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It will then assess the relationship between these measures and risk of diabetes and cardiovascular disease, to inform public health guidance on the appropriate measure of excess body fat in this population, the ideal 'normal' range of these measures, and whether guidance should vary for the different ethnic groups in Malaysia. DXA imaging will also significantly enhance the potential of The Malaysia Cohort to investigate the genetic and environmental determinants of obesity in Malaysia, and the biological pathways through which it causes diabetes and cardiovascular disease. Not all people who are overweight or obese suffer adverse consequence from their excess weight, in part due to differences in fat distribution. Indeed, as recently reported from The Malaysia Cohort, the prevalence of obesity (based on BMI) and type 2 diabetes is very divergent between the major ethnic groups in Malaysia (Malay, Indian and Chinese) and this is only partly explained by BMI. Therefore, a better understanding of the between-ethnic group risk, based on tissue and organ-specific fat depots, will enable more precise targeting of limited resources to those who will gain the most benefit.","The Newton Fund builds research and innovation partnerships with developing countries across the world to promote the economic development and social welfare of the partner countries."], "participating_org_ref":["GB-GOV-26","GB-COH-RC000346","GB-COH-RC000346","GB-UKPRN-10007774"], "participating_org_role":["1","2","3","4"], "participating_org_type":["10","15","15","80"], "participating_org_narrative":["DEPARTMENT FOR SCIENCE, INNOVATION AND TECHNOLOGY","MEDICAL RESEARCH COUNCIL","MEDICAL RESEARCH COUNCIL","UNIVERSITY OF OXFORD"], "other_identifier_ref":["GB-GOV-13"], "other_identifier_owner_org_ref":["GB-GOV-13"], "other_identifier_owner_org_narrative":["DSIT previous reporting-org identifier"], "activity_status_code":"4", 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Adding to this problem is the growing number of obese Malaysian children and adolescents who are now or will be affected by diabetes. The harmful effects of diabetes on the vasculature or blood vessels dominate the complications caused by diabetes. These vascular effects affect the heart (to cause heart attack, stroke and heart failure), feet (leading to amputations), eyes (to cause blindness) and kidneys (to cause kidney failure). This escalating diabetes pandemic with its cardiovascular complications has huge effects both for the affected individual and their society. Despite sugar-lowering diabetic drugs and control of other cardiovascular risk factors, people with diabetes continue to succumb to the cardiovascular-related diseases. While efforts are being made to combat this diabetic epidemic through public health measures, new strategies are clearly needed to address and prevent the cardiovascular complications of diabetes. In the UK, we have pioneered the concept of personalised medicine through the use of genetics to determine who will and will not respond to commonly used drugs in diabetes, as well as for heart protective drugs such as those that lower blood pressure and cholesterol. We have also made substantial inroads in the use of artificial intelligence to analyse digital pictures of patients' retinas to find features that reveal a patient's current disease status and is predictive of future risk of complications such as stroke and heart disease. However, the majority of these studies on how diabetes and the cardiovascular complications arise and how patients respond to medications are from white European ancestry populations despite the fact that diabetes in Europeans is very different to diabetes in Asians. There is therefore an urgent need for detailed research into the specific causes and cardiac consequences of diabetes in Asians including those in Malaysia in order to identify the processes that drive the onset of cardiovascular complications of diabetes that exist in Malaysian ethnicities and use this to understand how best to manage diabetes in Malaysia. In our proposed PRIME partnership, we propose to build upon the precision medicine expertise in Dundee that includes the on-going £7 million NIHR Global Health Research Unit on Global Diabetes Outcomes Research INdia-Scotland Partnership for Precision medicine in Diabetes - INSPIRED (https://inspired-nihr.com/) project that is exploring specific differences in combinations of genomic, retinal and clinical determinants of complications of diabetes and therapeutic response between Scottish and the South Indian population. The plan is to embed insights from the on-going INSPIRED program into the PRIME project that will add value to each project. Using the available precision medicine expertise in Dundee, we will facilitate knowledge transfer to Malaysia for initial establishment of a similar concept using the Malaysian government initiated The Malaysian Cohort (TMC) study, that is the biggest and most comprehensive population-based cohort study in Malaysia. The overarching objective of the PRIME project is to develop an international collaboration between Dundee and Malaysia that will establish the potential for translation of precision medicine to management of diabetes and its associated cardiovascular complications in Malaysia.","The Newton Fund builds research and innovation partnerships with developing countries across the world to promote the economic development and social welfare of the partner countries."], "participating_org_ref":["GB-GOV-26","GB-COH-RC000346","GB-COH-RC000346","GB-SC-015096"], "participating_org_role":["1","2","3","4"], "participating_org_type":["10","15","15","80"], "participating_org_narrative":["DEPARTMENT FOR SCIENCE, INNOVATION AND TECHNOLOGY","MEDICAL RESEARCH COUNCIL","MEDICAL RESEARCH COUNCIL","UNIVERSITY OF DUNDEE"], "other_identifier_ref":["GB-GOV-13"], "other_identifier_owner_org_ref":["GB-GOV-13"], "other_identifier_owner_org_narrative":["DSIT previous reporting-org identifier"], 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After the baby is born, the blood sugar returns to normal. The number of women in Malaysia that develop gestational diabetes is about 50,000 each year and these numbers are increasing with the worldwide epidemic of obesity. Around half od the women with gestational diabetes are likely to develop either type 2 diabetes or pre diabetes within 10 years. In other words, these women who are child-rearing and who may also be working outside the home, are developing diabetes in their 30s and 40s, almost 20 years before the average person. Gestational diabetes leads to further health problems and the baby can be born big-for-dates which increases his/her chances of developing type 2 diabetes later in life. Malays, Indian and Chinese Malaysians are all at high risk for getting diabetes. The chances of getting type 2 diabetes could be significantly reduced if women made lifestyle changes to lose weight and increase their physical activity. This can be very difficult with modern lifesyles and demands. Also getting gestational diabetes is usually a very upsetting experience because the mother feels guilty and also worrying about the health of her baby. There have been trials, mainly in North America, testing different types of lifestlyes but the findings from these trials are not clear cut. There have been no trials reported in Malaysia. We still do not know what kind of support women would find the most helpful. King's Health Partners has one of the largest clinical and research units for diabetes. We have been developing new approaches to supporting women with gestational diabetes (led by Prof Angus Forbes and Pro Helen Murphy). Our interviews with women with gestational diabetes showed that women in the UK have a poor understanding of their risk of developing diabetes and we think this might be the same for women in Malaysia. They also did not know how best to lower their risk and worried that exercise and different diet might harm their baby. We also found that women became very upset, guilty and burdened after they were told they had gestational diabetes. This project is called MY GODDESS and we aim to share the ideas and experiences of women in the UK and Malaysia. In the first set of studies, we will review the research already published and find out what works and what doesn't. We will focus on studies that uses digital technology such as apps, websites from the smartphone or computer. We will then interview women with a history of gestational diabetes and ask what was difficult about making lifestyle changes and what helped. We will then use use our shared knowledge as researchers and as patients to design a new treatment to support lifestyle change. We will consider ideas such as group sessions, lifestyle coaches text messages, and wearing devices that measure our step counts and heart rate. We will develop the MY GODDESS app which can be downloaded onto a smartphone. We believe that if we understand better how to harness the 'health power' in digital technology, we will produce stronger support systems to help women with GDM lead healthier lifestyles. The second project is to test our new treatment, MY GODDESS, in a small study to see if we could test our new could be conducted at a largerthat it does help women to make lifestyle changes. We will recruit about 50 patients. We will study how many women we could identify, who will be interested in participating and who will stay in the treatment to the end. We will ask women for feedback about their experience, what worked and what did not and any suggestions about improvement. By the end of the project if our findings are in the right direction, we will submit a proposal to conduct a full scale trial to test whether MY GODDESS works in a much larger sample of women across Malaysia.","The Newton Fund builds research and innovation partnerships with developing countries across the world to promote the economic development and social welfare of the partner countries."], "participating_org_ref":["GB-GOV-26","GB-COH-RC000346","GB-COH-RC000346","GB-COH-RC000297"], "participating_org_role":["1","2","3","4"], "participating_org_type":["10","15","15","80"], "participating_org_narrative":["DEPARTMENT FOR SCIENCE, INNOVATION AND TECHNOLOGY","MEDICAL RESEARCH COUNCIL","MEDICAL RESEARCH COUNCIL","KING'S COLLEGE LONDON"], "other_identifier_ref":["GB-GOV-13"], "other_identifier_owner_org_ref":["GB-GOV-13"], "other_identifier_owner_org_narrative":["DSIT previous reporting-org identifier"], "activity_status_code":"4", 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People who survive stroke are often unable to use parts of their body due to brain injury. As a result of this, they may not be able to move around or carry out daily tasks (such as feeding, bathing and dressing) on their own. They may also need physical therapy to help them with the recovery. Such physical therapy and help with daily activities is generally provided by family members and friends (also called caregivers) who receive help and guidance from social and community rehabilitation services in western countries. In Malaysia, such support is not available, therefore the caregivers have to take on most of the patient care responsibilities, for which they are not trained or prepared. As a result of this, the recovery of stroke patient is not as good and the caregiver themselves may feel overwhelmed and their health and finances may suffer. In India, where the situation is similar to Malaysia, we have previously developed a training programme to support stroke caregivers using mobile phones. Using lessons from this research and an in-depth assessment of local knowledge, skills, resources and cultural beliefs of stroke caregivers in Malaysia, we will develop a training programme to improve caregivers' skills in managing physical and psychological needs of stroke survivors and their own needs. Initial training will be delivered in person, with further support provided through a mobile phone application that will include videos of key skills, a searchable map of local stroke services and access to expert advice through text messaging or phone call. We will then offer the training and mobile application to new caregivers to find out whether they find it helpful and how it can be improved. We will also work with health policy makers to explore how our training and support programme could be integrated within the Malaysian healthcare system. Stroke is one of the leading causes of death and disability in Malaysia, which causes enormous suffering and loss to the economy. Our training programme may be able to reduce both of these.","The Newton Fund builds research and innovation partnerships with developing countries across the world to promote the economic development and social welfare of the partner countries."], "participating_org_ref":["GB-GOV-26","GB-COH-RC000346","GB-COH-RC000346","GB-EDU-133903"], "participating_org_role":["1","2","3","4"], "participating_org_type":["10","15","15","80"], "participating_org_narrative":["DEPARTMENT FOR SCIENCE, INNOVATION AND TECHNOLOGY","MEDICAL RESEARCH COUNCIL","MEDICAL RESEARCH COUNCIL","LONDON SCHOOL OF HYGIENE AND TROPICAL MEDICINE"], "other_identifier_ref":["GB-GOV-13"], "other_identifier_owner_org_ref":["GB-GOV-13"], "other_identifier_owner_org_narrative":["DSIT previous reporting-org identifier"], "activity_status_code":"4", "activity_date_iso_date":["2019-12-01T00:00:00Z","2019-12-31T00:00:00Z","2021-11-30T00:00:00Z","2023-03-31T00:00:00Z"], "activity_date_type":["1","2","3","4"], 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While research in European and US-based populations has found that particular lifestyle factors might cause adolescents to be fatter and less fit we do not have a complete picture of what causes these problems in Malaysia. In this study we are going to look at how different lifestyle factors, like foods eaten, timing or frequency of eating, physical activity, sedentary behaviours and their timing or location, relate to whether adolescents have good health. We plan to use a reproducible laboratory technique, known as metabolomics, to measure 150 different components of blood that indicate a range of metabolic processes. This will help us find out in much more detail than ever before how behaviour leads to better cardiovascular health via metabolic pathways. When we know more about the pathway that leads from lifestyle to disease we will be better able to predict who will stay healthy and who will not. This research is possible because of an ongoing large community study including over 6000 adolescents, called SEACO, in Segamat, Malaysia. The aim of SEACO is to monitor changes in population health using annual surveys. Data collection started in 2012 and is repeated yearly from over 13000 households. The participants have already had measurements of their height and weight at two previous times, which we will use to look at how body size changes in different groups. We will approach children in the cohort at school to collect samples of blood and urine and ask them to wear an activity monitor on their wrist for 7 days. In a smaller selection of the sample we'll measure metabolic components in urine and see if they can tell us about what foods have been eaten recently. We also give a small group of children a smartwatch to ask them regular questions about eating so we can explore the possibility of measuring eating behaviour using the activity monitors without have to ask in future. We are interested to see whether lifestyle behaviours are associated with changes in the blood chemical profile of participants before they develop clear symptoms of cardiovascular disease or diabetes. Finally, within this project we will lay the foundations for improving the measurement of food intake to make methods passive, rather than relying on participants to tell you every time they eat.","The Newton Fund builds research and innovation partnerships with developing countries across the world to promote the economic development and social welfare of the partner countries."], "participating_org_ref":["GB-GOV-26","GB-COH-RC000346","GB-COH-RC000346","GB-UKPRN-10007786"], "participating_org_role":["1","2","3","4"], "participating_org_type":["10","15","15","80"], "participating_org_narrative":["DEPARTMENT FOR SCIENCE, INNOVATION AND TECHNOLOGY","MEDICAL RESEARCH COUNCIL","MEDICAL RESEARCH COUNCIL","UNIVERSITY OF BRISTOL"], "other_identifier_ref":["GB-GOV-13"], "other_identifier_owner_org_ref":["GB-GOV-13"], "other_identifier_owner_org_narrative":["DSIT previous reporting-org identifier"], "activity_status_code":"4", 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