Effectiveness of a ReMIND Diet Intervention on Sarcopenia, Cognitive Frailty and Nutritional Status in Older Adults

NCT07325760 | Not Yet Recruiting

• 1 other identifier: JKEUPM-2025-383
• Study Type: interventional
• Target: 70
• Locations: 1 country
• Sites: 2

Brief Summary

This research is a single-blinded, 12-week, two-arm cluster randomized controlled trial to evaluate the effectiveness of a Malaysian-adapted MIND (Mediterranean-DASH Intervention for Neurodegenerative Delay) diet retort meal intervention on sarcopenia risk, cognitive frailty status, nutritional status, depression, functional ability, and food security among older adults in Malaysia. With Malaysia projected to become an aged society by 2030, addressing age-related health challenges, including cognitive frailty and sarcopenia, is a national priority. Current evidence indicates that poor diet quality and food insecurity among older adults, especially those in low-income urban communities, exacerbate these conditions. The study is grounded on the Meals on Wheels (MoW) program, which has been effective in reducing malnutrition among older populations globally but is limited in scalability due to high delivery costs. Retort meals which are shelf-stable and nutritionally balanced offer a feasible alternative for meal provision in poor urban settings. The MIND diet, originally designed to support brain health, also demonstrates benefits for muscle health and overall physical function. However, its adaptation to the Malaysian context is crucial due to cultural dietary preferences and cost barriers to certain ingredients. The intervention will recruit 70 older adults (aged 60-84 years) from Program Perumahan Rakyat (PPR) Seri Alam Fasa 2 and Perumahan Awam (PA) Loke Yew in Kuala Lumpur, classified under the B40 income group and at risk of food insecurity. The intervention group will receive retort meals designed according to the adapted MIND diet principles, while the control group will not receive intervention. Data will be collected at baseline, 6 weeks, and 12 weeks to assess outcomes in muscle health, cognitive frailty, nutritional status, depression, functional ability, food security, and cost-effectiveness. Overall, the conceptual framework provides a structured approach to understanding how the intervention contributes to improved nutritional well-being and supports the economic viability of the Meals on Wheels program. Potential confounding variables, including socioeconomic status, baseline health conditions, social support, and lifestyle factors, may also influence the outcomes. Participants will fill up a questionnaire regarding their sociodemographic characteristics, medical factors, psychological factors, lifestyle factors, food security status, functional ability, and depression status. Besides, the researcher will conduct face-to-face interviews to collect data regarding anthropometric measurements, handgrip strength, medical costs, and diet history. Statistical analyses will employ mixed-effects models to evaluate both continuous and categorical outcomes over time. The findings will generate crucial evidence on the feasibility, effectiveness, and cost-efficiency of using retort meals within MoW programs in Malaysia. Furthermore, it will inform national strategies to address food insecurity, promote healthy ageing, and reduce the burden of age-related health conditions. With Malaysia's rapidly ageing population and increasing prevalence of sarcopenia and cognitive frailty, this study has the potential to shape policy and practice by offering a sustainable, culturally tailored nutrition intervention. The evidence derived will support the scaling up of MoW programs using retort meals and contribute to long-term solutions for improving the quality of life and independence of older adults in Malaysia.

Conditions

Sarcopenia; Cognitive Frailty; Nutritional Interventions

Keywords

older adults; sarcopenia; cognitive; cognitive frailty; malnutrition; mind diet; my-mindd; nutrition intervention

Outcome Measures

Primary Outcomes (16)

• Appendicular skeletal muscle mass in kilograms (kg)

  Appendicular skeletal muscle mass will be estimated using BIA in kilograms (kg). Prior to the assessment, participants will be screened to confirm they are not fitted with pacemakers. To ensure standardization, they will be instructed to remove footwear, socks, and any heavy accessories, as well as to empty their pockets and bladder. During the procedure, participants will be positioned at the center of the platform, standing upright with eyes forward while firmly holding the electrodes until the measurement is completed. BIA is selected for its simplicity, non-invasive nature, and suitability for field settings. Nevertheless, as hydration status can influence the readings, bladder emptying will be emphasized as a precaution to reduce measurement variability.

  3 months

• Appendicular skeletal muscle index (ASMI) in kilograms per square meter (kg/m²)

  ASMI in kilograms per square meter (kg/m²) will be obtained by dividing an individual's appendicular skeletal muscle mass by the square of their height. Low skeletal muscle mass, a key diagnostic component of sarcopenia, was defined according to the AWGS 2025 criteria as an ASMI \<7.6 kg/m² for men aged 50-64, \<7.0 kg/m² for men aged 65 and above, and \<5.7 kg/m² for women.

  3 months

• Muscle strength in kilograms (kg)

  Muscle strength will be assessed using handgrip dynamometry and recorded in kilograms (kg). Three consecutive measurements will be obtained from the dominant hand, and the highest value will be used for analysis. Handgrip strength is a validated measure of overall muscle strength and is commonly used to assess muscular weakness. Muscle weakness will be defined according to the AWGS 2025 criteria. Low handgrip strength is defined as \<34 kg for men aged 50-64 years, \<28 kg for men aged ≥65 years, \<20 kg for women aged 50-64 years, and \<18 kg for women aged ≥65 years. Participants with handgrip strength below these sex- and age-specific thresholds will be classified as having muscle weakness. Muscle weakness identified by handgrip dynamometry will be used to operationalize the weakness component of the FFP and the muscle strength criterion within the AWGS sarcopenia framework.

  3 months

• Height in centimetres (cm)

  Participants' height will not be obtained through direct standing height but will instead be estimated from arm span length, which is regarded as a more accurate indicator for older adults due to progressive reductions in height with ageing. Arm span refers to the distance measured between the tips of the middle fingers when both arms are fully stretched out to the sides. For the measurement procedure, each participant will be asked to stand upright against a wall with their back straight and arms extended horizontally at shoulder level. Measurements will be taken three times using a standardized metal measuring tape, and the average will be used for analysis. Predictive equations developed for Malaysian older adults will then be applied: for men, Height = \[0.681 × arm span (cm)\] + 47.56; and for women, Height = \[0.851 × arm span (cm)\] + 18.78.

  3 months

• Body weight in kilograms (kg)

  Body weight will be assessed using BIA with the InBody 270 device. Prior to the assessment, participants will be screened to confirm they are not fitted with pacemakers. To ensure standardization, they will be instructed to remove footwear, socks, and any heavy accessories, as well as to empty their pockets and bladder. During the procedure, participants will be positioned at the center of the platform, standing upright with eyes forward.

  3 months

• Body mass index (BMI) in kilograms per square meter (kg/m²)

  BMI, which will be obtained by dividing body weight in kilograms by the square of height in meters (kg/m²). Among older adults, an optimal BMI is expected to fall between 24 and 27 kg/m². Readings below 24 kg/m² will indicate underweight status, while values exceeding 27 kg/m² will reflect overweight conditions.

  3 months

• Body fat percentage in percentage (%)

  Body fat percentage will be measured using BIA. Male participants presenting with 25% or more body fat will be identified as obese, while those below this level will be considered non-obese. For females, obesity will be defined at 35% or higher body fat, with measurements under this threshold reflecting a non-obese status.

  3 months

• Waist circumference in centimetres (cm)

  Waist circumference of the participants will be measured using a metal measuring tape. Male participants with a waist circumference of 90 cm or above will be categorized as having abdominal obesity, while those with measurements below 90 cm will be considered non-abdominally obese. For female participants, abdominal obesity will be defined as a waist circumference of 80 cm or greater, with values under 80 cm classified as non-abdominally obese.

  3 months

• Calf circumference in centimetres (cm)

  Calf circumference will be assessed using a metal measuring tape. The measurement will be taken at the widest part of the calf, ensuring the tape is positioned horizontally and parallel to the floor. During the assessment, participants will be seated with knees and ankles flexed at 90°, feet resting flat on the ground. To ensure precision, the tape will be placed directly on the skin without clothing interference.

  3 months

• Cognitive performance

  Cognitive frailty will be evaluated based on the presence of both cognitive impairment and physical frailty. Cognitive performance will be assessed using the MoCA, which is scored from 0 to 30, with higher scores indicating better cognitive function. For classification purposes, MoCA scores will be interpreted as follows: Normal cognition: 26-30; MCI: 18-25; Moderate to severe impairment: ≤17 Participants who demonstrate mild cognitive impairment (MoCA score 18-25) in combination with pre-frailty or frailty (FFP score ≥2) will be classified as having cognitive frailty.

  3 months

• Malaysian-MIND diet (MY-MINDD) score

  Baseline and follow-up 7-day diet histories will be collected, and adherence to the MY-MINDD will be evaluated using the MY-MINDD score, a tool specifically developed for Malaysian older adults. Dietary intake will be assessed based on 11 food groups: whole grains, green leafy vegetables, other vegetables, flavonoid-rich fruits, deep-sea fish (non-fried), poultry (non-fried), legumes and soy products, desserts, sweetened kuih and beverages, red meat, fried/fast foods, and butter/margarine. Each group will be scored according to intake frequency and serving sizes (0, 0.5, or 1). The total score will be obtained by summing all components, with a maximum of 11 points, which is a modified version of the original MIND diet score (15 points). An increased score will denote stronger compliance with the MY-MINDD dietary guidelines.

  3 months

• Unintentional Weight Loss in kilogram (kg)

  Unintentional weight loss will be assessed by self-report. Participants will be asked whether they have experienced an unintentional weight loss of \>10 kg of their body weight within the past 12 months. Participants meeting this criterion will be classified as fulfilling the weight loss component of the FFP.

  3 months

• Exhaustion

  Exhaustion will be assessed using two items from the Center for Epidemiologic Studies Depression Scale (CES-D): "I felt that everything I did was an effort," and "I could not get going." Participants reporting either symptom for ≥3 days per week during the past week will be classified as having exhaustion, thereby fulfilling the exhaustion component of the FFP.

  3 months

• Physical Performance in seconds (s)

  Physical performance will be assessed using the 5t-CST. Participants will be instructed to stand up and sit down five times as quickly as possible from a standard chair without using their arms. The total time to complete five repetitions will be recorded in seconds. Slowness will be defined based on established cut-off values for the 5t-CST. Participants with performance times exceeding the specified threshold will be classified as fulfilling the slowness component of the FFP.

  3 months

• Physical Activity Score

  Physical activity level will be assessed using a validated PASE questionnaire. The PASE assesses the frequency and duration of leisure-time, household, and occupational physical activities performed over the previous 7 days. Weekly energy expenditure will be calculated and expressed in kilocalories per week (kcal/week). Low physical activity will be defined according to sex-specific cut-off values consistent with the FFP. Participants with weekly energy expenditure below the specified thresholds will be classified as fulfilling the low physical activity component of the Fried Frailty Phenotype.

  3 months

• Frailty

  Frailty will be assessed using the FFP, a validated multidimensional construct comprising five components: unintentional weight loss, exhaustion, weakness, slowness, and low physical activity. Each component will be assessed according to standardized criteria. Participants will be classified based on the total number of criteria met: robust (0 criteria), pre-frail (1-2 criteria), and frail (≥3 criteria). Frailty status will be used as a categorical outcome measure in the present study.

  3 months

Secondary Outcomes (4)

• Incremental Cost-Effectiveness Ratio (ICER)

  3 months

• Brain-Derived Neurotrophic Factor (BDNF) in picograms per milliliter (pg/mL)

  3 months

• 6-item USDA Household Food Security Survey Module (HFSSM) score

  3 months

• Depressive Symptoms

  3 months

Study Arms (2)

PPA Loke Yew (Control Group)

NO INTERVENTION

Participants in the control group will continue with their usual daily dietary intake and routine living activities without receiving any intervention throughout the 3-month study period. However, they will be assured that they will receive the reMIND meals upon study completion, both for ethical reasons and as an appreciation for their participation and cooperation, known as wait-list control design. This post-study provision also aims to help alleviate food insecurity among participants. This arrangement ensures ethical equity between groups while maintaining the validity of the control condition. It may also help enhance participants' dietary awareness and motivation toward healthier eating habits in the future. Data collection for this group will occur three times, at baseline (week 1), mid-intervention (week 6), and post-intervention (week 12), mirroring the schedule of the intervention group to maintain consistency. To minimise bias, basic nutrition education will be provided.

PPA Seri Alam Fasa 2 (Intervention Group)

EXPERIMENTAL

Participants in the intervention group will receive home-delivered reMIND meals for a duration of 3 months, in addition to their usual dietary intake and daily activities. The retort meals will be nutritionally balanced and portion-controlled, designed in accordance with the Recommended Nutrient Intakes (RNI) Malaysia for older adults and the MY-MINDD dietary concept. These meals are formulated to meet the nutritional requirements outlined by the MY-MINDD framework, emphasising nutrient density and cognitive health support. Each participant will receive two meals per day, delivered once weekly, and will be encouraged to consume the meals as part of their regular diet. All meal plans will be developed by qualified dietitians and nutritionists to ensure appropriate macronutrient and micronutrient composition, food safety, and palatability. At the baseline visit, participants will receive brief dietary guidance and educational materials.

Other: PPR Seri Alam Fasa 2 (Intervention Group)

Interventions

PPR Seri Alam Fasa 2 (Intervention Group) OTHER

Participants in the intervention group will receive home-delivered reMIND meals for a duration of 3 months, in addition to their usual dietary intake and daily activities. The retort meals will be nutritionally balanced and portion-controlled, designed in accordance with the RNI 2017 Malaysia for older adults and the MY-MINDD dietary concept. These meals are formulated to meet the nutritional requirements outlined by the MY-MINDD framework, emphasising nutrient density and cognitive health support. Each participant will receive two meals per day, delivered once weekly, and will be encouraged to consume the meals as part of their regular diet. All meal plans will be developed by qualified dietitians and nutritionists to ensure appropriate macronutrient and micronutrient composition, food safety, and palatability. At the baseline visit, participants will receive brief dietary guidance and educational materials.

Also known as: reMIND

PPA Seri Alam Fasa 2 (Intervention Group)

Eligibility Criteria

• Age: 60 Years - 84 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Malaysian older adults aged 60 to 84 years.
• Classified under the B40 income group.
• Preferably living independently, without receiving daily meals from family members; cohabitation with other older adults is acceptable if meal support is not provided.
• Experiencing food insecurity as assessed by screening questionnaires.
• Able to provide informed consent.
• Participate in the study for the full duration.
• Able to stand without support.
• For older adults living with a spouse, preferably both partners must be eligible, willing to participate, and recruited for the study.

You may not qualify if:

• Individuals with diagnosed terminal illnesses (e.g., cancer, end-stage liver failure, end-stage lung disease, and severe form of heart diseases) and having medical conditions requiring specialized dietary restrictions (e.g., chronic/end-stage renal disease, severe dysphagia).
• Those with cognitive impairments or disabilities that prevent them from understanding the study procedures or providing consent.
• Participants or their spouse enrolled in other nutrition-related intervention programs during the study period.
• Those unwilling or unable to adhere to the intervention protocol.
• Bedridden
• Handicapped or amputated
• Wearing pacemaker
• Vegetarian, food allergies or food intolerance

Sponsors & Collaborators

• Universiti Putra Malaysia: lead
• United Nations: collaborator

Study Sites (2)

Perumahan Awam (PA) Loke Yew

Kuala Lumpur, Malaysia

Location

Project Perumahan Rakyat (PPR) Seri Alam Fasa 2

Kuala Lumpur, Malaysia

Location

MeSH Terms

Conditions

Sarcopenia; Malnutrition

Condition Hierarchy (Ancestors)

Muscular Atrophy; Neuromuscular Manifestations; Neurologic Manifestations; Nervous System Diseases; Atrophy; Pathological Conditions, Anatomical; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Nutrition Disorders; Nutritional and Metabolic Diseases

Study Officials

• Yoke Mun Prof. Dr. Chan, Ph.D(Community Nutrition)(UPM)

  Universiti Putra Malaysia

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Yoke Mun Prof. Dr. Chan, Ph.D(Community Nutrition)(UPM)

CONTACT

+603-97692433; cym@upm.edu.my

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: Given the nature of the nutrition intervention, participants cannot be blinded to group assignment. To reduce bias, however, the researchers responsible for data entry and analysis will be blinded. Group assignments will be coded as "Group A" and "Group B" by the supervisor, and researchers will enter and analyze data without knowledge of which cluster corresponds to the intervention or control group.
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Prof. Dr. Chan Yoke Mun

Model Details: A 12-week, two-arm, cluster randomized controlled trial, quantitative study. This study adopts an experimental design, specifically a 12-week, two-arm, cluster randomized controlled trial (RCT). Cluster allocation will be determined by simple randomization. Between the two comparable housing clusters, PPR Seri Alam Fasa 2 and PA Loke Yew, the intervention and control groups will be assigned by drawing lots. PPR Seri Alam Fasa 2 was randomly designated as the intervention cluster, while PPA Loke Yew served as the control cluster. Under this randomization process, eligible participants from PPR Seri Alam Fasa 2 will receive the retort meals through the MoW program for 12 weeks, while participants from PPA Loke Yew will form the control group and will only receive the retort meals after the completion of the study.

Study Record Dates

• First Submitted: November 18, 2025
• First Posted: January 8, 2026
• Study Start: May 2, 2026
• Primary Completion (Estimated): July 26, 2026
• Study Completion (Estimated): July 26, 2026
• Last Updated: January 26, 2026

Record last verified: 2026-01

Data Sharing

• IPD Sharing: Will not share

Locations

MY (2)