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International Journal of Endocrinology
Volume 2013, Article ID 679396, 7 pages
Review Article

Transcultural Diabetes Nutrition Algorithm: A Malaysian Application

1Department of Medicine, Hospital Putrajaya, Pusat Pentadbiran Kerajaan Persekutuan, Presint 7, 62250 Putrajaya, Malaysia
2Division of Endocrinology, Diabetes and Metabolism, Joslin Diabetes Center, Harvard Medical School, Boston, MA 02215, USA
3Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
4Department of Medicine, Hospital Pulau Pinang, Penang, Malaysia
5Department of Medicine, Hospital Tengku Ampuan Rahimah, Selangor, Malaysia
6Family Medicine, Putrajaya Health Clinic, Putrajaya, Malaysia
7Department of Health Care, International Medical University, Kuala Lumpur, Malaysia
8Department of Dietetics and Food Services, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
9Department of Nutrition and Dietetics, University Putra Malaysia, Selangor, Malaysia
10Department of Nutrition and Dietetics, International Medical University, Kuala Lumpur, Malaysia
11Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey, Newark, NJ 07101, USA
12Abbott Nutrition, Columbus, OH 43219, USA
13Division of Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA

Received 27 June 2013; Accepted 27 September 2013

Academic Editor: Patrizio Tatti

Copyright © 2013 Zanariah Hussein et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Glycemic control among patients with prediabetes and type 2 diabetes mellitus (T2D) in Malaysia is suboptimal, especially after the continuous worsening over the past decade. Improved glycemic control may be achieved through a comprehensive management strategy that includes medical nutrition therapy (MNT). Evidence-based recommendations for diabetes-specific therapeutic diets are available internationally. However, Asian patients with T2D, including Malaysians, have unique disease characteristics and risk factors, as well as cultural and lifestyle dissimilarities, which may render international guidelines and recommendations less applicable and/or difficult to implement. With these thoughts in mind, a transcultural Diabetes Nutrition Algorithm (tDNA) was developed by an international task force of diabetes and nutrition experts through the restructuring of international guidelines for the nutritional management of prediabetes and T2D to account for cultural differences in lifestyle, diet, and genetic factors. The initial evidence-based global tDNA template was designed for simplicity, flexibility, and cultural modification. This paper reports the Malaysian adaptation of the tDNA, which takes into account the epidemiologic, physiologic, cultural, and lifestyle factors unique to Malaysia, as well as the local guidelines recommendations.