Acute diarrhoea is a major health problem in many parts of the world, contributing to about 1.8 million deaths globally. The objectives of the study were to assess the incidence, determinants, and severity of acute diarrhoea in the population. A nation-wide cross-sectional survey involving about 57,000 respondents was conducted via face-to-face interview among eligible respondents of all ages. An acute diarrhoeal episode was defined as having three or more episodes of loose stools in any 24-hour period within the past four weeks before the interview. The severity was measured by duration of acute diarrhoea and associated symptoms. The variables tested as determinants were age, sex, ethnicity, the highest educational level, total monthly household income, and locality. Univariate, bivariate and multivariate procedures meant for complex study design were used in the analyses. The four-week incidence of acute diarrhoea was 5% [95% confidence interval (CI) 4.8-5.2]. The incidence of acute diarrhoea among the estimated population was the highest among young adults aged 20-29 years, Other Bumiputras (the pre-dominant ethnic group in East Malaysia), those with tertiary-level of education, those earning a monthly household income of less than RM 400, and rural dwellers. Only age, ethnicity, the highest level of education attained, and locality were significantly associated with acute diarrhoea in bivariate analysis. In multivariate analysis, these four variables were found to be the determinants of acute diarrhoea. Sex and monthly household income were excluded from the model. The mean duration of acute diarrhoea was 2.0 days (standard deviation 1.3). Forty-six percent of the respondents reported stomach cramps as an associated symptom. The findings revealed that acute diarrhoea is still a major public-health concern in Malaysia and grossly under-notified. There is a need for intensification of public-health intervention efforts to reduce the incidence of acute diarrhoea while improving surveillance and notification of the disease.

Objective: To determine the relationship between BMI and risk of CVD mortality and all-cause mortality among Malaysian adults. Design: Population-based, retrospective cohort study. Participants were followed up for 5 years from 2006 to 2010. Mortality data were obtained via record linkages with the Malaysian National Registration Department. Multiple Cox regression was applied to compare risk of CVD and all-cause mortality between BMI categories adjusting for age, gender and ethnicity. Models were generated for all participants, all participants the first 2 years of follow-up, healthy participants, healthy never smokers, never smokers, current smokers and former smokers. Setting: All fourteen states in Malaysia. Subjects: Malaysian adults (n 32 839) aged 18 years or above from the third National Health and Morbidity Survey. Results: Total follow-up time was 153 814 person-years with 1035 deaths from all causes and 225 deaths from CVD. Underweight (BMI < 18·5 kg/m 2 ) was associated with a significantly increased risk of all-cause mortality, while obesity (BMI ≥ 30·0 kg/m 2 ) was associated with a heightened risk of CVD mortality. Overweight (BMI = 25·0-29·9 kg/m 2 ) was inversely associated with risk of all-cause mortality. Underweight was significantly associated with all-cause mortality in all models except for current smokers. Overweight was inversely associated with all-cause mortality in all participants. Although a positive trend was observed between BMI and CVD mortality in all participants, a significant association was observed only for severe obesity (BMI ≥ 35·0 kg/m 2 ). Conclusions: Underweight was associated with increased risk of all-cause mortality and obesity with increased risk of CVD mortality. Therefore, maintaining a normal BMI through leading an active lifestyle and healthy dietary habits should continue to be promoted.Obesity is becoming a major public health problem in both developed and developing countries (1) . The most recent WHO global estimate showed that in 2014, 39 % of adults (≥18 years old) were overweight (38 % of males and 40 % of females). An estimated 11 % of adult males and 15 % of adult females were obese. Thus, approximately half a billion of the world's adult population were obese (2) . The National Health and Morbidity Survey (NHMS) conducted in 2011 (3) reported that 29·4 % of Malaysian adults (≥18 years old) were overweight and 15·1 % were obese by the WHO classification (4) .Previous studies have demonstrated a link between overweight and obesity and risk of all-cause, CVD, cancer and mortality from other causes (5)(6)(7) . The WHO listed overweight and obesity as the fifth leading risk factor for death globally in 2008. At least 2·8 million adults die each year as a result of being overweight or obese. Most of the large prospective observational studies that evaluated the relationships between BMI and risks of all-cause and cause-specific mortality were carried out in European, America and a few Asian countries (8,9) . The relationship between obesity and ris...

Two methods of identifying smokers with high nicotine dependence, the heaviness of smoking index (HSI) and number of cigarettes per day (CPD) were compared with the Fagerstrom test for nicotine dependence (FTND). The HSI, CPD and the FTND were administered to 316 adult Malaysian male, daily smokers aged between 25-64 years old in the Malaysian NCD Surveillance-1 Survey using a two-stage stratified random sampling of enumeration blocks and living quarters, via an interview based on a validated questionnaire. The cut-off point for classification of high nicotine dependence on the HSI was a score of four or higher, and for the heavy smoking category, smoking more than 20 cigarettes per day. Classification using each method was compared with classification by the FTND (score of six or more) as the reference standard. Sensitivity, specificity and kappa statistics for concordance between both measures and the FTND were evaluated. The HSI gave a similar prevalence rate of high nicotine dependence as the FTND. There was substantial agreement between the HSI and the FTND (kappa=0.63.), with moderate sensitivity (69.8%) and high specificity (92.5%). However, prevalence of high nicotine dependence using the CPD was 7% lower than the FTND. The heavy smoking category also showed fair agreement with the FTND (kappa=0.45) and moderate sensitivity (67.0%), but specificity was high (86.9%). The findings indicate that the HSI can be used as an alternative to the FTND in screening for high nicotine dependence among daily smokers in large population-based studies, while CPD may not be a suitable alternative to the FTND. Keywords: Fagerström test for nicotine dependence -heaviness of smoking index -heavy smoking -Malaysians