has been linked to improved long-term neurocognitive development and cardiovascular health outcomes.

Additionally, numerous studies have demonstrated the effectiveness of breast milk in offering protection even to preterm infants in the Neonatal Intensive Care Unit (NICU).

THE JUGGLE BETWEEN BABY AND BRIEFCASE

For many working mothers, balancing work and breastfeeding can be challenging.

If you’re one of these mothers, you can choose to breastfeed exclusively or partially once you go back to work.

If you choose to exclusively breastfeed, you should express your milk while you’re on your work breaks. You can use this expressed milk to build up a supply for the feeding of your infant by a caregiver while you’re at work or for moments when you face a shortage of breast milk.

TIPS & ADVICE

The following may be useful for working mothers that still wish to breastfeed as well as to support needs of their infants.

Don’t stress yourself out!

While it’s always ideal to aim to complete your breastfeeding journey until 2 years, you and your health matters too.

Studies have shown that the benefits of breast milk on babies are dose-dependent, so the more and the longer you give, the better the beneficial effects are.

With that said, it also means that some breast milk is better than none.

Every drop matter, so while you are trying your best to pump your milk within your capacity, do not be discouraged by the amount. You might get to express more in some days and just a little in other days, and it’s totally fine.

Seek help whenever necessary.

Being a new mother is overwhelming with both love and new responsibilities, so it is very important for you to prioritise your mental and physical well-being.

Also, go for consistent health check-ups and give yourself ample time to rest.

Know your employment policies.

Nowadays, many companies provide reasonable breaks for breastfeeding employees to express breast milk. Certain companies even provide special rooms or areas for pumping the breastmilk, which comes with a refrigerator to store breast milk as well as a wash area. These venues are kept out of sight and away from public or coworker intrusion.

You can request for such an area at your workplace if such a space is not available.

The location to express your breast milk, the number of breaks available for you, and the length of each break likely differ from company to company. You should get a better understanding on your employer’s company’s policy when it comes to expressing breast milk at the workplace. This way, you can incorporate breast milk expression into your work schedule without negatively affecting your work performance or your ability to get enough rest.

You have the right to ask for permission, explain about your timetable routines to express milk, and enquire about any accommodations to improve your ability express milk more conveniently, so don’t hesitate to talk to your supervisor or human resource department.

You can do this early, such as before your delivery date, so that you can transition from your maternity leave to back to work more seamlessly.

Manage your expectations.

Know how much you need to pump, how many sessions you need to spare your time for, and how much breast milk your baby needs.

How much does your baby need? While it is quite difficult to estimate how much a baby receives from direct breastfeeding, Recommended Nutrient Intake for Malaysia 2017 states that:

  • Babies need around 500 to 600 kcal/day during their first year of life.
  • This amount increases to around 900 to 980 kcal/day at the age of 1 to 3 years.

The number of breastfeeding sessions is reduced as the baby ages, but the amount of milk needed by the baby is increased, from 6 to 8 sessions and 60 to 150 ml.

So, the number of pumping sessions and amount of milk needed to be expressed could be tailored to that.

The amount of milk consumed by your baby is usually reduced once you start them on complementary feeding, but they can still be breastfed on demand, with direct breastfeeding done at home.

Estimated daily milk requirements of babies from 0 to 6 months old. Click image for a larger, clearer version.


The recommended nutrient intake for infants from 0 to 3 years old. Click on the image for a larger, clearer version.

Invest in a good breast pump and breast milk storage.

There are many innovations and developments in the design of breast pumps and related accessories.

Hence, before purchasing a breast pump, take time to research by reading reviews or talking to your healthcare about the necessary equipment to meet your breastfeeding needs. You can also opt for trial or rental period to determine whether a breast pump is suitable for you.

Don’t just choose based on design and brand—you must also choose based on your needs also your budget. Local brands are usually more economical while still having comparable good quality to imported brands.

If you have a busy schedule, there are certain brands that offer quiet, wearable, or hands-free option which could accommodate your routine.

You will also need specialised storage bags made specifically to hold breast milk for safe transportation and storage.

  • Look for BPA-free bags that are strong enough to be kept in the freezer or refrigerator.
  • Consider bags with double zipper seal, the ability to stand alone for simple pouring, and a write-on section to record the time and date you expressed the milk.

Also, after each use of the breast pump, you should clean every area that came into contact with your breast milk or breast tissue. It is not always possible to use soap and water, particularly at work when you might not have access to a sink or have limited time. Cleansing wipes prevail for these instances!

Breastfeeding sanitizer spray is another useful consideration for quick or last-minute cleaning.

To make breast pump cleaning easier when you are on the go, make sure the supplies you buy fit compactly inside your pump bag.

Maintain proper hydration.

Have a bottle of water ready every time you pump your breast milk as well as every time you breastfeed your baby.

Water is essential, but it’s especially critical for working breastfeeding moms to stay focused and energised throughout the day.

Studies have shown that consuming more fluids than normal does not result in an increase in milk production. However, drinking too little water can lead to dehydration, which can harm your health and the quality of your breast milk.

Therefore, to ensure that your body is functioning at its best, it is crucial to consume enough fluids as to stay hydrated, which can range from 1.5 to 2.5 litres per day.

Some mothers rely on coffee to stay awake— which makes sense when your baby decided to play at 3 am! —so consuming low to moderate amounts (around 2 to 3 cups per day, or less than 300 mg of caffeine) is still considered acceptable.

Balanced meals are always key!

Recommended Nutrient Intake for Malaysia 2017 recommends that lactating mothers should consume about 2,400 kcal/day in the first 6 months of lactation, which is approximately 500 kcal more than normal adult women (1,800 to 1,900 kcal for a moderately active individual).

For mothers that want to lose some of their pregnancy weight, make sure to have adequate calories and protein according to your needs. Schedule an appointment with a dietitian if you need help to plan your meal.

Make sure to include plenty of fruits and vegetables in your meals as they are a great supply of important vitamins and minerals. Carbohydrates, especially from whole grains, is a great source of energy and fibre that can support the ability to feel full for longer.

Healthy snacking is encouraged in between meals. Go for fruit smoothies, toast, crackers, yogurt, and nuts.

TO SUM THINGS UP

Exclusive breastfeeding is one of the essential components of early childhood nutrition, but every breastfeeding mother’s circumstances are different. Therefore, it’s critical to identify a schedule and strategy that are most effective for you and your baby.

Furthermore, practice self-compassion while you manage this delicate balancing act, and don’t be afraid to seek for help and advice from your loved ones, coworkers, family members, and friends.

Can Parkinson’s Disease Be Prevented with the Mediterranean Diet?

WORDS OH YAN TING, DR MUNIRAH ISMAIL & PROFESSOR DATO’ DR ROSLEE RAJIKAN

FEATURED EXPERTS

OH YAN TING
Dietitian and Student of MHSc in Clinical Nutrition
Faculty of Health Sciences
Universiti Kebangsaan Malaysia
DR MUNIRAH ISMAIL (PhD)
Lecturer and Dietitian
Dietetics Program
Centre for Healthy Ageing and Wellness (H-CARE)
Faculty of Health Sciences
Universiti Kebangsaan Malaysia
PROFESSOR DATO’ DR ROSLEE RAJIKAN
Professor in Clinical Nutrition and Dietetics
Centre for Healthy Ageing and Wellness (H-CARE)
Faculty of Health Sciences
Universiti Kebangsaan Malaysia

Parkinson’s disease is a degenerative neurological disorder affecting movement.

It occurs when there is damage to brain cells that results in a reduction of dopamine, a chemical in the brain that controls movement, mood, concentration, and others. A lack of dopamine will result in the brain’s nerves being unable to effectively regulate the activities as mentioned earlier.

Individuals with Parkinson’s disease usually experience motor symptoms such as tremors, slower body movements, limb stiffness, postural instability, and uncoordinated body movements. In addition, they may also suffer from depression, behavioural changes, sleep disorders, constipation as well as smell disorders.

PARKINSON’S DISEASE IN MALAYSIA

To date, approximately 15,000 to 20,000 Malaysians have been diagnosed with Parkinson’s disease, and this number is expected to increase by five times in the year 2040.

CAUSES & CURE

Various factors can contribute to the development of this disease, including genetic predisposition and environmental factors such as diet and physical activity as well as exposure to toxic agents such as heavy metals and pesticides.

Although the cause of Parkinson’s disease is not fully understood, there is evidence to suggest a link between oxidative damage, chronic neuroinflammation, and mitochondrial dysfunction, which can result in the development of this disease.

Currently, there isn’t a cure for Parkinson’s disease. Therefore, preventive measures must be implemented to reduce one’s risk of developing this disease.

NUTRITION & PARKINSON’S DISEASE

Nutrition is one of the environmental factors found to influence one’s risk of developing Parkinson’s disease.

A high intake of vegetables as well as fish and legumes are moderately associated to a reduced risk of Parkinson’s disease.

Meanwhile, high consumption of meat, processed meat, sugary foods, and carbonated drinks is associated to an increased risk.

THE MEDITERRANEAN DIET

The Mediterranean diet is practiced widely in Greece, Spain, and Italy.

Many previous studies found that this diet confers benefits for health and longevity.

It is associated with a reduced risk of type 2 diabetes, heart disease, and stroke.

In addition, the Mediterranean diet is also widely recognized for its role in reducing oxidation and inflammation in the body. Since the onset and progression of Parkinson’s disease involve neuroinflammation and oxidative stress, the Mediterranean diet can therefore play an important role in the prevention of this disease.

Two large cohort studies have shown that a high level of adherence to the Mediterranean diet is associated with a lower risk of Parkinson’s disease. Whereas a lower level of adherence to this diet is associated with an earlier onset of Parkinson’s disease.

In addition, short-term adherence to the Mediterranean diet has also been found to reduce constipation, which is one of the signs and symptoms of Parkinson’s disease.

Characteristics of the Mediterranean diet.

This diet emphasizes the following 4 components:

High intake of fresh fruits and vegetables, as well as whole grains. According to the Greek Dietary Guidelines 1999, it recommends the following:

  • Vegetables: 6 servings a day.
  • Fruits: 3 servings a day.
  • Whole grains: 8 servings a day.

These foods contain high dietary fibre, vitamins, and polyphenols. Vitamins A, C, and E and polyphenols contain antioxidant and anti-inflammatory properties that are likely to reduce the risk of Parkinson’s disease. In addition, the high dietary fibre content can also help to reduce occurrences of constipation.

Consistent use of olive oil. This oil contains monounsaturated fatty acids and polyphenols that can reduce oxidative stress and inflammation.

Consumption of milk, dairy products, potatoes, chicken eggs, fish, nuts, legumes, seeds and red wine in moderation.

  • Milk and dairy products: 2 servings a day.
  • Nuts and legumes: 3 to 4 servings a week.
  • Fish or seafood: 5 to 6 servings a week.
  • Chicken or duck: 4 servings a week.
  • Eggs: 3 servings a week.
  • Red wine: no more than 2 glasses a day for men and 1 glass a day for women.

Foods such as nuts, legumes, fish, chicken, and eggs are important sources of protein for building and repairing body cells and tissues.

For fish, go for deep-sea fish that contain high levels of omega-3 fatty acids. Omega-3 fatty acids can maintain brain function and reduce inflammation and oxidation.

As for red wine, it contains high amounts of polyphenols.

Low intake of red meat, sweet foods, and saturated fat.

  • Red meat: 4 servings a month.
  • Sweet foods: 3 servings a week.

High intake of red meat has been linked to an increased risk of Parkinson’s disease. There are several possibilities that contribute to this. The high haem content in red meat can act as a toxin when this substance is not digested properly. Secondly, the high content of saturated fat in red meat is associated with increased oxidative stress.

RECONCILING THE MEDITERRANEAN DIET WITH OUR MALAYSIAN DIET

Although this diet is practiced by the people in Mediterranean countries that have a different dietary culture from Malaysians, it is possible to include their recommendations into our Malaysian diet.

In fact, there is a high similarity between the Mediterranean Diet Pyramid and the Malaysian Food Pyramid.

Image 1 shows the Mediterranean Diet Pyramid while Image 2 shows the latest Malaysian Food Pyramid. Click on these images for larger, clearer versions.

  • Both the Mediterranean diet and the Malaysian Food Pyramid encourage the consumption of fruits and vegetables, followed by the consumption of various grain products, especially whole grains.
  • In line with the recommendations of the Mediterranean diet, the Malaysian Food Pyramid also recommends the selection of lean meat and the incorporation of plant protein sources such as legumes in a simple daily diet.
  • Both of these pyramids also emphasize limiting the intake of fat, oil, sugar, and salt.

However, a slight difference is that the Mediterranean diet emphasizes the consistent use of olive oil.

The Mediterranean diet also encourages moderate wine consumption, but individuals may make decisions on whether to include this into their diet, based on their own personal religion and beliefs.

HOW TO USE THE MALAYSIAN FOOD PYRAMID AS A FOUNDATION TO INCORPORATE MEDITERRANEAN DIET IN OUR LIVES

One simple way is to follow the Malaysian Healthy Plate concept.

The Malaysian Healthy Plate concept. Click on the image for a larger, clearer version.

  • The first quarter of the plate is allocated for carbohydrate food sources such as rice, bread, grains, and others.
  • The second quarter is allocated for protein sources such as legumes, fish, chicken, and meat.
  • The remaining half is allocated for fresh vegetables and fruits.

The “Suku Suku Separuh” (“Quarter Quarter Half”) concept emphasizes portion control and balanced meals. Following it allows us to adhere to the recommendations of the Malaysian Food Pyramid.

Additionally, the cooking methods used in meal preparation also play a key role in enabling the incorporation of the Mediterranean diet into our Malaysian diet. We can use olive oil in the grilling, baking, and roasting of meat, fish, and vegetables. It can also be used as drizzle for our salads and ulams.

References:

  1. Chu, C., Yu, L., Chen, W., Tian, F., & Zhai, Q. (2021). Dietary patterns affect Parkinson’s disease via the microbiota-gut-brain axis. Trends in food science and technology, 116, 90–101. https://doi.org/10.1016/j.tifs.2021.07.004
  2. Bexci, M.S. & Subramani, R. (2018). Decoding Parkinson’s associated health messages in social media pages by Malaysian service administrators. Malaysian journal of medical research (MJMR), 2(4), 64-72.
    3. Torti, M., Fossati, C., Casali, M., De Pandis, M. F., Grassini, P., Radicati, F. G., Stirpe, P., Vacca, L., Iavicoli, I., Leso, V., Ceppi, M., Bruzzone, M., Bonassi, S., & Stocchi, F. (2020). Effect of family history, occupation and diet on the risk of Parkinson disease: A case-control study. PLoS one, 15(12), e0243612. https://doi.org/10.1371/journal.pone.0243612
  3. Molsberry, S., Bjornevik, K., Hughes, K. C., Healy, B., Schwarzschild, M., & Ascherio, A. (2020). Diet pattern and prodromal features of Parkinson disease. Neurology, 95(15), e2095–e2108. https://doi.org/10.1212/WNL.0000000000010523
  4. Georgiou, A., Demetriou, C. A., Christou, Y. P., Heraclides, A., Leonidou, E., Loukaides, P., Yiasoumi, E., Pantziaris, M., Kleopa, K. A., Papacostas, S. S., Loizidou, M. A., Hadjisavvas, A., & Zamba-Papanicolaou, E. (2019). Genetic and environmental factors contributing to Parkinson’s disease: A case-control study in the Cypriot population. Frontiers in neurology, 10, 1047. https://doi.org/10.3389/fneur.2019.01047
  5. Gao, X., Chen, H., Fung, T. T., Logroscino, G., Schwarzschild, M. A., Hu, F. B., & Ascherio, A. (2007). Prospective study of dietary pattern and risk of Parkinson disease. The American journal of clinical nutrition, 86(5), 1486–1494. https://doi.org/10.1093/ajcn/86.5.1486
  6. Yin, W., Löf, M., Pedersen, N. L., Sandin, S., & Fang, F. (2021). Mediterranean dietary pattern at middle age and risk of Parkinson’s disease: A Swedish cohort study. Movement disorders : official journal of the Movement Disorder Society, 36(1), 255–260. https://doi.org/10.1002/mds.28314
  7. Alcalay, R. N., Gu, Y., Mejia-Santana, H., Cote, L., Marder, K. S., & Scarmeas, N. (2012). The association between Mediterranean diet adherence and Parkinson’s disease. Movement disorders : official journal of the Movement Disorder Society, 27(6), 771–774. https://doi.org/10.1002/mds.24918
  8. Rusch, C., Beke, M., Tucciarone, L., Dixon, K., Nieves, C., Jr, Mai, V., Stiep, T., Tholanikunnel, T., Ramirez-Zamora, A., Hess, C. W., & Langkamp-Henken, B. (2021). Effect of a Mediterranean diet intervention on gastrointestinal function in Parkinson’s disease (the MEDI-PD study): Study protocol for a randomised controlled trial. BMJ open, 11(9), e053336. https://doi.org/10.1136/bmjopen-2021-053336
  9. Rusch, C., Beke, M., Tucciarone, L., Nieves, C., Jr, Ukhanova, M., Tagliamonte, M. S., Mai, V., Suh, J. H., Wang, Y., Chiu, S., Patel, B., Ramirez-Zamora, A., & Langkamp-Henken, B. (2021). Mediterranean diet adherence in people with Parkinson’s disease reduces constipation symptoms and changes fecal microbiota after a 5-week single-arm pilot study. Frontiers in neurology, 12, 794640. https://doi.org/10.3389/fneur.2021.794640
  10. Calder P. C. (2006). n-3 polyunsaturated fatty acids, inflammation, and inflammatory diseases. The American journal of clinical nutrition, 83(6 Suppl), 1505S–1519S. https://doi.org/10.1093/ajcn/83.6.1505S
  11. The Hellenic Health Foundation. (n.d.). Dietary guidelines for adults in Greece. https://www.hhf-greece.gr/hydria-nhns.gr/adultdietarytext_eng.html
  12. Bisaglia, M. (2022). Mediterranean diet and Parkinson’s disease. International journal of molecular sciences, 24(1), 42. https://doi.org/10.3390/ijms24010042
  13. Lange, K. W., Nakamura, Y., Chen, N., Guo, J., Kanaya, S., Lange, K., & Li, S. (2019). Diet and medical foods in Parkinson’s disease. Food science and human wellness, 8(2), 83–95. https://doi.org/10.1016/j.fshw.2019.03.006
  14. Foo Chung, C., Pazim, K., & Mansur, K. (2020). Ageing population: Policies and programmes for older people in Malaysia. Asian journal of research in education and social sciences, 2(2), 92-96.  https://myjms.mohe.gov.my/index.php/ajress/article/view/10227

Universiti Kebangsaan Malaysia Confers Distinguished Alumni Award to Minister of Health

WORDS LIM TECK CHOON

On 5 October 2023, the Faculty of Medicine of Universiti Kebangsaan Malaysia (UKM) conferred the Distinguished Alumni award to Dr Zaliha Mustafa, our Minister of Health.

This conferment was in acknowledgment and celebration of Dr Zaliha’s accomplishments and successes as the Minister of Health. Notably, she is the first female Minister of Health of Malaysia.

CELEBRATING THE PRESENT & CONTEMPLATING THE FUTURE

Upon receiving the title, Dr Zaliha shares: “I would like to express my utmost appreciation to UKM, especially the Faculty of Medicine, for bestowing upon me the Distinguished Alumni award. Indeed, I’m very proud of having the privilege to receive my education in the faculty.”

The conferment ceremony was also graced by the presence of Professor Emeritus Dato’ Dr Mohamad Abd Razak, the Chairman of the UKM Board of Directors.

He delivered a talk entitled ‘Reformasi Sistem Kesihatan yang Kalis Masa Hadapan’ (Reformation of a Future-Proof Healthcare System), which touches on relevant health issues that affect the way in which societies in this country would confront the challenges of the future.

Professor Emeritus Dato’ Dr Mohamad Abd Razak also shared his experiences as a student in the faculty around 1983 to 1989. “There are far more advances in technology and methodology today to provide optimal benefits to students,” he said.

Additionally, Dr. Zaliha took the opportunity to officiate the Space for Distinguished Alumni at the Faculty of Medicine of UKM.

A SPACE TO CELEBRATE THE LEGACY OF UKM’S DISTINGUISHED ALUMNI

The Space for Distinguished Alumni is set up by UKM to honour the accomplishments of the Distinguished Alumni of UKM.

A multimedia display is set up in this space to commemorate these accomplishments with visitors.

Aside from Dr Zaliha, the other Distinguished Alumni are Tan Sri Dato’ Seri Dr Noor Hisham Abdullah (2020), Datuk Dr Rohaizat Yon (2021), and Professor Emeritus Dato’ Dr. Lokman Saim (2022).

Experts & Parents Come Together to Raise Awareness of Respiratory Syncytial Virus

WORDS LIM TECK CHOON

On 4 September 2023, the Pertubuhan Kumpulan Sokongan Ibu Bapa Dan Bayi Pramatang Malaysia (BPM) and the Galen Centre for Health and Social Policy partnered to organize a media roundtable called Taking a Closer Look at RSV.

RSV is short for respiratory syncytial virus, one of the most prevalent viruses that infect the respiratory system of mostly children below 3.

FEATURED EXPERT
ASSOCIATE PROFESSOR DR ADLI ALI
Head of Clinical Immunology
UKM Children’s Specialist Hospital

“RSV is a disease that has been around for a long time, yet the number of cases is still high. The actual burden of the disease is not known from the economic impact on the healthcare system which includes admission costs, utilization of respiratory supports, as well the economic and social impact on the family of patients. Therefore, prevention is very important in addressing the further progression of the disease in the country.”

FEATURED EXPERT
AZRUL ABDUL KHALIB
Founder and Chief Executive Officer
Galen Centre for Health and Social Policy

“With the varied guidelines on prevention, we need to prioritize and respond with more urgency to RSV which can have a life-long impact. Parents, caregivers and the community at large need to understand the severity of the disease, how it can affect the future of our nation and what can be done to address them immediately.”

Azrul also called for more streamlined guidelines for RSV prevention and to ensure the channels for parents to seek support and financial aid for their children are made more accessible.

Furthermore, increased availability of preventive options would help reduce mortality and save children’s lives.