Tengku Saifudin Tengku Ismail

Extrinsic allergic alveolitis

Abstract:  Extrinsic allergic alveolitis (also known as hypersensitivity pneumonitis) is caused by repeated inhalation of mainly organic antigens by sensitized subjects. This induces a hypersensitivity response in the distal bronchioles and alveoli and subjects may present clinically with a variety of symptoms. The aims of this review are to describe the current concepts of the immunological response, the diverse clinical presentation of this disease, the relevant investigations and management, and areas for future studies.

Global differences in lung function by region (PURE): an international, community-based prospective study

BACKGROUND Despite the rising burden of chronic respiratory diseases, global data for lung function are not available. We investigated global variation in lung function in healthy populations by region to establish whether regional factors contribute to lung function. METHODS In an international, community-based prospective study, we enrolled individuals from communities in 17 countries between Jan 1, 2005, and Dec 31, 2009 (except for in Karnataka, India, where enrolment began on Jan 1, 2003). Trained local staff obtained data from participants with interview-based questionnaires, measured weight and height, and recorded forced expiratory volume in 1 s (FEV₁) and forced vital capacity (FVC). We analysed data from participants 130-190 cm tall and aged 34-80 years who had a 5 pack-year smoking history or less, who were not affected by specified disorders and were not pregnant, and for whom we had at least two FEV₁ and FVC measurements that did not vary by more than 200 mL. We divided the countries into seven socioeconomic and geographical regions: south Asia (India, Bangladesh, and Pakistan), east Asia (China), southeast Asia (Malaysia), sub-Saharan Africa (South Africa and Zimbabwe), South America (Argentina, Brazil, Colombia, and Chile), the Middle East (Iran, United Arab Emirates, and Turkey), and North America or Europe (Canada, Sweden, and Poland). Data were analysed with non-linear regression to model height, age, sex, and region. FINDINGS 153,996 individuals were enrolled from 628 communities. Data from 38,517 asymptomatic, healthy non-smokers (25,614 women; 12,903 men) were analysed. For all regions, lung function increased with height non-linearly, decreased with age, and was proportionately higher in men than women. The quantitative effect of height, age, and sex on lung function differed by region. Compared with North America or Europe, FEV1 adjusted for height, age, and sex was 31·3% (95% CI 30·8-31·8%) lower in south Asia, 24·2% (23·5-24·9%) lower in southeast Asia, 12·8% (12·4-13·4%) lower in east Asia, 20·9% (19·9-22·0%) lower in sub-Saharan Africa, 5·7% (5·1-6·4%) lower in South America, and 11·2% (10·6-11·8%) lower in the Middle East. We recorded similar but larger differences in FVC. The differences were not accounted for by variation in weight, urban versus rural location, and education level between regions. INTERPRETATION Lung function differs substantially between regions of the world. These large differences are not explained by factors investigated in this study; the contribution of socioeconomic, genetic, and environmental factors and their interactions with lung function and lung health need further clarification. FUNDING Full funding sources listed at end of the paper (see Acknowledgments).

Effects of adding tocotrienol-tocopherol mixed fraction and vitamin C supplementation on coronary risk biomarkers in patients with hypercholesterolaemia with moderate coronary risk.

Article history: Received on: 07/01/2016 Revised on: 07/02/2016 Accepted on: 24/03/2016 Available online: 30/04/2016 This study was a prospective clinical trial to investigate the effects of adding combined tocotrienol-tocopherol mixed fraction (TTMF) and vitamin C (TTMF+C) supplementation on coronary biomarkers in non-statin and statin treated patients with hypercholesterolaemia (HC) with moderate coronary risk. A total of 35 patients were randomised at baseline into one of two groups, (G1) TTMF+C (320mg TTMF plus 500mg vitamin C) alone daily and (G2) TTMF+C (320mg TTMF plus 500mg vitamin C) plus atorvastatin 10 mg daily. The entire supplementation were taken for 12 months. Fasting serum samples were taken at baseline, 2weeks, 3months, 6months and 12months post-randomisation and analysed for inflammatory biomarkers; high sensitivity Creactive protein (hsCRP) and interleukin-6 (IL6). Combination of TTMF and vitamin C supplementation leads to neutral effects on lipid profiles and inflammation; with no added benefit in statin-treated HC patients with moderate coronary risk. This neutral effects may be attributed to the tocopherol composition in TTMF which could possibly attenuate any potential beneficial effects of tocotrienols. Clinical studies using pure tocotrienols in the absence of tocopherols would further confirm this.

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.

676 DYSLIPIDAEMIAS IN THE MALAYSIAN POPULATION

Background: Coronary artery disease (CAD) is the leading cause of mortality globally, primarily attributed by atherosclerosis, of which dyslipidaemia is one of the main risk factors. There is limited data in Malaysia on the prevalence and awareness of having dyslipidaemia, and the proportion who are treated. Objectives: To investigate the prevalence of (1)dyslipidaemia; (2)awareness of dyslipidaemia and (3)subjects with dyslipidaemia who are treated. Methodology: This was a cross-sectional study involving 11,525 Malaysian subjects from various rural and urban populations, with representations from the three major ethnic groups (age mean + SD: 52.6 + 11.3years; 6487 females, 5038males). Clinical history and physical examinations were performed and fasting blood samples were collected for the measurement of lipid profiles. Dyslipidaemia was defined by mild, moderate or severe hypercholesterolaemia(HC):TC > 5.2, 6.5 and 7.8mmol/L respectively, or hypertriglyceridaemia (HTG):TG > 1.7 mmol/L, or low HDL-c:females < 1.3, males < 1.0mmol/L. Questionnaires were completed for data on awareness and treatment of dyslipidaemia. Results: Subjects with HC and HTG were 66.9% and 40.9% respectively. Low HDL-c were found in 15.2% and 74.9% in females and males respectively. Among those with HC, 42.6%, 19.3% and 5.0% had mild, moderate and severe HC respectively. Awareness of dyslipidaemia was only found in 13.9% of the population, of whom only 8.0% were on treatment. Conclusion: There is a high prevalence of dyslipidaemias in Malaysia, majority of whom are unaware of having the major risk factor for atherosclerosis-related complications such as CAD. Hence, there is an urgent need for coronary risk identification, prevention and intervention to combat the global epidemic of CAD

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.

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.