Paradoxes with weight disorders for health systems
Author:Mark L Wahlqvist MD (Adelaide & Uppsala), FRAC
Keywords:nutritional economics, obesity paradox, endocrine disrupters, sarcopenic obesity, orthosarcal
Abstract:The body mass index (BMI) has served public health and clinical medicine well in the recognition of obesity.
However, its use has generated some instructive paradoxes and misunderstandings which argue for the appreciation of body compositional disorders (BCD) as such and, in particular, for the parallel evaluation of muscle mass
with a definition of ‘orthosarcal’ conditions to enable the early detection of sarcopenia. Across the life-span, and
with gender and ethnic differentials, BCD is basic to the full spectrum of nutritionally-related disorders and diseases. In the case of metabolic diseases like diabetes, muscle, fatness and its distribution, and even bone seem to
play pathogenetic roles. Optimal body fat and distribution are relevant to child development, maternal health and
healthy ageing, with much more to learn about the mechanisms. The economic and societal costs of obesity tend
to increase progressively with the BMI, but the health outcomes, at least for mortality, are J-or U-shaped. With
some established chronic diseases, like diabetes, renal failure or cardiac failure, overfatness may be protective;
sometimes this may be because contaminant fat-soluble endocrine disrupters are segregated in fat tissue. This
means that some of the relatively favourable survival in the elderly who have more body fat is at the expense of
the health care system. Younger children with chronic energy deficiency, on the other hand, may succumb before
expenditure saves them. In these respects, our species is more vulnerable than we have thought. Fortunately , a
better understanding of BMI and health is emerging.
Asia Pac J Clin Nutr. 2012;21(4):471-475.doi:
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Micronutrient interventions on cognitive performance of children aged 5-15 years in developing countries
Author:Geok Lin Khor PhD, Snigdha Misra PhD
Keywords:micronutrients, cognitive performance, children aged 5-15 years
Abstract:It is estimated that more than 200 million young children worldwide fail to reach their potential incognitive development owing to undernutrition. Numerous studies have assessed the effects of micronutrient supplementation
on growth and cognitive development in infants, toddlers and preschoolers. However, micronutrient interventions
on the cognitive performance of older children are limited. This article seeks to provide an update on micronutrient interventions and cognitive outcomes among children aged 5-15 years in developing countries. A total of 13
randomized controlled trials published since 2000 were identified. Majority of these studies assessed the effects
of micronutrient-fortified foods on various domains of cognitive function. Among key micronutrients assessed
were iron, zinc, iodine and vitamin A. This review found a lack of consistency in the impact of micronutrient
supplementation on intelligence, long term mental functions and school examination grades of the children. A
beneficial effect of micronutrient supplementation on short term memory was more consistently reported. Overall,
the evidence from this review for the impact of micronutrients on cognitive performance in older children remains equivocal. In light of the growing interest on the influence of nutrition on cognition, it is important that
culturally -appropriate and sufficiently sensitive assessment tools be used for measuring the desired cognitive outcomes that are most likely to be affected by the nutrients under study.
Asia Pac J Clin Nutr. 2012;21(4):476-486.doi:
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Fish advisories in the USA and Japan: risk communication and public awareness of a common idea with different backgrounds
Author:Ping Han Ser BSc, Chiho Watanabe PhD
Keywords:fish advisory, fish consumption, mercury, public awareness, risk communication
Abstract:Some countries have established fish advisories to manage fish consumption to minimize methylmercuryexposure. Our objective was to compare the fish advisories and the resultant consumer behavior in the United States of
America (USA) and Japan. Both countries have national consumption guidelines, but American states enjoy
greater independence in issuing guidelines for local water bodies and vary in the information that is provided for
the public. The proportion of the American public that has heard of state fish advisories is thought to be close to
30%. There is a concern that this low level of awareness extends to pregnant women. In Japan, the current problem is the lack of comprehensive studies on the public awareness of fish advisories. Nonetheless, there is evidence that fish consumption has decreased in both countries. In USA, there is a possibility that thestrong emphasis on mercury toxicity drives the general population towards a trend of lower fish consumption. In Japan, the fish
advisory encourages seafood consumption for nutritional benefits. Consequently, the decrease may be due to the
shift towards a “Western diet”. Also, the Japanese fish advisory seems to be less active in advocating the issue of
fish consumption and mercury exposure, which may be partly responsible for the possible lesser attention of the
consumers. Cultural factors may explain for the baseline difference in consumption and account partly for the
change in Japanese consumer behavior. However, the dissimilarities in fish advisories may also be responsible for
the variations in consumer behavior.
Asia Pac J Clin Nutr. 2012;21(4):487-494.doi:
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Chest circumference in infancy predicts obesity in 3-year-old children
Author:Izumi Akaboshi MD, Akito Kitano MD, PhD, Hiroaki K
Keywords:area under the curve, chest circumference, obesity, rapid growth, receiver operating characteristic curve
Abstract:The purpose of this study was to investigate the associations between chest circumference in infancyand rapid
growth or obesity at 3 years of age. We conducted a retrospective observational study of 1353 children in Kumamoto, Japan. Data collected included chest circumference, head circumference, weight, and body mass index.
The area under the receiver operating characteristic curves for chest circumference were analyzed to determine
the ability of this index to identify obesity at 3 years of age. Chest circumference at 3-4 months of age and increases in chest circumference during the first 3-4 months of life had higher mean standard deviation scores for
rapid growth than for slow or no change in growth (p<0.05). Chest circumference and the increase in chest circumference were also positively correlated with rapid weight gain, and were associated with obesity at 3 years of
age. The area under the curve for chest circumference was significantly different from the area under the curve
for weight z-score at 6-9 months but not for weight z-score at 3-4 months. In conclusion, we found that chest circumference is associated with obesity in young children, and is positively correlated with rapid growth. Therefore, chest circumference may be a useful marker for rapid growth, and may help clinicians to identify obese
children at 3 years of age.
Asia Pac J Clin Nutr. 2012;21(4):495-501.doi:
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Fish oil supplementation is beneficial on caloric intake, appetite and mid upper arm muscle circumference in children with leukaemia
Author:Zalina Abu Zaid MSc, Suzana Shahar PhD, A Rahman A
Keywords:fish oil, MUAMC, appetite, caloric intake, leukaemia
Abstract:A randomised trial was carried out to determine the effect of supplementation of fish oil among 51 children with
leukaemia aged 4 to 12 years on appetite level, caloric intake, body weight and lean body mass. Theywere randomly allocated into the trial group (TG) and the control group (CG). At baseline, 30.8% of TG subjects and
44.0% of CG subjects were malnourished and 7.7% of subject from TG and 28.0% from CG were classified as
stunted. The majority of subjects from TG and CG were in the mild malnutrition category for mid upper arm
muscle circumference (MUAMC)-for-age. The TG group showed significant increment in MUAMC (0.13 cm vs
-0.09 cm) compared with CG at 8 weeks (p<0.001). There was a significant higher increase for appetite level
(0.120.33) (p<0.05) and an increasing trend on energy and protein intake in the TG group (213554 kcal; 3.64
26.8 g) than in the CG group. In conclusion, supplementation of fish oil has a positive effect on appetite level, caloric intake and MUAMC among children with leukaemia.
Asia Pac J Clin Nutr. 2012;21(4):502-510.doi:
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Effects of omega−3 fatty acids supplementation on serum adiponectin levels and some metabolic risk factors in women with polycystic ovary syndrome
Author:Elahe Mohammadi MSc, Maryam Rafraf PhD, Laya Farza
Keywords:omega−3 fatty acids, polycystic ovary syndrome, adiponectin, insulin resistance, lipid profile
Abstract:Objective: Polycystic ovary syndrome (PCOS) is a common female endocrine disorder associated with several
risk factors of type 2 diabetes and cardiovascular diseases. The objectives of this study were to investigate the effects of omega−3 fatty acids on serum adiponectin levels and some metabolic risk factors in PCOS patients.
Methods: This double-blind randomized controlled clinical trial was conducted on 64 overweight or obese PCOS
patients; aged 20-35 years. Subjects in omega−3 fatty acids (n=32) and placebo (n=32) groups were given 4 omega−3 fatty acids capsules (each one contained 180 mg eicosapentaenoic acid and 120 mg docosahexanoic acid) or
placebo daily for 8 weeks. Fasting blood samples, anthropometric measurements and 3-day, 24-hour dietary recalls were collected at the baseline and at the end of the trial. Results: The study was completed by 61 subjects.
Omega−3 fatty acids significantly increased serum levels of adiponectin (p=0.003) and decreased glucose
(p<0.001), insulin (p=0.002), homeostatic model assessment for insulin resistance (p<0.001), total cholesterol
(p=0.002) and low-density lipoprotein cholesterol (p=0.003) compared with placebo. Serum levels of triglyceride
significantly decreased (p=0.024) and high-density lipoprotein cholesterol increased (p=0.018) in the omega−3
fatty acids group, in comparison with baseline values. No significant changes were shown in serum high sensitive
C-reactive protein (hs-CRP) levels in both groups. Conclusion: Omega−3 fatty acids had some beneficial effects
on serum adiponectin levels, insulin resistance and lipid profile in PCOS patients and may contribute to the improvement of metabolic complications in these patients.
Asia Pac J Clin Nutr. 2012;21(4):511-518.doi:
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Plasma ω-3 fatty acid levels negatively and ω-6 fatty acid levels positively associated with other cardiovascular risk factors including homocysteine in severe obese subjects
Author:Idris Mehmetoglu PhD, F Hümeyra Yerlikaya PhD, Se
Keywords:ω-3 fatty acids, ω-6 fatty acids, homocysteine, obesity, vitamin B-12
Abstract:Obesity and homocysteine (tHcy) are important risk factors for cardiovascular diseases (CVD). Plasma omega-3
fatty acids (ω-3 FAs) and omega-6 fatty acids (ω-6 FAs) are essential fatty acids with diverse biological effects in
human health and disease. We have investigated the relation of plasma ω-3 FAs and ω-6 FAs levels with other
cardiovascular risk factors including tHcy in severe obese subjects. This study was performed on 96 severe obese
and 65 normal weight subjects. Plasma fatty acid composition was measured by GC/MS and serum tHcy level
was measured by HPLC methods. There were no differences between groups in terms of concentrations of serum
tHcy, plasma ω-3 FAs, ω-6 FAs and ω-3/ω-6 ratio, whereas serum vitamin B-12 (p<0.01) and folic acid (p<0.05)
levels were lower than those of the normal weight subjects. Homocysteine positively correlated with ω-6 FAs and
negatively correlated with ω-3 FAs in severe obese and normal weight subjects. Serum vitamin B-12 positively
correlated with ω-3 FAs (p<0.01) and ω-3/ω-6 ratio (p<0.01) and negatively correlated with ω-6 FAs (p<0.05) in
severe obese subjects. Serum folic acid positively correlated with ω-3 FAs (p<0.01) in severe obese subjects. Our
results suggest an association between the plasma ω-3 FAs and ω-6 FAs and serum tHcy concentrations in severe
obese and normal weight subjects. Low levels vitamin B-12 and folic acid may have been responsible for the
elevated tHcy levels in severe obese subjects, increasing the risk for future development of cardiovascular
diseases.
Asia Pac J Clin Nutr. 2012;21(4):519-525.doi:
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25(OH)D status and demographic and lifestyle determinants of 25(OH)D among Korean adults
Author:Eun Young Choi MD, PhD
Keywords:25(OH)D, prevalence, determinants, lifestyle, Korean
Abstract:Purpose: Vitamin D deficiency is a global health problem that is associated with increased risks of major diseases.
This study investigated the status of 25-hydroxyvitamin D [25(OH)D] and its demographic and lifestyle determinants among Korean adults. Methods: A total of 5,847 adults who had participated in the Korean National Health
and Nutrition Examination Survey of 2008 (KNHANES) were included in the present study. Stepwise linear regression analysis was performed to determine the demographic and lifestyle determinants of 25(OH)D concentration. Results: The weighted prevalence (standard error) of 25(OH)D deficiency (<20 ng/mL) was 49.9 (2.1)%
among the males and 67.4 (1.7)% among the females. Severe 25(OH)D deficiencies (<10 ng/mL) were found in
5.7 (0.8)% of the males and 11.1 (1.0)% of the females. These peaked in spring and winter. Only 12.2 (1.1)% of
the males and 6.4 (0.6)% of the females exhibited 25(OH)D sufficiency (≥30 ng/mL). The correlates with higher
25(OH)D concentration for both genders included summer, fall (vs spring), the 60s age group (vs 20s), rural residence (vs urban), moderate and vigorous physical activity (vs sedentary), alcohol consumption, and multivitamin
supplementation. Higher education and unmarried status were inversely associated with 25(OH)D concentration
for both genders. The strongest predictors of 25(OH)D concentration were season and residential area. Conclusions: 25(OH)D deficiency is a prevalent condition in Korea. Understanding the determinants of 25(OH)D can
facilitate identification of persons at risk of 25(OH)D deficiency.
Asia Pac J Clin Nutr. 2012;21(4):526-535.doi:
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Age- and gender-specific associations between low serum 25-hydroxyvitamin D level and type 2 diabetes in the Korean general population: analysis of 2008-2009 Korean National Health and Nutrition Examination Survey data
Author:Byung-Kook Lee MD, Sunmin Park PhD, Yangho Kim MD
Keywords:vitamin D, diabetes, age, gender, 25-hydroxyvitamin D
Abstract:Introduction: We present data from the Korean National Health and Nutritional Examination Survey (KNHANES)
2008-2009 on the association between 25-hydroxyvitamin D[25(OH)D] status and type 2 diabetes in a representative sample of the adult Korean population. Methods: This study was based on data obtained from the
KNHANES 2008–2009, which was conducted for 3 years (2007-2009) using a rolling sampling design that involved a complex, stratified, multistage, probability-cluster survey of a representative sample of the noninstitutionalized civilian population of South Korea. Results: We showed that serum 25(OH)D concentration is
inversely associated with type 2 diabetes in the Korean general population. In particular, low serum 25(OH)D
concentration was associated with an increased prevalence of type 2 diabetes in young women and old men. The
present study showed that 25(OH)D has a significant negative association with fasting insulin and insulin resistance. Conclusion: The age- and gender-specific association between low 25(OH)D level and type 2 diabetes
may be related to interactions between vitamin D, sex hormone concentrations, and type 2 diabetes. In conclusion,
we showed that low 25(OH)D concentration is associated with type 2 diabetes in the Korean general population
in an age- and gender-specific pattern.
Asia Pac J Clin Nutr. 2012;21(4):536-546.doi:
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Choline and betaine food sources and intakes in Taiwanese
Author:Da-Ming Chu PhD, Mark L Wahlqvist MD, Hsing-Yi Cha
Keywords:USDA food composition, gender, eggs, pork, soy, green leafy vegetables, wheat, choline, betaine
Abstract:Choline and betaine are involved in several similar health-relevant metabolic pathways, but the foods sources are
different. We have assessed their intakes (individual, sums and ratios) from a dominantly Chinese food cultural
point of view. A representative free-living Taiwanese population aged 13-64 years was drawn from the Nutrition
and Health Survey in Taiwan (NAHSIT) 1993-1996. Food intake was derived from interviews as 24-hour recalls.
The USDA database, with adaptations for Taiwan, provided choline and betaine food compositions. Major food
contributors of these nutrients were identified and compared with data from the US Framingham offspring study.
Mean and variance reduced median nutrient intakes were calculated. Top ten major food contributors of choline
in Taiwan were eggs, pork, chicken, fish, soybean and its products, dark leafy vegetables, dairy, fruit, wheat
products and light leafy vegetables in sequence. For betaine, the top ten were dark leafy vegetables, wheat products, fish, pork, bread, chicken, cake/cookies, grain-based alcoholic beverages, rice and its products and sauces.
The main contributors of choline in Taiwan and the USA were, respectively, eggs and red meat; and for betaine,
greens were similarly best contributor. The rankings of the main food contributors of choline and betaine differed
substantially between Taiwan and the USA. The total daily intakes (mean±SE, mg) in Taiwan for choline were
372±19 (median=348) in men and 265±9 (median 261) for women; for betaine, values were 101±3 (median 93)
in men and 78±8 (m edian 76) for women. These allow for health outcome considerations.
Asia Pac J Clin Nutr. 2012;21(4):547-557.doi:
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Snack foods consumption contributes to poor nutrition of rural children in West Java, Indonesia
Author:Makiko Sekiyama PhD, Katrin Roosita M.A., Ryutaro
Keywords:child nutrition, developing country, Indonesia, schoolchild
Abstract:Dietary habits of children, including snack foods consumption, in developing countries have seldom been investigated in relation to their nutrition and health. To assess the effects of snack foods consumption of154 children
aged 1-12 years in a rural village of West Java, Indonesia, a 3-hour-interval food recall survey for all meals and
snack foods consumed in seven consecutive days for each subject, anthropometry, and interviews for sociodemographic indicators were conducted. Their overall prevalence of stunting and underweight was 69.5% and
35.7%. There were 221 foods consumed by the subjects, among which 68 foods were categorized as snack foods.
Though the children of both <7 year and ≥7 year age groups consumed snack foods similarly throughout the day,
the latter group only consumed larger amounts of energy from snack foods at school recess-times. The mean percent contribution of snack foods was 59.6% for fat, 40.0% for energy, 20.6% for calcium, and <10% for vitamins
A and C. Half number of the subjects who snacked more than the median amount consumed less carbohydrate
and vitamin C than the remaining half. Furthermore, the more snack-consuming group the lower z score for
height-for-age (HAZ) among schoolchildren. To improve this nutritionally vulnerable situation, consumption of
snack foods should be replaced by the non-snack foods which contain much higher nutrient density , i.e., 15 times
for calcium and 32 times for vitamin A. Moreover, considering high snack foods consumption of ≥7 y age group
at school, appropriate school nutrition programs should be promoted.
Asia Pac J Clin Nutr. 2012;21(4):558-567.doi:
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Trends in the prevalence of undernutrition, nutrient & food intake and predictors of undernutrition among under five year tribal children in India
Author:Indrapal Ishwarji Meshram MD, Nimmathota Arlappa M
Keywords:underweight, stunting, wasting, Households wealth index, nutrient intakes
Abstract:Undernutrition among children under five year is a significant public health problem in India. The present study
was carried out to assess trends in nutritional status, nutrient and food intake among children under five year over
two time periods. It was a community -based cross-sectional study, carried out in tribal areas of India. A total of
14,587 children, 0-5 years old were covered for nutritional assessment in terms of underweight, stunting and
wasting. A 24 hour diet survey was carried out in a sub-sample of households surveyed. Wealth index was constructed using principle component analysis. The prevalence of underweight and stunting had declined significantly over the periods (49% vs 57%, 51% vs 58%, respectively), while the prevalence of wasting remained sim ilar (22% vs 23%). There was marginal decrease in the intake of foods and nutrients over the periods, and was below recommended levels. Stepwise regression showed that the risk of underweight and stunting was significantly
(p<0.01) higher among children of illiterate mothers and children from lowest and middle households wealth index. Morbidities during preceding fortnight had 1.3 times higher risk of underweight and wasting. In conclusion,
undernutrition is a significant health problem among tribal children and is associated with literacystatus of mothers, household wealth index and morbidities. Therefore implementation of appropriate nutritional intervention
strategies and improvement in households food security through public distribution systems, food intakes, socioeconomic condition, literacy of parents and personal hygiene may help in improving the nutritional status of tribal
children.
Asia Pac J Clin Nutr. 2012;21(4):568-576.doi:
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The U-shaped relationship between BMI and all-cause mortality contrasts with a progressive increase in medical expenditure: a prospective cohort study
Author:Wen-Harn Pan PhD, Wen-Ting Yeh MS, Hsin-Jen Chen M
Keywords:cohort studies, body mass index, mortality, expenditure, Asians
Abstract:The U-shaped relationship between body mass index (BMI) and all-cause mortality has generated uncertainty
about optimal BMI. For clarification, we have related BMI to both mortality and medical expenditure. The MJ
Health examination cohort of 111,949 examinees established during 1994-1996 was followed with endpoint information derived from death certificates and National Health Insurance records from 1996 to 2007. Age- and
gender-specific relative risks between BMI groups were estimated by Cox and logistic regressions. The BMI and
all-cause mortality relationship is U-shaped with the concave regions sitting in the region of BMI 22-26,
butshifted rightward for the elderly. After excluding smokers and cancer patients at baseline, the low mortality
region moved leftward to BMI 20-22. Cause-specific mortalities from respiratory disease, injury, and senility increased in the underweight group (BMI <18.5). Above 18.5, BMI was negatively associated with mortality from
respiratory diseases and senility, but not with others. In contrast, irrespective of age and gender,the overall median and mean medical expenditures progressively increased with BMI, particularly beyond 22. Expenditures for
injury, respiratory, circulatory diseases and senility all increased with BMI. The U-shaped BMI-mortality relation was a result of elevated death rate at both ends of the BMI scale. Increased mortality at the low end did not
contribute to higher medical expenditure, maybe because the lean and frail deceased tend to die abruptly before
large amount of medical expenditure was consumed. Our findings suggest that current recommendations to
maintain BMI at the lower end of the desirable range remain tenable for the apparently healthy general public.
Asia Pac J Clin Nutr. 2012;21(4):577-587.doi:
>>Abstract
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Alcohol consumption and the risk of type 2 diabetes mellitus: effect modification by hypercholesterolemia: The Third Korea National Health and Nutrition Examination Survey (2005)
Author:Hyeongap Jang MD, MPH, Won-Mo Jang MD, PhD, Jong-H
Keywords:diabetes, alcohol consumption, hypercholesterolemia, dyslipidemia, effect modification, interaction
Abstract:OBJECTIVE: While the protective nature of moderate alcohol consumption against diabetes mellitus is well
known, inconsistent findings continue to be reported. The possibility of different mixes of effect modifiers has
been raised as a reason for those inconsistent findings. Our study aim was to examine potential effect modifiers
that can change the effect of alcohol consumption on type 2 diabetes. METHODS: From data in the third Korea
National Health and Nutrition Examination Survey, 3,982 individuals over the age of 30 years who hadnot been
diagnosed with diabetes were selected for inclusion in the study population. Breslow and Day's test and the Wald
test between hypercholesterolemia and alcohol consumption in a multiple logistic regression model were used to
assess effect modification. RESULTS: Odds ratios for diabetes stratified by alcohol consumption strata and assessed using Breslow and Day's tests for homogeneity indicated that hypercholesterolemia was not a significant
confounding factor (p=0.01). However, the Wald test for interaction terms, which is a conservative method of effect modification, was significant (p=0.03). CONCLUSIONS: The results indicate that moderate alcohol consumption is not necessarily protective for type 2 diabetes mellitus, if a person has hypercholesterolemia. People
who have hypercholesterolemia should be aware of the risk associated with alcohol consumption, a risk that contrasts with the reported protective effect of moderate alcohol consumption on diabetes.
Asia Pac J Clin Nutr. 2012;21(4):588-593.doi:
>>Abstract
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Prevalence of functional gastrointestinal disorders in Taiwan: questionnaire-based survey for adults based on the Rome III criteria
Author:Fang-Yuan Chang MD, Po-Hon Chen MD, Tzee-Chung Wu
Keywords:Rome criteria, functional gastrointestinal disorders, irritable bowel syndrome, functional constipation, prevalence
Abstract:Functional gastrointestinal disorders (FGID) are a group of disorders of the digestive system in which the chronic
or recurrent symptoms cannot be explained by the presence of structural or tissue abnormality. This survey used
a modified Rome III questionnaire on the health and nutrition status of a general population in Taiwan during
2005-2008. A total of 4,275 responders completed the questionnaire. The sample was evenly distributed for men
(n=2,137) and women (n=2,138). The prevalence of FGID was 26.2%. Unspecified functional bowel disorder
was the most prevalent (8.9%). The second was functional dyspepsia (5.3%), and the third were irritable bowel
syndrome (4.4%) and functional constipation (4.4%). Women had a greater prevalence than males (33.2% compared to 22.4%, p<0.05) with regards to total FGID. Most categories of FGID were significantly prominent in
women, except functional diarrhea. The FGID groups took fewer servings of vegetables and fruits than the nonFGID group each day (vegetables 2.51 vs 2.70, p<0.001; fruits 0.82 vs 0.91, p<0.001). Smoking, alcohol consumption, and betel nut chewing had no significant impaction on prevalence of FGID. The mean BSRS (briefsymptom rating scale) for screening depression and suicide ideation was higher in the FGID group (2.86 vs 1.63,
p<0.001). In conclusion, FGID diagnosed with Rome III criteria are not uncommon in Taiwan’s general population. Subjects who met the Rome III criteria for FGID in Taiwan were younger, had less vegetables and fruits intake, higher BSRS scores and were of greater female predominance.
Asia Pac J Clin Nutr. 2012;21(4):594-600.doi:
>>Abstract
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Effects of healthy dietary pattern and other lifestyle factors on incidence of diabetes in a rural Japanese population
Author:Akiko Morimoto PHN, MSc, Yuko Ohno PhD, Yukako Tat
Keywords:diabetes mellitus, prospective study, dietary habits, lifestyle, Japanese
Abstract:This study assessed the effects of dietary habits and other lifestyle factors on the incidence of diabetes in a rural
Japanese population. This 10.3-year study investigated a cohort of 1,995 men and 3,670 women aged 40-69 years
without diabetes at baseline who underwent health check-ups between April 1990 and March 1992. Participants
were followed up until diabetes was confirmed or until the end of 2006. The incidence of diabetes was determined from fasting and random levels of plasma glucose, HbA1c levels or being under medical treatment for diabetes. Principal component analysis identified a major dietary pattern characterized by more frequent consumption of vegetables, potatoes, seaweeds, fruits and soybean products that we labeled “healthy”. Diabetes developed
in 446 of the participants during 58,151 person-years of follow-up. Consuming a healthy diet was associated with
a lower risk of diabetes (multivariable-adjusted hazard ratio for highest vs lowest quartiles, 0.78 [95% CI, 0.61-0.95] . In addition, scores for a healthy diet were associated with a lower risk for diabetes among persons who
consumed regular meals (0.76 [0.58-0.96]), persons with an exercise habit (0.65 [0.44-0.96]) and non- and exsmokers (0.72 [0.53-0.96]). Our findings suggest that consuming a healthy diet is associated with a lower risk for
diabetes among the Japanese, particularly among those who eat regularly, those who habitually exercise and nonand ex-smokers.
Asia Pac J Clin Nutr. 2012;21(4):601-608.doi:
>>Abstract
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Public support for restrictions on fast food company sponsorship of community events
Author:Simone Pettigrew PhD, Melanie Pescud BSc (Hons),
Keywords:attitudes, community, children, food companies, sponsorship
Abstract:This study investigated community attitudes to fast food companies’ sponsorship of community events. The aim
was to inform future efforts to introduce greater restrictions on these marketing activities to reduce child obesity.
While previous research has focused on the sponsorship of sporting events, the present study included all community events and gauged public support for fast food company sponsorships in general as well as specific sponsorship activities such as securing event naming rights, advertising on event premises, and distributing free items
to children in the form of food and redeemable vouchers. A large and diverse sample of Western Australian adults
(n=2,005) responded to a community attitudes telephone survey that included questions relating to event sponsorship. Almost half of the respondents reported that the promotion of fast foods is inappropriate at community
events, and only a third considered it appropriate at events where children are likely to be present. Around twothirds agreed that promoting fast foods at such events sends contradictory messages to children and just a quarter
of respondents considered it acceptable for free fast food to be distributed at events or for children tobe rewarded
for participation with fast food vouchers. The results suggest that efforts to reduce child obesity that involve restrictions on the sponsorship of community events by organisations promoting unhealthy foods may be supported
by a substantial proportion of the population.
Asia Pac J Clin Nutr. 2012;21(4):609-617.doi:
>>Abstract
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South Korea’s entry to the global food economy: shifts in consumption of food between1998 and 2009
Author:Haeng-Shin Lee PhD, Kiyah J Duffey PhD, Barry M Po
Keywords:nutrition transition, South Korea, diet, National Health and Nutrition Examination Survey, energy intake
Abstract:Korea has undergone a major opening of its food markets and economy in the past decade. Little is understood
about the impact of these shifts on the diet of Koreans. This analysis studies the shifts in consumption of foods
between 1998 and 2009 to provide a thorough understanding of the transition and insights into directions in the
next decades in Korea. Data are from the Korea National Health and Nutrition Examination Survey (KNHANES).
The sample used was a nationally representative sample of individuals age ≥2 in 1998 and 2009 (n=10,267 and
9,264, respectively). The data was corrected for seasonality, and the original raw food data was regrouped into 53
food groups. SAS was used to adjust for design effects and weight. Despite a decade of efforts to increase whole
grains intake, and fruit and vegetable intake, the mean intake of whole grains increased only a small amount (16
kcal/person/day); however, the proportion consuming any whole grains doubled from 24% to 46.3%. Rice declined significantly, and several important less healthful food trends emerged: total alcohol intake increased from
39 kcal/person/day to 82 kcal/person/day. Also, energy from sugar-sweetened beverages increased among teens
and energy from tea and coffee increased among adults. Remarkably, compared to other Asian countries and a
general worldwide trend, vegetable intake remained relative high in South Korea during this last decade while fat
energy increased modestly from relative low levels. Dynamic causes of these trends and the government’s response are discussed.
Asia Pac J Clin Nutr. 2012;21(4):618-629.doi:
>>Abstract
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Do registered dietitians search for evidence-based information? A nationwide survey of regional hospitals in Taiwan
Author:Ya-Wen Chiu PhD, Yi-Hao Weng MD, Mark L Wahlqvist
Keywords:evidence-based nutrition, registered dietitian, information, online, database
Abstract:Dietitians can obtain nutrition-related information from a variety of sources. The current study was to investigate
how registered dietitians look for nutritional information and perceive evidence-based nutrition (EBN). A postal
questionnaire survey was conducted, with 67 valid returns collected. The most common informational sources
were Web portals, followed by continuing education, colleague consultation, textbooks, online databases, electronic journals, printed journals, and electronic textbooks. Among the 11 commonly used online databases, dietitians preferred to access MEDLINE and three databases in Chinese. Sixty-two dietitians (92.5%) were aware of
EBN. Although they had a favorable impression of EBN, their knowledge of and skills in EBN were relatively
lacking. The most common barrier to the implementation of EBN was a lack of library resources in Chinese
(58.1%), followed by deficient skill in critical appraisal (54.8%), insufficient convenient kits (53.2%), and time
constraints (50.0%). In conclusion, most registered dietitians search for information through non-EBN resources.
Language is an important element relevant to the implementation of EBN. These findings may help the refining
of strategies to promote the accessing of evidence-based information.
Asia Pac J Clin Nutr. 2012;21(4):630-637.doi:
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Repeated lung lavage with extracorporeal membrane oxygenation treating severe acute respiratory distress syndrome due to nasogastric tube malposition for enteral nutrition: a case report
Author:Xiaoming Kao MS, Wenkui Yu MD, Weiming Zhu MD, Nin
Keywords:enteral nutritional support, acute respiratory distress syndrome, extracorporeal membrane oxygenation, nasogastric tube malposition, bronchopleural fistula
Abstract:Enteral nutritional support, a frequently applied technique for providing nutrition and energy, played a pivotal
role in the treatment of high risk patients. However, severe complications induced by malposition ofnasogastric
tube caused great danger and even death to the patients. In this case report, we present a patient w ith severe acute
respiratory distress syndrome (ARDS) induced by bronchopleural fistula (BPF) due to malposition of nasogastric
tube. Repeated lung lavage combined with extracorporeal membrane oxygenation (ECMO) was performed after
transferring to the ICU of our hospital. Finally, the patient recovered and discharged 7 days after admission.
Asia Pac J Clin Nutr. 2012;21(4):638-641.doi:
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Bleeding tendency in an adolescent with chronic small bowel obstruction
Author:Chonnikant Visuthranukul MD, Voranush Chongsrisawa
Keywords:bleeding tendency, fat-soluble vitamin deficiency, vitamin K deficiency, small bowel obstru ction, blind loop syndrome
Abstract:We report a case of fat-soluble vitamin deficiency in a 14-year old boy who had chronic duodenal obstruction. He
presented with periodic unexplained bleeding tendency. The laboratory results showed positive fat globules in
stool and prolonged prothrombin time. His further investigation revealed low plasma vitamin A and undetectable
plasma vitamin E. After parenteral vitamin K and oral vitamin A and E supplement, these abnormalities resolved
although he still had absent knee jerk. We propose that fat malabsorption and fat-soluble vitamin deficiency can
occur after prolonged duodenal obstruction that induce bacterial overgrowth following by bile acid deconjugation.
Despite very few case reports, screening for fat malabsorption and fat-soluble vitamin deficiency might be warranted in patients with chronic small bowel obstruction.
Asia Pac J Clin Nutr. 2012;21(4):642-647.doi:
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