Wan Mohd Izani Wan Mohamed

Background: The increasing prevalence of overweight and obesity highlights the need for practical and sustainable dietary strategies for weight management. Although dietary fibre intake is associated with improved satiety and metabolic health, achieving recommended intake levels through whole foods alone remains challenging. Evidence supporting convenient, ready-to-consume fibre beverages in free-living overweight adults is also limited. Therefore, this study evaluated the effects of a soya-based dietary fibre beverage (SBB) on body composition and metabolic parameters in overweight adults. Methods: A 12-week parallel, cluster-randomized controlled trial was conducted on overweight university students and staff. An intervention group (IG) (n = 21) consumed the soya-based dietary fibre twice daily for 12 weeks, while the control group (CG) (n = 21) continued their habitual diet. Results: Significant group × time interactions were observed for body weight (p < 0.001), BMI (p = 0.021), waist circumference (p = 0.046), waist-to-hip ratio (p = 0.042), and body fat percentage (p = 0.004). The IG showed reductions in body weight (−1.12 kg), waist circumference (−4.29 cm), and body fat percentage (−0.73%), whereas the CG demonstrated minimal changes. No significant changes were observed in fasting glucose, lipid profile, CRP, or IL-6, suggesting no clinically significant adverse biochemical changes during the intervention period and supporting its short-term tolerability. Dietary analysis confirmed a marked increase in fibre intake in the IG (~50 g/day), indicating good adherence to the intervention. Conclusions: SBB supplementation improved body composition and central adiposity without affecting systemic inflammatory biomarkers and may represent a practical dietary approach for weight management in free-living overweight adults. Further studies are needed to confirm its long-term efficacy and safety.

Background: Many patients with T2DM on insulin are not optimally controlled despite receiving standard diabetes education counselling. Poor insulin adherence may be a contributing factor. We developed and evaluated a new module [Universiti Sains Malaysia-Insulin Adherence Module (USM-IAM)] on insulin-treated patients with poorly controlled diabetes.Methods: Eligibility criteria are those diagnosed with T2DM, aged between 18 and 65 years, with HbA1c between 8 and 15% and on insulin therapy for 1 year. Patients were randomly allocated to receive either the USM-IAM-based counselling or the standard counselling (SC) at baseline and the second visit. Patients were instructed to adjust insulin doses based on blood glucose levels. Outcomes were changes in adherence score, FBS and HbA1c levels from baseline to 3 months and baseline to sixth month.Results: Ninety patients were randomised to each group. The baseline sociodemographic and clinical characteristics were homogenous among groups. Ninety patients were analysed for each group. Adherence score changes between baseline to 3 months were − 8.30 (− 11.47, − 5.14) in USM-IAM-based counselling group (USM-IAM) and − 7.64 (− 10.89, − 4.40) in standard counselling group (SCG), between baseline to sixth month were − 10.21 (− 13.40, − 7.03) in USM-IAM and − 10.79 (− 14.64, − 6.97) in SCG. FBS changes between baseline to 3 months were 1.374 (0.25, 2.50) in USM-IAM and 0.438 (− 0.66, 1.54) in SCG, and between baseline to sixth month were 1.713 (0.473, 2.95) in USM-IAM and 0.998 (− 0.02, 2.01) in SCG. HbA1c changes between baseline to 3 months were 1.374 (0.25, 2.50) in USM-IAM and 0.547 (0.12, 0.98) in SCG, and between baseline to sixth month were 1.03 (0.65, 1.41) in USM-IAM and 0.617 (0.20, 1.03) in SCG. Between-subjects effects for all outcomes were not statistically significant.Conclusion: Both groups had significant improvements in adherence score and HbA1c with time, with higher improvement in patients receiving the USM-IAM. FBS reductions were significant in the intervention group but not in the control group.Trial registration: This study protocol is registered withClicaltrials.govwith ID NCT05125185 dated 17th November 2021.

Background : Achieving good glycaemic control is essential to reducing the risk of diabetes complications. Insulin is the most effective therapy for achieving good glycaemic control; however, it is associated with a higher risk of hypoglycaemia, especially with human insulin. This study aimed to evaluate the efficacy of intensification from human to analogue insulin and its added cost. Methods : This retrospective study was conducted at the Hospital Universiti Sains Malaysia (HUSM). Patients with type 2 diabetes mellitus (T2DM) who underwent intensification for at least 3 months from human to analogue insulin were included in this study. The patients' medical records, haemoglobin A1c (Hba1c) and fasting blood sugar (FBS) were retrieved. The total cost pre- and post -intensification of insulin was obtained from the pharmacy database. Differences in HbA1c, FBS and total insulin cost pre- and post -intensification were analysed. Results : A total of 163 patients with T2DM who had intensification from human to analogue insulin were included in this study. HbA1c and FBS levels were significantly lower in analogue insulin. However, the differences were not clinically significant, as the mean reduction in HbA1c was less than 0.5%. Meanwhile, the total costs of analogue insulin for 3 months were higher. Conclusion : There were no clinically significant improvements in patients' HbA1c and FBS after the intensification of insulin, despite the extra costs spent. Hence, it is vital to choose the right group of patients to receive an insulin analogue to maximise its benefit but at the most optimal cost.

Background : Many patients with type 2 diabetes mellitus (T2DM) do not achieve the desired glycaemic control despite being treated with insulin. Studies found this due to an improper understanding of insulin function, its intensification process and patients' negative perspective on insulin. We developed an education module to enhance adherence to insulin therapy. Methods : This study applied a mixed design. It was conducted in three phases: i) Phase I: literature search and focus group discussions (FGDs), ii) Phase II: module development and iii) Phase III: content and face validation of Universiti Sains Malaysia -Insulin Adherence Module (USM-IAM). FGDs were used to gather patients' opinions. All researchers repeatedly discussed about the module content and arrangement, the words and images used, and the grammar in producing the final draft. Specialists and target audience performed content and face validation of the module. Results : Thirty-six participants were involved in the FGDs. Data saturation was achieved at the 4th FGD. Three themes emerged from qualitative data analysis and were incorporated into the module. USM-IAM was finalised with five units. The content validity index (CVI) was 0.92, while face validity agreements were between 86% and 97%. Conclusion : The CVI and face agreement for USM-IAM exceed the cut-off point for a sound module. It has good potential to be used as a resource for educating patients in enhancing insulin adherence.

Background: Many patients with T2DM on insulin are not optimally controlled despite receiving standard diabetes education counselling. Poor insulin adherence may be a contributing factor. We developed and evaluated a new module [USM-Insulin Adherence Module (USM-IAM)] on insulin-treated patients with poorly controlled diabetes. Methods: Eligibility criteria are those diagnosed with T2DM, aged between 18 and 65 years, with HbA1c between 8 -15% and on insulin therapy for one year. Patients were randomly allocated to receive either the USM-IAM-based counselling or the standard counselling at baseline and the second visit. Patients were instructed to adjust insulin doses based on blood glucose levels. Outcomes were changes in adherence score, FBS and HbA1c levels from baseline to three months and baseline to sixth month. Results: Ninety patients were randomised to each group. The baseline sociodemographic and clinical characteristics were homogenous among groups. Ninety patients were analysed for each group. Adherence score changes between baseline to three months were -8.30 (-11.47, -5.14) in UCG and -7.64 (-10.89, -4.40) in SCG, between baseline to sixth month were -10.21 (-13.40, -7.03) in UCG and -10.79 (-14.64, -6.97) in SCG. FBS changes between baseline to three months were 1.374 (0.25, 2.50) in UCG and 0.438 (-0.66, 1.54) in SCG, and between baseline to sixth month were 1.713 (0.473, 2.95) in UCG and 0.998 (-0.02, 2.01) in SCG. HbA1c changes between baseline to three months were 1.374 (0.25, 2.50) in UCG and 0.547 (0.12, 0.98) in SCG, and between baseline to sixth month were 1.03 (0.65, 1.41) in UCG and 0.617 (0.20, 1.03) in SCG. Conclusion: Both groups had significant improvements in adherence score and HbA1c with time, with higher improvement in patients receiving the USM-IAM-based counselling. FBS reductions were significant in the intervention group but not in the control group. Trial registration: This study protocol is registered with Clicaltrials.gov with ID NCT05125185 dated 17th November 2021.

Che Anis Jauharah Che Mohd Zin, Wan Mohd Izani Wan Mohamed, Nurzalina Abdul Karim Khan, and Wan Rosli Wan Ishak. Prev Nutr Food Sci 2022;27:257-64. https://doi.org/10.3746/pnf.2022.27.3.257

(1) Background: Several studies have suggested that the vitamin D receptor (VDR) gene plays a role in type 2 diabetes mellitus (T2DM) susceptibility. Nonetheless, the association between T2DM and VDR polymorphisms remains inconclusive. We determined the genotype of VDR rs1544410 (BsmI) and rs2228570 (FokI) polymorphisms among Malaysian patients with T2DM and their association with glycemic control factors (vitamin D levels, calcium, magnesium, and phosphate). (2) Methods: A total of 189 participants comprising 126 patients with T2DM (63 with good glycemic control and 63 with poor glycemic control) and 63 healthy controls were enrolled in this case–control study. All biochemical assays were measured using spectrophotometric analysis. VDR gene FokI and BsmI polymorphisms were analyzed using polymerase chain reaction and endonuclease digestion. (3) Results: Our findings revealed no significant differences in VDR FokI and BsmI genotypes between participants with T2DM and healthy controls. Moreover, no significant association was observed between both single nucleotide polymorphisms and glycemic control factors. Participants with poor glycemic control had significantly lower serum magnesium levels and significantly higher HOMA-IR compared to the other groups. (4) Conclusions: The present study revealed that VDR gene BsmI and FokI polymorphisms were not significantly associated with T2DM.

Thyroid hormones have a catabolic effect on bone homeostasis. Hence, this study aimed to evaluate serum vitamin D, calcium, and phosphate and bone marker levels and bone mineral density (BMD) among patients with different thyroid diseases. This cross-sectional study included patients with underlying thyroid diseases (n = 64, hyperthyroid; n = 53 euthyroid; n = 18, hypothyroid) and healthy controls (n = 64). BMD was assessed using z-score and left hip and lumbar bone density (g/cm²). The results showed that the mean serum vitamin D Levels of all groups was low (<50 nmol/L). Thyroid patients had higher serum vitamin D levels than healthy controls. All groups had normal serum calcium and phosphate levels. The carboxy terminal collagen crosslink and procollagen type I N-terminal propeptide levels were high in hyperthyroid patients and low in hypothyroid patients. The z-score for hip and spine did not significantly differ between thyroid patients and control groups. The hip bone density was remarkably low in the hyperthyroid group. In conclusion, this study showed no correlation between serum 25(OH)D levels and thyroid diseases. The bone markers showed a difference between thyroid groups with no significant difference in BMD.