Vitamin mineral supplement (VMS) consumption is prevalent among the population, particularly adolescents. However, literature about the factors associated with the reasons for consuming VMS has not been investigated in Malaysia, indeed adolescents’ nutrition is important as they experience body change during this period. Thus, this cross-sectional, national health study aims to determine the association between nutritional status, dietary practice and reasons for VMS consumption among secondary schools in Malaysia. A total of 40,087 adolescents aged 10-18 completed the questionnaire. Among them, only 22.6% (9,077) of them from secondary school consumed VMS and were included in this study. Gender, height-for-age, strata, ethnicity, hunger experience, eating out and breakfast intake frequency were associated with the reasons for VMS intake. After the adjustment, stunted adolescents were more likely to consume VMS due to the doctor’s prescription (RRR:1.51, 95% CI: 1.11-2.10). Adolescents who sometimes experienced hunger were more probable to consume VMS due to doctor’s instruction, self-awareness and friends’ influence as compared to other unspecified reasons (RRR: 1.41, 95% CI: 1.08-1.85; RRR 1.38, 95% CI: 1.07-1.77; RRR: 1.98, 95% CI: 1.27-3.08, respectively). No association was found between dietary behaviour and the reason for the VMS intake. For meal pattern, adolescents who skipped breakfast were less likely to consume VMS due to doctor’s instruction, parents’ advices and self-awareness (RRR: 0.53, 95% CI: 0.39-0.72; RRR: 0.50, 95% CI: 0.38-0.66; RRR: 0.59, 95% CI: 0.45-0.78, respectively). This study suggested that further studies were needed to investigate the role of VMS use in relation to nutrient adequacy, overconsumption and health.

ABSTRAK Kegagalan menguruskan peralihan pemimpin boleh menjadi ancaman langsung terhadap prestasi organisasi. Justeru, pelan pewarisan yang sistematik adalah penting bagi memastikan kesinambungan kepimpinan, mengekalkan dan mengembangkan modal insan untuk masa depan. Kajian lepas menunjukkan beberapa model berkaitan pelan pewarisan. Namun, ia tidak menerangkan secara terperinci berkaitan proses yang paling kritikal. Oleh itu, kajian ini bertujuan menjawab persoalan bagaimana proses pelan pewarisan dilaksanakan dan mengenal pasti apakah proses yang paling kritikal. Pendekatan kajian kes berbilang menggunakan kaedah temu bual telah dijalankan terhadap tujuh orang peserta dari tiga buah Syarikat Berkaitan Kerajaan (GLC) di Malaysia. Kajian ini menggunakan analisis dalaman dan silang kes. Ketiga-tiga GLC didapati melaksanakan enam proses asas pelan pewarisan iaitu inisiatif pelan pewarisan, pengenalpastian jawatan kritikal, pengenalpastian calon, penilaian dan pemilihan calon, latihan dan pembangunan calon, serta penilaian pelan pewarisan. Manakala dua proses yang kritikal telah dikenal pasti iaitu pengenalpastian calon pengganti, dan latihan dan pembangunan calon. Kajian ini memberi implikasi praktikal iaitu pengurus sumber manusia dapat membantu pihak pengurusan dalam menambahbaik pelaksanaan pelan pewarisan agar sesuai dengan peredaran masa. Katakunci: Kajian kes; pelan pewarisan; proses paling kritikal; proses pelan pewarisan; pengurusan sumber manusia strategik; model proses pelan pewarisan ABSTRACT Failure to manage leader transition can be a direct threat to organizational performance. Thus, a systematic succession planning is important to ensure the continuity of leadership, maintain and develop human capital for the future. Past studies have shown several models related to succession planning. However, it does not describe in detail the most critical processes. Therefore, this study aims to answer the question of how the succession planning process is implemented and identify what are the most critical processes. A multiple case study approach using the interview method was conducted on seven participants from three Government Linked Companies (GLCs) in Malaysia. This study used within-case and cross-case analysis. The three GLCs were found to implement six basic processes of the succession planning, namely the succession planning initiatives, identification of critical positions, the identification of candidates, the evaluation and selection of candidates, training and development of candidates, as well as the evaluation of the succession planning. Two critical processes have been identified namely the identification of replacement candidates, and the training and development of candidates. This study gives practical implications that human resource managers can help their management in improving the implementation of succession planning to suit the passage of time. Keywords: Case study; succession planning; the most critical process; succession planning processes; strategic human resources management; succession planning processes model

Background Monitoring sodium intake through 24-h urine collection sample is recommended, but the implementation of this method can be difficult. The objective of this study was to develop and validate an equation using spot urine concentration to predict 24-h sodium excretion in the Malaysian population. Methods This was a Malaysian Community Salt Study (MyCoSS) sub-study, which was conducted from October 2017 to March 2018. Out of 798 participants in the MyCoSS study who completed 24-h urine collection, 768 of them have collected one-time spot urine the following morning. They were randomly assigned into two groups to form separate spot urine equations. The final spot urine equation was derived from the entire data set after confirming the stability of the equation by double cross-validation in both study groups. Newly derived spot urine equation was developed using the coefficients from the multiple linear regression test. A Bland-Altman plot was used to measure the mean bias and limits of agreement between estimated and measured 24-h urine sodium. The estimation of sodium intake using the new equation was compared with other established equations, namely Tanaka and INTERSALT. Results The new equation showed the least mean bias between measured and predicted sodium, − 0.35 (− 72.26, 71.56) mg/day compared to Tanaka, 629.83 (532.19, 727.47) mg/day and INTERSALT, and 360.82 (284.34, 437.29) mg/day. Predicted sodium measured from the new equation showed greater correlation with measured sodium ( r = 0.50) compared to Tanaka ( r =0.24) and INTERSALT ( r = 0.44), P < 0.05. Conclusion Our newly developed equation from spot urine can predict least mean bias of sodium intake among the Malaysian population when 24-h urine sodium collection is not feasible.

BACKGROUND:Sodium is an essential mineral needed by the human body that must be obtained from food. An excess intake, however, can lead to many diseases. As food is the main source of sodium, this study aims to provide information on high sodium food consumption patterns in the Malaysian adult population.METHODS:The Malaysian Community Salt Study (MyCoSS) was a nationwide cross-sectional study, conducted between October 2017 and March 2018. A multistage complex sample was applied to select a nationally representative sample of respondents aged 18 years and above. Face to face interview by a validated Food Frequency Questionnaire (FFQ) comprising 104 food items was used to gain information on high sodium food consumption patterns.RESULTS:A total of 1047 respondents were involved in this study, with 1032 (98.6%) answering the FFQ. From the number, 54.1% exceed the recommendation of sodium intake <2000mg/day by FFQ assessment. The results also demonstrated that fried vegetables (86.4%) were the most common high sodium food consumed, followed by bread (85.9%) and omelet (80.3%). In urban areas, bread was the most common while fried vegetables took the lead in rural areas. By sex, bread was most commonly eaten by males and fried vegetables by females. The results also found that kolok mee/kampua mee contributed the highest sodium, 256.5mg/day in 9.0% adult population, followed by soy sauce 248.1mg/day in 33.2% adult population, and curry noodles 164.2mg/day in 18.5% adult population.CONCLUSION:Fried vegetables, bread, and soy sauce were the main source of sodium consumption among adult. Reducing the amount of sodium added to these foods should be the top priority to reduce population sodium intake and thereby prevent sodium-related diseases in Malaysia.

BACKGROUND:High blood pressure or hypertension is well recognized as an important modifiable risk factor for cardiovascular diseases. Several studies had indicated potassium intake has a blood pressure lowering effect. This study aimed to estimate potassium intake via 24-h urinary potassium excretion and to determine the association between potassium intake and blood pressure among adults in Malaysia.METHODS:Data for 424 respondents in this study were drawn from MyCoSS, a nationwide cross- sectional study conducted among Malaysians who were 18 years and above. Respondents were recruited using stratified cluster sampling, covering urban and rural areas in each state in Malaysia. Data collection was undertaken from October 2017 until March 2018. A single urine sample was collected over 24 h for quantification of potassium excreted. Information on socio-demography and medical history of the respondents were collected by interviewer-administered questionnaires. Anthropometric measurements were measured using validated equipment. BMI was estimated using measured body weight and height. Digital blood pressure monitor (Omron HBP-1300) was used to measure blood pressure. Descriptive statistics, analysis of variance (ANOVA), and multivariable linear regression were used to analyze the data in SPSS Version 21.RESULTS:Mean 24-h urinary potassium excretion for the 424 respondents was 37 mmol (95% CI 36, 38). Gender and ethnicity showed statistically significant associations with 24-h urinary potassium excretion. However, potassium excretion was not significantly associated with blood pressure in this study.CONCLUSION:Potassium intake is very low among the adults in Malaysia. Therefore, further education and promotional campaigns regarding daily consumption of potassium-rich diet and its benefits to health need to be tailored for the Malaysian adult population.

Exposure to environmental pollutants in humans can be conducted through direct measurement of biological media such as blood, urine or hair. Assessment studies of metals and metalloids in Malaysia is very scarce although cross-sectional nationwide human biomonitoring surveys have been established by the USA, Canada, Germany, Spain, France, and Korea. This study aims to assess urinary metal levels namely cadmium (Cd), nickel (Ni), lead (Pb) and arsenic (As) among Malaysian adults. This was a cross-sectional study involving 1440 adults between the age of 18 and 88 years old. After excluding those with 24 h urine samples of less than 500 ml, urine creatinine levels < 0.3 or > 3.0 g/L and those who refuse to participate in the study, a total of 817 respondents were included for analysis. A questionnaire with socio-demographic information such as age, gender, occupation, ethnic, academic qualification and medical history was administered to the respondents. Twenty-four-hour urine samples were collected in a container before being transported at 4 °C to the laboratory. Samples were then aliquoted into 15 ml tubes and kept at − 80 °C until further analysis. Urine was diluted ten-fold with ultrapure water, filtered and analysed for metals and metalloids using Inductively Coupled Plasma-Mass Spectrometry (ICP-MS). The geometric mean of urinary As, Ni, Cd and Pb concentrations among adults in Malaysia was 48.21, 4.37, 0.32, and 0.80 µg/L, respectively. Males showed significantly higher urinary metal concentrations compared to females for As, Cd and Pb except for Ni. Those who resided in rural areas exhibited significantly higher As, Cd and Pb urinary concentrations than those who resided in urban areas. As there are no nationwide data on urinary metals, findings from this study could be used to identify high exposure groups, thus enabling policy makers to improve public health strategically.

Introduction: Prevalence of malnourished children in Putrajaya was unexpectedly high in 2016. This paper describes the study protocol for a case-control study conducted to identify the associated factors of malnutrition among children under 5 years old in Putrajaya. Methods: This study involved two phases. Phase I was ‘screening’ where all children aged 6-59 months in 118 preschools and four government health clinics were measured for their weight and height. The World Health Organization Anthro software was used to determine the nutritional status of these children. Phase II was the ‘interview’ where children from screening were sampled into four pairs of case and control. The optimum sample size for the case of stunted, wasted, underweight, and overweight were 380, 335, 318, and 308, respectively. The same number of controls were recruited. Parents/caregivers of selected children were approached to obtain data on parental factors, children factors, food intake factors, and environmental factors that contributed to malnutrition. Data analysis was performed by multiple logistic regression in SPSS version 26. Results: Screening phase successfully measured 8,261 (50.1%) children from an estimated 16,500 children under 5 years old in Putrajaya. The number of children who were stunted, wasted, underweight, and overweight were 2,105 (25.5%), 512 (6.2%), 1,516 (18.4%), and 248 (3.0%), respectively. As overweight was undersampled, the number of controls for overweight was doubled to increase the power of the study. Parents/caregivers of selected cases and controls were interviewed in their household or any other venues at their convenience. Conclusion: This protocol promises beneficial outputs to stakeholders and policy makers that can be used for combating malnutrition in children.

Background Recognising that excessive dietary salt intake is associated with high blood pressure and adverse cardiovascular health, the Ministry of Health Malaysia conducted the Malaysian Community Salt Survey (MyCoSS) among Malaysian adults. This paper introduced MyCoSS projects and presented findings on the salt intake of the Malaysian adult population. Methods MyCoSS was a nationally representative survey, designed to provide valuable data on dietary salt intake, sources of salt in the diet, and knowledge, perception, and practice about salt among Malaysian adults. It was a cross-sectional household survey, covering Malaysian citizens of 18 years old and above. Multi-stage-stratified sampling was used to warrant national representativeness. Sample size was calculated on all objectives studied, and the biggest sample size was derived from the knowledge on the effect of high salt on health (1300 participants). Salt intake was estimated using a single 24-h urine collection and its sources from a food frequency questionnaire. Knowledge, attitude, and practice were determined from a pre-tested questionnaire. All questionnaires were fully administered by trained interviewers using mobile devices. Anthropometric indices (weight, height, and waist circumference) and blood pressure were measured using a standardised protocol. Ethical approvals were obtained from the Medical Research Ethics Committee, Ministry of Health Malaysia, and Queen Mary University of London prior to conducting the survey. Results Findings showed that the average sodium intake of Malaysian adults (3167 mg/day) was higher than the WHO recommendation of 2000 mg/day. Daily intake was significantly higher among males and individuals with higher BMI and higher waist circumference. Conclusion Salt intake in the Malaysian population was higher than the WHO recommendation. MyCoSS’s findings will be used for the development and implementation of national salt reduction policy. A successful implementation of a national salt reduction programme in Malaysia will benefit the whole population.

Background Hypertension is one of the most common risk factors for cardiovascular disease and leading cause of mortality globally. The aims of this study were to assess the prevalence of hypertension and its associated risk factors among Malaysian population using data from the Malaysian Community Salt Study (MyCoSS). Methods This study was a cross-sectional study using multi-stage stratified sampling method. Data collection was carried out via face-to-face interview at the respondent’s home from October 2017 until March 2018. A total of 1047 respondents aged 18 years and above completed the questionnaires and blood pressure measurement. A person who reported diagnosis of hypertension by a physician and had systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg on three readings was categorised as hypertensive. Risk factors of hypertension were analysed using multiple logistic regression. Results The prevalence of hypertension in the present study was 49.39% (95% CI 44.27–54.51). There was no statistically significant difference in gender. Age, household income, BMI, and diabetes were significantly associated with hypertension. Hypertension found had inverse association with the level of education. Age was the strongest predictor of hypertension (35–44 years old; OR=2.39, 95% CI=1.39–4.09, 45–54 years old; OR=5.50, 95% CI=3.23–9.38, 55–64 years old OR=13.56, 95% CI=7.77–23.64 and 65 years old and above; OR=25.28, 95% CI=13.33–48.66). Those who had higher BMI more likely to be hypertensive as compared to respondents with normal weight (overweight, OR=1.84; 95% CI=1.18–2.86; obese, OR=4.29% CI=2.56–7.29). Conclusion The findings showed that hypertension is prevalent among adults in Malaysia. Those with older age, higher BMI, and diabetes are more likely to have hypertension. Efforts regarding lifestyle modification and education could be important in hypertension management and prevention.

BACKGROUND:Excessive intake of sodium is a major public health concern. Information on knowledge, perception, and practice (KPP) related to sodium intake in Malaysia is important for the development of an effective salt reduction strategy. This study aimed to investigate the KPP related to sodium intake among Malaysian adults and to determine associations between KPP and dietary sodium intake. METHODS:Data were obtained from Malaysian Community Salt Survey (MyCoSS) which is a nationally representative survey with proportionate stratified cluster sampling design. A pre-tested face-to-face questionnaire was used to collect information on socio-demographic background, and questions from the World Health Organization/Pan American Health Organization were adapted to assess the KPP related to sodium intake. Dietary sodium intake was determined using single 24-h urinary sodium excretion. Respondents were categorized into two categories: normal dietary sodium intake (< 2000 mg) and excessive dietary sodium intake (≥ 2000 mg). Out of 1440 respondents that were selected to participate, 1047 respondents completed the questionnaire and 798 of them provided valid urine samples. Factors associated with excessive dietary sodium intake were analyzed using complex sample logistic regression analysis. RESULTS:Majority of the respondents knew that excessive sodium intake could cause health problems (86.2%) and more than half of them (61.8%) perceived that they consume just the right amount of sodium. Overall, complex sample logistic regression analysis revealed that excessive dietary sodium intake was not significantly associated with KPP related to sodium intake among respondents (P > 0.05). CONCLUSION:The absence of significant associations between KPP and excessive dietary sodium intake suggests that salt reduction strategies should focus on sodium reduction education includes measuring actual dietary sodium intake and educating the public about the source of sodium. In addition, the relationship between the authority and food industry in food reformulation needs to be strengthened for effective dietary sodium reduction in Malaysia.

BACKGROUND:Studies have shown that having away from home meals contributes to high sodium intake among young people and those who lived in urban areas. This study aimed to determine the association between dietary sodium intake, body mass index, and away from home meal consumption behaviour among Malaysian adults.METHODS:MyCoSS was a cross-sectional household survey involving 1440 adults age 18 years and above. This study utilized stratified cluster sampling to obtain a nationally representative sample. Data was collected between October 2017 and March 2018. Socio-demographic information, dietary assessment using food frequency questionnaire (FFQ), and away from home meal consumption were assessed through a face-to-face interview by trained health personnel. Descriptive analysis and logistic regression were applied to identify the association of socioeconomic status and away from home meal consumption with dietary sodium intake.RESULTS:A total of 1032 participants completed the FFQ, with a mean age of 48.8 + 15.6 years. Based on the FFQ, slightly over half of the participants (52.1%) had high sodium intake. Results showed that 43.6% of participants consumed at least one to two away from home meals per day, while 20.8% of them had their three main meals away from home. Participants aged less than 30 years old were the strongest predictor to consume more sodium (adjusted OR: 3.83; 95%CI: 2.23, 6.58) while those of Indian ethnicity had significantly lower sodium intake. Surprisingly, having three away from home meals per day was not associated with high dietary sodium intake, although a significant association (crude OR; 1.67, 95% CI: 1.19, 2.35) was found in the simple logistic regression. Obese participants were less likely to have high dietary sodium intake compared with the normal BMI participants in the final model.CONCLUSION:Over half of the participants consumed sodium more than the recommended daily intake, especially those who consumed three away from home meals. However, there was no significant association between high sodium intake and having three away from home meals per day. The promotion of healthy cooking methods among the public must continue to be emphasized to reduce the dietary sodium intake among Malaysian adults.

BACKGROUND:High sodium intake was an established risk factor for stroke and cardiovascular diseases. The objective of this study was to investigate factors associated with high sodium intake based on 24-h urinary sodium excretion from the MyCoSS study.METHODS:The cross-sectional survey was conducted among adults aged 18 years and above in Malaysia. A multi-stage stratified sampling was used to represent nationally. Twenty-four-hour urine was collected from a total of 900 respondents. Indirect ion-selective electrode (ISE) method was used to measure sodium intake. Descriptive and logistic regression analysis was applied to determine factors associated with high sodium intake based on 24-h urinary sodium excretion.RESULTS:A total of 798 respondents (76% response rate) completed the 24-h urine collection process. Logistic regression revealed that high sodium intake associated with obese [aOR 2.611 (95% CI 1.519, 4.488)], male [aOR 2.436 (95% CI 1.473, 4.030)], having a waist circumference of > 90cm for adult males [aOR 2.260 ( 95% CI 1.020, 5.009) and >80cm for adult females [aOR 1.210 (95% CI 0.556, 2.631)], being a young adult [aOR 1.977 (95% CI 1.094, 3.574)], and living in urban areas [aOR 1.701 (95% CI 1.094, 2.645)].CONCLUSION:Adults who are obese, have a large waist circumference, of male gender, living in urban areas, and belonging to the young adult age group were found to have higher sodium intake than other demographic groups. Hence, reduction of salt consumption among these high-risk groups should be emphasised to reduce the risk of cardiovascular diseases.

Background High blood pressure or hypertension has become one of the main health problems, worldwide. A number of studies have proven that an increased intake of salt was related to an increased prevalence of cardiovascular diseases. Of late, its relationship with high salt intake has received a lot of attention. Studies in Malaysia have shown both rising hypertension over time as well as high salt consumption. Actions to reduce salt intake are essential to reduce hypertension and its disease burden. As such, we carried out a study to determine associations between knowledge, attitude and behaviour towards salt intake and hypertension among the Malaysian population. Methods Data obtained from the Malaysian Community Salt Survey (MyCoSS) was used partially for this study. The survey used a cross-sectional two-stage sampling design to select a nationally representative sample of Malaysian adults aged 18 years and above living in non-institutional living quarters (LQ). Face-to-face interviews were done by trained research assistants (RA) to obtain information on sociodemography, medical report, as well as knowledge, attitude and behaviour of the respondents towards salt intake and blood pressure. Results Majority of the respondents have been diagnosed with hypertension (61.4%) as well as knowledge of the effects of high salt intake on blood pressure (58.8%). More than half of the respondents (53.3%) said they controlled their salt intake on a regular basis. Those who knew that a high salt diet could contribute to a serious health problem (OR=0.23) as well as those who controlled their salt intake (OR=0.44) were significantly less likely to have hypertension. Conclusion Awareness of the effects of sodium on human health, as well as the behaviour of controlling salt intake, is essential towards lowering the prevalence of hypertension among Malaysians.

Background Sodium intake is associated with anthropometric measurement including weight, waist circumference (WC), and body mass index (BMI). Higher intake of sodium is usually linked to higher risk of obesity among adults globally, especially in developing countries. This study aims to explore the probable relationship between sodium intake by 24-h urine excretion assessment and anthropometric measurement of adults in Malaysia. Methods A cross-sectional study was conducted from October 2017 to March 2018 using a multi-stage stratified sampling method among Malaysian adults aged 18 years old and above. Sodium intake was determined by 24-h urinary sodium excretion, estimated from the respondents’ 24-h urinary sample. Height was obtained based on standard protocol. Weight and WC were measured twice using validated anthropometric equipment and BMI was calculated according to World Health Organization (WHO) 1998 classification. Descriptive analysis was done to describe socio-demographic characteristics. A simple linear regression and multiple linear regression tests were done to assess the relationship of 24-h urinary excretion and anthropometric measurement. All statistical analysis was done using SPSS version 22.0. Results Of 1047 interviewed respondents, 798 respondents had done the 24-h urine collection (76.0% response rate). Majority was between 40 and 59 years old (43.5%) and married (77.7%). Simple linear regression showed a significant positive linear association between 24-h urinary excretion and household income, WC, and obese group. In the multivariate analysis, it was indicated that, an increase of 1 unit of BMI will significantly increase the sodium intake by 129.20 mg/dl and an increase of 1 cm of WC will significantly increase the sodium intake by 376.45 mg/dl. Conclusion Our study showed a positive significant relationship between sodium intake estimated by 24-h urinary sodium excretion and BMI of Malaysian adults. More research is suggested on how sodium control can potentially contribute to obesity prevention.

Abstract Many modifiable factors contribute to the high prevalence rates of hypertension, among them is the consumption of too much salt (sodium). Another curable cause of hypertension is the excess of the hormone aldosterone. Aldosterone is normally produced by the zona glomerulosa (ZG) of the adrenal glands in response to a lack of salt and conversely suppressed by salt excess. We hypothesize that [i] suppression of aldosterone production induces apoptosis of ZG cells, as occurs following genetic deletion1; [ii] this sets up a maladaptive response to chronic salt overload by conferring a survival advantage to cells in which mutations drive autonomous aldosterone production. To address [i], we measured apoptosis of cells in which aldosterone synthesis was inhibited; to address [ii] we undertook a cross-sectional clinical study of aldosterone and sodium excretion, hypothesising that aldosterone excretion will be highest in the outside quartiles of sodium excretion. Aldosterone was inhibited by modification, in human adrenocortical H295R cells, of either CADM1 expression (mutated in aldosterone-producing adenomas2) or intracellular calcium concentration3. Apoptosis was measured by flow cytometric analysis of annexin V conjugates. 24-hour urinary aldosterone excretion (24h-Ualdo) was correlated with 24-hour urinary sodium (24h-Usodium) in 24h-urine samples collected for a Malaysian population-based salt intake study (MyCoSS). The prevalence of autonomous aldosterone production was estimated from the proportion of subjects with serum measurement whose “SUSSPUP” ratio (= serum sodium to urinary sodium)/(serum potassium2 to urinary potassium) was >5.34. Modification of CADM1 in human adrenocortical H295R cells decreased aldosterone production by half compared to vector control, and this was associated with a 3 to 5-fold increase of apoptotic cells (p<0.05; n>3). Pilot investigation of a Cav1.3 inhibitor decreased aldosterone production by 70%, and increased apoptosis by 7-fold (p<0.10; n=2). In 767 subjects, 24h-urine samples from the high urinary sodium quartile (>150mmol/d) had higher urinary aldosterone (4+0.18 ug/d) than other quartiles (p=0.00001). Overall, the estimated prevalence of autonomous aldossterone production using SUSSPUP ratio was 4.5% (8 of 179 subjects). In 63 subjects with 24h-Usodium>200 mmol/day, autonomous aldosterone secretion (conventionally >10µg/d) was found in 9.5%. Our results support the hypothesis that initial suppression of aldosterone production by salt excess may create a selective advantage for cells which autonomously produce aldosterone, and hence an inappropriate long-term increase in aldosterone production. 1Lee et al., Endocrinology. 2005;146:2650-6. 2Wu et al., 21st European Congress of Endocrinology. Vol. 63. BioScientifica, 2019. 3Xie et al., Sci Rep. 2016;6:24697. 4Willenberg et al., Eur J Clin Invest. 2009;39:43-50.

Background The prevalence of chronic kidney disease (CKD) in Malaysia was 9.07% in 2011. We aim to determine the current CKD prevalence in Malaysia and its associated risk factors. Methods A population-based study was conducted on a total of 890 respondents who were representative of the adult population in Malaysia, i.e., aged ≥18 years old. Respondents were randomly selected using a stratified cluster method. The estimated glomerular filtration rate (eGFR) was estimated from calibrated serum creatinine using the CKD-EPI equation. CKD was defined as eGFR < 60 ml/min/1.73m 2 or the presence of persistent albuminuria if eGFR ≥60 ml/min/1.73m 2 . Results Our study shows that the prevalence of CKD in Malaysia was 15.48% (95% CI: 12.30, 19.31) in 2018, an increase compared to the year 2011 when the prevalence of CKD was 9.07%. An estimated 3.85% had stage 1 CKD, 4.82% had stage 2 CKD, and 6.48% had stage 3 CKD, while 0.33% had stage 4–5 CKD. Hypertension (aOR 3.72), diabetes mellitus (aOR 3.32), increasing BMI (aOR 1.06), and increasing age (aOR 1.06) were significantly associated with CKD. Conclusion Our study has shown that CKD has become one of the leading public health issues in Malaysia. Thus, there is an urgent need to screen for CKD and prevent its progression, associated morbidity, and mortality at the national level.

Dietary consumption and other environmental factors are known factors associated with sodium intake. However, little is known about the influence of energy intake on this relationship. The aim of this study was to determine the risk factors associated with high sodium intake assessed from urine sodium excretion and the influence of energy intake. A nationwide, cross-sectional study was conducted from 2015 to 2016 among Malaysian health staff (MySalt 2015). A total of 1027 participants from 1568 targeted participants aged 18 years and older that were randomly selected were included in this study. Sodium intake was determined by measuring sodium excretion in the 24 hr urine test. Dietary, sociodemography, and anthropometry variables as associated risk factors were assessed. Multiple logistic regression models were used to determine the association between high sodium intake (≥2000 mg/day urinary sodium) and potential risk factors. The prevalence of high sodium intake in this study was 70.1% (n=733). High sodium intake was associated with male (OR 1.93, 95% confidence interval (CI) 1.41, 2.64), Bumiputera Sarawak ethnicity (OR 0.24, 95% CI 0.09, 0.62), and energy-adjusted sodium intake (mg/d) (OR 1.19, 95% CI 1.03–1.39). Our results suggested that sex, ethnicity, and energy-adjusted sodium consumption were strong risk factors associated with high sodium intake independent from energy and other potential confounding factors.

The prevalence of obesity has increased dramatically and is now a global public health concern. This study examined trends in mean body mass index (BMI), mean waist circumference (WC) and prevalence of overweight, obesity and abdominal obesity (AO) among Malaysian adults obtained from the National Health and Morbidity Surveys (NHMS) in 2006, 2011 and 2015. These cross-sectional population based survey applied a two-stage stratified sampling design provided data on household members aged 18 years and above. Face-toface interviewed and anthropometric measurements, including weight, height and waist circumference (WC) were collected. Age-adjusted mean BMI is significantly increased from 24.6 kg / m(2) in 2006 to 25.7 kg / m(2) in 2015 (p <0.001), while age-adjusted mean WC increased from 81.9 cm to 85.7 cm during the same period of time. Prevalence of overweight significantly increases from 28.3% to 31.3% (p <0.001), that of obesity from 13.2% to 19.1% (p <0.001) and that of AO, the largest, from 39.1% to 51.0% (p <0.001). The prevalence of obesity and, in particular, abdominal obesity among Malaysian adults has increased in all age groups over the past 10 years. Thus, there is an urgent need to determine the factors associated with obesity and abdominal obesity towards developing a national program to prevent deleterious obesity-related health outcomes.

*Corresponding author: Professor Dr Suzana Shahar Head Community Rehabilitation and Ageing Research Centre, Dietetic Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia. Tel: (6)(03)92897511; Fax: (6)(03)26947621; E-mail: suzana.shahar@ukm.edu.my Association between intake of soy isoflavones and blood pressure among urban and rural Malaysian adults