There are many Mediterranean diets
Author:Ann Noah MScand Arthur Stewart Truswell MD,DSc
Keywords:different Mediterranean diets, food habits, Mediterranean diet, Sydney
Abstract:Interest in Mediterranean diet began 30 years ago, when Ancel Keys published the results of the famous Seven
Countries Study. Since 1945, almost 1.3 million people have come to Australia from Mediterranean countries as
new settlers. There are 18 countries with coasts on the Mediterranean sea: Spain, southern France, Italy, Malta,
Croatia, Bosnia, Albania, Greece, Cyprus, Turkey, Syria, Lebanon, Egypt, Libya, Malta, Tunisia, Algeria and
Morocco. This study from which this report derives aims to investigate the influence of the food habits of
immigrants from Mediterranean countries on Australian food intake. Here we look at the ‘traditional’ food
habits of the above Mediterranean countries as told by 102 people we interviewed in Sydney, who came from
18 Mediterranean countries to Sydney. Most of the informants were women, their age ranged from 35 to
55 years. The interview was open-ended and held in the informant’s home. It usually lasted around 1
1
/2 hours.
The interview had three parts. Personal information was obtained, questions relating to the food habits of these
people back in their original Mediterranean countries and how their food intake and habits have changed in
Australia were also asked. From the interviews, we have obtained a broad picture of ‘traditional’ food habits in
different Mediterranean countries. The interview data was checked with books of recipes for the different
countries. While there were similarities between the countries, there are also important differences in the food
habits of the Mediterranean countries. Neighbouring countries’ food habits are closer than those on opposite
sides of the Mediterranean Sea. We suggest that these food habits can be put into four groups. The data here
refer to food habits in Mediterranean countries 20 or 30 years ago, as they were recovering from the Second
World War. There is no single ideal Mediterranean diet. Nutritionists who use the concept should qualify the
individual country and the time in history of their model Mediterranean diet.
Asia Pac J Clin Nutr. 2001;10(1):2-9.doi:
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Contemporary Minangkabau food culture in West Sumatra, Indonesia
Author:Nur I Lipoeto MD,MMedSci, Zulkarnain Agus MD,MPH,
Keywords:coconut, fish, food culture, Indonesia, Minangkabau, rice, West Sumatra, women
Abstract:Diet has a strong relationship with food culture and changes in it are likely to be involved in the pathogenesis of
newly emergent degenerative diseases. To obtain in-depth opinions about the food culture of Minangkabau
people, focus group discussions were conducted in a Minangkabau region, represented by four villages in West
Sumatra, Indonesia, from January to March 1999. The members of the discussion groups were principally
women aged from 35 to 82 years old. Minangkabau culture is matriarchal and matrilineal which accounts for
female gender dominants in the discussions. Rice, fish, coconut and chilli are the basic ingredients of the
Minangkabau meals. Meat, especially beef and chicken, is mainly prepared for special occasions; pork is not
halal and therefore not eaten by Muslim Minangkabau people; and for reasons of taste preference and
availability, lamb, goat and wild game are rarely eaten. However, rendang, a popular meat dish, has been
identified as one of the Minangkabau food culture characteristic dishes. Vegetables are consumed daily. Fruit is
mainly seasonal, although certain kinds of fruit, such as banana, papaya and citrus, can be found all year around.
Coconut has an important role in Minangkabau food culture and is the main source of dietary fat. While almost
all food items consumed by the Minangkabau can be cooked with coconut milk, fried food with coconut oil is
considered to be a daily basic food. Desiccated coconut is also used as a food ingredient on about a weekly basis
and in snack foods almost every day. Although there have been no changes in food preparation and there is a
slight difference in taste preference between the young and the old generations, there has been a dramatic shift
in food preferences, which is reflected in the changing percentage of energy consumed over the past 15 years.
The traditional combination of rice, fish and coconut in Minangkabau culture goes back hundreds of years, long
before the emergence of the degenerative diseases of the newer economies, and is likely to offer food security
and health protection to the Minangkabau for as long as the lifestyle remains traditional. Whether or not a recent
increase in energy intake from fat and the quality of fat may contribute to the shift of disease pattern is
fundamentally important for the Minangkabau, it seems unlikely the traditional use of coconut and its products
was a health issue. Moreover, it was clear from the focus group discussions that the use of coconut encouraged
the consumption of fish and vegetables.
Asia Pac J Clin Nutr. 2001;10(1):10-16.doi:
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Lack of awareness of public health promotion messages among a group of adult New Zealanders who meet national guidelines for food intake and physical activity
Author:J Hilary Green PhDand Fiona E Boyle P Dip CommNutr
Keywords:exercise, guidelines, health promotion, New Zealand, nutrition
Abstract:The aim of this study was to assess the awareness of national health promotion messages in a group of selfselected New Zealanders. This study involved 104 self-selected New Zealanders (41 men and 63 women) over
the age of 40. Awareness of national health promotion messages was assessed using a mailed out questionnaire,
and 69 of these were returned. Basic anthropometric measurements were made (height, weight, hip and waist
circumference) and habitual physical activity was defined using a questionnaire. Food intake was estimated by
24-h dietary recall. Overall, this group of people met the New Zealand national guidelines for exercise, physical
activity and food intake. There was good awareness of the public health organisations in New Zealand, but only
half the people that we sampled had a general idea about the content of the health messages of these
organisations. This group of New Zealand adults had a healthy lifestyle that was not associated with a high
awareness of public health messages, suggesting that other sources of health information are used.
Asia Pac J Clin Nutr. 2001;10(1):17-20.doi:
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Significance of wild vegetables in micronutrient intakes of women in Vietnam: an analysis of food variety
Author:Britta M Ogle MSc, Pham Huang Hung MD and Ho Thi
Keywords:dietary diversity, dietary intake of women, food-based dietary guidelines, food variety analysis, sociocultural variations, Vietnam, wild vegetables
Abstract:The association between food variety and nutrient intake/health status among rural women was tested in two
agro-ecological settings in Vietnam. Special emphasis was placed on the significance of wild vegetables ‘Rau
Dai’ in micronutrient supply and on the usefulness of food variety analysis in determining their current role.
Data from 7-day food frequency interviews and a nutrition/health survey with 93 and 103 rural women in the
Mekong Delta and the Central Highlands, respectively, were used in the analysis. Energy and nutrient intakes in
the groups with the highest food variety score (FVS) (high = ≥21) in the two regions were compared to those
with the lowest food variety score (low =≤15). The high FVS groups in both regions also had a more diversified
diet in terms of food categories. With the exception of low iron and riboflavin intakes in all groups, the high
FVS groups had relatively adequate diets. A large variety of vegetables was used and only approximately half of
the vegetable species were cultivated. In both regions the high FVS groups used a significantly greater variety
of vegetables than the low FVS groups. Wild vegetables contributed significantly to the overall micronutrient
intakes, mostly carotene, vitamin C and calcium intakes, but only the contribution to carotene intake was
significantly higher in the high FVS group. Overall, we conclude that a food variety analysis is a useful tool in
capturing the dietary role of wild vegetables.
Asia Pac J Clin Nutr. 2001;10(1):21-30.doi:
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Poor nutritional status in older black South Africans
Author:Karen E Charlton MSc,MPhil, Lesley T Bourne MSc,
Keywords:anthropometry, Cape Town, elderly, nutritional status, South African
Abstract:A cross-sectional analytical study was undertaken to describe the nutritional status and dietary intake of the
elderly black population of Cape Town. A stratified proportional sample of 148 men and women aged 60 years
and older (mean = 68.9 ± 5.7) was selected from informal and formal peri-urban settlements. The study
population was predominantly urbanized, although most subjects had migrated from non-urban areas. Trained
fieldworkers conducted a 24-h recall dietary assessment and performed anthropometrical measurements. Mean
energy intakes fell below the recommended dietary allowance (RDA) for both men and women; 27% and 36%
of men and women, respectively, had energy intakes <67% RDA. Total fat intake was low and contributed
24–26% total energy. Mean dietary fibre intake was low at 11–16 g/day. Mean intakes fell below the RDA for
vitamin D, calcium, zinc and vitamin B6. Less than two and a half servings per day were consumed from the
vegetable and fruit group and less than one serving per day from the calcium-rich food group. Over half (51.3%)
of the women and 18% of the male were obese (body mass index ≥30). We concluded that older black subjects
in Cape Town have energy profiles in line with prudent dietary guidelines and more favorable than other elderly
groups in the country, with regard to atherogenic risk. However, micronutrient and dietary fiber intake is
inadequate, largely due to low reported energy intakes, particularly in women.
Asia Pac J Clin Nutr. 2001;10(1):31-38.doi:
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Can dietary factors explain differences in serum cholesterol profiles among different ethnic groups (Chinese, Malays and Indians) in Singapore?
Author:Mabel Deurenberg-Yap MD,PhD, Teresa Li BSc, Wei L
Keywords:Chinese, dietary factors, ethnic, Indians, Malays, serum cholesterol, Singapore
Abstract:In Singapore, there exists differences in risk factors for coronary heart disease among the three main ethnic
groups: Chinese, Malays and Indians. This study aimed to investigate if differences in dietary intakes of fat,
types of fat, cholesterol, fruits, vegetables and grain foods could explain the differences in serum cholesterol
levels between the ethnic groups. A total of 2408 adult subjects (61.0% Chinese, 21.4% Malays and 17.6%
Indians) were selected systematically from the subjects who took part in the National Health Survey in 1998.
The design of the study was based on a cross-sectional study. A food frequency questionnaire was used to assess
intakes of energy, total fat, saturated fat, polyunsaturated fat, monounsaturated fat, cholesterol, fruits, vegetables
and cereal-based foods. The Hegsted score was calculated. Serum total cholesterol, low density lipoprotein
cholesterol, high density lipoprotein cholesterol were analysed and the ratio of total cholesterol to high density
lipoprotein cholesterol was computed. The results showed that on a group level (six sex–ethnic groups), Hegsted
score, dietary intakes of fat, saturated fat, cholesterol, vegetables and grain foods were found to be correlated to
serum cholesterol levels. However, selected dietary factors did not explain the differences in serum cholesterol
levels between ethnic groups when multivariate regression analysis was performed, with adjustment for age,
body mass index, waist-hip ratio, cigarette smoking, occupation, education level and physical activity level. This
cross-sectional study shows that while selected dietary factors are correlated to serum cholesterol at a group
level, they do not explain the differences in serum cholesterol levels between ethnic groups independently of
age, obesity, occupation, educational level and other lifestyle risk factors.
Asia Pac J Clin Nutr. 2001;10(1):39-45.doi:
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Effects of a liquid diet supplement containing structured medium- and long-chain triacylglycerols on bodyfat accumulation in healthy young subjects
Author:Tatsuhiro Matsuo Ph D, Masako Matsuo MSc, Michio
Keywords: body fat, healthy subjects, Hiroshima, Japan liquid-formula diet, medium-chain triacylglycerol, structured lipids
Abstract:The effects of a liquid-formula diet supplement containing structured medium- and long-chain triacylglycerols
(SMLCT) composed of medium- (10%) and long-chain (90%) fatty acids were compared with those of longchain triacylglycerols (LCT) on bodyfat accumulation in 13 healthy male volunteers aged 18–20 years. The
subjects were randomly assigned the SMLCT or LCT group. The subjects in each group received a liquidformula diet supplement of the SMLCT or LCT, which provided 1040 kJ plus daily energy intake for 12 weeks.
Mean energy intake containing liquid diet throughout the 12-week period did not differ between the SMLCT
and LCT groups. Bodyweight of subjects in both groups increased slightly from the baseline throughout the 12-week period, but the differences were not significant. Rates of variation of bodyfat percentage were significantly
lower in the SMLCT group than in the LCT group throughout the 12-week period. Comparisons between the
SMLCT and LCT groups at baseline and 12 weeks showed no significant differences in any of the biochemical
blood parameters. These results suggest that replacing LCT with SMLCT over long periods of time could
produce bodyfat loss in the absence of reduced energy intake.
Asia Pac J Clin Nutr. 2001;10(1):46-50.doi:
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Study of biochemical prevalence indicators for the assessment of iodine deficiency disorders in adults at field conditions in Gujarat (India)
Author:Sheela R Brahmbhatt MSc(Med), Ron Fearnley (Cert
Keywords:blood spot TSH, goitrogens, Gujarat; (Western India), iodine deficiency disorders, urinary iodine
Abstract:The main objective of this study was to assess the severity of iodine deficiency disorders (IDD) in the adult
populations of the Baroda and Dang districts from Gujarat, western India using biochemical prevalence indicators of IDD. The other aim of this study was to establish a biochemical baseline for adequate iodine intake as
a result of program evolution in the face of multiple confounding factors, like malnutrition and goitrogens
responsible for goiter. A total of 959 adults (16–85 years) were studied from two districts (Baroda and Dang)
and data was collected on dietary habits, anthropometric and biochemical parameters such as height, weight,
urinary iodine (UI) and blood thyroid stimulating hormone (TSH). Drinking water and cooking salt were
analyzed for iodine content. All subjects, irrespective of sex and district, showed median UI = 73µg/L and mean
blood TSH ± SD = 1.59 ± 2.4 mU/L. Seven per cent of the studied population had blood TSH values > 5 mU/L.
Females in Baroda and males from Dang district were more affected by iodine deficiency as shown by a lower
median UI. Mean TSH was significantly higher in women from both districts as compared to men (P= 0.001).
The blood spots TSH values > 5 mU/L were seen in 20% of women from Dang. The normative accepted WHO
values for UI and TSH for the severity of IDD as a significant health problem are not available for target
population of adults. Urinary iodine normative limits and cut-offs are established for school-aged children.
Blood spot TSH upper limit and cut-off values are available for neonate populations. The IDD has not been
eliminated so far, as more than 20% of both male and female subjects had UI < 50 µg/L. Males were more
malnourished than females in both districts (P< 0.05). Pearl millet from Baroda contained flavonoids like
apigenin, vitexin and glycosyl-vitexin. Dang district water lacked in iodine content. Iodine deficiency disorder is
a public health problem in Gujarat, with the Baroda district a new pocket of IDD. High amounts of dietary
flavonoids in Baroda and Dang, malnutrition and an additional lack of iodine in Dang water account for IDD.
Asia Pac J Clin Nutr. 2001;10(1):51-57.doi:
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Elimination of iodine deficiency disorders by 2000 and its bearing on the people in a district of Orissa, India: a knowledge–attitude–practices study
Author:Surendra SS Mohapatra MBBS, Gandham Bulliyya PhD,
Keywords:iodine deficiency disorders, iodised salt, knowledge–attitude–practice study, Orissa (India)
Abstract:A knowledge–attitude–practices (KAP) study was conducted along with a prevalence study of iodine deficiency
disorders (IDD) between 1998–99 in the district of Bargarh, Orissa state, India. A total of 635 people were
interviewed by a pretested structured questionnaire, adopting the probability proportional to size cluster
sampling method. The aim was to assess the baseline information on the KAP of the people regarding IDD.
Only 37% of the males and 29.3% of the females perceived goitre as a disease. Less than 5% of both sexes
knew how goitre is caused. Only 16.4% used iodised salt regularly. The awareness and perception of IDD does
not correspond with the time and effort we have spent in education of this disease. The implications of this poor
knowledge about IDD and consequent poor use of iodised salt is contrasted to the optimistic target of
elimination of IDD. This aspect is discussed in this paper, at a time when we are at the beginning of the new
millennium.
Asia Pac J Clin Nutr. 2001;10(1):58-62.doi:
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Serum vitamin A concentrations and growth in children and adolescents in Gansu Province, China
Author:Wenbiao Hu BMed, Shilu Tong BMed,PhD, Brian Olden
Keywords:body mass index, Gansu Province (China), height, nutrition and growth, vitamin A, weight
Abstract:The association between serum vitamin A concentration and growth was assessed in a random sample of 650
children aged 0–14 years and 143 adolescents aged 15–19 years from the four prefectures of Jiayuguan, Linxia,
Lanzhou and Tianshui in Gansu Province, China. Serum vitamin A concentrations were measured using a high
performance liquid chromatograph. Height and weight were measured with standard methods. The results show
that serum vitamin A concentration appeared to be the lowest in the age group 5–9 years which was only 0.28
mg/mL (95% confidence interval [CI]: 0.27–0.30) in males and 0.30 mg/mL (95% CI: 0.28–0.32) in females;
and then it gradually increased with age. There was no statistically significant difference between males and
females in any of the age groups. There were statistically significant correlations between vitamin A and weight
(r= 0.37; P< 0.001) and body mass index (r= 0.26; P< 0.001). This study suggests that serum vitamin A
concentrations in children and adolescents may affect child growth. Concerted efforts to improve vitamin A
status from a very early age become increasingly important if vitamin A has a genuine impact on child growth.
Asia Pac J Clin Nutr. 2001;10(1):63-66.doi:
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Focused gut-mucosal nutrition for diarrhoeal disease: improved nutrient therapy
Author:William EW Roediger MB,BCh,MSc,DPhil (Oxon), FRACS
Keywords:glutamine, groundnuts, oral rehydration solution, short-chain fatty acids
Abstract:The main substrates fuelling ion absorption in the mucosa of the small intestine and large intestine are
respectively glutamine and short-chain fatty acids, . Measurements now reported showed that derivation of both
glutamine and fibre for short-chain fatty acid production can be achieved from a single foodstuff – macerated
groundnuts. Macerated groundnuts may be more suitable as an additive in oral rehydration solutions for
promoting ion absorption than other agents that are low either in glutamine or fibre, such as rice water or
resistant starch.
Asia Pac J Clin Nutr. 2001;10(1):67-68.doi:
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