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Feasibility and acceptability of a dietary intervention study to reduce salt intake and increase high-nitrate vegetable consumption among middle-aged and older Malaysian adults with elevated blood pressure: a study protocol

Lookup NU author(s): Dr Andrea FairleyORCiD, Professor Bloss Stephan, Dr Louise Robinson, Dr Mario Siervo



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Introduction: Global population ageing is one of the key factors linked to the projected rise of dementia incidence. Hence, there is a clear need to identify strategies to overcome this expected health burden and have a meaningful impact on populations’ health worldwide. Current evidence supports the role of modifiable dietary and lifestyle risk factors in reducing the risk of dementia. In South-East Asia, changes in eating and lifestyle patterns under the influence of westernised habits have resulted in significant increases in the prevalence of metabolic, cardiovascular and neurodegenerative non-communicable diseases (NCDs). Low vegetable consumption and high sodium intake have been identified as key contributors to the increased prevalence of NCDs in these countries. Therefore, nutritional and lifestyle strategies targeting these dietary risk factors are warranted. The overall objective of this randomised feasibility trial is to demonstrate the acceptability of a dietary intervention to increase the consumption of high-nitrate green leafy vegetables and reduce salt intake over 6 months among Malaysian adults with raised blood pressure. Methods and analysis: Primary outcomes focus on feasibility measures of recruitment, retention, implementation and acceptability of the intervention. Secondary outcomes will include blood pressure, cognitive function, body composition and physical function (including muscle strength and gait speed). Adherence to the dietary intervention will be assessed through collection of biological samples, 24-hour recall and Food Frequency Questionnaire. A subgroup of participants will also complete post-intervention focus groups to further explore the feasibility considerations of executing a larger trial, the ability of these individuals to make dietary changes and the barriers and facilitators associated with implementing these changes. Ethics and dissemination: Ethical approval has been obtained from Monash University Human Research Ethics Committee and Medical Research and Ethics Committee of Malaysia. Results of the study will be disseminated via peer-reviewed publications and presentations at national and international conferences.

Publication metadata

Author(s): McGrattan AM, Mohan D, Chua PW, Hussin AM, Yee CS, Alawad M, Kassim ZB, Ghazali AN, Stephan B, Allotey P, Reidpath D, Robinson D, Siervo M

Publication type: Article

Publication status: Published

Journal: BMJ Open

Year: 2020

Volume: 10

Issue: 8

Online publication date: 27/08/2020

Acceptance date: 20/07/2020

Date deposited: 16/10/2020

ISSN (electronic): 2044-6055

Publisher: B M J Group


DOI: 10.1136/bmjopen-2019-035453


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Funder referenceFunder name
16/137/62National Institute for Health Research (NIHR)