An original discovery: selenium deficiency and Keshan disease (an endemic heart disease)
Author:Junshi Chen MD
Keywords:selenium, Keshan disease, translational research , essential trace element
Abstract:This is a review article telling a 50-years old story about the studies on selenium deficiency and Keshan disease
in China, an endemic heart disease with high case-fatality, as an example of translational research. Extensive
cross-sectional epidemiological studies showed that low selenium concentrations in cereal grains and low selenium status of local residents were associated with the occurrence of Keshan disease. Several large populationbased intervention trials using oral administration of sodium selenite tablets showed significant reduction of Keshan disease incidence. Based on the above evidence, it was concluded that selenium deficiency is the major
cause of Keshan disease, although other etiological factors could not be ruled out. The implicationsof the findings include: provided critical scientific evidence for selenium being an essential trace element for humans; as
scientific basis for identifying minimum requirement and RDA/RNI for selenium; and as solid reference for the
formulation of effective preventive measures for Keshan disease in China.
Asia Pac J Clin Nutr. 2012;21(3):320-326.doi:
>>Abstract
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Sasang types may differ in eating rate, meal size, and regular appetite: a systematic literature review
Author:Duong Duc Pham MD, PhD, Jae Chul Lee OMD, Myeong S
Keywords:Sasang constitutional medicine, Sasang typology, eating behaviour, appetite, review
Abstract:Eating behaviours may be implicated in the increasing prevalence of obesity and metabolic disorders.The Sasang
typology, a unique form of traditional Korean medicine, classifies individuals into four constitutional types that
differ in a distinctive complex of external manifestations and innate natures, including eating behaviours. Our aim
is to portray a picture of the distinguishing characteristics of eating behaviours across Sasang types and to provide
suggestions for future studies. Six Korean and one English database were searched to acquire relevant articles.
Ten peer-reviewed relevant research articles were found. The extracted data were categorised into the domainsof
i) food preferences; ii) eating rate; iii) eating initiation and termination; iv) meal size; v) regularity of eating; vi)
regular appetite; vii) eating disorders; and viii) psychological factors. Eating rate and meal size were the issues of
most concern that more frequently were different among Sasang types. The TaeEum type seemed to have obesity linked eating behaviours, including a rapid eating rate, large meal sizes, and a strong appetite, whereas those attitudes seemed to be in contrast with those of the SoEum type. The SoYang type shared similarities with both the
TaeEum and SoEum types. Future studies should be conducted with more reliable, objective, and quantitative assessment tools such as the Three Eating Factor Questionnaire or the Dutch Eating Behaviour Questionnaire
Asia Pac J Clin Nutr. 2012;21(3):327-337.doi:
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Comparison between measured and predicted resting energy expenditure in mechanically ventilated patients with COPD
Author:Zhi-Yong Rao MM, Xiao-Ting Wu PhD, Mao-Yun Wang MD
Keywords:resting energy expenditure, indirect calorimetry, mechanical ventilation, APACHE II score, predictive equation for energy expenditure
Abstract:The aim of this study was to compare resting energy expenditure (REE) obtained by indirect calorimetry (IC) and
Harris-Benedict (H-B) equations, and to examine whether hypocaloric nutrition support could improve protein
nutritional status in mechanically ventilated patients with chronic obstructive pulmonary disease (COPD). Thirtythree COPD patients (20 males, 13 females) were recruited and REE was measured by IC. Measured REE
(REEm) was compared to predictive REE by H-B equations (REEH-B
) and its corrected values. Correlation between REEm and APACHE II score was also analyzed. Patients were randomly divided into hypocaloric energy
group (50%-90% of REEm, En-low) and general energy group (90%-130% of REEm, En-gen) for nutrition support. The differences of albumin, prealbumin, transferrin, hemoglobin, and lymphocyte count before and after 7
days nutrition support were observed. Results show that REE
H-B
and REE
H-B
×1.2 were significantly lower than
REEm (p<0.01). REEm positively correlated with APACHE II score (p<0.05 or p<0.01). After nutrition support,
hemoglobin decreased significantly in En-gen group (p<0.05); lymphocyte count in both groups, and transferrin
and prealbumin in the En-low group increased significantly (p<0.05 or p<0.01). Our data suggest that 1) these patients’ REE were increased; 2) since IC is the best method to determine REE, in the absence of IC, H-B equations
(with standard body weight) can be used to calculate REE, but the value should be adjusted by correction coefficients derived from APACHE II; 3) low energy nutrition support during mechanical ventilation in COPD patients
might have better effects on improving protein nutritional status than high energy support.
Asia Pac J Clin Nutr. 2012;21(3):338-346.doi:
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Height prediction from anthropometric length parameters in Thai people
Author:Kaweesak Chittawatanarat MD, Sakda Pruenglampoo
Keywords:anthropometry, body measure, body height, linear models, Thai
Abstract:Height is an important clinical parameter. However, there were no specific measurements available for particular
clinical situations. Although many anthropometric measurements were suggested, no formula was recommended
in Thailand. The objective of this study was to develop a formula for height prediction with acceptable validity.
Two thousand volunteers were included and were divided consecutively according to both age and gender. Model
and validation groups were further separated independently. Linear regression was analyzed to create a predictive
formula. Ten parameters were included and analyzed. Of these, demispan, sitting height and knee height were selected with a correlation coefficient of more than 0.5 and significant F test in all age groups and genders. All single parameters and the highest predictive value of double (sitting and knee height) and triple regression models
(demispan, sitting and knee height) were proposed and these were modified into a simple formula. After validation of both formulas the correlation, quantitative error and relative error were comparable. The si mple formula
had more than 90% precision with an error of up to 10 cm in the validation group (89.7 to 99.0% in range). Of
these, knee height had the least predictive error in all subgroups. The double and triple models had decreased error only in the younger group. In summary, anthropometric parameters with demispan, sitting height, knee height
and combination could be applied to height prediction in the adult Thai with acceptable error. These formulas
should be applied only in people who could not be directly measured.
Asia Pac J Clin Nutr. 2012;21(3):347-354.doi:
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Development and evaluation of a semi-quantitative food frequency questionnaire for use in urban and rural India
Author:Liza Bowen PhD, Ankalmadagu Venkatsubbareddy Bhara
Keywords:dietary assessment, food frequency questionnaire, validity, India, dietary intake
Abstract:The objective of this study was to develop and evaluate a semi-quantitative food frequency questionnaire (FFQ)
for use in urban and rural India. A single FFQ was developed for use in cities and rural areas of four regions of
India. To assess validity, the FFQ was administered to 530 factory workers and rural dwellers, and subsequently
three 24 hour recalls were administered on different days. Nutrient and food group intake calculated from these
two methods were compared using medians, kappa statistics, Spearman’s correlation coefficients and BlandAltman plots. Dietary intake was overestimated by the FFQ compared to the 24 hour recalls (mean difference in
energy intake = 1743 kJ), with kappa statistics ranging from 0.07 (egg) to 0.51 (carbohydrate). The results
showed acceptable validity for measuring intakes of groups, and demonstrated that it is feasible to measure dietary intake in diverse regions of India with a single FFQ.
Asia Pac J Clin Nutr. 2012;21(3):355-360.doi:
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Combined intensive nutrition education and micronutrient powder supplementation improved nutritional status of mildly wasted children on Nias Island, Indonesia
Author:Dyah A Inayati M.Phil, PhD, Veronika Scherbaum MSc
Keywords:educational activities, micronutrients, fortified, weight gain, mildly wasted children
Abstract:To assess the impact of intensive nutrition education (INE) with or without the provision of micronutrient powder
(MNP) on the nutritional status of mildly wasted children in Nias, Indonesia, two groups of mildly wasted (≥-1.5
to <-1.0 WHZ) children aged ≥6 to <60 months in the Church World Service (CWS) project areas were assigned
by village randomization to receive INE (n=64) or INE+MNP (n=51) in a weekly program. Another two groups
of mildly wasted children who were living at a clear distance from INE and INE+MNP villages were selected to
receive a monthly non-intensive nutrition education program (NNE) with or without MNP (n=50 both respectively). WHZ, weight, height, haemoglobin (Hb) level, and morbidity data were assessed at admission,during the
study, and at individual discharge. Children’s weight gain (g/kg body weight/day) was highest in INE+MNP
group (2.2±2.1), followed by INE (1.1±0.9), NNE+MNP (0.3±0.5) and NNE (0.3±0.4) group. In both MNP intervention groups (INE+MNP, NNE+MNP), supplements significantly increased Hb value (g/L) of respective children (10.0±10.0; p<0.001 and 3.0±8.0; p<0.05 respectively). Proportion of children who reached discharge criterion was highest among the INE+MNP (70.6%; n=36), followed by INE (64.1%; n=41), NNE+MNP (26.0%;
n=13), and NNE (20.0%; n=10) groups (p<0.001). Shortest length of stay until recovery was observed among
children in the INE+MNP group (29.9 days), followed by INE (40.0 days), NNE+MNP (80.6 days), and NNE
(86.2 days) respectively (p<0.001). Weekly intensive nutrition education supported by MNP supplementation
produced the best results regarding weight gain and haemoglobin status of mildly wasted children.
Asia Pac J Clin Nutr. 2012;21(3):361-373.doi:
>>Abstract
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Supplementary feeding with locally-produced Ready-toUse Food (RUF) for mildly wasted children on Nias Island, Indonesia: comparison of daily and weekly program outcomes
Author:Ratna C Purwestri MSc, PhD, Veronika Scherbaum M
Keywords:ready-to-use foods, fortified, supplementary feeding, mildly wasted children, weight gain
Abstract:Ready-to-Use Foods (RUFs) in the form of fortified cereal/nut/legume-based biscuits (±500 kcal and 8-10% protein per 100 g) were tested among mildly wasted children from October 2007 to June 2008, and were labelled as
RUF-Nias biscuits. This study reports on a comparison of supplementary feeding program outcomes of mildly
wasted children with weight-for-height z-score (WHZ) ≥-2 to <-1.5 SD aged ≥6 to <60 months old given locally
produced RUF-Nias biscuits within daily (in semi-urban areas) and weekly (in rural remote regions) distribution
and supervision program settings. In the Church World Service project area, all eligible children were recruited
continuously from monthly community -based screening programs and admitted into existing nutrition centers
managed by the community on Nias I sland, Indonesia. Individual discharge criterion of the programs was WHZ
≥-1.5 SD. Of the index children admitted in daily programs (n=51), 80.4% reached target WHZ, which was
higher than in weekly programs (72.9%; n=48) by a similar length of stay of about 6 weeks. Weight gain of the
children in daily programs was higher (3.1±3.6 g/kg body weight/day) than in weekly programs (2.0±2.1 g/kg
body weight/day), and they achieved significantly higher WHZ at discharge. However, the majority of caretakers
preferred weekly programs due to lower time constraints. Locally produced RUF in the form of biscuits for
treatment of mild wasting among children demonstrated promising results both in daily and weekly communitybased intervention programs.
Asia Pac J Clin Nutr. 2012;21(3):374-379.doi:
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Glutamine for chemotherapy induced diarrhea: a metaanalysis
Author:Juxian Sun MD, Hui Wang MD, Heping Hu MD
Keywords:glutamine, diarrh ea, chemotherapy, meta-analysis, prophylactic
Abstract:The clinical efficacy of glutamine in the control of chemotherapy-induced diarrhea remains controversial. We
conducted a meta-analy sis, including as many randomized control trails (RCTs) as possible, to clarify the effectiveness of prophylactic glutamine in patients requiring chemotherapy. Methods: the Embase, MEDLINE, Cochrane Library, and BIOSIS databases were searched, and the included studies were RCTs that compared the use of
prophylactic glutamine versus placebo in patients receiving chemotherapy. The main outcomes were diarrhea severity and duration. Results: a total of 298 patients in eight RCTs were reviewed (147 patients who received
glutamine, and 151 patients who received placebo). There was a statistically significant difference in the duration
of diarrhea (weighted mean difference (WMD), -1; 95% confidence interval (CI), -1.73, -0.26) between the two
groups, but there was no significant difference in the severity of diarrhea (WMD, -0.49; 95% CI, -1.36, 0.39) between the groups. Conclusion: we concluded that glutamine could reduce the duration of diarrhea but could not
improve its severity.
Asia Pac J Clin Nutr. 2012;21(3):380-385.doi:
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The complexity of treating wasting in ambulatory rehabilitation: is it starvation, sarcopenia, cachexia or a combination of these conditions?
Author:Alison Yaxley BSc(Hons), Michelle D Miller PhD, R
Keywords:wasting, starvation, sarcopenia, cachexia, aged
Abstract:Nutritional status is often impaired in ambulatory rehabilitation patients. Wasting conditions can be classified as
starvation, sarcopenia or cachexia but differences between these are not well defined, and misdiagnosis may lead
to inappropriate intervention. A secondary analysis of data from 187 ambulatory rehabilitation patients aged ≥60
years aimed to identify patients with one or more wasting condition, and investigate the impact on common rehabilitation outcomes. Starvation was defined by fat-free mass index and the Council on Nutrition A ppetite Questionnaire score; sarcopenia by fat-free mass index and quadriceps strength; and cachexia by fat-free mass index
and serum C-reactive protein. Selected rehabilitation outcomes were compared for those who were, and those
who were not, identified as having one or more wasting condition. Of those identified with starvation (n=30), all
were also identified as sarcopenic and 20 as cachectic; of those identified as sarcopenic (n=75), 30 had starvation
and 37 were cachectic; and of those identified as cachectic (n=37), 20 had starvation and all were sarcopenic.
Twenty participants were identified as having all three conditions. Those with starvation had higherlevel of depression (p=0.003), lower self-rated health (p=0.032), and lower levels of physical function (motor p=0.006;
process p=0.004) than those with no evidence of a wasting condition. Those who had sarcopenia had lower
physical function (motor p=0.012; process p=0.003) as did those with cachexia (motor p=0.025; process p=0.042).
Results suggest problems in operationalising definitions in an ambulatory clinical setting. The overlap identified
in this analysis suggests that up to 40% (75/187) of patients could be misidentified and prescribed inappropriate
nutritional support.
Asia Pac J Clin Nutr. 2012;21(3):386-393.doi:
>>Abstract
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Plasma phospholipid polyunsaturated fatty acids and homocysteine in Chinese type 2 diabetes patients
Author:Tao Huang PhD， Sailimuhan Asimi BSc, Dajun Lou MD
Keywords:n-3 polyunsaturated fatty acid, homocysteine, type 2 diabetes, phospholipids, monounsaturated fatty acids
Abstract:The main aim of the present study was to investigate the plasma phospholipids (PL) fatty acids status and its association with plasma Hcy in patients with type 2 diabetes mellitus (T2DM). One hundred and four T2DM (aged
57.3±13.4 y) and 150 healthy subjects (aged 48.4±8.7 y) were recruited. Plasma Hcy and PL fatty acids were determined by standard methods. Plasma Hcy concentration in T2DM was significantly higher than that in healthy
subjects (p<0.001). The prevalence of hyperhomocysteinemia was significantly higher in T2DM (36.54%) than
that in healthy subjects (17.32%) (p=0.012). Plasma PL 20:4n-6 (r=0.303, p=0.012), 22:5n-3 (r=0.312, p=0.01),
total PUFA (r=0.303, p=0.012), n-6 PUFA (r=0.261, p=0.032) were significantly positively associated with
plasma Hcy concentration in T2DM. While, plasma PL n-3:n-6 PUFA (r=-0.400, p=0.046) was negatively associated with plasma Hcy in T2DM. In healthy subjects, plasma PL 22:6n-3 (r=-0.201, p=0.042) was negatively
associated with plasma Hcy. In addition, plasma PL 22:6n-3 (r=0.193, p=0.044) and 22:5n-6 (r=0.234, p=0.038)
were significantly negatively associated with plasma vitamin B-12 in healthy subjects. Our results suggested that
increased plasma Hcy levels in T2DM associated with low n-3:n-6 ratio intake. We suggest that T2DM increase
their long chain n-3 PUFA intake from fish or fish oil while decrease n-6 PUFA intake.
Asia Pac J Clin Nutr. 2012;21(3):394-399.doi:
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Assessing current nutritional status of patients with HCV-related liver cirrhosis in the compensated stage
Author:Kenichiro Yasutake PhD, Machiko Bekki MSc, Masako
Keywords:liver cirrhosis, HCV, nutrition, obesity, chronic hepatitis C
Abstract:Background/Aim: Nutritional states of Japanese patients with liver cirrhosis have recently shown great diversity,
some show protein energy malnutrition and others excessive nutrition and obesity. For there to be adequate guidance regarding dietary treatment, it is important that a patient’s current nutritional state be clarified.Methods: We
assessed nutritive intake in Japanese cirrhotic patients and determined their nutritional problems. Subjects were
non-hospitalized patients with hepatitis C virus (HCV)-related cirrhosis in the compensated stage (n=47), chronic
hepatitis C (n=46) or healthy volunteers (n=32). A brief self-administered diet history questionnaire was conducted with assistance from a registered dietitian. Results: We categorized patients with cirrhosis according to
daily intake of energy and protein; 10.6% had an energy and protein intake within a normal range, 72.4% showed
excessive intake, and 17.0% showed insufficient intake of energy or protein. In cirrhotic patients with diabetic
complications, the intake levels of energy, proteins, fat and carbohydrates were significantly higher than in patients without diabetes. Moreover, cirrhotic patients had significantly higher intake levels of energy, protein and
fat than did chronic hepatitis C patients and healthy individuals. In patients with HCV-related liver cirrhosis, insufficient intake of energy and protein was shown in some, while many, especially those with diabetes, showed
excessive intake. Conclusion: For nutritive management of cirrhotic patients, the intake of various nutrients
should be appropriately assessed and effective nutritional education sy stems established.
Asia Pac J Clin Nutr. 2012;21(3):400-405.doi:
>>Abstract
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Evaluation of taste acuity by the filter-paper disc in Japanese young women: the relationship with micronutrients status
Author:Ayako Nagai MS, Masaru Kubota MD, PhD, Yuriko Kata
Keywords:Japanese young women, taste acuity, filter-paper disc method, micronutrient, dietary record
Abstract:The aim of the present study is to investigate the taste acuity in Japanese young women in relation to their micronutrient status. Thirty-eight healthy young women (mean age; 21.3, range; 19-27 years) were enrolled. Gustatory
thresholds were estimated for four basic tastes: sweet (sucrose), salty (sodium chloride), sour (tartaric acid), and
bitter (quinine hydrochloride) by a filter-paper disk method. Various concentrations at each taste were serially
scored from disc number 1 (lowest) to number 5 (highest). The lowest concentration at which the quality of the
taste was correctly identified was defined as the recognition threshold. The mean of three measurements for each
test on three different days was calculated. We divided our participants into normal taste and hypogeusia groups
based on the mean threshold disc numbers, ≤3.5 and >3.5, respectively, according to previous literature using the
same method. We also measured serum concentrations and dietary intakes of micronutrients including zinc, iron,
copper, and selenium. The numbers of participants belonging to the hypogeusia group were 24 (63.2%) for sweet,
19 (50.0%) for sour, 17 (44.7%) for bitter, and 16 (42.1%) for salty taste. Although the hypogeusia group exhibited significantly lower serum iron concentrations, except for the salty taste, the other three micronutrients concentrations did not show any association with the four taste acuities. Dietary micronutrient intake did not show
any association with the four taste acuities. This study indicates that in addition to zinc status, iron status should
be considered in the study of taste acuity.
Asia Pac J Clin Nutr. 2012;21(3):406-410.doi:
>>Abstract
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Microcytic anaemia predominates in adolescent school girls in the delta region of Myanmar
Author:Min Kyaw Htet PhD, Drupadi Dillon PhD, Arwin Akib
Keywords:anaemia, haemoglobinopathy, Myanmar, adolescent, schoolgirls
Abstract:Objective: Anaemia is one of major nutritional problems in Myanmar affecting all age groups. However, there is
lack of recent information and a study was conducted to acquire information on the current status of anaemia
among adolescent schoolgirls in Nyaung Done township, Ayeyarwady division where an intervention study was
planned. Subjects and Methods: A cross-sectional survey was conducted on 1269 subjects to obtain complete
blood count, anthropometry and socioeconomic characteristics were obtained by questionnaire. Using red cell indices, we applied Bessman’s, and Green and King’s index classification to differentiate the types of anaemia.
Electrophoresis was also done on a subsample (n=228). Results: Stunting was 21.2% and wasting was 10.7% respectively. Prevalence of anaemia was 59.1% and was mainly microcytic. Green and King’s index showed 35.8%
were iron deficient. Electrophoresis revealed 36 cases of Hb E haemoglobinopathy in the subsample. Conclusion:
Anaemia is still a major nutrition problem in Myanmar. The reasons for this high prevalence should be explored
and properly addressed. The study highlights the need for a comprehensive and large scale survey for the anaemia
control programme in Myanmar.
Asia Pac J Clin Nutr. 2012;21(3):411-415.doi:
>>Abstract
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High prevalence of anemia with lack of iron deficiency among women in rural Bangladesh: a role for thalassemia and iron in groundwater
Author:Rebecca D Merrill PhD, Abu Ahmed Shamim MSc, Hasmo
Keywords:Bangladesh, anemia, iron-deficiency, thalassemia, women
Abstract:Iron deficiency was absent in a recent population assessment of rural Bangladeshi women exhibiting anemia
(57%), suggesting other causes of low hemoglobin. We assessed the relative influence on anemia of thalassemia,
groundwater arsenic and iron, and diet among women of reproductive age living in rural Bangladesh. Women
(n=207) sampled from a previous antenatal nutrient intervention trial in rural Bangladesh were visited during
two seasons in 2008. Collected data included 7-day dietary and 24-hour drinking water intake recalls, 7-day
morbidity recall, anthropometry, and drinking water arsenic and iron concentrations. Capillary blood was analyzed for iron (plasma ferritin, soluble transferrin receptor), inflammation (C-reactive protein) and thalassemia (β
thalassemia and Hb E) status. In stratified, adjusted analyses, only parity was associated with anemia (odds ratio,
OR (95% CI): 11.34 (1.94, 66.15)) for those with thalassemia (28% prevalent). In contrast, groundwater iron intake (>30 mg/d, 0.48 (0.24, 0.96)) and wasting (2.32 (1.17, 4.62)) were associated with anemia among those
without thalassemia. Elevated groundwater arsenic (>50 µg/L, 12% of tubewells) and a diverse diet were unrelated to anemia regardless of thalassemia diagnosis (p>0.70 and >0.47, respectively). Among women in this
typical rural Bangladeshi area, the prevalence of thalassemia was high and, unlike iron deficiency which was absent most likely due to high iron intake from groundwater, contributed to the risk of anemia. In such settings, the
influence of environmental sources of iron and the role of thalassemias in contributing to anemia atthe population level may be underappreciated
Asia Pac J Clin Nutr. 2012;21(3):416-424.doi:
>>Abstract
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Sugary beverage intakes and obesity prevalence among junior high school students in Beijing – a cross-sectional research on SSBs intake
Author:Meng Jia MS † , Chao Wang MD † , Yumei Zhang PhD,
Keywords:beverages, energy, overweight, obesity, dietary
Abstract:Background: Excessive consumption of sugar-sweetened beverages (SSBs) may increase the risk of obesity. Data
in regards to the consumption of SSBs is insufficient in the Chinese population, especially in middle school students experiencing rapid nutritional transition. We aimed to describe the consumption of SSBs among junior high
school students and explore the relationship between SSB intake and adolescents’ overweight/obesity in Beijing.
Methods: This was a cross-sectional study under which 322 (46%) male and 380 (54%) female (age 11-15 y, median 13 y) were recruited from two middle schools of Xicheng District in Beijing. All subjects completed a questionnaire and 24-hour dietary recall for 3 consecutive days. Results: Prevalence of overweight was 21.1% in
males and 11.6% in females. Prevalence of obesity was 22.7% in males and 10.3% in females. Of the students,
7.7% consumed SSBs at least once per day. Students whose storage of SSBs at home is more than 1 type are
more likely to consume higher quantities of SSBs everyday (p<0.001). After adjusting for confounding factors,
OR of high SSBs intake group versus low SSBs intake group was 2.6. Students whose parents had a higher BMI
had a higher risk of overweight/obesity (OR=1.13, p=0.007). Conclusions: Among middle school students in Beijing, prevalence of obesity is more severe than that of overweight. Sugar-sweetened beverages have been the
most popular drinks, and consumption of SSBs has a positive association with levels of overweight/obesity
among male students.
Asia Pac J Clin Nutr. 2012;21(3):425-430.doi:
>>Abstract
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Lack of folate improvement in high risk indigenous Australian adults over an average of 6.5 years: a cohort study
Author:Katina D’Onise PhD, Robyn Anne McDermott PhD, Dymp
Keywords:folic acid, indigenous population, policy, nutrition policy, cohort studies
Abstract:Socioeconomically vulnerable groups in developed countries suffer excess chronic disease due in large part to an
energy dense but nutrient poor diet. Low folate can be a marker of poor dietary quality and is also affected by
smoking and chronic alcohol intake, all of which cluster in groups with a low socioeconomic position. A 4.5 to 9
year follow-up study of 567 indigenous adults from remote communities in far north Queensland, Australia, from
1998 to 2007 was conducted. Analysis of the effects of demographic factors, smoking, risky alcohol drinking,
fruit and vegetable intake and waist circumference on changes in red cell folate (RCF) status was conducted.
Prevalence of low red cell folate doubled in the cohort from a high baseline over this seven year period: 36.9%
deficient in 2007, 15.9% at baseline (p<0.001). Smoking was associated with lower folate levels. People with a
normal RCF were less likely to be smokers, and were more likely to have a greater number of serves of vegetables (RR 1.06, 95% CI 1.02-1.10) than those who were deficient at follow-up. The introduction of voluntary
folate fortification since 1995 does not appear to have impacted on the already poor folate status of this cohort of
adults. The increased prevalence of low folate has occurred despite improvements in the food supply,indicating
the need for nutrition promotion, and subsidies for healthy food in remote communities. The impact of mandatory
folate fortification of flour since 2009 should be assessed in this high risk population.
Asia Pac J Clin Nutr. 2012;21(3):431-439.doi:
>>Abstract
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Folate knowledge and consumer behaviour among pregnant New Zealand women prior to the potential introduction of mandatory fortification
Author:Simonette R Mallard MSc, Lisa A Houghton PhD
Keywords:folic acid, neural tube defects, fortification, health behaviour, nutrition policy
Abstract:To reduce the risk of neural tube defects, the New Zealand Ministry of Health recommends women take supplemental folic acid from at least one month preconception until the end of the twelfth week of pregnancy, as well
as consume folate-rich foods. A postpartum survey was conducted to describe folate knowledge and consumer
behaviour among pregnant New Zealand women prior to the potential implementation of mandatory folic acid
fortification of bread in May 2012. Increasing knowledge of folic acid recommendations was associated with
higher supplement uptake among women who planned their pregnancies (p=0.001 for linear trend). Folic acid information failed to adequately reach some socio-demographic subgroups before conception, even when pregnancy was planned, including: indigenous Māori, Pacific and Asian women, younger women, women with large
families, and women with lower educational attainment and income. Only half of all women surveyed knew
some bread contained added folic acid, and among these women, less than 2% consistently chose voluntarily fortified bread during the periconceptional period by inspecting labels. Sixty -one percent of women indicated they
were either in favour of mandatory fortification, or held no opinion on the matter, while 4% were opposed to the
addition of folic acid to bread. Approximately one-third (35%) of women agreed with voluntary fortification. Future health promotion initiatives should be tailored toward women who are younger, less educated, with lower
income, multiparous or of minority ethnicity status. Nonetheless, mandatory folic acid fortification maybe required to attain the desired degree of equity.
Asia Pac J Clin Nutr. 2012;21(3):440-449.doi:
>>Abstract
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Food group intake among adolescents in Guangzhou city compared with the Chinese dietary guidelines
Author:Cai-Xia Zhang PhD, Yu-Ming Chen PhD, Wei-Qing Chen
Keywords:adolescents, China, Chinese dietary guidelines, food group intake, nutrients
Abstract:Food group intake in adolescents has many health implications. However, no study has been conducted to assess
food group intake among Chinese adolescents. Objective: The purpose of this study was to evaluate food group
intakes among Chinese adolescents living in Guangzhou city and the proportion of adolescents surveyed meeting
the Chinese dietary guidelines, and the Chinese food pagoda for a balanced diet 2007. Methods: A school-based
cross-sectional survey was conducted in Guangzhou city between October 2006 and April 2007. A random sample of 2977 adolescents, aged 12 to 17 years, was interviewed. A self-administered semi-quantitative food frequency questionnaire was used to estimate food group intakes of adolescents. Results: A high percentage of adolescents consumed too little plant foods including vegetables, fruit, and soybean products. Only 9%,14% and 6%
of adolescents surveyed reached the minimum daily recommended intake levels for vegetables, fruit, and soybean
products and nuts. Nearly 70% of the studied adolescents consumed dairy less than the recommended daily intake
and more than 20% adolescents reached the recommended amounts for cereals and eggs. More than one-third
(35.6%) of adolescents did not meet any food group recommendations. And no adolescents reached all eight food
group recommendations. An inadequate consumption of calcium and iron among adolescents was also found.
Conclusions: The results of this study indicate that most adolescents living in Guangzhou city are not meeting the
current recommendations for intakes of the various food groups.
Asia Pac J Clin Nutr. 2012;21(3):450-456.doi:
>>Abstract
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Association between insulin receptor gene polymorphism and the metabolic syndrome in Han and Yi Chinese
Author:Chunxiu Wang PhD, Bin Wang PhD, Huijing He MS, Xia
Keywords:metabolic syndrome (MS), insulin receptor (INSR) gene, NsiI Polymorphism, ethnic Yi, China
Abstract:Insulin resistance has been a possible underlying pathophysiologic defect inducing the metabolic syndrome (MS).
However association studies regarding Insulin receptor gene in different ethnic groups are scarce inliterature.
Here we conduct an association study between MS and genetic polymorphism of the INSR gene in Yi and Han
Chinese. In a cross-sectional study , 3,436 Yi and Han people were investigated. Ethnicity-specific case-control
studies were designed, with MS patients diagnosed as cases and non-MS people as controls matched on gender
and age. Polymerase chain reaction-restriction fragment length polymorphism was used to detect the genotypes
of the exon 8 of the INSR gene. Data were analyzed using one-way analysis of variance, chi-square test, and logistic regression where appropriate. Systolic blood pressure (SBP) was significantly higher in MS patients with
the N1N2/N2N2 genotypes than that in those with the N
1N1 genotype of both ethnic population (p<0.05). Frequency of the N
2 allele was significantly higher in MS patients than that in controls of ethnic Han (p=0.020).
Multivariable logistic regression analysis showed that the NsiI polymorphism of the exon 8 of the INSR was an
independent predictor for MS in Han people adjusted for total cholesterol, sex, physical activity, educational
level, family income, alcohol intake and smoking (OR=2.55, 95% CI: 1.31-4.94, p=0.006). The results indicated
that NsiI polymorphism of the INSR gene is associated with SBP in these two different ethnic groups, and significantly associate with MS in Han Chinese. These findings contribute to our better understanding on the genetic basis of MS.
Asia Pac J Clin Nutr. 2012;21(3):457-463.doi:
>>Abstract
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High output enterocutaneous fistula: a literature review and a case study
Author:Chung Yan Tong RD, CNSC, Li Lin Lim MRCP, Rebecca
Keywords:intestinal fistula, cutaneous fistula, parenteral nutrition, enteral nutrition, intestinal secretions
Abstract:An enterocutaneous (EC) fistula is referred to as a channel between the gut and the skin. Effluent of an EC fistula
of more than 500 ml per day is considered as high output. Patients with high output EC fistulae have a high morbidity and mortality rate. No evidence-based guidelines are available for this condition and more research is required to evaluate the effectiveness of treatment. Nevertheless, patients with fistulae should be managed based on
the available evidence, detailed clinical and nutrition assessment, and close monitoring. Managementof high output EC fistula is complex and challenging. It involves nutrition, medical, skin care and psychological treatment,
which is best managed by a multidisciplinary team. It requires an individualized nutrition and clinical treatment
plan to maximize patient outcomes. Up to 70% of patients with fistulae have malnutrition and it is a significant
prognostic factor of spontaneous fistula closure. Nutrition therapies including macronutrient and micronutrient
delivery, enteral nutrition and parenteral nutrition are discussed in this review. A case study of a patient with multiple EC fistulae is presented to illustrate the management of high output EC fistulae.
Asia Pac J Clin Nutr. 2012;21(3):464-469.doi:
>>Abstract
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