Nafiza Mat Nasir

Linguistic and psychometric validation of the Malaysian version of Diabetes Quality of Life-Brief Clinical Inventory (DQoL-BCI)

Background: Quality of life (QoL) assessment provides valuable outcome to support clinical decision‐making, particularly for patients with chronic diseases that are incurable. A brief, 15‐item diabetes‐specific tool [i.e. Diabetes Quality of Life‐Brief Clinical Inventory (DQoL‐BCI)] is known to be developed in English and validated for use in clinical practice. This simplified tool, however, is not readily available for use in the Malaysian setting. Objective: To translate the DQoL‐BCI into a Malaysian version and to assess its construct validity (factorial validity, convergent validity and discriminant validity), reliability (internal consistency) and floor and ceiling effects among the Malaysian diabetic population. Material and methods: A forward‐backward translation, involving professional translators and experts with vast experience in translation of patient reported outcome measures, was conducted. A total of 202 patients with Type 2 diabetes mellitus (T2DM) who fulfilled the inclusion criteria were invited to complete the translated DQoL‐BCI. Data were analysed using SPSS for exploratory factor analysis (EFA), convergent and discriminant validity, reliability and test‐retest, and AMOS software for confirmatory factor analysis (CFA). Results: Findings from EFA indicated that the 4‐factor structure of the Malaysian version of DQoL‐BCI was optimal and explained 50.9% of the variance; CFA confirmed the 4‐factor model fit. There was negative, moderate correlation between the scores of DQoL‐BCI (Malaysian version) and EQ‐5D‐3L utility score (r = −0.329, p = 0.003). Patients with higher glycated haemoglobin levels (p = 0.008), diabetes macrovascular (p = 0.017) and microvascular (p = 0.013) complications reported poorer QoL. Cronbachs alpha coefficient and intraclass coefficient correlations (range) obtained were 0.703 and 0.86 (0.734–0.934), indicating good reliability and stability of the translated DQoL‐BCI. Conclusion: This study had validated the linguistic and psychometric properties of DQoL‐BCI (Malaysian version), thus providing a valid and reliable brief tool for assessing the QoL of Malaysian T2DM patients. HighlightsA Diabetes Quality of Life Brief Clinical Inventory (DQoL‐BCI Malaysian version) to assess QoL of type 2 diabetic patients.This shorten scale instrument is able to measure all relevant dimensions as did the full version of DQoL.It is useful in routine clinic visits and research settings.

674 CARDIOVASCULAR RISK FACTORS ASSOCIATED WITH PREHYPERTENSION IN MALAYSIAN ADULTS

Background & Objectives: Malaysia is facing an epidemic of cardiovascular diseases (CVD) withhypertension asa major driver. Given that cardiovascular risk factors (CVRFs) occur in clusters, the aim of the study is to determine the prevalence of CVRFs among Malaysian adults with Prehypertension (PreHT). Methods: This community-based, cross sectional study involving 11,288 adults aged ≥ 30 years was carried out in urban and rural areas in Malaysia between 2007 and 2010. An average of 3 readings of the brachial blood pressures (BP) was recordedwith semi-automated, validated Omron HEM 757 sphygmomanometers. Anthropometric measurements and fasting venous blood for lipid and glucose assays were obtained. Multiple logistic regression analysis was used to determine the factors associated with PreHT. Results: The prevalence of PreHT was 34% (35.4% in males and 33.0% in females). Males (odds ratio [OR] 1.76, 95% confidence interval [CI] 1.43–2.17), rural dwellers (OR 1.29 CI 1.04–1.61), overweight (OR 1.92, CI 1.25–2.95), obesity (OR 2.58, CI 1.60–4.16), increased waist circumference (OR 1.29, CI 1.01–1.65), hypertriglyceridaemia (OR 1.23 CI 1.01–1.49) and family history of hypertension (OR 1.31 CI 1.08–1.58) were more likely to be associatedwith PreHT. Interestingly, waist-hip ratio, total cholesterol, HDL-cholesterol and diabetes mellitus were not associated with PreHT Conclusion: Prevalence of PreHT is overwhelming in Malaysian adults and is associated with multiple CVRFs. Concerted effort must be undertaken aggressively to manage CVRFs in the community and to prevent progression of PreHT to hypertension.

Response to Editor-in-Chief Letter: Linguistic and psychometric validation of the Malaysian version of Diabetes Quality of Life-Brief Clinical Inventory (DQoL-BCI): Methodological issues to avoid misinterpretation

We thank Safiri and Ayubi for their interest in our paper and their valuable comments. Also, we thank the Editor for the opportunity to respond to the letter by Safiri and Ayubi1 that was recently published in Research in Social and Administrative Pharmacy. The authors raised their concerns with regard to a potential overfitting problem which seemed to involve the validation of the Malaysian version of Diabetes Quality of Life-Brief Clinical Inventory (DQoLBCI) using the same dataset for both exploratory factory analysis (EFA) and confirmatory factor analysis (CFA). The overfitting issue, however, may not be relevant in our case. What was not mentioned in themanuscript is that of the 202 dataset collected in the study by Samah et al.,2 100 dataset was run for EFA and the remainders were entered into CFA. This is in line with the minimum datasets required for each analysis. Indeed, to validate the usefulness of the 15-itemMalaysian version of DQoL-BCI, a minimum of 75 datasets was required.3 To avoid the overfitting in the questionnaire validation, two independent datasets (i.e. a minimum of 150 datasets) were needed for testing and confirming the construct/factorial validity of the Malaysian version of DQoL-BCI.

Relationship between coping styles and lipid profile among public university staff

BackgroundThe scarcity of data about coping styles with a biochemical marker namely lipid profile, potentially associated with cardiovascular risk factors is most striking among professionals working in public university. Hence, this research aimed to investigate the relationship between coping styles and lipid profile comprising total cholesterol (TC), triglyceride (TG), HDL-cholesterol (high density lipoprotein-cholesterol) and LDL-cholesterol (Low density lipoprotein-cholesterol) among this group of professionals.MethodsA cross sectional survey was conducted among staff from a tertiary education centre. Subjects were contacted to ascertain their medical history. A total of 320 subjects were interviewed and 195 subjects were eligible and subsequently recruited on a suitable date for taking blood and administration of the questionnaires. The subjects completed questionnaires pertaining to demographic details and coping styles. Pearson’s correlation coefficient was used to measure the strength of association between lipid profile and coping styles.ResultsMajority of the subjects were non-academic staff (60.0%), female (67.2%), Malay (91.8%), married (52.3%) and educated until Diploma level (34.9%). Academic staff scored significantly higher mean scores in task-oriented coping styles (Mean = 64.12). Non-academic staff scored significantly higher mean scores in emotion (Mean = 48.05) and avoidance-oriented coping styles (Mean = 57.61). Malay subjects had significantly higher mean scores in emotion (Mean = 47.14) and avoidance-oriented coping styles (Mean = 55.23). Non-malay subjects (Mean = 66.00) attained significantly higher mean scores in task-oriented coping styles. Single/divorced/widowed individuals scored significantly higher mean scores in emotion (Mean = 48.13) and avoidance-oriented coping styles (Mean = 56.86). There was a significant negative correlation between TC (r = −0.162) and LDL (r = −0.168) with avoidance-oriented coping styles (p = 0.023, p = 0.019 respectively).ConclusionAvoidance-oriented coping style was more likely to engender favourable lipid profile. Hence, assessment of coping styles would certainly assist health care practitioners in predicting subjects who would be at a greater risk of developing cardiovascular diseases.

682 PREVALENCE OF METABOLIC SYNDROME AMONG MALAYSIAN ADULTS AGED ≥ 30 YEARS ACCORDING TO THE NCEP-ATP III, IDF AND JIS DEFINITIONS

Objective: The objective of this study is to compare the prevalence of Metabolic Syndrome (MetS) as defined by the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (NCEP-ATP III)1, International Diabetes Federation (IDF) world-wide definition2 and the ‘harmonised’ definition by the Joint Interim Statement (JIS)3. Methods: A community based cross-sectional study involving 11,288 adults aged ≥ 30 years was conducted in urban and rural areas of Malaysia between 2007 and 2010. Demographic data, waist circumference (WC), blood pressure readings; and fasting venous blood for lipid and glucose assays were obtained. Data was analysed using STATA version 11. Results: Out of the11,288 subjects, 8836 had complete data on all the MetS components and were therefore included in the analysis. Mean age was 53.2 years (SD ± 10.6). The table shows the overall and age-adjusted prevalence of MetS according to the NCEP-ATP III, IDF and JIS definitions by location, gender, ethnicity and education attainment. Table. No title available. Conclusions: The JIS definition gave the highest overall prevalence of MetS among Malaysian adults, as well as the age-adjusted prevalence by location, gender, ethnicity and education attainment. The NCEP-ATP III gave the lowest prevalence due to the higher WC cut points. Prevalence was significantly lower in Chinese and Indigenous groups regardless of the criteria used. There was no significant difference in the prevalence between urban and rural population using IDF and JIS definitions. ReferencesNational Cholesterol Education Program (NCEP)Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002; 106: 3143–421.Alberti KG, Zimmet P, Shaw J, International Diabetes Federation (IDF) Epidemiology Task Force Consensus Group. The metabolic syndrome: a new world- wide definition. Lancet 2005; 366: 1059–62.Alberti KGMM, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. Harmonizing the metabolic syndrome. A Joint Interim Statement (JIS) of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009; 120: 1640–5.

220 OVERWEIGHT AND OBESITY IN MALAYSIA: AN EPIDEMIOLOGY SURVEY

Background and Objective: In Malaysia, the prevalence of overweight and obesity (>18 years old) is escalating with 16.6% and 4.4% in 1996, 29.1% and 14.0% in 2006, and 33.6% and 19.5% in 2008 (1-3). This study aim at continue monitoring the prevalence and its associations as it is strongly related to cardiovascular death (4). Design and Method: A community-based cross sectional study, was carried out in Malaysia between 2007 and 2010, using cut-off points body mass index (BMI) of 23 and 27.5 kg/m2 for overweight and obese (5). Data was analysed using STATA version 11. Results: A total of 10,963 subjects with complete BMI readings, out of 11,572 adult (>18 years old) subjects’ (mean age 51.2±11.0) data were analysed. The age-adjusted prevalence of overweight and obese were 38.3% (95% CI: 37.7- 39.1) and 34.0% (95% CI: 33.0-34.8), with female was significantly more obese (36.7%, CI; 35.4-37.8) than male (30.4%, CI; 29.1-31.7) (p<0.001) and urban population was significantly more obese (36.9%, CI; 35.6-38.1) than rural population (30.9%, CI; 29.6-32.1) (p<0.001). Highest prevalence of obesity were in Malays (38.9%, CI; 37.8-39.9), followed by Indians (35.8%, CI; 30.7-41.2) and lowest in Chinese (17.4%, CI; 15.2-19.5). Obese subjects were 1.8 (CI; 1.44-2.33), 1.7 (CI; 1.04-2.81), 2.38 (CI; 1.34-4.23) and 2.4 (CI; 1.91-3.01) more likely to have dyslipidaemia, impaired fasting glucose (IFG), newly diagnosed diabetes and hypertension, when compared to normal BMI, respectively. Conclusion: This study highlights the serious rise in obesity prevalent which deem the health system into action strategy at national level, as suggested by WHO (6) in fighting globesity. References:Khambalia AZ, Seen LS. Trends in overweight and obese adults in Malaysia (1996–2009): a systematic review. Obesity Reviews. 2010;11(6):403-12.Kee CC, Jamaiyah H, Noor Safiza MN, Geeta A, Khor GL, Suzana S, et al. Abdominal obesity in Malaysian adults: National Health and Morbidity Survey III (NHMS III, 2006). Malaysian Journal of Nutrition. 2008;14(2):125-35.Mohamud WN, Musa KI, Khir AS-M, Ismail AA-S, Ismail IS, Kadir KA, et al. Prevalence of overweight and obesity among adult Malaysians: an update. Asia Pacific Journal Of Clinical Nutrition. 2011;20(1):35-41.Gaziano TA, Bitton A, Anand S, Abrahams-Gessel S, Murphy A. Growing Epidemic of Coronary Heart Disease in Low- and Middle-Income Countries. Current Problems in Cardiology. 2010;35(2):72-115.MOH. Clinical Practice Guideline on the Management of Obesity 2004. 2004.

679 PREVALENCE OF DIABETES MELLITUS AMONG URBAN AND RURAL POPULATION IN MALAYSIA: IS THERE A DIFFERENCE?

Background & Objectives: Diabetes mellitus (DM) is one of the major cardiovascular risk factors. Its prevalence in Malaysia has showed an increased trend in the past three decades. The 3rd Malaysian National Health and Morbidity Survey 2006 reported that 14.9% of adults aged ≥ 30 years had DM. The aim of this study is to determine the prevalence, awareness, treatment and control of DM among the urban and rural population in Malaysia. Methods: This was a cross-sectional community-based study involving 11,288 adults aged ≥ 30 years conducted between 2007 and 2010. Demographic data, anthropometric measurements and venous blood glucose were obtained. Data was analysed using STATA version 11. Results: The prevalence of DM was 15.9 % (CI: 15.2 – 16.5), awareness rate was 76.3% (CI: 74.3 – 78.3), treatment rate was 56.1% (CI: 53.7 – 58.4) and control rate was 57.4% (CI: 55.0 – 59.7). The age, gender and ethnicity adjusted prevalence was significantly higher in the urban than rural population (15.8 % vs 14.5 %, p = 0.002). Similar trend was found for the treatment rate (57.4% vs 45.3%, p = 0.001). However, a reverse trend was seen for the control rate (47.7% vs 53.6%, p = 0.001). There was no significant difference in the adjusted awareness rate observed between urban and rural population (73.8% vs 66.7%, p = 0.356). Conclusions: The prevalence of DM in the urban population is higher in Malaysia. This might reflect the effect of urbanization. However, the control rate was lower for the urban population in spite of having higher treatment rate.

678 CLUSTERING OF CARDIOVASCULAR RISK FACTORS AMONG MALAYSIAN ADULTS IN URBAN AND RURAL POPULATION

Background & Objectives: Cardiovascular disease (CVD) accounts for half of non-communicable disease deaths worldwide. Rapid sosioeonomic progress caused the rural areas to have similar prevalence of cardiovascular risk factors (CVRFs). The aim of the study is to determine the clustering of CVRFs among Malaysians adult in urban population (UP) and rural population (RP). Methods: A community-based, cross sectional study involving 11,288 adults aged ≥ 30 years conducted in urban and rural areas of Malaysia between 2007 and 2010. Average of 3 readings of blood pressure measurements using validated Omron HEM 757 sphygmomanometers was taken. Anthropometric measurements and fasting venous blood for lipid and glucose assays were obtained. Data analysed using STATA version 11. Results: Mean age for study subjects was 53.52 ± 10.61. CVRFs is define as hypertension, hypercholesterolemia, diabetes, low HDL level, obesity and smoking. Table. No title available. Table. No title available. Conclusion: There was similar clustering for CVRFs among urban and rural population in Malaysia.Effective population-based interventionssuch as improved diet and increased physical activity can safely and effectively lower the CVRFs.

699 COMPARING CARDIOVASCULAR RISK FACTOR PROFILES BETWEEN URBAN AND RURAL MALAYSIA

Background & Objective: Cardiovascular diseases were the leading cause of NCD deaths in 2008, with over 80% occurred in low and middle-income countries1. Rapid socioeconomic development and urbanisation are a major force for this development. Our objective was to compare the cardiovascular risk factor (CVRF) profiles between urban and rural Malaysia. Design & Methods: We enrolled 11,288 adults (53.4% urban) between 2007 and 2011. CVRF were obtained through questionnaires, physical examination and fasting blood tests for lipids and glucose. The study was approved by the institutional ethics committee. Results: The urban population (UP) was significantly younger than the rural population (RP), (52.3 + 9.9 years vs 53.9 + 11.7 years; p < 0.001). Age-adjusted prevalence of hypertension was higher in RP (50.5% [49.2–51.8%] vs 45.9% [44.7–47.1%]; p < 0.01). Hypercholesterolemia was more prevalent in UP with higher TC (74.7% [73.5–75.8%] vs 65.3% [63.9–66.7%]; p < 0.001) and higher LDL (69.6% [68.4–70.9%] vs 58.7% [57.3–60.2%]; p < 0.001). However, RP had higher prevalence of hypertriglyceridemia (47.0% [45.5–48.4%] vs 44.6% [43.3–46.0%]; p = 0.266) and low HDL-c (26.7% [25.4–28.0%] vs 20.6% [19.5–21.7%]; p < 0.001). UP has higher prevalence of diabetes, obesity and increased WC; (17.4% [16.5–18.4%] vs 14.3% [13.3–15.2%]; p < 0.01), (36.4% [35.1–37.7%] vs 32.1% [30.7–33.5%]; p < 0.001) and (61.9% [60.6–63.3%] vs 52.2% [50.8–53.7%]; p < 0.001) respectively. There were more current smokers in the RP compared to UP (14.7% [13.6–15.7%] vs 9.9% [9.0–10.7%]; p < 0.001). Conclusions: The burden of CVRF were prevalent both in urban and rural populations in Malaysia with specific differences between them. The health delivery system needs to be streamlined to face this reality such that preventive efforts can be pursued effectively2. ReferencesGlobal status report of noncommunicable diseases (WHO 2010), Available from: http://www.who.int/nmh/publications/ncd_report_full_en.pdf. (retrieved 11 October 2011).S Selvarajah, J Haniff, G Kaur, TG Hiong, KC Cheong, CM Lim and ML Bots for the NHMS III Cohort Study Group. Clustering of cardiovascular risk factors in a middle-income country: a call for urgency. European Journal of Preventive Cardiology 2012. DOI: 10.1177/2047487312437327.

685 CARDIOVASCULAR RISK PROFILES OF THE ELDERLY POPULATION IN MALAYSIA

Background & Objective: Cardiovascular disease (CVD) is the 2nd leading cause of death in Malaysian hospitals and the prevalence of CVD risk factors is especially high amongst the elderly. This study aims to determine the cardiovascular risk profiles of the Malaysian elderly population. Methods: This community-based, cross sectional study involving 3113 adults aged ≥ 60 years was conducted in urban and rural areas in Malaysia between 2007 and 2010. Demographic data, anthropometric measurements and venous blood assays were obtained. Data was analyzed using STATA version 11. Results: Among the 3113 elderly subjects, 55% were from the urban areas and 45% were from the rural areas. 52.1% were males and 47.9% were females. Mean age was 67 years (SD ± 5.86). The subjects consisted of 71.7% Malays, 11.3% Chinese, 2% Indians and 15% others including Bumiputra Sabah & Sarawak. In relation to the various CVD risk factors among the elderly, comparing the urban and rural population, it is illustrated in the table below: Table. No title available. Conclusion: The elderly subjects from the urban areas had a higher prevalence of CVD risk factors compared to the rural areas. CVD risk factors assessment should be conducted routinely in the elderly and treated accordingly to reduce CV mortality in this vulnerable group.