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National Health and Morbidity Survey of Malaysia 2011 revealed that hypercholesterolemia (35.1 per cent, 6.2 million) was the primary leading causes of cardiovascular disease in Malaysia. Currently, three established recommended approaches such as therapeutic lifestyle change (TLC) diet, pharmacotherapy (simvastatin) and TLC + simvastatin are available to the public but, to our knowledge, have never been compared in Malaysia Primary Health Care setting. Hence, this paper aims to compare the lipid lowering effects of these three approaches in a primary health care clinic.

This randomized trial enrolled 180 patients with hypercholesterolemia who met adult treatment panel III (ATP III) criteria. All participants were randomized to TLC diet, simvastatin (10-20 mg/d) or TLC + simvastatin diets. The TLC group was enrolled in a 12-week multidisciplinary lifestyle program that involved monthly 45 minutes to hour meetings. The simvastatin group received medication, and traditional counseling was conducted by registered medical officer. Another group was enrolled into TLC + simvastain treatment. The primary outcome measure was the percentage change in low-density lipoprotein-cholesterol. Secondary measures were changes in weight loss, blood pressure and dietary changes. Assessments were repeated at three-month interval.

Lifestyle changes combined with simvastatin had a better lipid lowering effect compared to the other two treatments. However, TLC had a better weight and blood pressure reduction compared to the other two treatments. Nevertheless, TLC group showed reduction proportions similar to standard therapy with simvastatin or TLC + simvastatin. TLC has proven as an alternative approach to hyperlipidemia for a subset of patients unwilling or unable to take statins especially in a community-based, primary health care setting.

Weight loss was not recorded for simvastatin participants, and this was the major drawback of this study, and there was no comparable weight loss reduction with other groups.

In Malaysia, the efficacy of hypocholesterolemic therapies among patients who are receiving the most common lipid-lowering drug, simvastatin, in primary health care setting has not been clearly defined. There is also a lack of research on the efficacy of TLC conducted by registered dietitian in a primary health care setting in Malaysia.

This study aims to pilot test a new multi-component worksite intervention for weight loss in a primary healthcare setting.

This randomized trial involved 88 participants (43, 45; intervention, control group). The intervention group enrolled in a 12-week lifestyle program that involved modification of dietary intake by community Registered Dietitian (RDs) and increasing high-intensity interval training (HITT) with motivational interviewing (MI) to support changes. The control group received traditional counselling and weekly aerobic exercise from Medical Officer and physiotherapist. The primary outcome measure was the changes in body weight. Secondary measures were changes in blood pressure, fasting blood glucose, fasting blood lipid and dietary changes. Assessments were repeated at a three-month interval.

There was a significant reduction in body weight and waist circumference within groups. Intervention group demonstrated a significant improvement in all cardiometabolic risk factors. This study showed that primary healthcare setting can be successful locations in promoting short-term health benefits. RDs were more successful and HITT appeared to be a favorable workout with MI in achieving drastic weight loss.

The short-term worksite intervention and not recording of body composition were the major drawbacks in this study.

The efficacy of multi-component worksite intervention (Diet–HITT–MI) in primary healthcare setting has not been clearly defined.

Recent public health initiatives have promoted accumulating 10,000 steps per day. Little previous research has evaluated the using pedometer in sustaining the physical activity level during worksite intervention. Hence, this study aims to the step changes of pedometer in a multicomponent worksite intervention.

This trial enrolled 43 participants recruited from brochures at outpatient clinic. Throughout the 12-week multidisciplinary lifestyle program, participant required to wear a pedometer and reported daily step count at baseline, 1st, 3rd, 5th, 7th, 9th and 12th week. The primary outcome measure was the step goal over the 12th week of intervention.

All subjects regardless men and women prior enter into the intervention recorded less than 5,000 of average steps count per day which is sedentary. At the 12th week of intervention, there were only 9.3 per cent subjects are sedentary. Majority of subjects (55.8 per cent) had achieved at least somewhat active, followed by low active (23.3 per cent). There were only 11.6 per cent subjects are classified as highly active at the end of the intervention. The result indicated the changes of average steps per day from baseline to 2nd (p < 0.01), 4th (p < 0.01), 6th (p < 0.01), 8th (p < 0.01), 10th (p < 0.01) and 12th (p < 0.01) week were significant. Likewise, the changes of average steps per day from previous time were significant at 4th (p < 0.01) week and 10th (p < 0.001) week.

This study did not associate the improvement health parameter and step counter as the core stone of this study intervention were extensive individual dietary regime and reinforcement of ZUMBA participation among participants through motivational interviewing counseling. Third, there was no control group in this study, where no pedometer and goal setting were provided to the control group in the previous reported effectiveness study (Jian Pei et al., 2017).

The step goal during a multicomponent worksite intervention in primary health-care setting has not been clearly defined. Besides, there are no clear data of generally daily step among primary health-care employees.