Is socio-demographic status, body mass index, and consumption of food away from home associated with high sodium intake among adults in Malaysia?: findings from the Malaysian Community Salt Survey (MyCoSS)

Bridging Implementation Science and Human-Centered Design: Developing Tailored Interventions for Healthier Eating in Restaurants

Restaurants are important institutions in the communities' economy with the potential to promote healthier foods but have been under-engaged in public health nutrition efforts. In particular, independently owned, minority-serving and minority-owned restaurants, remain under-represented in nutrition promotion efforts despite disproportionate burdens of diet-related health outcomes among minority populations. Addressing this gap in engagement, we undertook a process of co-designing and implementing healthy eating-focused interventions in two Latin American restaurants in New York City, combining the Behavior Change Wheel intervention development framework with a Human-Centered Design approach. Restaurant owners and chefs were involved in the research synthesis and solution development processes, resulting in two tailored interventions. This paper describes this co-development process and offers reflections and lessons regarding: (1) implementation research in community settings, (2) the application of Human-Centered Design to promote the uptake of community-based interventions on food and health equity, and (3) the combined use of Human-Centered Design and Implementation science in these complex community settings.

Identifying obesogenic environment through spatial clustering of body mass index among adults

BACKGROUND

The escalating trend of obesity in Malaysia is surmounting, and the lack of evidence on the environmental influence on obesity is untenable. Obesogenic environmental factors often emerge as a result of shared environmental, demographic, or cultural effects among neighbouring regions that impact lifestyle. Employing spatial clustering can effectively elucidate the geographical distribution of obesity and pinpoint regions with potential obesogenic environments, thereby informing public health interventions and further exploration on the local environments. This study aimed to determine the spatial clustering of body mass index (BMI) among adults in Malaysia.

METHOD

This study utilized information of respondents aged 18 to 59 years old from the National Health and Morbidity Survey (NHMS) 2014 and 2015 at Peninsular Malaysia and East Malaysia. Fast food restaurant proximity, district population density, and district median household income were determined from other sources. The analysis was conducted for total respondents and stratified by sex. Multilevel regression was used to produce the BMI estimates on a set of variables, adjusted for data clustering at enumeration blocks. Global Moran's I and Local Indicator of Spatial Association statistics were applied to assess the general clustering and location of spatial clusters of BMI, respectively using point locations of respondents and spatial weights of 8 km Euclidean radius or 5 nearest neighbours.

RESULTS

Spatial clustering of BMI independent of individual sociodemographic was significant (p < 0.001) in Peninsular and East Malaysia with Global Moran's index of 0.12 and 0.15, respectively. High-BMI clusters (hotspots) were in suburban districts, whilst the urban districts were low-BMI clusters (cold spots). Spatial clustering was greater among males with hotspots located closer to urban areas, whereas hotspots for females were in less urbanized areas.

CONCLUSION

Obesogenic environment was identified in suburban districts, where spatial clusters differ between males and females in certain districts. Future studies and interventions on creating a healthier environment should be geographically targeted and consider gender differences.

Perceptions, barriers and enablers on salt reduction in the out-of-home sectors in Malaysia (MySaltOH) from the perspective of street food vendors, caterers and consumers

OBJECTIVE

To explore the perspectives, barriers and enablers on salt reduction in out-of-home sectors in Malaysia among street food vendors, caterers and consumers.

DESIGN

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

SETTING

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

PARTICIPANTS

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

RESULTS

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

CONCLUSIONS

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

Fatty Acid Composition of Selected Street Foods Commonly Available in Malaysia

Despite growing evidence of increased saturated and trans fat contents in street foods, little is known about their fatty acid (FA) compositions. This study aimed to analyse the saturated fatty acids (SFAs), monounsaturated fatty acids (MUFAs), polyunsaturated fatty acids (PUFAs), and trans fatty acids (TFAs) content of 70 selected and most commonly available street foods in Malaysia. The street foods were categorised into main meals, snacks, and desserts. TFAs were not detected in any of the street foods. Descriptively, all three categories mainly contained SFAs, followed by MUFAs, and PUFAs. However, the one-way ANOVA testing showed that the differences between each category were insignificant (p > 0.05), and each FA was not significantly different (p > 0.05) from one to another. Nearly half of the deep-fried street foods contained medium to high SFAs content (1.7 g/100 g–24.3 g/100 g), while the MUFAs were also high (32.0–44.4%). The Chi-square test of association showed that the type of preparation methods (low or high fat) used was significantly associated (p < 0.05) with the number of SFAs. These findings provide valuable information about fat composition in local street foods for the Malaysian Food Composition Database and highlight the urgency to improve nutritional composition.

Estimation of Sodium Availability and Food Sources from 2018 to 2019 and Its Trends during the 2004-2019 Period in Costa Rica

Sodium availability and food sources in 2018−2019 were estimated and trends analyzed for 15 years (2004−2019) in Costa Rica. Food purchase records from the National Household Income and Expenditure Survey (ENIGH) 2018−2019 were converted to energy and sodium using food composition tables measuring “apparent consumption”. Foods were classified by sodium content. ENIGH is a probabilistic, stratified, two-stage and replicated national survey, carried out regularly by the national statistics institution. Results from the 2004−2005 and 2012−2013 ENIGHs came from previous analysis. Differences between periods were determined through descriptive and inferential statistics. The available sodium adjusted to 2000 kcal/person/day was 3.40, 3.86, and 3.84 g/person/day (g/p/d) for periods 2004−2005, 2013−2014, and 2018−2019, respectively. In this last period, this was 3.94 urban and 3.60 g/p/d rural (p < 0.05), with a non-linear increase with income. During 2004−2019 sodium from salt and salt-based condiments increased from 69.5 to 75.5%; the contribution of common salt increased, from 60.2 to 64.8% and condiments without added salt from 9.3 to 10.7%. From 2012−2013 to 2018−2019, processed and ultra-processed foods with added sodium intake increased from 14.2 to 16.9% and decreased in prepared meals (7.2 to 2.8%). Costa Rica has been successful in reducing salt/sodium available for consumption; after a 12% increase of salt consumption between 2004−2005 and 2012−2013, to a level almost twice as high as recommended, it has stabilized in the last period.

Do Temporal Eating Patterns Differ in Healthy versus Unhealthy Overweight/Obese Individuals?

This study examined whether the temporal patterns of energy and macronutrient intake in early and late eating windows were associated with metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO) among non-shift workers. A total of 299 overweight/obese non-shift workers (Age: 40.3 ± 6.9 years; 73.6% women; BMI: 31.7 ± 5.0 kg/m²) were recruited in the Klang Valley area of Malaysia. The biochemical parameters were determined from fasting blood samples, whereas information on dietary intake and timing was obtained from a 7-day diet history questionnaire. The midpoint of eating was used to determine the early and late windows. Compared to MHO non-shift workers (n = 173), MUO non-shift workers (n = 126) had lower energy intake from carbohydrates and protein during the early window. In contrast, MUO participants had greater energy intake from carbohydrates and fat during the late window. Participants with unhealthy metabolic status (regardless of their chronotypes) had similar temporal patterns of energy intake characterized by smaller energy intake during the early window and greater energy intake during the late window compared with participants with healthier metabolic status. Overall, the lowest percentile of energy intake during the early window was associated with an increased risk of MUO, after adjustment for potential confounders [odds ratio (OR) = 4.30, 95% confidence interval (CI) 1.41-13.11]. The greater the energy intake during the late window, the greater the risk of MUO (OR = 2.38, 95% CI 1.11-5.13) (OR = 2.33, 95% CI 1.03-5.32) (OR = 4.45, 95% CI 1.71-11.56). In summary, consuming less energy earlier in the day and more energy and carbohydrate later in the day was associated with a greater risk of MUO. Thus, a prospective study is needed to explore the potential role of chrono-nutrition practices in modifying risk factors to delay the transition of MHO to MUO.