Type 2 diabetes is a non-communicable disease that affects most people around the world and is generally the result of excessive food intake and physical inactivity. Therefore, the purpose of this review was to identify facilitators and barriers for lifestyle modifications among type 2 diabetes patients. We combined quantitative and qualitative studies for this systematic narrative review. A literary search was carried out using EBSCO, HighWire Press, Medline, PsycInfo, PubMed and Scopus. Narrative review was used to extract results from quantitative studies, while thematic synthesis was used to extract results from qualitative studies. Twenty-three studies were included in this review, with a total of 2287 participants from Western, Arab and Asian populations. The two main themes generated from this review are intrinsic factors and extrinsic factors that can either be facilitators or barriers to implementing lifestyle change. Among the barriers faced by the participants are established food habits, lack of self-efficacy, lack of motivation, lack of social support, inadequate knowledge, low socioeconomic status, food culture and poor time management. In contrast, the facilitating factors generated are strong self-efficacy, high motivation, good habits, and sufficient knowledge. In general, patients with diabetes observed more barriers than facilitators to implementing healthy lifestyle changes.

Early childhood caries (ECC) is one of the most prevalent dental diseases among children and is related to their early feeding practices. This multi-factorial disease involves susceptible tooth and host, fermentable carbohydrates in the diet, cariogenic micro-organisms and time (American Academy of Pediatric Dentistry, 2008). Thus, this study aimed to identify the associations between bottle-feeding and weaning practices, and ECC formation. By using convenience sampling, 201 children were recruited from the IIUM Outpatient Dental Clinic and ten kindergartens around the area of Kuantan, in the state of Pahang (Malaysia). Examination for caries was conducted visually to determine caries status (with or without caries). The caregivers were requested to fill in a questionnaire regarding feeding practices of their children. The findings of the study indicated that 67% of the children identified with caries practiced bottle-feeding in bed either sometimes or always (every night/day) (p=0.005). The prevalence of ECC was also significantly (p<0.001) the highest (48.5%) among children who had been bottle-feeding for the longest duration (>4 years) among the study population. In addition, the mean intake of sweetened drinks among children with ECC was significantly higher than those with no ECC (5.4 vs. 3.1 servings/week, p=0.001). The results of this research indicated that the increased frequency and prolonged duration of bottle-feeding practices, as well as high consumption of sweet drinks during weaning, could be associated with the formation of ECC. In conclusion, these findings would increase the awareness particularly among parents regarding bottle-feeding practices and weaning diet contents and its potential implication on their children's oral health.

Pancreas divisum (PD) is a congenital anomaly in which the ventral and dorsal pancreatic ducts fails to fuse in the early fetal period. This anomaly has been known to rarely cause recurrent pancreatitis and to require surgical intervention. With the recent advances in image diagnostic procedures, an increasing incidence of this anomaly has been recognized in the pediatric age group. Seven cases of PD were encountered in our institution between 1978 and 1998. Six were female and one was male, with a mean age of 8 years. All cases were diagnosed to have PD by endoscopic retrograde pancreatography (ERCP) or operative pancreatography. One case (14.3%) had PD associated with a bout of pancreatitis and was operated on by transduodenal papilloplasty, but recurrent bouts of pancreatitis led to the performance of longitudinal pancreaticojejunostomy (Puestow procedure). Six cases (85.7%) were found to have PD as an incidental finding during operation for congenital dilatation of the bile ducts (CDBD), however, 2 cases (33.3%) out of the 6 developed pancreatitis in a later stage and ERCP was effective in their follow-up assessment. One benefited from conservative treatment while the other needed transduodenal papilloplasty along with pancreatoductoplasty. Imaging procedures (ERCP or operative pancreatography) revealed complete PD in 3 cases (42.9%), and incomplete PD in 4 cases (57.1%), however, there was no clinically significant difference between the groups.

Purpose This paper aims to identify and explore the factors affecting type 2 diabetes mellitus (T2DM) patients' adherence to lifestyle change recommendations, with the guidance of the trans-theoretical model (stages of change). Design/methodology/approach This study was conducted in two parts. In Part A, 163 randomly selected participants were asked to complete a cross-sectional survey. Data regarding demographics, stages of change and levels of confidence to engage in lifestyle changes were collected. In Part B, in-depth interviews were conducted among 30 individuals, aged between 30 and 65 years, had been diagnosed with T2DM and had seen dietitian at least once. Purposive sampling was used to recruit participants with different sociodemographic characteristics. Findings Part A showed that most of the participants were in the pre-action group (60%), with a higher mean HbA1c (8.9%) as compared to the action group (40%) which had a mean HbA1c of 6.9%. Part B further revealed the pre-action group and action group identified four key themes concerning lifestyle changes adherence: stumbling block; self-care belief; knowledge implementation; and self-empowerment. Practical implications Health-care providers should identify patients' stages of change before lifestyle changes implementation. Originality/value This study highlighted that many factors might influence a T2DM patient's adherence to lifestyle change recommendations. Determining the stages of change and self-confidence of T2DM patients is needed to ascertain long-term adherence.

Introduction: This study aimed to determine the relationship of maternal dietary intake with human milk nutritional composition, among Malay mothers during the postpartum period of exclusive breastfeeding. Methods: Human milk samples (20-30ml) were collected from mothers (n=32) at least once monthly for six months postpartum. Macronutrients and fatty acids contents were determined using proximate analysis and gas chromatography methods, respectively. Maternal dietary intakes were recorded using the multiple-pass diet recall method prior to each milk sampling and were analysed using the Nutritionist Pro TM software. Associations between the milk composition and maternal diet were tested using Spearman correlation. Results: The energy content ranged between 49.6-59.2 kcal/100ml, protein 1.3-1.4 g/100ml, carbohydrate 6.5-9.7 g/100ml and total fat 6.5-9.7 g/100ml. The polyunsaturated, monounsaturated, and saturated fatty acids concentrations were 10.5-19.1 %, 40.6-43.5 %, and 38.0-49.7 %, respectively. During confinement (first month postpartum), total energy and total fat content of human milk were the highest whereas total carbohydrate was the lowest, compared to the rest of the exclusive breastfeeding period. In contrast, intakes of total calorie and total fat were the lowest, whereas protein was the highest during this period. However, no associations were detected between human milk nutritional contents and maternal dietary intake. Conclusion: In our study population, the composition of maternal diet and nutritional content of human milk differed between confinement and post-confinement periods. However, the association between maternal diet and human milk composition itself warrants further investigation.