Nutrition and Lifestyle Behaviours in Cardiometabolic Syndrome: Development of a Community-specific Peer-support Programme.
Phase: NA
Conditions: Metabolic Syndrome X, Nutritional and Metabolic Diseases, Health Behavior
Sponsor: Monash University

Nutrition and lifestyle behaviour peer support for 
Malaysian adults with metabolic syndrome (PERSUADE)
AMUTHA RAMADAS 
MONASH UNIVERSITY 
JALAN LAGOON SELATAN, 47500 BANDAR SUNWAY, MALAYSIA 
MUHREC Ethics Reference : CF16/56 - 2016000022
Document Date: 15th March, 2016

 
 
Summary 
The outlook of a community-based intervention targeting nutrition and lifestyle behaviour 
modification among adults with metabolic syndrome (MetS) has not been fully explored. We describe 
the protocol of the development and three-month RCT of PERSUADE; a group-based community peer 
support intervention for Malaysian adults with MetS. The primary aim is to evaluate the effect of the 
peer support intervention on the clinical outcomes MetS components followed by improvements in 
the participants’ dietary practices, physical activity levels and lifestyle behaviours. The PERSUADE 
module will be constructed using the Health Belief Model (HBM) to address relevant health messages 
from the appropriate guidelines and recent literature evidence on MetS among Malaysian adults. 
Following that, a minimum sample of 96 Malaysian adults with MetS will be randomised, either to the 
control group, who will receive one-time standard nutrition and lifestyle advice or the intervention 
group, who will participate in a three-month peer support program using the PERSUADE module. The 
participants will be followed up for three months post-intervention with data collection scheduled at 
baseline, 3-month and 6-month. PERSUADE is a peer support program developed with the aim 
improvement in nutrition and lifestyle behaviours among adults with MetS. The program constructed 
using information obtained from the published clinical and dietary guideline in Malaysia.   
 
Introduction 
In Malaysia, non-communicable diseases such as cardiovascular diseases are the major cause of 
mortality, accounting for 70–80% of deaths, and its long-term complications are creating a major 
health burden for people by reducing the quality of life and increasing the healthcare cost to the 
society (1). Metabolic syndrome (MetS) is the clustering of three of more risk factors that increases 
the risk of developing type 2 diabetes and cardiovascular diseases and its increasing prevalence 
throughout the country is now recognized as a major health problem (2). The development of effective 
strategies for modifying antecedent conditions and risky behaviours, such as abdominal obesity, poor 
dietary habit and physical inactivity, is in a high priority to aid MetS management and prospective 
prevention endeavour in Malaysia.  
 
There is a close relationship between MetS and poor lifestyle behaviour (3). Several lifestyle 
behaviours have been identified as predictors to MetS in Malaysia; poor dietary habit, food insecurity, 
poor food hygiene, physical inactivity and poor sleeping pattern (4). Hence, lifestyle intervention is 
seen as the most sustainable approach to the management and prevention step for MetS in Malaysia. 
However, there is currently only one lifestyle intervention studied among elderly with MetS (5) in 
Malaysia despite its increasing prevalence. Furthermore, a yearly increase in lifestyle-related non-
communicable diseases in this country (4) calls for a need to develop a community-based campaign 
to promote an adoptable and sustainable healthy lifestyle program among Malaysian adults.  
 
PERSUADE is a three months evidence-based community nutrition and lifestyle behaviour peer 
support program. The program brought together the existing clinical practice and medical nutrition 
therapy guidelines in the development process of its peer intervention modules. Furthermore, Health 
Belief Model (HBM) (6) will be incorporated in the content development of peer modules as its 
theoretical background. Consequently, the contents were further refined to suit local context using 

 
 
input gathered from literature evidence synthesis and a qualitative study on motivation and barriers 
of healthy lifestyle. Eventually, the feasibility of this intervention is designed to be studied as a RCT for 
Malaysian adults with MetS with the aim to improve clinical outcome of MetS components. PERSUADE 
is aiming for an overall improvement in the MetS clinical outcomes in participants of the peer 
intervention group, besides investigating the impact of the peer intervention on the dietary practices, 
lifestyle behaviours, physical activity and health related quality of life. 
 
Methodology 
Study Design 
This three-month RCT was designed to explore the feasibility of PERSUADE in community settings. The 
design was in accordance to the recommendations of the CONSORT statement for randomised trials 
of non-pharmacologic treatment (7). Based on Chronic Care Model (8) and the HBM (6) we developed 
a hypothetical framework of the study. This framework is constructed to form a theoretical design 
approach while addressing the patient activation concept in peer support (9) (Figure 1).  
 
Four parent peer intervention modules are designed based on the information gathered from the 
published national practice guidelines and reported evidence of MetS in Malaysia. The flowchart 
detailing PERSUADE development and feasibility study is presented in Figure 2. The delivery of this 
intervention package through peer support program is expected to improve the clinical outcome of 
MetS components among participants’ following their changes in dietary practices, physical activity 
levels and lifestyle behaviours. Furthermore, adoption of healthy dietary practices and lifestyle 
behaviours is expected to be reflected on the anthropometric outcomes and health related quality of 
life. 
 
Study Aims 
The primary aim of our study is to evaluate the effect of a three-month peer support intervention on 
the clinical outcome of MetS components as compared to the control group. Furthermore, this study 
aims to determine the impact of the peer support intervention on dietary practices (nutrient intake, 
food frequency score), physical activity levels and lifestyle behaviours (smoking, alcohol consumption 
and sleeping habit) compared to the control group. 
 
Ethics Approval 
The study has received ethics approval from Monash University Human Research Ethics Committee 
(CF16/56 - 2016000022). 
 

 
 
Study Sample 
Sample Size and Power Calculation 
The estimated sample size based on earlier similar study (10) on one the study variables, fasting 
plasma glucose at 95% confidence and 80% power of an anticipated fall in FPG of 1.5 to 1.8 mmol/L. 
Using an equation to detect changes in a standard parallel-group trial and a 20% drop out rate, the 
calculated minimum required sample size is 48 participants for each group thus the totalling 96 for 
both randomized arm. 
 
Recruitment Process 
A series of health screening camp were organised around Kulai district located in the south of 
Malaysia. Johor state was specifically selected due to high prevalence of MetS as reported in Malaysia 
Adults Nutrition Survey (MANS) (11) (12), Metabolic Syndrome Study Malaysia (MSSM) (13) and 
National Health and Morbidity Survey 2015 (NHMS) (14). The eligibility screening and recruitment of 
study participants were conducted in four low to middle income neighbourhoods. The research team 
provide assistance on identifying potential study participants according to the eligibility criteria (Table 
1). If an individual is found to eligible to participate, they will be requested to complete the baseline 
questionnaire after consenting for their participation. 
 
Randomisation and Treatment Allocation 
Eligible adults who have consented to participate are matched for age, sex and ethnicity as baseline. 
To minimised contamination, participants were randomised to either intervention or control group 
based on their location.  
 
Control Group 
Participants in the control group will receive a one-time personalised nutrition and lifestyle advised 
based from the Malaysian Dietary Guideline 2010  
(15). They will be assured to be followed up twice for the next  six month. During this session, 
participants will be required to set realistic health goals particularly on their anthropometric 
measures, blood biomarkers, dietary practice and physical activity levels. 
 
Intervention Group 
Participants residing in the location selected to be intervene will to form at minimum 4 peer groups. 
This group will receive a continuous three-months, peer-led nutrition and lifestyle behaviour 
intervention through a series of peer gathering. Two participants from each peer group will be 
selected as the peer leader (PL). PL will be trained to deliver the content of PERSUADE modules and 
will be responsible to run a weekly peer gathering with their respective groups for the following three 
months. 
 

 
 
Randomisation and Blinding 
This study is an open label parallel randomized-controlled trial hence both the research team and 
participants will not be blinded. However, as the randomisation will be made based on participants 
location, contamination of participants was minimised.  
 
Development of Peer Modules 
A stepwise formative research was conducted to initiate the development of an evidence-based, 
community-specific and culturally-sensitive peer support program. This formative step aimed to 
assess the need of a sustainable lifestyle intervention, to form a behavioural change objective matrix, 
to develop a community-relevant interventional content and finally to elucidate the most sustainable 
delivery method for the targeted peer population.  
 
Evidence-based Module 
The formative research initiated by reviewing the objectives and lifestyle recommendations set in the 
National Strategic Plan for Non-Communicable Diseases 2010-2014 (16), Malaysian Clinical Practice 
Guidelines (CPG) for Primary and Secondary Prevention of Cardiovascular Disease 2017 (17) and 
Malaysian Dietary Guideline 2010 (15) which are the three key guidelines informing the peer modules. 
Furthermore, to address component specific recommendations, the peer modules were added with 
inputs from several other clinical practice and MNT guidelines namely, Malaysian CPG for Type 2 
Diabetes Mellitus 2015 (18), Malaysian CPG for Management of Dyslipidemia 2017 (19), Malaysian 
CPG for Management of Obesity 2004 (20), Malaysian CPG Management of Hypertension 2013 (21), 
Malaysian Medical Nutrition Therapy (MNT) for Type 2 Diabetes 2005 (22), Malaysian MNT for 
Hyperlipidemia 2005 (23), and Malaysian MNT Hypertension 2005 (24). This is to ensure that the 
module is thoroughly developed in line with the published national guidelines. Additionally, published 
studies on MetS in Malaysia were systematically reviewed. In this review, the nutrition and lifestyle 
behaviour risk factors will be explored to which those may explains the notably increase of MetS 
prevalence in Malaysians. The review is regarded as crucial as the risk factors affecting different 
population were found to be distinctive (25). Eventually, four behavioural change objective themes 
were determined and elaborated according to the conceptual model to form a matrix containing 
respective change objectives as well as self-efficacy skills needed to achieve it (Table 2).  
 
Community-relevant Approach 
PERSUADE behavioural change matrix is used as the backbone of its content development. Each 
modules is carefully developed using respective HBM constructs. For instance, in first module; 
Metabolic Syndrome, contents were developed to deliver the information on risk and susceptibility of 
MetS. Furthermore, the module is integrated with the information on the self-efficacy skills of 
measuring waist circumference as the most important risk of MetS. To make PERSUADE to be a 
community-relevant intervention, internal and surface makeover of contents were done on each 
module. These makeover is done using the input obtained from the focus group discussion done 
among Malaysian adults with MetS. During the internal makeover, contents is revised to reflects the 

 
 
social, psychological, environmental and cultural influences on individuals’ health behaviours. 
Especially that in Malaysia it spread differently across racial populations (26), a holistic understanding 
how the target audience perceives the disease, its risk and its susceptibility is crucial as these 
perceptions may influence specific health behaviours. Following that, during the surface makeover 
step, the content is ensured to match characteristics of the community; low-to-middle income 
population. As a whole, the PERSUADE module contents health were created by acknowledging the 
social and behavioural context of the target population.  
 
Intervention Poster Design 
Since PERSUADE is designed for low to middle class community with limitation in technology reach, 
literacy and affordability, each peer modules objectives will be addressed out using an infographic 
poster as a stimulus for a peer discussion. Poster design and health information to be highlighted in 
the posters are discussed in a research panel comprising of a nutritionist, a public health expert, and 
a layman. The information is aimed to improve peer knowledge, giving them the ability to 
acknowledge their own barriers and motivations of adopting healthy nutrition and lifestyle 
behaviours. To increase peer engagement and enhance understandability, poster will include 
appropriate visual aids such photographs and illustrations. Relevant self-efficacy skills were also 
included to making the poster as an interactive stimulus for peer gathering sessions. Other than that, 
to initiate peer discussion, a list of Frequently Asked Question (FAQ) sheet will be provided together 
with the posters. This FAQ contains factsheets of frequent queries on MetS as gathered earlier from 
focus group discussions. Following that, all materials will be prepared in two languages, Bahasa 
Melayu and English to make it more inclusive. 
 
Peer Leader Selection 
As an elaboration to the study flowchart (Figure 2), the intervention group will form a minimum 
number of eight peer groups with two PL will be selected from each group on voluntarily basis. PL will 
be trained for the all four modules and an extra module; health promotion. This module aimed at 
assessing appointed PL for leadership, health educator role, and understanding of the PERSUADE 
modules. All PL attended a two-days training session on focussing on leadership and communication 
skills. On top of that, a practical approach will be used, including physical, nutritional, and 
psychological aspects of a lifestyle change as included in all four PERSUADE modules. PL will be trained 
to engage with their peers in conversations about the issues of concern, seeking to promote health-
enhancing knowledge and skills. The goal for each peer group is to be able to identify potential barriers 
and determinants of lifestyle improvement and subsequently take actions to reduce their CVD risk. At 
the end of PL training, a simple post-questionnaire will be distributed among them to indicate validity 
and adequateness of their knowledge and skills on all peer modules.  
Respective PL will distribute the posters among their peer group every week to initiate discussion of 
relevant topics based on the weekly objectives. In order to maximise the participation, regular 
reminder about the next peer gathering sessions and short health message through text were 
regularly sent by PL.  Peers will then have to keep the poster and returned it to the PL at the end of 
three months as a measure of compliance to the peer support program. Besides, peers are also 
encouraged to distribute the poster as a health promotion steps among the community. 

 
 
 
Outcome Assessment 
All assessments will be conducted at during designated peer gathering sessions by the research team 
and assisted by trained PL (Table 3). 
 
Primary Outcome – Metabolic Syndrome Biomarkers 
Anthropometric measurements (body mass index, waist circumference and percentage of body fat) 
and blood pressure are taken during each follow-up sessions based on the WHO Protocol (27). Blood 
clinical outcomes will be screened using rapid finger-prick testing method; glucometer (B Braun 
Omnitest®3, Germany) and blood lipid profile meter (Cardiocheck® PA, Germany), as it is an accurate 
and sensitive method to cater a community setting intervention (28). Besides, a bio-impedance body 
composition analyser (InBody® H2OB Analyser, Korea) will be used to estimate fat and muscle 
percentage of the participants.  
 
Secondary Outcome – Dietary Pattern, Physical Activity Levels and Lifestyle Behaviour 
A three days 24-hour dietary recall is used to analyse the nutrient intake. The recall will be done in a 
week timeframe with three non-consecutive days will be randomly selected (29). Physical Activity 
levels are measured using the validated short-form International Physical Activity Questionnaire 
(IPAQ) (30) while a short questionnaire on sleeping pattern, smoking and alcohol intake is used to 
elucidate lifestyle behaviour. 
 
Process Evaluation 
A questionnaire will be developed and validated to measure the self-efficacy change of all peers at 
two levels; individual and peer group. Adherence to the intervention is assessed by the number of 
posters collected by all participants at the end of the peer support period. Other than that, PL is 
responsible to record all peer attendance throughout the three months period. Eventually, the 
participants’ satisfaction of the intervention will be assessed by self-administered questionnaire at 
post-intervention. 
 
Other Measurements 
The socio-demographic characteristics of all participants will be recorded in a structured questionnaire 
at baselines. Participants’ quality of life will also be recorded using a validated questionnaire (31, 32). 
 
Statistical Analysis 
Diet and nutrition data will be analysed using Axxya Systems Nutritionist Pro™ Diet Analysis while all 
statistical analyses are performed with IBM® SPSS® Statistics 23.0. Descriptive methods will be used 
to demonstrate to describe participant characteristics and the consistency of both groups. 
Independent t-test or Chi Square will be used to evaluate baseline characteristics of peer intervention 

 
 
participants compared to control, overall significance of improvement across clinical outcome 
measures. As this is a RCT involving repeated measures, the ANOVA repeated measures model is 
applied to observe significant differences between and within the study groups. This includes change 
in clinical measures of MetS component from baseline, end of trial (3rd month) and follow up (6th 
month). The magnitude of change in both primary and secondary outcome measures will be estimated 
and the given 95% confidence intervals with the p value 0.05 was taken as the level of significance. 
 
Discussion 
PERSUADE community peer support program is intended to ‘activate’ a few individuals to be PL within 
the intervened community whom are able promote improvements on healthy nutrition and lifestyle 
behaviour among adults with MetS. This “activation” will eventually contribute to the prevention and 
management of the lifestyle-related diseases.  
 
Community-specific and culturally-sensitive design 
PERSUADE content development is designed to be evidence-based using information gathered from a 
systematic review of available guidelines and published literature on prevalence and risk factors of 
MetS in Malaysia. Interestingly, the HBM framework allows PERSUADE to be designed as a culturally 
sensitive health promotion program. The framework allows PERSUADE program components to be 
designed in a manner that incorporated community-specific characteristics, such as beliefs, norms, 
values, and behaviour patterns, which shapes up the community social and environmental influences 
as shown in a the previous interventional model (33). Consequently, the characteristics of the 
community can be carefully matched with the intervention materials hence acknowledging the social 
and behavioural context of the target population. Additionally, a holistic understanding on how the 
target community perceives the severity and risk of MetS thus influence their lifestyle and health 
behaviours is emphasised by a qualitative analysis of focus group discussion that was recuperated as 
a part of PERSUADE intervention development. As a result, PERSUADE is carefully designed to address 
the need and acknowledge the readiness of behavioural change by reinstate the community health 
knowledge gap thus endowed a better module delivery method.  
 
Peer Empowerment 
The concept of peer empowerment was first introduced in 1997 by Olsson et al. (34) and since then a 
number of intervention on chronic diseases has been developed based on it. The empowerment of PL 
is reported to be capable of sustaining an evidence-based community-sustained nutrition and lifestyle 
behaviour intervention program for a large group of individuals residing within a close-knit community 
(35). The outlook of the peer support program is expected to be a low-in-cost thus sustainable 
prevention step in combating the rising prevalence of MetS due to its attempt to improve the 
concomitant lifestyle behaviour rather than focussing on any pharmacological approach (36). 
However, this empowerment of the peers will only be effective when peers acquired great 
understanding of the health message of the intervention materials thus can actively promote it within 

 
 
and across their community as found in previous studies (37-39). Hence, PERSUADE is carefully 
designed to consider appropriate channel of intervention that is easily executed, intervention 
materials that used a common and simple language, lifestyle advices that is affordable and executable, 
and finally selection of program settings that are accessible and are familiar to and preferred by the 
target community (40). 
 
Applicability in Low-to-middle Income Population 
The RCT of PERSUADE will be conducted in four low-to-middle class neighbourhoods in Johor which 
means the participants may be of a lower socioeconomic background than average Malaysians. This 
is not the exact representation of the entire population as the access to health providers, high quality 
food availability, health-supportive infrastructure and health knowledge levels are different in the 
urban as compared to the rural (41, 42). Hence, we are aiming for a better response in these areas 
due to a higher prevalence of MetS, absent of prevention measures and poor management among 
individuals with lower socioeconomic background (43). The applicability of peer support in these 
communities were shown to be well facilitated by the influence of lay health person, simplicity of 
health message, ability to collective set realistic health goals and the most important is that it is low 
in cost (43-45). Hence, it will be interesting to investigate responses from those with lower socio-
economic status to a peer-led community health program. Eventually, PERSUADE can be an initiative 
peer support model to be implemented at the low socioeconomic community and suburban area for 
evaluation of its feasibility and cost-effectiveness. If successful, it can be a precursor for policy makers 
to initiate more rigorous promotion of such community peer-based programs to other parts of the 
country.  
 
Process Evaluation 
Furthermore, PERSUADE combines the HBM concept in a peer support framework. The use of 
theoretical construct in this study allows the outcome evaluation to be supplemented by an adjunct 
process evaluation. The process evaluation will measure the degree of knowledge delivered and 
received, fidelity of acquired skills and its implementation as well as the participants’ acceptability and 
satisfaction with the program. Similar to all peer-based interventions, this trial’s reach is highly 
dependent on the participants’ compliance based on the peer attendance rates and usability of 
PERSUADE materials. Collectively, these measures will enable us to resolve any enhancers and barriers 
of a peer-based program if the program were to be harnessed in other settings and context.  
 
As a conclusion, PERSUADE is a three months community peer support nutrition and lifestyle 
behaviour peer support intervention for Malaysian adults with MetS. Peer support is a cost-effective, 
straightforward and sustainable measure to combat lifestyle-related diseases. Thus, a feasibility study 
among Malaysian adults is designed as RCT to elucidate its acceptance and effectiveness. As 
PERSUADE modules were theoretical, evidence-based and community-specific, the overall 
improvement in metabolic risk profile is greatly expected prior to nutrition and lifestyle behaviour 
improvement.  
 
 

 
 
Table and Figures  
Figure 1: Conceptual framework of PERSUADE peer support program 
 
 
 
 
 
 
 
Figure 2: PERSUADE peer support program randomised controlled trial flow chart 
 
 
 
 
 
 

 
 
Table 1: PERSUADE inclusion and exclusion criteria 
Inclusion Criteria 
Exclusion Criteria 
Physically healthy men and women who are ≥ 18 
years old. 
Pregnant, lactating or intend to become 
pregnant during the study period. 
Literate with a fair command of Bahasa Melayu 
and/or English. 
Diagnosed with Type 1 Diabetes Mellitus (T1DM) 
Have been confirmed of having MetS according 
to Harmonised Criteria (46, 47). 
Any predisposing condition compromising the 
quality of life or ability to participate according 
to protocol. 
Willing to attend weekly peer gathering 
sessions. 
Reported severe complications (chronic heart 
disease, cerebrovascular disease, diagnosed 
HIV/AIDS, cancer, emphysema, chronic liver or 
kidney 
disease) 
that 
would 
affect 
the 
participants’ ability to follow the participation in 
peer activity. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Table 2: PERSUADE behavioural change matrix 
No 
Behavioural Theme 
Behavioural Change Objectives 
Delivery Approach 
Self-efficacy Skills 
1 
MetS and its components 
To understand MetS, its risk 
factors and disease severity. 
An infographic to show the clustering of 
MetS components and premature death 
due to cardiovascular diseases 
To be able to determine MetS based on the 
Harmonised criteria.  
 
To be able to measure waist circumference to 
detect abdominal obesity 
2 
Good Dietary Habit 
To eat a variety of foods within 
your recommended intake. 
An infographic to introduce Malaysian 
Food Pyramid and different classes of 
macronutrients 
To be able to prepare meals according to 
“Pinggan Sihat Malaysia” concept 
To prepare foods healthily with 
adequate amount of salt, sugars 
and condiments. 
An infographic on daily serving sizes of 
main food class 
To be able to estimate food quantity using 
household measures and palm estimation. 
To drink plenty of water daily. 
An infographic on the importance of 
hydration 
To be able to estimate the minimum amount 
of water required based on body weight 
To make effective use of nutrition 
information on food labels. 
An infographic on Nutrition Information 
Panel and Food Health Claims 
To be able to read and understand NIP hence 
to limit the intake of processed food 
3 
Cardiorespiratory Fitness 
To be physically active every day. 
An infographic on Physical Activity Pyramid 
To be able to plan weekly workout schedule 
To understand physical inactivity 
and sedentary habits. 
An infographic on sedentariness 
To be able to incorporate movement in daily 
live (i.e. walking steps, stairs climb) 

 
 
To understand sleeping pattern 
and adequate rest. 
An infographic on adequate sleeping 
pattern 
To understand the importance of adequate 
rest and  night sleep as well as naps in 
between 
To manage stress effectively 
An infographic on everyday stress and its 
complications 
To be able to acknowledge the presence of 
daily stress and seek help if necessary 
4 
Health Monitoring 
To maintain body weight in a 
healthy range. 
An infographic on BMI and Body Fat 
Percentage 
To be able to calculate BMI and measure 
waist circumference 
To go for a blood screening every 
six week. 
An 
infographic 
on 
good 
and 
bad 
cholesterol. 
To have an increased awareness on how 
frequent to check blood pressure, lipid profile 
and fasting glucose 
To identify and set a personal 
health goals 
An infographic on healthy life style 
To be able to set realistic health goals in term 
of body weight, waist circumference and 
weekly diet and physical activity planning 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Table 3: PERSUADE outcome assessment 
Outcome 
Instrument 
Socio-demographic information 
A brief sociodemographic questionnaire is use to collect basic details (i.e. 
age, marital status, ethnicity, educational status, occupation, personal and 
household income, family size and number of years of residence in current 
location). 
Lifestyle characteristics 
A brief questionnaire will inquire on participants’ smoking habit, alcohol 
consumption and sleeping pattern.  A validated health-related quality of 
life (HRQOL) questionnaire will be used to determine subject’s fulfilment 
of life. 
Physical Activity 
International Physical Activity Questionnaire (IPAQ) will be used to 
determine the level of physical activity of the participants. 
Anthropometry 
A height scale, body tape and bio-impedance machine will be used to 
measure participants’ height, weight, waist and hip circumferences and 
body composition. 
Nutrition and diet 
A semi-food frequency questionnaire (SFFQ) and 3 days 24H food recall 
will be used to record the participants’ nutrients and dietary intake.  
Blood biomaker 
Finger prick rapid method will be used to detect participants’ fasting blood 
sugar levels and fasting lipid profile. 
 
 
 

 
 
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