The high intake of fruits and vegetables contribute to sufficient physiological levels of flavonoids as flavonoids have numerous roles in improving general health. Ministry of Health (MOH) Malaysia reported that Malaysians did not meet the dietary guidelines for fruits and vegetables intake daily. Hence, this study was conducted to better understand the relation between flavonoids intake and the expression of histatin 5 in healthy adults. A total of 36 subjects were given Flavonoid Food Frequency Questionnaire (FFQ) and socio demographic questionnaire for assessment of their total flavonoid intake. The mean flavonoids intake amongst the subjects tested was 1721.88 mg/day. Saliva samples were collected and histatin 5 was extracted using zinc chloride in an alkaline condition (pH 9). The extracted protein was then subjected to reversed-phase high-performance liquid chromatography (RP-HPLC). When tested with RP-HPLC, all 35 successfully tested subjects showed the expression of histatin 5 in various concentrations. Subsequently, the extracts were analysed using SDS PAGE, using histatin 5 standards and a low protein marker. Amongst the 35 subjects that were successfully tested, 15 subjects showed the presence of bands which indicated the presence of histatin 5 and 20 subjects showed no presence of band, which indicated no histatin 5 indicated when tested using SDS PAGE. Numerical data were analysed using Pearson’s correlation and Student’s T-test. No significant correlation was established between total flavonoid intake and the expression of histatin 5 (p=0.544). However, a gradual modest increase of the salivary protein was seen with the increase of flavonoid intake among the subjects. The intake of fruits and vegetables remain an important source of flavonoids among Malaysian adults.

Dyslipidaemia is a highly prevalent and asymptomatic disorder that warrants blood lipid screenings to identify at-risk individuals and to prevent the development of vascular diseases. Various predisposing, enabling and need factors have been described in literature to elucidate the inclination of an individual to perform medical screenings. The objectives of this study were to determine the level of knowledge about dyslipidaemia, to determine the association between the level of knowledge about dyslipidaemia and the frequency of lipid testing, and to determine the personal and healthcare related factors in relation to predisposing, enabling and need factors that are associated with the frequency of lipid testing among adults aged 30 and above, residing in Taman Selatan, Klang, Selangor, Malaysia. Methods: A cross-sectional survey was carried out amongst 314 residents of Taman Selatan from September 2022 to October 2022. Participants were selected via systematic random sampling and were administered a paper-based 42-item bilingual questionnaire, that assessed the predisposing, enabling and need factors, in terms of the respondent’s sociodemographic characteristics, knowledge about dyslipidaemia, belief and attitude towards screening, and healthcare related factors that may influence lipid testing practice, as measured by the lipid testing frequency of Malaysian adults aged 30 and above, residing in Taman Selatan, in the past year. Results: Out of the 314 residents approached, 271 responded to the questionnaire yielding a response rate of 86.31%. The median and interquartile range for total dyslipidaemia knowledge score was found to be 5 and 1 respectively. A medium positive correlation was identified between total dyslipidaemia knowledge score and frequency of blood lipid testing (r=0.447, p<0.001). Four variables, namely total knowledge score (OR=1.385, 95% CI = 1.112, 1.726), respondent’s belief and attitude, in terms of fatalistic attitudes, fear and perception of good health (OR=0.276, 95% CI = 0.132, 0.575), ethnicity, specifically Chinese (OR=0.458, 95% CI = 0.225, 0.933), and lower income group (OR=3.428, 95% CI = 1.379, 8.525) were found to be statistically significantly associated with the frequency of lipid testing. Conclusion: The sample had below average knowledge level about dyslipidaemia. Higher knowledge score and low monthly income were associated with frequent lipid testing. Higher fatalistic attitudes, fearfulness and perception of good health correlated to a decrease in lipid testing frequency. Respondents of Chinese ethnicity were found to be associated with a lower lipid testing frequency. Key words: Dyslipidaemia, knowledge, lipid testing, practice, frequency.

INTRODUCTION: Oropharyngeal candidiasis (OPC) remains one of the most common opportunistic infections among HIV-infected adults. This study assessed the comparative efficacy and safety of different antifungals used for the prevention and management of OPC in adult patients with HIV. METHODS: A systematic literature review was conducted on the 4 major databases (Medline, Embase, CENTRAL and Scopus) to identify randomized controlled trials (RCTs) that evaluated the efficacy of antifungal agents for their therapeutic or preventive effect compared to other antifungal agents or placebo, in HIV patients with OPC. Network meta-analysis was performed from the data extracted from the selected studies. For the therapeutic effect, the primary outcome was the clinical cure; the incidence of OPC was the primary outcome for preventive effect. The agents were ranked according to their efficacy as well as safety in the treatment as well as prevention of OPC using surface under the cumulative ranking (SUCRA). RESULTS: 28 were included in the qualitative analysis and 22 for quantitative analysis RCTs involving 3882 participants. In terms of clinical efficacy, fluconazole was ranked as the most effective antifungal agent in treating OPC (SUCRA=0.87) followed by posaconazole and itraconazole respectively. Gentian violet [RR, 0.61 (95%CI=0.40-0.94)] and nystatin [RR, 0.59 (95%CI=0.43-0.82)] were the least effective in achieving clinical cure when compared to fluconazole. Posaconazole was ranked the most efficacious agent in achieving mycological followed by fluconazole. When compared to placebo, fluconazole was found to be effective in the prevention of OPC [RR, 0.45 (95%CI=0.27-0.77)]. While nystatin was ranked the safest, effect estimates of none of the other systemic antifungal agents were significantly higher than fluconazole. CONCLUSION: Based on the available evidence, fluconazole can be considered as the most effective drug in treatment as well as prevention of OPC among HIV-infected adults and has a favourable safety profile. Keywords: oropharyngeal candidiasis, oral candidiasis, HIV; antifungal agents, prevention, treatment; systematic review, network meta-analysis

Objective: The objective of this study was to identify the correlates of diet quality among adults in a suburban area in Johor, Malaysia. Methodology: A cross sectional study among 300 participants was carried out in a suburban area located in Johor during the study period of two weeks in September 2018. A systematic random sampling without replacement method was conducted and the individuals who met the selection criteria were selected for this study. The Healthy Eating Index for Malaysians (M-HEI) was used to determine the diet quality of adults. The survey instruments to determine sociodemographic, socioeconomic, lifestyle, 24-hour dietary recalls and health status were also conducted amongst the participants. Results: The prevalence of participants who scored M-HEI score of 46 and below with an indication of at risk of poor diet quality is 58.3%. The factors such as lower education level (p=0.047) and consumption of alcohol (p=0.010) were statistically significantly associated with M-HEI scores. No association could be seen from other factors with M-HEI scores. Conclusion: The findings of this study showed that the prevalence of at risk of poor diet quality among the participants residing in a suburban area in Johor, Malaysia was 58.3%. Multivariate analysis revealed that adults with an education level below tertiary level were more likely to be at risk of poor diet quality. Those adults who reported alcohol intake were non-Muslims and found to be at low risk of poor diet quality. Key words: Determinants, diet quality, Healthy Eating Index (HEI), adults, Malaysia

Objective: The objective of this study was to determine the relationship between eating behaviours and work-related stress among working-adults residing at Rasah Kemayan, Malaysia. Methodology: A cross sectional study was conducted among 133 working-adults at the residential area of Rasah Kemayan to determine the relationship between eating behaviour and work-related stress and identify the coping strategies used by the respondents when they are stressed. The study was conducted between September to November 2016. Systematic sampling was carried out to select the houses and from each house a working-adults who met the selection criteria was selected for this study. The Eating Behaviour of the subjects was assessed using Three Factor Eating Questionnaire (TFEQ). The Job Content Questionnaire was used to determine the work-related stress among the employees. The Brief Cope Inventory Questionnaire (BCI) survey instruments were used to determine the coping skills of the subjects. Results: The prevalence of work-related stress among the working population in Rasah Kemayan is 25.6%. Factors that were statistically significantly associated with work-related stress are transport mode; shared vehicle (13.5%), self-driven vehicle (12.0%) and emotional eating (21.8%). Other factors had no association with Work-related stress. As for coping, the strategies that were used frequently by the respondents are Behavioural Disengagement, Self-Blame, and Positive Reframing with median of 4. Conclusion: These findings bear potential implications in preventing work-related stress by applying suitable coping strategy to combat of work-related stress which may alter their eating behaviour. There is need for working adults to come up with interventions to manage stress and healthy eating at the work place for better health. Keywords: Work-related stress, eating behaviour, coping skills

The world is moving fast towards an ageing population, with older adults representing a significant and growing proportion of the population. As older adults age, their health and well-being become increasingly important. The use of the Internet for health information gathering among older adults is a topic of growing interest in research and policy discussions and is a growing concern. Motivation for this study stemmed from the need to understand patterns and behaviours of how older adults use the internet for health information seeking. The use of the internet has been prevalent since the year 2000 and the older adults are not left behind in utilizing this resource. There has been a growing body of research on the use of technology, including the internet, by older adults. However, there is still limited research on the specific use of the internet for health information gathering among older adults. The aim of the study is to explore the potential benefits and ethical implications of Internet-based information gathering in promoting active ageing, with a focus on data analytics and visualization as an approach. The rationale for this study is to analyze the data collected on how the elderly use the Internet for health information seeking to add more insightful information to plan an effective policy to support the better use of the Internet for them in the future. By exploring this, policymakers can plan effective policies and support the elderly in better utilizing the internet for their health needs . The methodology for this study involved a quantitative and analytical approach to visualizing the data collected on the use of the internet for health information seeking among older adults. The data obtained from the National Health Institute (NIH), Ministry of Health Malaysia survey conducted in 2017 will serve as the baseline data on the use of the internet in searching for health information by the elderly. For this study, we will focus on the data analytics and visualization approach to exploring the potential benefits and ethical implications of internet-based information gathering for active ageing among the older adults. The findings of this study will provide valuable insights into the patterns and behaviours of older adults in using the internet for health information seeking. First of all, there are positive indications that the older adults that use the internet for health information seeking trusts its source and finds it useful. There is also evidence of active participation in social activities and also positive behaviours in taking actions upon getting health information from the internet like making lifestyle changes or seeking medical advice. The potential benefits of internet-based information gathering for active ageing are significant. Older adults are motivated to seek health related information online for a variety of reasons, including being self-reliant, staying active and productive, making better treatment choices, achieving a healthier life, valuing a healthy lifestyle, feeling relieved from stress, and lack of adequate information on health issues. They seek health information to maintain their independence, participate in decision-making about their care plan, and to stay healthy and active even in the face of physical limitations. However, this also exposes them to potential risks and ethical implications. The ethical implications of internet-based information gathering for active ageing must be carefully considered. For example, there is a concern about the quality and reliability of the health information available online which are further discussed in this study. As another example, privacy concerns arise as older adults may unknowingly share personal and sensitive information while seeking health information online. The study also focuses on the importance of addressing ethical implications and potential risks associated with internet-based information gathering for active ageing. In conclusion, exploring the potential benefits and ethical implications of internet-based information gathering in promoting active ageing is crucial in order to develop effective policies and programs to support the health and well-being of older adults.

Introduction: Overweight and obesity are pandemic public health concern, where more than a billion people worldwide are estimated to be overweight or obese. Reports have shown that Malaysia is now the fattest nation in the Southeast Asia region, where almost half of its population are either overweight or obese. Many public health interventions have been introduced to modify behaviour associated with weight management, but with low success rate. This has been attributed to failures in identifying the perception about health and obesity from the overweight and obese individuals themselves. Objective: To determine the factors associated with attempts to lose weight among overweight and obese adults. Methodology: This was a cross sectional study conducted in a public health clinic at Klang District from 12 December 2018 to 28 January 2019. A self-administered questionnaire, incorporating Health Belief Model constructs, was used to collect data from 300 randomly selected overweight and obese respondents, aged 18 to 59 years. Data was analysed to generate descriptive statistics and binary logistic regressions were used to determine the factors associated with attempts to lose weight. Results: It was found that 33.7% of the respondents were overweight with BMI between 24.0kg/m2-29.9kg/m2, and 66.3% were obese with BMI 30kg/m2 or more. About one third of them claimed to have attempted to lose their body weight in the last 12 months. The multivariate binary logistic regressions found that females are 2.4 times more likely to attempt to lose weight compared to males (OR=2.4, 95% CI=1.4-4.1), those with absence of associated medical conditions are 3.8 times more likely to attempt to lose weight compared to those with associated medical conditions (OR=3.8, 95% CI=2.1-6.7), those who currently satisfied with weight status are 6.2 times more likely to attempt to lose weight compared to those not satisfied with their weight status (OR=6.2, 95% CI=2.7-14.2), and those who have a higher mean score in the perception of benefits gained from healthy eating and exercise habits are 2.2 times more likely to attempt to lose weight (OR=2.2, 95% CI=1.4-3.3). Conclusion and recommendation: This study identified gender, associated medical condition, weight satisfaction, and perceived benefits as the predictors to attempts to lose weight. The predictors should be optimally used in the design of interventional activities to support overweight and obese adults to manage their weight. Keywords: Adults, Overweight, Obese, Health Belief Model, predictors, attempts to lose weight.

Introduction: Self-medication with Antibiotics is the use of antibiotic drugs to treat self-diagnosed disorders or symptoms, or the intermittent or continued use of a prescribed Antibiotic drug for chronic or recurrent disease or symptoms. A major problem with self-medication with antibiotics is the emergence of antibiotic resistance. There is enough evidence of Antibiotic resistance in Bangladesh, due to its misuse like self-medication, but studies aimed to find out the factors associated with self-medication with Antibiotic has not been done before in Bangladesh. Objective: To determine the prevalence of self-medication with antibiotics among the adult population of Ward 1 of Chuadanga Town, Bangladesh; and to identify potential factors that are associated with self-medication with antibiotics. Methodology: This was a cross-sectional study done among 300 residents of Ward 1 of Chuadanga Town. Simple random sampling was used to select unit numbers of Ward 1.A list of the unit numbers was obtained from the municipality office and used as sampling frame. Everyone residing in the unit who fitted the inclusion criteria was included in the study. For the study instrument face validated structured questionnaire was used, which had two parts. The first part was socio-demographic data and the second part of the questionnaire was on self-medication with antibiotics and its related factors. Data collection was done by face to face interview. Univariate and Multivariate analysis were used to determine associations, and P-value <0.05 was considered statistically significant. Results: The prevalence of self-medication with antibiotics among the population of Ward 1 of Chuadanga Town was 32%. In bivariate analysis participants with age of below 34 years, who were unmarried, whose jobs were not related to medical profession, had access to antibiotics and lacked knowledge about antibiotic resistance were more likely to self-medicate with antibiotics (P-value <0.05). Predictors of self-medication with antibiotics include age, access to antibiotics and knowledge about antibiotic resistance. Conclusion: In this study the prevalence of self-medication with antibiotics was 32%. The factors that were significantly associated with self-medication with antibiotics were age, access to antibiotics and knowledge about Antibiotic resistance. To decrease this high prevalence of self-medication with antibiotics policy makers have to take into account these factors that are associated with self-medication with antibiotics. Better enforcement of laws regarding OTC drug sales to minimize access to antibiotics. Public awareness about antibiotic resistance and its potential health hazards should be increased through campaigns. Keywords: Self-medication, Antibiotic, Chuadanga town, Bangladesh

Introduction: Little is known about the utility of meal replacements to manage obesity in Malaysians with diabetes. This study investigated the use of a low calorie diet, incorporating liquid meal replacements versus using conventional food, on weight loss in Malaysian adults with Type 2 Diabetes and obesity in an outpatient clinic setting over a period of 12 months. Methods: In this single-centre non-blinded study, 70 subjects (women: 68.6%; mean + SD age: 47.5 + 9.5 years; mean + SD Body Mass Index: 32.7 + 3.6) were randomized into one of three isocaloric low calorie diet groups: MR1 (n=20); MR2 (n=30); CD (n=20). In Phase 1 (Baseline to 6-months), the intervention differed across groups by use of MR: MR1 – one MR/day; MR2 – two MR/day; CD – conventional food only. In Phase 2 (6-months to 12-months), all groups followed a conventional food only low calorie diet. Primary outcomes were changes in weight and waist circumference. Secondary outcomes were changes in glycaemic control, lipid profile, blood pressure, and energy/macronutrient intake. Dietary challenges encountered in Phase 1 were also assessed. Results: Subjects who completed both Phase 1 and 2 (MR1: n=11; MR2: n=9; CD: n=11) were included for analysis. There were significant baseline differences between the study groups (body weight, BMI, waist circumference, and blood pressure) that did not have significant effect on change in primary outcomes over time and adjustments for these covariates were not preformed. From baseline to 6-months, mean + SE weight change (kg) (MR1: -1.6 + 0.6; MR2: -3.8 + 0.9; CD: -2.4 + 0.6) was not significant between groups but significant within MR2 and CD. Mean + SE waist circumference change (cm) (MR1: -1.9 + 0.9; MR2: -3.5 + 1.0; CD: -2.3 + 1.0) was not significant between groups but significant within MR2. The MR2 group had the highest proportion of subjects who achieved a weight loss of > 5% from baseline (MR1: 14.3%; MR2: 40.0%; CD: 16.7%). Among the meal replacers, the median + IQR number of MR sachets consumed/day was significantly higher in subjects who achieved (1.0 + 0.4) than subjects who did not achieve (0.6 + 0.9) > 5% weight loss. Change in both fasting blood glucose and HbA1c was not significant between groups. Mean + SE fasting glucose change (mmol/L) (MR1: 0.2 + 0.5; MR2: -2.8 + 0.7; CD: -1.5 + 0.6) was significant within MR2, while HbA1c change (% point) (MR1: -0.5 + 0.2; MR2: -0.6 + 0.83; CD: -1.0 + 0.3) was significant within CD. No significant change was seen in lipid profile and blood pressure between and within all groups. Mean + SE energy intake change (kcal/day) (MR1: -426 + 112; MR2: -515 + 157; CD: -463 + 129) was not significant between but significant within groups. No significant macronutrient intake change was seen between groups. Mean + SE carbohydrate intake change (g/day) (MR1: -61.7 + 13.0; MR2: -65.5 + 17.2; CD: -35.2 + 23.2) was significant within MR1 and MR2 while fat intake change (g/day) (MR1: -20.1 + 7.5; MR2: -24.8 + 9.2; CD: -31.8 + 6.4) was significant within CD. No significant change was seen in protein intake within all groups. At 12-months, only MR2 maintained a mean + SE weight change of -2.3 + 0.7 kg. Recidivism at 12-months was seen in all other outcomes within all groups. Irrespective of groups, subjects faced similar challenges with hunger, dietary deprivation, social support, need for constant care, food planning, and life complications. Challenges specific to meal replacement use were taste fatigue and unsuitability of the regimen or meal replacement product. Conclusion: With low calorie diets in adults with obesity and Type 2 Diabetes, there was no difference between the use of meal replacement and conventional food for weight and energy intake reduction. However, subjects in the MR2 group had better weight loss (6-months) and weight maintenance (12-months) when compared to MR1 or CD. Among the meal-replacers, increased compliance to the meal replacement regimen was associated with greater weight loss. During energy intake restriction, use of meal replacement produced compensatory reductions in carbohydrate intake while use of conventional food produced compensatory reductions in fat intake.

Isomaltulose is a disaccharide in which glucose is α- 1,6 linked to fructose. The capacity of fasted Malaysian adults to tolerate boluses of isomaltulose (25 g, 50 g, 75 g, 100 g) was investigated by serial measurements of breath hydrogen. A response of > 20 ppm was considered to indicate spill-over of isomaltulose to the colon. Twenty-eight consenting participants [10 males, 18 females, 20 - 36 years of age, with body mass index (BMI) ranging from 15 – 31 kg/m2] underwent crossover studies using a portable apparatus over five hours. 9/25 (36 %) participants gave evidence of spill-over at 75 g and 19/28 (70 %) to 100 g of isomaltulose. In 6 males and 11 females, glycaemic responses were compared to sucrose with a two-week washout period. The blood glucose response to isomaltulose (6.6 ± 0.9 SD mmol/L) was significantly lower than to the same bolus of sucrose (8.7 ± 1.8 SD mmol/L; p = 0.001). Faecal pH changes were measured to test for possible prebiotic effects. After a bolus of 75 g of isomaltulose, the acidity of both the first and second subsequent faecal samples was significantly greater than pre-test samples, suggesting that isomaltulose may possess a prebiotic potential. The finding of intolerance to isomaltulose suggests that caution should be exercised in its use as a carbohydrate nutrient.

Objective: The objective of this study was to estimate the prevalence of both poor and normal sleep quality and to determine variables that may be associated with it among Malaysian adults who actively engage in video games. This study also aims to find the difference in association of sleep quality within hardcore and casual/mid-core gamers. Methodology: A cross-sectional study including 5 sections to inquire various variables including the Pittsburgh Sleep Quality Index (PSQI) was deployed using Google Forms to collect information from 415 members of local online gaming servers. 15 local online gaming servers were identified, and approval was granted to promote the questionnaire among the members. Snowball sampling was used within these servers by interacting with people who left likes and comments on the promoting post. Results: The proportion of Malaysian adult gamers who scored PSQI index above 5 were 57.8% and were classified as having “poor sleep quality” and those who scored 5 and below were 42.2% and were classified as having “good sleep quality.” Variables that were significantly associated were perceived stress, in-game purchasing habits as well as snacking habits 2 hours before bed. Other factors in this study showed no significant association with sleep quality during the multivariate analysis. Hardcore gamers in terms of the frequency of gameplay were also significantly associated with lowered sleep quality when compared to casual/mid-core gamers. Conclusion: This study found the prevalence of poor sleep quality and normal sleep quality was 57.8% and 42.2% respectively. Multivariate analysis disclosed the significant association between perceived stress was significantly associated with sleep quality. Also, in-game purchasing habits and snacking 2 hours prior to bedtime were significantly associated with varying sleep quality. Lastly, hardcore gamers are more likely to experience poor sleep quality when compared to casual/mid-core gamers. Keywords: Sleep Quality, Adult Gamers, Pittsburgh Sleep Quality Index (PSQI), Hardcore Gamers

Previous studies show that L. casei Shirota (Lcs) ease certain constipation-related symptoms. Use of LcS as treatment in otherwise-healthy subjects with Rome II-defined functional constipation has not been investigated. The study was aimed to evaluate the effects of LcS in adults with functional constipation. After screening of potential subjects from a database, 100 adults living in the Klang Valley who were diagnosed with functional constipation and met all other eligibility criteria were recruited for the study. The subjects were randomised (stratified based on constipation severity score and age) to receive either fermented milk containing live LcS (3.0 x 1010 colony forming units) or placebo drink without LcS once daily for 4 weeks under single-blind condition after a run-in observation period of 2 weeks and followed by a 1-week post-intervention observation period. Primary outcomes were constipation severity score measured using the Chinese Constipation Questionnaire and stool frequency; secondary outcomes were stool consistency and stool quantity estimations. During the 7-week study period, subjects completed bowel movement diaries and constipation severity was assessed weekly via questionnaire. Subjects were required to maintain their usual diet and lifestyle, which was monitored weekly via questionnaire. Dietary intake, physical activity and stress levels were assessed twice using three-day 24-hour diet recalls, International Physical Activity Questionnaire and Depression, Anxiety and Stress Scale questionnaire respectively. Eighty two subjects completed the study. Intent-to-treat analysis showed trend of improvement in constipation severity and stool consistency with probiotic administration versus placebo; but the improvements were not significant with the 4-week intervention (n=90). With re-evaluation at α=10% level, improvement in constipation severity was significant at Week 4 (P=0.058). The magnitude of the probiotics effect on stool consistency grew over time and was small but statistically significant at Week 4 (d = 0.19, 95% CI [0.00, 0.35]) and at post-intervention (d = 0.29, 95% CI [0.11, 0.52]). This indicates the stool softening effect was significant in the study sample but cannot be generalized to the population. No trends of change were observed in stool frequency and quantity. Post-hoc analysis showed improvement in severity of incomplete evacuation. Diversity of diet may have influenced the results. Four-week administration of LcS did not alleviate constipation severity or stool frequency, consistency and quantity compared to placebo, thus, null hypothesis could not be rejected. To obtain conclusive results, further studies with longer intervention of 6 to 8 weeks are warranted as the intervention period may have been insufficient.

In Malaysia, the rising incidence of type 2 diabetes mellitus (T2DM) among adolescent and adults is linked to obesity. Pharmaceutical therapy has been brought in to curb T2DM, more famously in the form of biguanides (metformin) and sulfonylureas (gliclazide). However, variation in the individual glycaemic response to metformin treatment might be due to heritability factors. Importantly, metformin has been reported to alter the microRNA (miRNA) expression profiles. Thus, the present study aims to provide data on differential expression of salivary miRNAs in responders and non-responders among T2DM patients under combined treatment of metformin and gliclazide. A total of 50 subjects were recruited each for responder and non-responder groups at the endocrine clinic of the Hospital Canselor Tuanku Mukhriz Universiti Kebangsaan Malaysia (HCTM). Subjects with HbA1c reduction levels of 0.5% or more were categorised as responders. The patients' demographic data including age, gender, BMI, WHR, ethnicity, smoking status, exercise routine and medical history were recorded. Total RNAs were isolated from the saliva collected and pooled prior to reverse-transcription-quantitative polymerase chain reaction (RT-qPCR) analysis. The levels of microRNA namely, miR 28-3p, miR 135a-5p, miR 126-5p, and miR 320a3p were determined using RNU6P as the endogenous control. Pearson's corelation coefficient analysis demonstrated significant (p<0.05) positive correlation between BMI (29.2 ± 1.25 kg/m2) and HbA1c reduction levels (0.78 ± 0.36%) and between WHR (0.91 ± 1.35) and HbA1c reduction, while age and HbA1c reduction had a negative correlation r = -0.126 with p-value = 0.008. Meanwhile Pearson's chi-square test demonstrated only smoking status (p<0.001) had a significant correlation with the HbA1c reduction levels. Based on the miRNA PCR assays, miR 135a-5p, miR 1265p, and miR 320a-3p were upregulated while miR 28-3p was downregulated in responders compared to non-responder regardless on ethnicity and smoking status. Among the Malay subjects, miR-126-5p was downregulated in the responders among smokers but upregulated in the responders among the non-smokers when compared to their counterparts of non-responder groups. Interestingly, smoking status was also found to be significantly correlated with the HbA1c reduction levels. The deregulation and upregulation of these four targeted miRNAs have been recognized as a contributing factor in several pathways across T2DM spectrum, encompassing insulin resistance, adherens junction, hippo signalling, and AMPK signalling, proposing these four targeted miRNAs to be potential biomarkers of T2DM while miR-126-5p downregulation within VEGF pathway should be researched further and within various ethnic groups as an indicator for both T2DM with smoking-related diseases.

Background: The relationship between spirituality and stress has been documented in the literature. This study aimed to determine the relationship between spirituality and stress and other associated factors among non-governmental organizations in Malaysia. Method: A cross-sectional study was conducted of 241 personnel from non-governmental organizations registered with the National Coalition for Mental Wellbeing (NCMW). The participants, including NGO employees, completed a self-administered online questionnaire. The survey included questions about sociodemographic and job-related factors. Stress levels were evaluated using the Perceived Stress Scale 10 (PSS-10) Questionnaire. Together, spiritual well-being was evaluated through 10 items from the Existential Well-Being Scale (EWB) incorporated within the Spiritual Well-Being Scale (SWBS). Results: The study found that a majority of NGOs (68.9%) reported moderate stress, with 18.1% experiencing low stress and 13.2% facing high perceived stress. Significant predictors of stress included age (P = 0.007), spirituality (P = 0.000), income satisfaction (P = 0.048), job satisfaction (P = 0.005), marital status (P = 0.026), and living status (P = 0.010). Conclusion: Contributors to stress among NGOs include age, spirituality, income satisfaction, job satisfaction, marital status and living status. Higher spirituality, linked to a connection with a higher power, reduces stress. Further studies are required to explore spirituality's role and manifestation. Keywords: Spirituality, Stress, NGOs, Malaysia, Spiritual Well-Being Scale (SWBS), and Perceived Stress Scale (PSS).

Vitamin D insufficiency is a widespread phenomenon globally, affecting all ages. In Malaysia, despite being a tropical country, there are increasing reports of vitamin D insufficiency among women. Vitamin D intake adequacy in child-bearing age women is important for reproductive health including in fertility, conception and birth outcomes. In line with international guidelines, the Malaysian recommended nutrient intake for vitamin D is 600 IU/day. However, the efficacy of the recommended vitamin D intake for healthy child-bearing age women to achieve sufficient plasma 25-hydroxyvitamin D [25(OH)D] levels (≥50 nmol/L) is currently unknown. This study aimed to investigate the efficacy of a 16 weeks vitamin D supplementation on plasma 25(OH)D and intact parathyroid hormone (PTH) concentrations in Malaysian women of child-bearing age. In this double blind, randomised controlled trial, 106 healthy women aged 20-45 years were randomised into four groups receiving daily 500 mg of calcium with either 0, 600 IU, 1200 IU or 4000 IU vitamin D supplement for 16 weeks. Questionnaires and anthropometric measurements were collected at baseline and post 16 weeks supplementation trial. Primary outcomes were plasma 25(OH)D and intact PTH measured at baseline and post 16 weeks trial. Baseline characteristics, including anthropometric status, sun exposure, vitamin D intake, plasma 25(OH)D and intact PTH did not differ significantly between groups (p > 0.03). Half of the participants showed vitamin D deficiency (25(OH)D <30 nmol/L), while another 40% were in the insufficiency category (25(OH)D 30-49 nmol/L) at baseline. After 16 weeks of supplementation, mean plasma 25(OH)D concentrations increased significantly (p < 0.03) among the test groups in a dose-dependent manner, with the group receiving 4000 IU/day vitamin D showing the highest increase (p < 0.03). About 30% of the women receiving 4000 IU/day vitamin D attained plasma 25(OH)D sufficiency level by 16 weeks of supplementation. Plasma intact PTH showed no significant changes between baseline and post-supplementation in the test groups (p > 0.03). General linear model revealed a significant correlation between plasma 25(OH)D concentration and skin colour tone (F = 9.064, p = <0.001). No significant association was observed between plasma intact PTH and key covariates, namely sun exposure, dietary vitamin D intake and body mass index. In conclusion, vitamin D supplementation of 4000 IU/day, compared to 600 IU and 1200 IU/day, showed the highest efficacy for increasing plasma 25(OH)D levels among women of child-bearing age. There was no obvious suppression in plasma intact PTH with vitamin D supplementation. Further investigations are recommended for a better understanding of the inverse relationship between plasma 25(OH)D and PTH levels in childbearing age women.