Background Prospective cohort studies documenting long-term dietary trends across multiple world regions are lacking. Objective To evaluate 15-year (2007-2022) changes in food and beverage consumption among adults aged 35 to 70 years living in 626 urban and rural communities across 16 high-income (HIC), middle-income (MIC) and low-income (LIC) countries. Methods In the Prospective Urban Rural Epidemiology (PURE) Study, dietary intake was assessed using an abbreviated food-frequency questionnaire at baseline and approximately every 3 years across four follow-up visits over a 15-year calendar period (2007-2022). Linear mixed-effect models and mixed-effect multinomial logistic regression were used to evaluate changes in food and beverage consumption over time . Dietary changes <0.05 servings/day (s/day) are presented as servings/week (s/week). Changes of <0.2 s/day change over the study period were considered modest. Participant demographics (age, sex, urban/rural residence, and education) closely matched national distributions in each country. Results 120,782 participants provided at least one dietary assessment (median follow-up: 12.1 years).Consumption of animal-based products has generally increased, with clear regional differences. Milk increased in China (+0.21 s/day, +0.15 to +0.26), and in LICs (+0.08 s/day, +0.05 to +0.11); decreased in HICs (-0.10 s/day, -0.12 to -0.07) and in MICs (-0.21 s/week, -0.28 to -0.15). Eggs increased in HICs MICs, and China up to 0.12 eggs/day (+0.11 to +0.14); no change in LICs. All regions increased chicken intake. Only HICs increased cooked fish consumption (0.28 s/week, +0.06 to +0.50). By contrast, plant-based food intake has generally decreased, but these changes were generally small and there was some regional variation. Fruit consumption decreased in HICs (-0.16 s/day, -0.18 to -0.14) and MICs (-0.09 s/day, -0.10 to -0.07); increased in China (+0.13 s/day, +0.11 to +0.14) and LICs (+0.22 s/week, +0.16 to +0.29). Fresh and cooked vegetable consumption decreased in HICs [-0.05 s/day (-0.06, -0.04) and -0.17 s/week (-0.30 to -0.03), respectively], MICs [-0.19 s/week (-0.23 to -0.16) and -0.08 s/day (-0.09 to -0.07), respectively], and in China [-0.07 s/day (-0.08 to -0.06) and -0.31 s/week (-0.40 to -0.23), respectively]. In LICs, fresh vegetable consumption increased (+0.19 s/week, +0.12 to +0.26); cooked vegetable intake was unchanged. All regions decreased rice consumption. Conclusions : In this international prospective study, dietary changes for most foods and beverages during the 15-year (2007-2022) study period were modest in size (most changes less than 0.2 s/day) but varied by region. Animal-source food intake generally increased, particularly in rapidly developing economies, while plant-based food intake decreased. As these shifts remain below the magnitude usually associated with measurable changes in disease risk, their clinical importance is uncertain.

Background Premature menopause is a risk factor for cardiovascular disease that is specific to women, but this association between premature menopause and cardiovascular disease has not been systematically assessed across ethnicities or across low-income, middle-income, and high-income countries. We aimed to estimate the prevalence of premature menopause and its association with cardiovascular events across various income-group countries and ethnicities. Methods The Prospective Urban Rural Epidemiologic (PURE) study was a multinational prospective cohort study in which 125 073 women from 28 countries aged 35–70 years were assessed for an association between age of menopause onset (not yet reached menopause, premature menopause [aged <40 years], early menopause [aged 40–45 years), and common age menopause (aged ≥45 years]) and cardiovascular events (myocardial infarction, stroke, or heart failure), using a mixed Cox proportional hazards model adjusted for age and INTERHEART risk score. The risk of early menopause was estimated using current status proportional hazards models. Recruitment varied from community announcements to mail and telephone calls inviting participants to central clinics as practical with an aim to be representative. Data were collected using standardised questionnaires through trained researchers. Findings Between Jan 5, 2005, and Dec 4, 2016, 111 619 women (mean age 50·6 years) from 28 countries (two of which did not have menopause data) were recruited with menopause data. 48 249 (43·2%) of 111 619 women were from rural areas and the median follow-up time was 14·6 years (IQR 12·0–16·1). Women in low-income and middle-income countries (LMICs) had a 53% (95% CI 46–61%) increased risk of premature menopause, with half of them reaching menopause by age 47·5 years compared with 50·6 years in high-income countries. South Asian women had a 34% (95% CI 27–42%) increased risk compared with European women, with half of south Asian women reaching menopause by age 47·4 years compared with 50·7 years for European women. Decreased menopause age was significantly associated with increased risk of major cardiovascular disease events (not yet reached menopause group adjusted hazard ratio 0·90 [95% CI 0·83–0·98]; early menopause group 1·14 [1·05–1·23]; and the premature menopause group 1·27 [1·15–1·40]) compared with common age menopause, adjusting for age and INTERHEART risk score, with similar associations for myocardial infarction and stroke. The findings were consistent across ethnicities and country-income groups. Interpretation Premature menopause was more common in LMICs and south Asian women and consistently associated with cardiovascular events across country-income group and ethnic groups. This finding suggests that women with premature and early menopause could be a target population for cardiovascular preventative interventions. Funding Full funding sources are listed at the end of the paper (see Acknowledgments).

INTRODUCTION:Ultraprocessed grains, commonly consumed in Western diets, undergo refining processes that often remove beneficial components and include additives to enhance taste, texture, or durability, potentially influencing gastrointestinal health. This study examines the association between ultraprocessed grain consumption and the risk of developing inflammatory bowel disease (IBD) using data from the Prospective Urban Rural Epidemiology (PURE) study. METHODS:This analysis included 124,590 participants from 21 countries who had dietary data available in the PURE study. Dietary intake was assessed through validated food frequency questionnaires, and ultraprocessed grain intake was categorized into 3 levels. The primary outcome was the development of IBD, including Crohn's disease (CD) and ulcerative colitis (UC). Multivariate Cox proportional hazard models were used to calculate hazard ratios (HRs), adjusting for confounders including age, sex, smoking status, eating habits, and physical activity. RESULTS:Among 124,590 participants, higher ultraprocessed grain intake was associated with increased IBD risk. Participants consuming ≥19 g/d of ultraprocessed grains had a higher risk of developing IBD compared with those consuming <9 g/d (hazard ratio [HR] 1.86, 95% confidence interval 1.26-2.61, Ptrend = 0.0003) after multivariate adjustment. Fresh bread and rice consumption were associated with lower IBD risk. Participants with greater ultraprocessed food intake (≥5 servings per day) were linked to a higher risk of developing IBD compared with those consuming <1 serving per day (HR 3.95, 95% confidence interval 2.74-5.71, Ptrend < 0.0001). DISCUSSION:Higher intake of ultraprocessed grains is associated with significantly increased risk of developing IBD. A healthy eating pattern should minimize consumption of ultraprocessed grains. Further studies should be performed to understand which components of ultraprocessed grains may be detrimental for health.

Background Current strategies to prevent adverse cardiovascular outcomes focus primary prevention in high-risk groups and secondary prevention in people with known cardiovascular disease. We aimed to determine the proportion of events occurring in lower-risk groups globally. Methods We included people aged 40 years to younger than 75 years who were enrolled in the Prospective Urban Rural Epidemiology (PURE) study, which is an ongoing, international, prospective, population-based cohort study that started recruiting adults from households selected to be broadly representative of the sociodemographic composition of their communities. We prospectively documented fatal or non-fatal myocardial infarction, stroke, heart failure, or any other fatal cardiovascular event stratified by history of cardiovascular disease and by the 10-year predicted disease risk scores based on WHO 2019 laboratory risk tables (<10% [low], 10% to <20% [intermediate], and >= 20% [high]) in people without previous cardiovascular disease from 26 high-income, middle-income, and lowincome countries. Outcome event rates were standardised for the cohort's age and sex distribution. Findings Between July 11, 2000, and May 6, 2019, 128 973 participants were included from 26 countries (mean age 536 years [SD 82]; 75 858 [588%] were female and 53 115 [412%] were male). We observed 11 483 outcome events affecting 89% of the cohort during a median follow-up of 123 years (IQR 98-146). Among participants, 89 508 (694%) had a low cardiovascular disease risk, 22 363 (173%) had an intermediate cardiovascular disease risk, and 5529 (43%) had a high cardiovascular disease risk, while 11 573 (90%) had known cardiovascular disease. The age-standardised and sex-standardised cardiovascular disease incidence rates per 1000 person-years was 41 (95% CI 40-42) in the low-risk group, 177 (152-202) in the intermediate-risk group, and 408 (251-564) in the high-risk group. Overall, 41% of outcome events occurred in cardiovascular disease-naive participants at low risk. The proportion of adverse cardiovascular outcomes occurring in this low-risk group was inversely related to country income level (32% in high-income, 38% in middle-income, and 54% in low-income countries) and was higher in women (51%) than in men (32%). Interpretation To achieve a substantial population-level reduction in cardiovascular disease, a fundamental change is needed, so that preventive strategies for cardiovascular disease extend beyond those at high or even intermediate predicted risk to include those at considered to be at low risk. Copyright (c) 2025 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.

This study aims to investigate the association between dietary vitamin (A, B6, B9, B12, C, E, and K) intake and hypertension (HPT) among Malaysian adult population. This is a cross-sectional analysis of baseline data from a population-based cohort of 10,031 participants from the Malaysia arm of the Prospective Urban and Rural Epidemiology (PURE) study. Participants were classified as having HPT if they reported a diagnosis of high blood pressure (systolic blood pressure (SBP)/diastolic blood pressure (DBP) > 140/90). Participants’ usual dietary intake was assessed using a validated food frequency questionnaire. Vitamin (A, B6, B9, B12, C, E, and K) intake was calculated using nutrient databases. The Mann-Whitney U test was used to assess differences in vitamin intake between the HPT groups. This study found that the prevalence of HPT among 10,031 respondents was 43.5%. The overall dietary intake of vitamins A and C was adequate, but the intake of vitamins B6, B9, B12, E, and K was inadequate compared to Malaysia’s Recommended Nutrient Intakes (RNI). The intake of vitamins A, B6, B9, B12, E, and K was significantly lower among patients with HPT compared to those without HPT (p-value < 0.001). This study found that the Malaysian adult population is not receiving sufficient intake of vitamins B6, B9, B12, E, and K from their diet. Improving vitamin intake can be achieved through nutrition education, a diet that includes a variety of healthy foods, and food fortification and supplementation.

Background Cardiovascular disease (CVD) is a significant public health challenge in the Western Pacific region, including Malaysia. Objective This study aimed to develop and validate machine learning (ML) models to predict 10-year CVD risk in a Malaysian cohort, which could serve as a model for other Asian populations with similar genetic and environmental backgrounds. Methods Utilizing data from the REDISCOVER Registry (5,688 participants from 2007 to 2017), 30 clinically relevant features were selected, and several ML algorithms were trained: Support Vector Machine (SVM), Logistic Regression (LR), Random Forest (RF), Extreme Gradient Boosting (XGBoost), Neural Network (NN) and Naive Bayes (NB). Ensemble model were also created using three commonly used meta learners, including RF, Generalized Linear Model (GLM), and Gradient Boosting Model (GBM). The dataset was split into a 70:30 train-test ratio, with 5-fold cross-validation to ensure robust performance. Model evaluation was primarily based on the Area Under the Curve (AUC), with additional metrics such as sensitivity, specificity, and the Net Reclassification Index (NRI) to compare the ML models against traditional risk scores like the Framingham Risk Score (FRS) and Revised Pooled Cohort Equations (RPCE). Results The LR model achieved the highest AUC of 0.77, outperforming the FRS (AUC = 0.72) and RPCE (AUC = 0.74). The ensemble model provided robust performance, though it did not significantly exceed the best individual model. SHAP (SHapley Additive exPlanations) analysis identified key predictors such as systolic blood pressure, weight and waist circumference. The study showed a significant NRI improvement of 13.15% compared to the FRS and 7.00% compared to the RPCE, highlighting the potential of ML approaches to enhance CVD risk prediction in Malaysia. The best-performing model was deployed on a web platform for real-time use, ensuring ongoing validation and clinical applicability. Conclusions These findings underscore the effectiveness of ML models in improving CVD risk stratification and decision-making in Malaysia and beyond.

Objectives:This study aimed to develop and validate a machine learning (ML)-based model for cardiovascular disease (CVD) risk prediction in a Malaysian cohort representative of the Southeast Asian population. Methods:Data from the Responding to Increasing Cardiovascular Disease Prevalence (REDISCOVER) Study, including 10,044 participants, were analyzed, with 4,299 cases retained after exclusions. The dataset was split into training (70 %) and validation (30 %) subsets. Logistic Regression (LR), Random Forest (RF), and Support Vector Machine (SVM) models were developed using feature selection techniques such as recursive feature elimination (RFE) and sequential backward elimination (SBE). Model performance was evaluated using the area under the curve (AUC), sensitivity, specificity, calibration, and Net Reclassification Index (NRI). Findings:Among the models evaluated, the SVM model with SBE-selected features performed best, achieving an AUC of 0.800. This was higher than the Framingham Risk Score (FRS; AUC = 0.693), Revised Pooled Cohort Equations (RPCE; AUC = 0.744), and WHO CVD charts (AUC = 0.741). NRI analysis showed significant improvements compared to FRS and RPCE (17.29 % and 14.23 %, respectively; p < 0.00001). Calibration analyses indicated initial overprediction by ML models, which was mitigated by Platt scaling. Conclusion:ML-based models incorporating regionally relevant variables demonstrated improved discrimination and reclassification compared with conventional risk scores in this Malaysian cohort. Further external validation is needed to establish their utility across broader Southeast Asian populations.

Vitamin deficiency could increase the prevalence of type 2 diabetes mellitus (T2DM). Thus, this study aimed to determine the association between dietary vitamin intake and the prevalence of T2DM among the Malaysian adult population. This cross-sectional study involved 9,314 participants from Prospective Urban and Rural Epidemiology Study (PURE) conducted in Malaysia. The participants comprised of 43

ABSTRACTThere are limited data on individual risk factors for SARS-CoV-2 infection (including unrecognized infection). In this seroepidemiologic substudy of an ongoing prospective cohort study of community-dwelling adults, participants were thoroughly characterized pre-pandemic. The SARS-CoV-2 infection was ascertained by serology. Among 8,719 participants from 11 high-, middle-, and low-income countries, 3,009 (35%) were seropositive for SARS-CoV-2. Characteristics independently associated with seropositivity were younger age (odds ratio, OR; 95% confidence interval, CI, per five-year increase: 0.95; 0.91–0.98) and body mass index >25 kg/m2 (OR, 95% CI: 1.16, 1.01–1.34). Smoking (as compared with never smoking, OR, 95% CI: 0.83, 0.70–0.97) and COVID-19 vaccination (OR, 95% CI: 0.70, 0.60–0.82) were associated with a reduced risk of seropositivity. Among seropositive participants, 83% were unaware of having been infected with SARS-CoV-2. Seropositivity and a lack of awareness of infection were more common in lower-income countries. The COVID-19 vaccination reduces the risk of SARS-CoV-2 infection (including recognized and unrecognized infections). Overweight or obesity is an independent risk factor for SARS-CoV-2 infection. Infection and lack of infection awareness are more common in lower-income countries.IMPORTANCEIn this large, international study, evidence of SARS-CoV-2 infection was obtained by testing blood specimens from 8,719 community-dwelling adults from 11 countries. The key findings are that (i) the large majority (83%) of community-dwelling adults from several high-, middle-, and low-income countries with blood test evidence of SARS-CoV-2 infection were unaware of this infection—especially in lower-income countries; and (ii) overweight/obesity predisposes to SARS-CoV-2 infection, while COVID-19 vaccination is associated with a reduced risk of SARS-CoV-2 infection. These observations are not attributable to other individual characteristics, highlighting the importance of the COVID-19 vaccination to prevent not only severe infection but possibly any infection. Further research is needed to understand the mechanisms by which overweight/obesity might increase the risk of SARS-CoV-2 infection.

Background:Erectile dysfunction (ED) is an independent predictor for cardiovascular diseases (CVD). The prevalence increases with age, but little is known about the relationship between handgrip strength (HGS) and ED, especially among men with a high risk of CVD. This study aimed to determine the prevalence of ED among men aged ≥40 years with metabolic syndrome (MetS) and its association with HGS. Materials and Methods:A cross-sectional study at an institutional primary care clinic in Malaysia was conducted between June 2021 and October 2021. HGS and erectile function were assessed using a hand dynamometer and International Index of Erectile Function (IIEF-5) questionnaire, respectively. Multiple logistic regression analyses were performed to determine the association between sociodemographics, clinical characteristics, and HGS with ED. Results:A total of 334 participants were recruited. The prevalence of ED was 79% (95% confidence interval [CI]: 0.75-0.84). ED was associated with elderly aged ≥60 years (odds ratio [OR] 3.27, 95%CI: 1.60-6.69), low HGS (OR 15.34, 95%CI: 5.64-41.81) and high total cholesterol (OR 0.36, 95%CI: 0.16-0.78). Conclusion:In conclusion, age above 60 years and those with low HGS are at higher risk of ED. Thus, robust screening of ED among men with MetS and improving muscle strength and physical fitness may be warranted.

Background: Bone fractures represent a significant health issue and impose a considerable burden on healthcare systems globally. However, data pertaining to bone fractures, especially among reproductive-age women in Malaysia, are very limited. Micronutrients like calcium, magnesium and phosphorus play vital roles in bone health, influencing bone mineral density and fracture risk. The objective of this study was to determine the prevalence of bone fractures among reproductive-age women and the association with dietary micronutrient intakes. Methods: In this cross-sectional study, a total of 1,730 participants of reproductive-age women from the Malaysia Prospective Urban and Rural Epidemiological (PURE) study were recruited. The participants' dietary intakes were assessed using a validated semi-quantitative food frequency questionnaire (FFQ). Selected micronutrients in the participants' diets were calculated using the Malaysian food composition and the US Department of Agriculture food composition databases. The association between micronutrient intakes, comorbidities and physical activity levels with bone fractures were evaluated to identify predictors of bone fractures among reproductive-age women. Results: The prevalence of bone fractures among Malaysian reproductive-age women was low (3.7%). The multiple logistic regression analysis showed that none of the micronutrients was associated with bone fractures. However, factors of diabetes and passive smoking in this study showed 2.6- and 4.0-times-higher odds of having bone fractures, respectively (AOR 2.580; 95% CI: 1.173-5.672) and (AOR 4.012; 95% CI: 2.265-7.107). Conclusions: It was found that the majority of women in this study were taking lower micronutrient intakes of calcium, magnesium, and vitamin K than the Malaysia recommended nutrient intakes (RNI). Although this study showed that a low micronutrient intake is not significantly associated with bone fractures, it is recommended that future studies focus on controlled trials or prospective data analyses to establish causal relationships and the optimal micronutrient requirements for maintaining strong and healthy bones in women of reproductive age.

Introduction: The fracture risk assessment (FRAX) is a tool to assess the fracture risk among the elderly. However, FRAX does not include other domains of fall risk and this can be assessed using the falls risk assessment tool (FRAT). The study looks to compare the FRAX and FRAT tools, as well as the prevalence of fall risk and fracture risk and factors associated with high risk of fracture. Methods: This was a cross-sectional study among elderly patients aged 60 years and above who attended a specialist primary care clinic. The study tool included the sociodemographic and clinical characteristics details of the participants and the FRAX and FRAT assessment. Data were entered and analysed using SPSS version 23. Results: A total of 307 participants were analysed with a mean age of 68.1 (SD=6.1). The prevalence for high fracture risk and high fall risk was 23.5% (95% CI: 18.7, 28.2) and 26.7% (95% CI: 21.7, 31.7) respectively. Six factors were found to be associated with high fracture risk. These six factors were higher age group (P<0.001), non-Malay ethnicity (P=0.004), patients on calcium supplements (P=0.003), medical history of gout (P=0.048), lower BMI categories (P<0.001) and history of previous fracture (P<0.001). The study also found that there was no correlation between FRAX and FRAT calculation [κ = 0.10 (95%CI: -0.02, 0.21), P=0.079]. Conclusion: FRAX calculation predicts fracture risk but does not include all of the domains of fall risk. Clinicians need to assess fall risk (FRAT) on top of the FRAX among the elderly for a more accurate fracture risk assessment.

ABSTRACT Background and Aims The Malaysian government has implemented various antismoking measures to reduce the incidence of unhealthy lifestyles within the population. This study analyzes the baseline data of the Prospective Urban Rural Epidemiology (PURE) study to establish the prevalence of sociodemographic factors that are associated with smoking habits among Malaysian adults. Methods This study was carried out in urban and rural communities with adults aged between 35 and 70 years using purposive sampling. Standardized questionnaires were used to assess the smoking status and sociodemographic data of the participants. Bivariate analysis and multiple logistic regression were done to determine the association between smoking status and demographic characteristics among Malaysian adults. Results The prevalence of smoking among adults is 23.2%. The sociodemographic factors significantly associated with active smoking status were being a younger adult (adjusted odds ratio [AOR] = 1.26, 95% CI: 1.06–1.50), being male (AOR = 24.16, 95% CI: 20.58–28.36), being Malay (AOR = 1.72, 95% CI: 1.49–1.98), being a blue‐collar worker (AOR = 1.75, 95% CI: 1.48–2.06), having no formal education (AOR = 1.99, 95% CI: 1.56–2.53), being unmarried (AOR = 1.22, 95% CI: 1.02–1.48) and being of low socioeconomic status (AOR = 1.45, 95% CI: 1.14–1.84). Conclusion Public health policies and actions on smoking reduction should emphasize those identified as high‐risk sub‐populations, particularly younger adults, males and those who are not yet married, have no formal education and are of low socioeconomic status.

BACKGROUND:The built environment can influence human health, but the available evidence is modest and almost entirely from urban communities in high-income countries. Here we aimed to analyse built environment characteristics and their associations with obesity in urban and rural communities in 21 countries at different development levels participating in the Prospective Urban and Rural Epidemiology (PURE) Study. METHODS:Photographs were acquired with a standardised approach. We used the previously validated Environmental Profile of a Community's Health photo instrument to evaluate photos for safety, walkability, neighbourhood beautification, and community disorder. An integrated built environment score (ie, a minimum of 0 and a maximum of 20) was used to summarise this evaluation across built environment domains. Associations between built environment characteristics, separately and combined in the integrated built environment score, and obesity (ie, a BMI >30kg/m2) were assessed using multilevel regression models, adjusting for individual, household, and community confounding factors. Attenuation in the associations due to walking was examined. FINDINGS:Analyses include 143 338 participants from 530 communities. The mean integrated built environment score was higher in high-income countries (13·3, SD 2·8) compared with other regions (10·1, 2·5) and urban communities (11·2, 3·0). More than 60% of high-income country communities had pedestrian safety features (eg, crosswalks, sidewalks, and traffic signals). Urban communities outside high-income countries had higher rates of sidewalks (176 [84%] of 209) than rural communities (59 [28%] of 209). 15 (5%) of 290 urban communities had bike lanes. Litter and graffiti were present in 372 (70%) of 530 communities, and poorly maintained buildings were present in 103 (19%) of 530. The integrated built environment score was significantly associated with reduced obesity overall (relative risk [RR] 0·58, 95% CI 0·35-0·93; p=0·025) for high compared with low scores and for increasing trend (0·85, 0·78-0·91; p<0·0001). The trends were statistically significant in urban (0·85, 0·77-0·93; p=0·0007) and rural (0·87, 0·78-0·97; p=0·015) communities. Some built environment features were associated with a lower prevalence of obesity: community beautification RR 0·75 (95% CI 0·61-0·92; p=0·0066); bike lanes RR 0·58 (0·45-0·73; p<0·0001); pedestrian safety RR 0·75 (0·62-0·90; p=0·0018); and traffic signals RR 0·68 (0·52-0·89; p=0·0055). Community disorder was associated with a higher prevalence of obesity (RR 1·48, 95% CI 1·17-1·86; p=0·0010). INTERPRETATION:Community built environment features recorded in photographs, including bike lanes, pedestrian safety measures, beautification, traffic density, and disorder, were related to obesity after adjusting for confounders, and stronger associations were found in urban than rural communities. The method presents a novel way of assessing the built environment's potential effect on health. FUNDING:Population Health Research Institute, Hamilton Health Sciences Research Institute, Heart and Stroke Foundation of Ontario, Canadian Institutes of Health Research's Strategy for Patient Oriented Research, Ontario Support Unit, Ontario Ministry of Health and Long-Term Care, AstraZeneca, Sanofi-Aventis, Boehringer Ingelheim, Servier, and GlaxoSmithKline.

INTRODUCTION:HIV late presenters were defined as individuals presenting with a CD4 count below 350 cells/μL or with an AIDS-defining event, according to the European Late Presenter Consensus working group. Early diagnosis and treatment of HIV have proven beneficial for people living with HIV (PLHIV), reducing the burden on healthcare systems, and contributing to ending the HIV/AIDS epidemic. However, in Malaysia, over 50% of newly diagnosed HIV patients present late, leading to increased morbidity and premature mortality. This study aims to determine the prevalence of late HIV presenters and its association with HIV-related stigma and HIV knowledge among PLHIV attending public primary care clinics in Selangor. METHODS:A cross-sectional study was conducted at selected public health clinics in Selangor, involving PLHIV aged 18 years and older, who were diagnosed since 2019. HIV-related stigma was measured using the Malay version of Berger's HIV Stigma Scale, and HIV knowledge was assessed using the Malay version of Brief HIV-KQ-18. Univariate and multivariate logistic regression analyses were performed to identify factors associated with late HIV presentation. RESULTS:A total of 400 participants were included in the study, with 60.0% (n = 240, 95% CI: 55.0-65.0) classified as late presenters. The participants had a mean age of 30.29 (±7.77) years. The risk factors for late presenters were high levels of HIV-related stigma (aOR = 1.049, 95% CI: 1.034-1.063, p-value <0.001), low levels of HIV knowledge (aOR = 0.709, 95% CI: 0.646-0.778, p-value <0.001), tertiary education background (aOR = 15.962, 95% CI: 1.898-134.235, p-value = 0.011), and being single (aOR = 3.582, 95% CI: 1.393-9.208, p-value = 0.008). CONCLUSION:This study highlights the association between high levels of HIV-related stigma, low levels of HIV knowledge, and late HIV presentation. Interventions targeting stigma reduction and HIV education can promote early testing and prompt access to care, improving health outcomes for PLHIV.

Hypertension (HPT) is the leading modifiable risk factor for cardiovascular diseases and premature death worldwide. Currently, attention is given to various dietary approaches with a special focus on the role of micronutrient intake in the regulation of blood pressure. This study aims to measure the dietary intake of selected minerals among Malaysian adults and its association with HPT. This cross-sectional study involved 10,031 participants from the Prospective Urban and Rural Epidemiological study conducted in Malaysia. Participants were grouped into HPT if they reported having been diagnosed with high blood pressure [average systolic blood pressure (SBP)/average diastolic blood pressure (DBP) ≥ 140/90 mm Hg]. A validated food frequency questionnaire (FFQ) was used to measure participants' habitual dietary intake. The dietary mineral intake of calcium, copper, iron, magnesium, manganese, phosphorus, potassium, sodium, and zinc was measured. The chi-square test was used to assess differences in socio-demographic factors between HPT and non-HPT groups, while the Mann–Whitney U test was used to assess differences in dietary mineral intake between the groups. The participants’ average dietary intake of calcium, copper, iron, magnesium, manganese, phosphorus, potassium, selenium, sodium, and zinc was 591.0 mg/day, 3.8 mg/day, 27.1 mg/day, 32.4 mg/day, 0.4 mg/day, 1431.1 mg/day, 2.3 g/day, 27.1 µg/day, 4526.7 mg/day and 1.5 mg/day, respectively. The intake was significantly lower among those with HPT than those without HPT except for calcium and manganese. Continuous education and intervention should be focused on decreasing sodium intake and increasing potassium, magnesium, manganese, zinc, and calcium intake for the general Malaysian population, particularly for the HPT patients.

Abstract Introduction The older adults (OA) is vulnerable to malnutrition, which may affect their health and quality of life. This study assesses the prevalence of deficiencies in dietary nutrients among the Malaysian OA stratified by residency, genders, socioeconomic status (SES) and body mass index (BMI). Methodology A cross-sectional study was conducted, utilizing purposive sampling, recruiting 2,299 Malaysian people aged 60 years old and above who agreed to be interviewed via a comprehensive semi-quantitative food frequency questionnaire. The nutrients intake was calculated based on the Malaysian food composition and US Department of Agriculture food composition databases. Then, the nutrients intake was compared with the Malaysian Recommended Nutrients Intake guidelines, and the prevalence of deficiencies in dietary nutrients were calculated. The median (interquartile ranges) intakes of nutrients were compared between residency (urban and rural), genders (male and female), and SES (low and middle-high) using the Mann-Whitney U test. The differences in nutrient intake between BMI categories (underweight, normal, and overweight) were identified using the Kruskal-Wallis test followed by Dunn’s post hoc test. Results The response rate was 70.3% (n = 2,299), predominantly were females (50.8%), received primary education (76.6%), were currently married (84.3%), were middle–high SES (57.7%), and had a normal BMI (59.8%). There was a notable inadequate intake prevalence of magnesium (100.0%), manganese (97.9%), zinc (95.6%), vitamin B6 (98.4%), potassium (91.0%), calcium (89.3%), vitamin B12 (80.2%), vitamin E (91.2%), and vitamin K (81.5%) among Malaysian OA. Additionally, significant differences were observed in nutrients intake levels across gender, residency, SES, and BMI within this population. Conclusions This study shows a high prevalence of dietary nutrients deficiency (> 80%) among the Malaysian OA, particularly for magnesium, manganese, potassium, zinc, vitamin B6, vitamin E, calcium, vitamin B12, and vitamin K. To improve the nutritional status of OA and safeguard against adverse health effects, it is necessary to formulate and execute strategies to enhance their dietary nutrient intakes. The strategies may involve intervention such as nutrient supplementation and promotion of consuming nutrient-rich foods.

BACKGROUND:Reducing inequities in hypertension control among those affected in low- and middle-income countries requires person-centred health system responses based on a contextualised understanding of the choices and care pathways taken by those who rely on the services provided, particularly those from poor and marginalised communities. We examine patterns of care seeking and pathways followed by individuals with hypertension from low-income households in the Philippines and Malaysia. This study aims to fill a significant gap in the literature by analysing the stages at which individuals make decisions that may affect the successful control of their blood pressure. METHODS:This study presents cross-sectional survey data collected as part of the Responsive and Equitable Health Systems-Partnership on Non-Communicable Diseases (RESPOND) project, a longitudinal observational study in low-income communities. The study participants were 1191 randomly selected adults aged 35-70 years with a self-reported history of hypertension or identified as hypertensive through blood pressure screening. RESULTS:While most low-income individuals with hypertension in both countries were diagnosed and receiving medication, Malaysians demonstrated higher self-reported medication adherence. Urban areas in the Philippines showed better hypertension management outcomes compared to rural areas. The study also provides insights into the care seeking pathways followed by low-income adults diagnosed with hypertension. Nearly half of these individuals in Malaysia and a third in the Philippines were following pathways where they had never changed or stopped treatment without professional advice, and where they were using and adhering to their prescribed medication. Following such pathways was strongly associated with a greater likelihood blood pressure control in the Philippines, but less so in Malayisa. CONCLUSIONS:These findings highlight the need for a contextualised understanding of care seeking choices and the importance of person-centred solutions. They offer a typology of hypertension care seeking pathways and a foundation for similar research in other settings.

Background The drivers of cardiovascular disease (CVD) and all-cause mortality may differ around the world. Regional-level prospective data can help guide policies to reduce CVD and all-cause mortality. Objectives This study examined the incidence of CVD and mortality in Malaysia and the Philippines and estimated the population-level risks attributable to common risk factors for each outcome. Methods This prospective cohort study included 20,272 participants from Malaysia and the Philippines. The mean follow-up was 8.2 years. The incidences of CVD and mortality rates were calculated for the overall cohort and in key subgroups. For each outcome, population-attributable fractions (PAFs) were calculated to compare risks associated with 12 modifiable risk factors. Results The mean age of the cohort was 51.8 years (59% women). Leading causes of mortality were CVD (37.9%) and cancer (12.4%). The incidence of CVD (per 1,000 person-years) was higher in the Philippines (11.0) than Malaysia (8.3), and CVD contributed to a higher proportion of deaths in the Philippines (58% vs 36%). By contrast, all-cause mortality rates were higher in Malaysia (14.1) than in the Philippines (10.9). Approximately 78% of the PAF for CVD and 68% of the PAF for all-cause mortality were attributable to 12 modifiable risk factors. For CVD, the largest PAF was from hypertension (24.2%), whereas for all-cause mortality, the largest PAF was from low education (18.4%). Conclusions CVD and cancer account for one-half of adult mortality in Malaysia and the Philippines. Hypertension was the largest population driver of CVD, whereas low education was associated with the largest burden of overall mortality.

BACKGROUND Polycythemia vera (PV) is a myeloproliferative neoplasm (MPNs) marked by elevated hemoglobin and hematocrit, which can lead to thromboembolic events and progress to myelofibrosis or acute myeloid leukemia (AML). MPNs, including PV, are relatively rare in Malaysia, and there is currently no recent published data reporting the demographics and outcomes of PV patients in the country. In Western countries, routine annual blood tests are standard, whereas this practice is less common in Malaysia, underscoring the need for improved awareness and accessibility to ensure timely diagnosis of PV. CASE REPORT This report presents a case of a 55-year-old Malaysian woman in a primary care setting, initially misdiagnosed with benign conditions due to atypical presentations of recurrent bilateral eye redness and dizziness. Persistent symptoms led to further evaluation by primary care and hematologist, which revealed elevated hemoglobin, hematocrit, leukocytosis, JAK2 V617F mutation, and low serum erythropoietin levels, confirming PV, even without proceeding with a bone marrow biopsy. Treatment with phlebotomy, hydroxyurea, and aspirin resulted in significant improvements in ocular symptoms and hematological parameters within 60 days. CONCLUSIONS This case underscores the critical role of primary care in the early detection of polycythemia vera. Timely identification and appropriate referral from primary care settings are essential to avoid diagnostic delays and ensure effective management, improving patient outcomes and preventing complications.