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Purpose: This study aimed to determine whether fenugreek seed powder could reduce the glycemic response and glycemic index (GI) when added to buns and flatbreads. Methods: In a randomised, controlled crossover trial, ten healthy human subjects (five men, five women) were given 50 g glucose (reference food, twice); buns (0 and 10 % fenugreek seed powder); and flatbreads (0 and 10 % fenugreek seed powder) on six different occasions. Finger prick capillary blood samples were collected at 0, 15, 30, 45, 60, 90 and 120 min after the start of the meal. The palatability of the test meals was scored using Likert scales. Results: The incremental areas under the glucose curve value of buns and flatbreads with 10 % fenugreek (138 ± 17 mmol × min/L; 121 ± 16 mmol × min/L) were significantly lower than those of 0 % fenugreek bun and flatbreads (227 ± 15 mmol × min/L; 174 ± 14 mmol × min/L, P = <0.01). Adding 10 % fenugreek seed powder reduced the GI of buns from 82 ± 5 to 51 ± 7 ( P < 0.01) and to the GI of flatbread from 63 ± 4 to 43 ± 5 ( P < 0.01). Conclusions: These results suggest that replacing 10 % of refined wheat flour with fenugreek seed powder significantly reduces the glycemic response and the GI of buns and flatbreads. Thus, fenugreek powder may be a useful functional ingredient to reduce postprandial glycemia. [ABSTRACT FROM AUTHOR]

This study determined the effects of fenugreek on postprandial plasma glucose (PPG) and satiety among overweight and obese individuals. Fourteen subjects were studied in the morning after overnight fasts on four separate occasions. Glycaemic responses elicited by 50 g carbohydrate portions of white bread and jam with or without 5.5 g of fenugreek and fried rice with or without 5.5 g fenugreek were determined over 2 h. The primary endpoint was the incremental area under the plasma glucose response curve (IAUC). Adding fenugreek to both foods significantly reduced the IAUC compared to the food alone: white bread and jam, 180 ± 22 versus 271 ± 23 mmol x min/L (P = 0.001); fried rice, 176 ± 20 versus 249 ± 25 mmol x min/L (P = 0.001). Fenugreek also significantly reduced the area under the satiety curve for white bread with jam (134 ± 27 versus 232 ± 33 mm x hr, P = 0.01) and fried rice (280 ± 37 versus 379 ± 36 mm x hr, P = 0.01). It is concluded that fenugreek significantly decreased the PPG response and increased satiety among overweight and obese individuals. [ABSTRACT FROM AUTHOR]

Abstract: Aim: To report the national prevalence of metabolic syndrome (MetS) and its risk factors among adult Malaysians (>18years old) based on World Health Organization (WHO), the National Cholesterol Education Program Expert Panel III (ATP III), International Diabetes Federation (IDF) and the ‘Harmonized’ criteria. Methods: A multi-stage stratified sampling method was used to select 4341 subjects from Peninsular and East Malaysia. Subjects underwent physical and clinical examinations. Results: Based on the WHO, ATP III, IDF and Harmonized definitions, the overall crude prevalences of MetS were 32.1, 34.3, 37.1 and 42.5%, respectively. Regardless of the criteria used, MetS was higher in urban areas, in females, in the Indian population and increased significantly with age. Risk factors also increased with age; abdominal obesity was most prevalent (57.4%), was higher in females (64.2%) and was highest in Indians (68.8%). Hypertension was higher in males (56.5%) and highest among Malays (52.2%). In contrast, the Chinese had the highest prevalence of hypertriglyceridemia (47.4%). Conclusions: Malaysia has a much higher prevalence of MetS compared with other Asian countries and, unless there is immediate intervention to reduce risk factors, this may pose serious implications on the country''s healthcare costs and services. [Copyright &y& Elsevier]

Aims: Our purpose was to determine whether the glycemic index (GI) of individual foods applies to mixed meals. Methods: The glycemic responses elicited by portions of 4 individual foods with 25 g of available carbohydrate when served alone (rice, lacy pancake, flatbread and noodles) and when made into typical Malaysian mixed meals (coconut milk rice, lacy pancake with chicken curry, flatbread with dhal curry and fried noodles) were measured in 10 subjects with type 2 diabetes. To allow calculation of the GI of the foods and the relative glycemic responses of the mixed meals, each subject also tested 25 g of glucose 3 times. Capillary blood glucose was measured at 30-min intervals for 180 min after consuming each test meal. Results: The mean ± SEM incremental area under the curve (AUC) after flatbread (345 ± 26 mmol × min/l) was significantly greater than after rice (238 ± 35) and lacy pancake (235 ± 31, p < 0.05), with noodles being intermediate (294 ± 35). The AUC after the flatbread with dhal curry (341 ± 49), coconut milk rice (238 ± 39) and fried noodle (272 ± 42) mixed meals were similar to those after the individual foods, but the AUC after the lacy pancake with chicken curry mixed meal (388 ± 52) was significantly greater than after the individual food item (p < 0.01). Conclusions: The results support the utility of the GI of individual foods such as rice, flatbread and noodles when applied to mixed meals. The reason for the higher response after the lacy pancake mixed meal compared to the individual food is not clear and may warrant further research. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Abstract: Aim: To report the national prevalence of metabolic syndrome (MetS) and its risk factors among adult Malaysians (>18 years old) based on World Health Organization (WHO), the National Cholesterol Education Program Expert Panel III (ATP III), International Diabetes Federation (IDF) and the ‘Harmonized’ criteria. Methods: A multi-stage stratified sampling method was used to select 4341 subjects from Peninsular and East Malaysia. Subjects underwent physical and clinical examinations. Results: Based on the WHO, ATP III, IDF and Harmonized definitions, the overall crude prevalences of MetS were 32.1, 34.3, 37.1 and 42.5%, respectively. Regardless of the criteria used, MetS was higher in urban areas, in females, in the Indian population and increased significantly with age. Risk factors also increased with age; abdominal obesity was most prevalent (57.4%), was higher in females (64.2%) and was highest in Indians (68.8%). Hypertension was higher in males (56.5%) and highest among Malaysians (52.2%). In contrast, the Chinese had the highest prevalence of hypertriglyceridaemia (47.4%). Conclusions: Malaysia has a much higher prevalence of MetS compared with other Asian countries and, unless there is immediate intervention to reduce risk factors, this may pose serious implications on the country''s healthcare costs and services. [Copyright &y& Elsevier]

Cardiovascular diseases are responsible for increased morbidity and mortality in people with diabetes. Diabetic macrovasculopathy is associated with structural and functional changes in large arteries, which causes endothelial dysfunction, increased arterial stiffness, or decreased arterial distensability. Diabetic complications can be controlled and avoided by strict glycemic control, maintaining normal lipid profiles, regular physical exercise, adopting a healthy lifestyle and pharmacological interventions. Treatment goals for patients with type 2 diabetes specify targets for glycemia and other cardiometabolic risk factors, for example, hypertension and dyslipidemia. In recent years, special attention has been devoted to both thiazolidindiones (TZDs) and angiotensin converting enzyme (ACE) inhibitors as clinical trials revealed that these drugs may reduce the rate of progression to diabetes or delay the onset of diabetes, regression of impaired glucose tolerance (IGT) to normoglycemia and reduces the composite of all-cause mortality, nonfatal myocardial infarction and stroke in patients with diabetes. This review focuses on the potential roles of rosiglitazone, a member of TZD class of antidiabetic agents, and ramipril, an ACE inhibitor, in preventing the preclinical macrovasculopathy in diabetes and IGT population. [ABSTRACT FROM AUTHOR]

Abstract: Type II diabetes patients have increased risk of macrovascular complications compared with the general population. Arterial stiffness is considered as an independent predictor of macrovascular events. This study investigated arterial stiffness in newly diagnosed never treated diabetes and impaired glucose tolerance (IGT) patients without any traditional cardiovascular diseases (CVD) risk factors. After preliminary screening of 1620 individuals, 30 diabetic and 30 IGT patients were recruited and compared with age- and sex-matched 30 normoglycaemic subjects. The subjects were newly diagnosed, never treated, normotensive, non-obese, non-hyperlipidaemic and non-smoker. Haemodynamic variables, pulse wave velocity (PWV) and augmentation index (AI) were measured. The PWV was significantly higher in diabetic patients (10.37±2.64m/s vs. 8.70±1.29m/s; p =0.035) and was of borderline significant in IGT subjects (9.54±1.56m/s vs.8.70±1.29m/s, p =0.078) compared to normoglycaemic individuals. Augmentation index was higher of borderline significant in diabetic (134.53±17.32% vs. 129.17±11.18%, p =0.055) and IGT patients (132.02±16.11% vs. 129.17±11.18%, p =0.059) compared to normoglycaemic individuals. The study demonstrated that newly diagnosed never treated diabetic patients without any CV complications had early manifestation of macrovascular diseases as evident by increased arterial stiffness. The findings also revealed early manifestations of preclinical vasculopathy and potentially increased risk for development of macrovascular diseases at an early age in diabetic patients. [Copyright &y& Elsevier]

The objective of the present study was to measure the glycemic index of durian, papaya, pineapple and watermelon grown in Malaysia. Ten (10) healthy volunteers (5 females, 5 males; body mass index 21.18±1.7kg/m²) consumed 50 g of available carbohydrate portions of glucose (reference food) and four test foods (durian, papaya, pineapple and watermelon) in random order after an overnight fast. Glucose was tested on three separate occasions, and the test foods were each tested once. Postprandial plasma glucose was measured at intervals for two hours after intake of the test foods. Incremental areas under the curve were calculated, and the glycemic index was determined by expressing the area under the curve after the test foods as a percentage of the mean area under the curve after glucose. The results showed that the area under the curve after pineapple, 232±24 mmol x min/L, was significantly greater than those after papaya, 147±14, watermelon, 139±8, and durian, 124±13 mmol x min/L (p<0.05). Similarly, the glycemic index of pineapple, 82±4, was significantly greater than those of papaya, 58±6, watermelon, 55±3, and durian, 49±5 (p<0.05). The differences in area under the curve and glycemic index among papaya, watermelon and durian were not statistically significant. We conclude that pineapple has a high glycemic index, whereas papaya is intermediate and watermelon and durian are low glycemic index foods. The validity of these results depends on the accuracy of the data in the food tables upon which the portion sizes tested were based. [ABSTRACT FROM AUTHOR]

To investigate whether pharmacological interventions with rosiglitazone/ramipril can reverse preclinical vasculopathy in newly diagnosed untreated patients with type 2 diabetes (T2DM) and impaired glucose tolerance (IGT). In this randomised, double-blind, placebo-controlled study, 33 T2DM and 33 IGT patients were randomised to 4 mg rosiglitazone or 5 mg ramipril or placebo for 1 year. The subjects were newly diagnosed, untreated, normotensive, nonobese, nonsmoker, and nonhyperlipidaemic. Haemodynamic variables were measured at three treatment phases and pulse wave velocity (PWV) and augmentation index (AI) were measured throughout the treatment period. Rosiglitazone showed a significant reduction in PWV ( p=0.039) and AI ( p=0.031) and ramipril demonstrated a significant reduction of AI ( p=0.025) in IGT in comparison to placebo on the 12th month of treatment. No significant difference was observed in PWV and AI in T2DM with rosiglitazone/ramipril in comparison to placebo during overall treatment period. Rosiglitazone significantly reversed preclinical vasculopathy in IGT as evident by significant decrease in PWV and AI after 1 year of treatment. Ramipril also reduced large artery stiffness as shown by significant decrease of AI after 1 year of treatment in IGT. Further trials are needed for a longer period of time, maybe with higher doses, to show whether rosiglitazone/ramipril can reverse preclinical vasculopathy in T2DM. [ABSTRACT FROM AUTHOR]

Insulin insensitivity is a common finding in several metabolic disorders including glucose intolerance, dyslipidemia, hyperuricemia and hypertension. Most of the previous studies on insulin sensitivity were performed on diabetic or obese population. So our knowledge about insulin sensitivity of healthy population remains limited. Rising prevalence of obesity, diabetes and metabolic syndrome is a serious issue in Malaysia and some other rapidly developing countries. So it is important to look at the insulin sensitivity status of healthy Malaysian subjects and to compare it in future with those of diabetic, obese or metabolic syndrome patients. In this study we sampled subjects who were independent of confounding factors such as obesity (including abdominal obesity), hypertension and glucose intolerance (diabetes, IGT or IFG) which may influence insulin sensitivity. Fasting plasma glucose, fasting insulin and lipid profile were determined. Insulin sensitivity and secretory status were calculated using the homeostasis model assessment (HOMA) software (HOMA %S, HOMA % B and HOMA-IR). The insulin sensitivity (HOMA%S) of healthy Malay subjects aged between 30-60 years was 155.17%, HOMA-IR was 1.05 and HOMA%B was 116.65% (values adjusted for age, sex, BMI and waist circumference). It was seen that non-obese Malaysians can prevent age related lowering of insulin sensitivity if they can retain their BMI within limit. [ABSTRACT FROM AUTHOR]

We examined the effect of diabetes knowledge and attitudes on self-management and quality of life (QoL) of people with type 2 diabetes mellitus (T2DM). We employed a cross-sectional study design. A total of 137 female and 129 male participants with T2DM completed the diabetes knowledge scale (DKN), Diabetes Integration Scale-19 (ATT19), Summary of Diabetes Self-care Activities (SDSCA) scale, and Diabetes Quality of Life (DQoL) scale, measuring diabetes knowledge, attitudes, self-management, and QoL respectively. The SDSCA scale measures diet, exercise, blood glucose monitoring, and foot care. The DQoL scale measures satisfaction and impact of QoL. An initial path model that tested the inter-relationships of the study variables was first identified based on previous research. Then, the path model was tested using Mplus 7.3. In the final model, diabetes knowledge was a significant predictor of attitudes and self-management in terms of blood glucose monitoring and foot care. Attitudes was a significant predictor of impact of QoL. Self-management in terms of blood glucose monitoring was a significant predictor of impact of QoL and diet was a significant predictor of satisfaction and impact of QoL. Exercise and foot care aspects of Self-management were significant predictors of satisfaction and impact of QoL respectively. The final model showed a good fit to the data: RMSEA = .045 (90% CI: .009, .071; Clfit = .601), CFI = .950, SRMR = .058. The findings suggest a theoretical basis to direct the development of appropriate health programs and interventions for improving QoL in people with T2DM and warrant replication in diverse samples. [ABSTRACT FROM PUBLISHER]

Introduction: The glycaemic index (GI) concept is useful for diet planning and identifying foods in the usual Malaysian diet with desired glycaemic effects such as delayed rise in blood glucose and low area under the curve. The purpose of this study was to measure the GI of durian, papaya, pineapple and watermelon that are grown in Malaysia. Methodology: This was an experimental study done within the Dietetics laboratory, Program in Dietetics, School of Health Sciences, Universiti Sains Malaysia. We selected ten healthy volunteers (5 females and 5 males) and gave 50 g available carbohydrate portions of glucose (reference food) and four test foods (durian, papaya, pineapple and watermelon) in random order after an overnight fast. Glucose was tested on three separate occasions and the test foods were each tested once. Postprandial plasma blood glucose levels were measured for two hours after intake of the test foods and incremental area under the curve (AUC) was calculated for both the test and reference foods. The GI of the test foods was determined by dividing AUC after the test foods by that after glucose. Results: The results showed that the mean AUC of pineapple was 232±24, papaya was 147±14, watermelon as 139±8 and durian was 124±13. The mean GI of pineapple was 90±9, papaya was 58±6, watermelon was 55±3 and durian was 49± 5. Statistical analysis showed significant difference (p<0.05) in AUC between pineapple and the other three foods (durian, papaya and watermelon). The GI of pineapple was also significantly higher than that of the other 3 fruits (p< 0.05). Conclusion: We conclude that pineapple is a high GI food whereas papaya is intermediate and watermelon and durian are low GI foods. [ABSTRACT FROM AUTHOR]

Introduction: The glycemic index (GI) is the classification of foods rich in carbohydrates based on the food's effect on blood sugar compared with a standard reference food's effect. The objective of this study was to determine the GI of Malaysian wild honey and Australian honey. Methodology: This was an experimental study performed at the Dietetics laboratory, Program in Dietetics, School of Health Sciences, and Universiti Sains Malaysia. A total of 10 healthy volunteers, five men and five women, aged 24 - 44 y, with normal body mass indices, were recruited. Subjects were served portions of two varieties of honey and a standard food (glucose), on separate occasions, each containing 50 g carbohydrate. Capillary blood glucose was measured from finger-prick samples in fasted subjects (0 min) and at 15, 30, 45, 60, 90 and 120 min after the consumption of each test food and the standard food. The GI value of the two types of honey was calculated geometrically by expressing the incremental area under the blood glucose curve (AUC) as a percentage of each subject's average AUC for the standard food. Results: The results showed that the mean AUC of Malaysian wild honey was 174 +/- 19 , Australian honey was 158 ± 16 , and glucose was 259 ± 15 . The mean GI of Malaysian wild honey was 65 ± 7 and Australian honey was 59± 5. Statistical analysis showed significant difference (P<0.05) in AUC between glucose and the two varieties of honey. The GI of Malaysian wild honey was not significantly different from that of Australian honey. Conclusion: We conclude that both Malaysian wild honey and Australian honey are intermediate GI foods. [ABSTRACT FROM AUTHOR]

The complications associated with diabetic vasculopathy are commonly grouped into two categories: microvascular and macrovascular complications. In diabetes, macrovascular disease is the commonest cause of mortality and morbidity and is responsible for high incidence of vascular diseases such as stroke, myocardial infarction and peripheral vascular diseases. Macrovascular diseases are traditionally thought of as due to underlying obstructive atherosclerotic diseases affecting major arteries. Pathological changes of major blood vessels leading to functional and structural abnormalities in diabetic vessels include endothelial dysfunction, reduced vascular compliance and atherosclerosis. Besides, advanced glycation end product formation interacts with specific receptors that lead to overexpression of a range of cytokines. Haemodynamic pathways are activated in diabetes and are possibly amplified by concomitant systemic hypertension. Apart from these, hyperglycaemia, non-enzymatic glycosylation, lipid modulation, alteration of vasculature and growth factors activation contribute to development of diabetic vasculopathy. This review focuses on pathophysiology and pathogenesis of diabetes-associated macrovasculopathy. [ABSTRACT FROM AUTHOR]

A total of 4428 adults (>18 years old) from 5 different selected regions in Peninsular and East Malaysia participated in this health survey. Using World Health Organization recommendations for body mass index (BMI), the prevalence of overweight and obesity were found to be 33.6% (95% CI= 32.2, 35.0) and 19.5% (95% CI= 18.3, 20.7) respectively. There were more females who were obese (22.5%, 95% CI=20.9, 24.0) compared to males (14.1%, 95% CI=12.3, 15.9). Highest prevalence of obesity were among the Indians (24.6%, 95% CI=20.3, 29.3), followed closely by the Malays (23.2%, 95% CI=21.6, 24.8%) and lowest prevalence was among the Chinese subjects (8.2%, 95% CI=6.2, 10.6). More than 43% of the 531 younger subjects (<30 years old) were either overweight (20%, 95% CI=16.6, 23.6) or obese (13.9%, 95% CI=11.1, 17.2%). All subjects who claimed to be non-diabetes were required to undergo 75 g glucose tolerance test. Compared to subjects with normal BMI (18.5-24.9 kg/m2), there was a 3- and 2-folds increase in the prevalence of newly diagnosed diabetes and impaired glucose tolerance respectively, among obese subjects (BMI>30 kg/m2) who initially claimed to have no diabetes. This study highlights a need for more active, inter-sectoral participation advocating a health-promoting environment in order to combat obesity in this country. [ABSTRACT FROM AUTHOR]

Non-communicable diseases (NCDs) are becoming increasingly common and important in developing countries, yet their enumeration is problematic. We have attempted to enumerate NCD patients in a rural district of KwazuluNatal, South Africa, using the techniques of electronic data linkage and capture-recapture (CR). We examined four major NCDs (hypertension, diabetes, asthma and epilepsy). Basic patient details were recorded onto EpiInfo software over a 6-week period, from the main hospital clinic at Hlabisa, as well as the 10 outlying peripheral health clinics. Using electronic data linkage of lists from the main hospital, the peripheral clinics, and repeat prescription cards, a district NCD register was produced of 2455 patients. The mean age was 51 +/- 16 years (1 SD) and 76% were female. Of the total NCD patients, 62% had hypertension (age 57 +/- 12 years, 82% female), 16% epilepsy (age 35 +/- 17 years, 49% female), 13% asthma (age 45 +/- 19 years, 60% female) and 12% diabetes (age 54 +/- 13 years, 61% female). Estimated population crude prevalence rates for known NCD cases on the register were 7.4% for hypertension, epilepsy 0.2%, asthma 0.2% and diabetes 0.2%. We also attempted a CR analysis to assess completeness of data, by comparing overlap between patients attending peripheral clinics, and the central Hlabisa Hospital clinic. Matching by name, age, and diagnosis proved feasible, but there was little overlap, and CR calculations were invalid because of the relative independence of sources. We conclude that NCDs are common in rural Africa, and that a simple NCD district register is a potentially feasible and inexpensive option. Capture-recapture analysis is feasible, but requires suitable lists with acceptable overlap of patients. [ABSTRACT FROM AUTHOR]