Poverty and the state of nutrition in India
Author:Kiruba S Varadharajan MD,Tinku Thomas PhD, Anura
Keywords:poverty, food security, undernutrition, India, agriculture
Abstract:India is often thought of as a development paradox with relatively high economic growth rates in thepast few
years, but with lower progress in areas of life expectancy, education and standard of living. While serious inequalities in growth, development and opportunity explain the illusion of the paradox at the country level, still, a
significant proportion of the world's poor live in India, as do a significant proportion of the world's malnourished
children. Poverty and undernutrition coexist, and poor dietary quality is associated with poor childhood growth,
as well as significant micronutrient deficiencies. Food security is particularly vulnerable to changes in the economic scenario and to inequities in wealth distribution. Migration from rural to urban settings with a large informal employment sector also ensures that migrants continue to live in food insecure situations. Whilefood production has for the most part kept pace with the increasing population, it has been with regard to cereal rather than of
pulses and millet production. Oil seeds, sugar cane and horticultural crops, along with non-food crops are also being promoted, which do not address nutrition security, and, coupled with the increase in the consumption of preprepared food, may indeed predispose towards the double burden of malnutrition. Access to food is also particularly susceptible to poverty and inequality. Many strategies and policies have been proposed to counter undernutrition in India, but their implementation has not been uniform, and it is still too early to assess their lasting impact at scale.
Asia Pac J Clin Nutr. 2013;22(3):326-339.doi: 10.6133/apjcn.2013.22.3.19
>>Abstract
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Iron status of the Pakistani population-current issues and strategies
Author:Saeed Akhtar PhD, Anwaar Ahmed PhD, Asif Ahmad PhD
Keywords:malnutrition, iron deficiency, iron deficiency anemia, Pakistan
Abstract:The present review aims to highlight the magnitude of iron status of Pakistani population and possible remedies
to address iron deficiency among vulnerable groups. A computer-based search was carried out on “PubMed”,
“Google Search” and “Sciencedirect.com” to retrieve relevant scientific literature published in the last two
decades. The search yielded 193 articles, of which 64 were culled and further screening was performed based on
the type of vulnerable population groups, age, sex and pregnancy. A thorough review of current literature reveals
that iron deficiency (ID) and iron deficiency anemia (IDA) widely persist in Pakistan and necessitate immediate
remedial actions. Females of reproductive age and children under 5 years have been shown to be the most IDA
affected population segment. Fortification of wheat flour has been suggested as the most viable approach aptly
matching Pakistan’s needs for combating IDA. The present review further stresses the need for global
involvement to scale up efforts for mitigating ID and IDA to achieve Millennium Development Goals (MDGs)
that are fundamentally based upon improving nutritional wellbeing of populations in developing economies by
2015.
Asia Pac J Clin Nutr. 2013;22(3):340-347.doi: 10.6133/apjcn.2013.22.3.17
>>Abstract
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Relationship between anthropometric and dual energy X-ray absorptiometry measures to assess total and regional adiposity in Malaysian adolescents
Author:Leng Huat Foo PhD, Pey Sze Teo MSc, Nurul Fadhilah
Keywords:anthropometric measures, body fatness, dual-energy X-ray absorptiometry, ethnicity, adolescents
Abstract:The main objective of this paper was to determine the utility of various anthropometric measures to assess total
and regional body fatness using dual-energy X-ray absorptiometry (DXA) as the criterion in 454 adolescent boys
and girls aged 12-19 years. Multivariable regression analyses of gender-specific and gender-combined models
were used to determine anthropometric measures on DXA-derived body fatness models, after adjusting for
known confounding biological factors. Partial correlation analyses, after adjusting for age, pubertal growth status
and ethnicity in boys and girls, showed that body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-height ratio (WhtR) were significantly correlated with total body fat (TBF), percent body
fat (%BF), android region fat (ARF) and trunk fat (TF) (all p<0.0001). BMI was the greatest independent determinant, contributing 43.8%-80.9% of the total variance for DXA-derived body fatness models. Results confirmed
that a simple anthropometric index such as the BMI is a good surrogate indicator of body fat levels in Malay and
Chinese adolescents.
Asia Pac J Clin Nutr. 2013;22(3):348-356.doi: 10.6133/apjcn.2013.22.3.02
>>Abstract
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Effect of soy isoflavone supplementation on vascular endothelial function and oxidative stress in postmenopausal women: a community randomized controlled trial
Author:Pusparini MD,Rahayuningsih Dharma MD, Fransiscus D
Keywords:soy isoflavone, supplementation, vascular endothelial function, oxidative stress, postmenopausal
Abstract:A 12-month randomized double blind controlled trial was conducted among 182 Indonesian postmenopausal
women aged 47 to 60 years to determine the effect of 100 mg/day soy isoflavone supplementation on vascular
endothelial function such as vascular cell adhesion molecule-1 (VCAM-1), nitric oxide (NO) and malondialdehyde (MDA) as oxidative stress marker. The subjects were randomized to the intervention group receiving tablets
consisting of 100 mg soy isoflavones and calcium carbonate 500 mg, and to the control group receiving 500 mg
calcium carbonate. The concentrations of VCAM-1, NO and MDA were measured at baseline, and postsupplementation at 6 months and 12 months. After supplementation, the MDA concentrations were significantly
lower in the soy isoflavone group compared with the control group (p=0.001). The concentrations of VCAM-1
and NO were not affected (p=0.992 and p=0.759, respectively). In all group the MDA concentration increased
compared with baseline concentrations but the relative change of MDA concentrations was significantly lower in
the soy isoflavone group compared with the control group. This study demonstrates that supplemental intake of
soy isoflavones for 6 months and 12 months had an effect on oxidative stress by decreasing MDA concentration,
but did not improve vascular endothelial function.
Asia Pac J Clin Nutr. 2013;22(3):357-364.doi: 10.6133/apjcn.2013.22.3.13
>>Abstract
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Effect of Korean red ginseng on insulin sensitivity in non-diabetic healthy overweight and obese adults
Author:Young Hye Cho MD, Soon Cheol Ahn PhD, Sang Yeoup L
Keywords: ginseng, overweight, obesity, insulin sensitivity
Abstract:Background: Korean red ginseng is one of the most popular herbs worldwide due to the belief that it contains ingredients that possess a variety of health enhancing effects including anti-diabetic effects. The objective of this
study was to determine whether Korean red ginseng supplement has an effect on insulin sensitivity in healthy
overweight or obese adults without overt diabetes and hypertension. Methods: In a double-blinded, placebocontrolled, randomized trial, a total of 68 participants (BMI ≥23 kg/m
2
) received either 6 g of Korean red ginseng rootlets (n=34) or a placebo each day over a 12 week period. Results: Similar insulin levels and insulin sensitivity index were observed at baseline in the Korean red ginseng and control groups. Korean red ginseng had
no significant effect on improving the insulin sensitivity over time. Korean red ginseng does not improve the insulin sensitivity of overweight and obese subjects who do not have diabetes or hypertension.
Asia Pac J Clin Nutr. 2013;22(3):365-371.doi: 10.6133/apjcn.2013.22.3.04
>>Abstract
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Effect of variety and cooking method on resistant starch content of white rice and subsequent postprandial glucose response and appetite in humans
Author:Yu-Ting Chiu MS, Maria L Stewart PhD
Keywords: resistant starch, rice, glycemic index, appetite, satiety
Abstract:Rice is a staple carbohydrate throughout much of the world. Previous work indicated that resistant starch (RS)
content of rice consumed in India varied with rice variety and cooking method. This study quantified RS in 4
white rice varieties (jasmine, long grain, medium grain, and short grain) cooked in three manners (oven baked,
conventional rice cooker, and pressure cooker), and analyzed for RS content immediately after preparation or after 3 days of refrigeration at 4°C. The rice varieties with the highest and lowest RS content were selected for a pilot-scale trial to characterize postprandial glycemic response and appetite ratings in healthy adults (n=21). Refrigerated long-grain rice cooked in a conventional rice cooker had the highest RS content (HRS, 2.55 g RS/100 g)
and refrigerated short-grain rice cooked in a pressure cooker had the lowest RS content (LRS, 0.20 g RS/100 g).
These rice samples were served reheated in the clinical trial. Glucose area under the curve (AUC) were significantly lower with HRS and LRS compared to glucose beverage; however, there was no difference betweenHRS
and LRS. Glycemic indices did not differ significantly between HRS and LRS. Subjects reported an overall increased feeling of fullness and decreased desire to eat based on incremental area under the curve (iAUC) for both
HRS and LRS compared to control. This study found that RS naturally occurring in rice had minimal impact on
the postprandial glycemic response and appetite.
Asia Pac J Clin Nutr. 2013;22(3):372-379.doi: 10.6133/apjcn.2013.22.3.08
>>Abstract
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Acute effects of oral preloads with increasing energy density on gastric emptying, gut hormone release, thermogenesis and energy intake, in overweight and obese men
Author:Natalie D Luscombe-Marsh PhD, Radhika V Seimon Ph
Keywords:gut function, body weight regulation, high-fat diet, high-protein diet, humans
Abstract:This study investigated the effect of high- and low-energy density preloads on gastrointestinal and metabolic factors, which act to regulate acute energy intake. Sixteen overweight and obese men (BMI range: 27.2-36.5 kg/m
2
)
each received 3 oral preloads in randomised order: i) high-energy-density, high-fat (1.5 kcal/g), ii) low-energydensity, high-fat (1.1 kcal/g), and iii) low-energy-density, high-protein (1.1 kcal/g). Over 180 min, gastric emptying, plasma glucagon-like peptide-1 concentrations, and diet-induced thermogenesis were assessed, and subsequent energy intake was determined. Total energy intake did not differ between preloads (high-energy-density,
high-fat, 2059±72 kilocalories (kcal); low-energy-density, high-fat, 1876±91 kcal; and low-energy-density, highprotein, 1867±63 kcal). Gastric emptying was slower following the high-energy-density, high-fat preload (158±8
min) compared with the low-energy-density, high-protein preload (130±9 min) (p=0.05), but did not differ between the high-energy-density, high-fat and low-energy-density, high-fat (147±8 min) preloads. Plasma glucagon-like peptide-1 did not differ substantially between preloads. Diet-induced thermogenesis was lower following
high-energy-density, high-fat (10.4±0.7 %) than low-energy-density, high-fat (14.9±1.2 %) and low-energydensity, high-protein (18.1±1.1 %) preloads (p<0.01 for both). We conclude that an increased energy density
slows gastric emptying and reduces thermogenesis, but that a high fat content overrides the effect of energy density on gastric emptying. The counter-regulatory modulation of these gastric and metabolic factors may explain,
at least in part, the lack of differences in subsequent energy intake in response to oral preloads with increasing
energy density.
Asia Pac J Clin Nutr. 2013;22(3):380-390.doi: 10.6133/apjcn.2013.22.3.11
>>Abstract
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Effects of sun exposure on 25(OH) vitamin D concentration in urban and rural women in Malaysia
Author:Musa Nurbazlin BBiomed, Winnie Siew Swee Chee PhD
Keywords:25(OH)D, sun exposure, body surface area, rural and urban women, Malaysia
Abstract:Ultraviolet B sunlight exposure is a primary source of vitamin D. There have been reports of low vitamin D status
amongst the Malaysian population despite it being a tropical country. This study was conducted to determine the
influence of sun exposure on 25(OH)D concentrations in urban and rural women in Malaysia and factors predicting 25(OH)D concentrations. Women aged above 45 years were recruited from urban (n=107) and rural areas
(n=293). Subjects were interviewed regarding their outdoor activities and usual outdoor attire over the previous
week. 25(OH)D concentrations were analyzed using the vitamin D3 (25-OH) electrochemiluminescence immunoassay. Median (Q1-Q3) age of the participants was 57 (53-61) years old. Median (Q1-Q3) 25(OH)D concentration of rural women was significantly higher [69.5 (59.0-79.1) nmol/L] compared to urban women [31.9 (26.1-45.5) nmol/L] (p<0.001). Rural women spent more time in the sun compared to urban women (7.83 (3.67-14.7)
vs 2.92 (1.17-4.92) hours, p<0.001), although the fraction of body surface area (BSA) exposed to sunlight was
significantly higher in the urban group [0.21 (0.21-0.43) vs 0.12 (0.07-0.17), p<0.001]. The calculated sun index
(hours of sun exposure per weekfraction of BSA) was significantly higher in rural [0.89 (0.42-1.83)] compared
to urban women [0.72 (0.26-1.28)], p=0.018. In the stepwise linear regression, rural dwelling increased the serum
25(OH)D by 31.74 nmol/L and 25(OH)D concentrations increased by 1.93 nmol/L for every unit increment in
sun index. Urban women in Malaysia had significantly lower vitamin D status compared to rural women. Rural
dwelling and sun index were key factors influencing vitamin D status in Malaysian women.
Asia Pac J Clin Nutr. 2013;22(3):391-399.doi: 10.6133/apjcn.2013.22.3.15
>>Abstract
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Serum ferritin and risk of the metabolic syndrome: a population-based study
Author:Jung-Su Chang PhD, Shiue-Ming Lin MSc, Tzu-chieh H
Keywords:metabolic syndrome, serum ferritin, National Nutrition and Health Survey in Taiwan, dietary iron intake, obesity
Abstract:Ferritin concentrations in circulation reflect iron stores in healthy individuals. However, elevated serum ferritin
(SF) concentrations have recently been implicated in the pathogenesis of the metabolic syndrome (MetS). We aim
to investigate factors associated with elevated SF and to evaluate the association between SF and risk of MetS in
Taiwanese adults. Data was collected from 2654 healthy individuals aged ≥19 years old, who participated in the
Nutrition and Health Survey in Taiwan (NAHSIT Adults 2005-2008). Mean concentrations of SF were 173±282
ng/mL (men 229±349 ng/mL and women 119±180 ng/mL). Prevalence proportion of MetS was 34.6% (men
43.1% and women 26.5%). Prevalence proportion of iron overload was 18.6% (men 21.5% and women 15.8%)
and iron deficiency anemia was 5.2% (2.0% for men and 8.3% for women). Individuals with the highest SF tertile
(T3) were more likely to consume higher amount of animal protein (p=0.001), betel nuts (p=0.004), and lower
amounts of carbohydrates (p<0.0001), compared with the lowest SF group (T1). After adjustments, individuals
with the highest SF tertile were associated with risk of MetS compared with those with the lowest (OR=1.724,
95% CI: 1.21-2.45). Serum ferritin concentrations showed a gradient relationship with individual components of
MetS (all p<0.0001). Individuals with the highest SF tertile were significantly associated with fasting serum glucose (OR=2.16, 95% CI: 1.75-2.65) and serum triglyceride (OR=2.58, 95% CI: 1.07-3.22) than those with the
lowest. In conclusions, our results highlight the crucial role of serum ferritin in the pathogenesisof the MetS in
healthy Taiwanese adults.
Asia Pac J Clin Nutr. 2013;22(3):400-407.doi: 10.6133/apjcn.2013.22.3.07
>>Abstract
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Overweight among primary school-age children in Malaysia
Author:Balkish Mahadir Naidu BSc, Siti Zuraidah Mahmud M
Keywords:National Health and Morbidity Survey III, school children, overweight, Malaysia, IOTF
Abstract:This study is a secondary data analysis from the National Health Morbidity Survey III, a population-based study
conducted in 2006. A total of 7,749 children between 7 and 12 years old were recruited into the study. This study
seeks to report the prevalence of overweight (including obesity) children in Malaysia using international cut-off
point and identify its associated key social determinants. The results show that the overall prevalence of overweight children in Malaysia was 19.9%. The urban residents, males, Chinese, those who are wealthy, have overweight or educated guardians showed higher prevalence of overweight. In multivariable analysis, higher likelihood of being overweight was observed among those with advancing age (OR=1.15), urban residents (OR=1.16,
95% CI: 1.01-1.36), the Chinese (OR=1.45, 95% CI: 1.19-1.77), boys (OR=1.23, 95% CI: 1.08-1.41), and those
who came from higher income family. In conclusion, one out of five of 7-12 year-old-children in Malaysia were
overweight. Locality of residence, ethnicity, gender, guardian education, and overweight guardian were likely to
be the predictors of this alarming issue. Societal and public health efforts are needed in order to reduce the burden
of disease associated with obesity.
Asia Pac J Clin Nutr. 2013;22(3):408-415.doi: 10.6133/apjcn.2013.22.3.18
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Overweight and obesity among internal migrants in India
Author:Kiruba Sankar Varadharajan MD, Tinku Thomas PhD
Keywords:internal migrants, overweight, obesity, India, NFHS 3
Abstract:Migration, chief ly from rural to urban areas has been linked to precursor conditions of cardiovascular diseases. We estimated the odds of overweight/obesity ( BMI ≥25 kg/m
2
) associated with different patterns of
internal migration, using data from the National Family Health Survey 3, a cross-sectional survey that covered
29 states of India in 2005/06. A total of 56,498 non-pregnant women, aged 15 to 49 years, and 42,190 men,
aged 15 to 54 years, with BMI >18.5 kg/m
2
were included in the final analysis. Odds ratios (ORs) for overweight/obesity were computed for different groups of migrants after adjusting for age, socioeconomic status
and parity using binomial logistic regression models. All analyses were performed separately for men and
women and weighted using national sampling weights. Rural to urban migrant women but not men, had higher
odds of being overweight/obese (adjusted OR (AOR) : 1.50, 95% confidence interval (CI): 1.36- 1.65) compared to non-migrant rural residents. Increased odds were also noted among women migrating from one urban area to another, compared to non-migrant urban women ( A OR: 1.10, 95% CI: 1.02-1.19). Women migrating from urban to rural areas, however had decreased odds (AOR: 0.75, 95% CI: 0.67-0.83) of overweight/obesity. Thus, apart from confirming rural to urban migration as a risk factor for overweight, this study
finds that other patterns of migration are also associated with overweight/obesity .
Asia Pac J Clin Nutr. 2013;22(3):416-425.doi: 10.6133/apjcn.2013.22.3.14
>>Abstract
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Nutritional status and body composition are already affected before oncology treatment in ovarian cancer
Author:Vanessa Fuchs-Tarlovsky PhD, Karolina Alvarez-Alta
Keywords:ovarian Cancer, nutritional status, body composition, nutritional assessment, bioelectrical impedanceanalysis
Abstract:Poor nutritional status is a common problem among ovarian cancer patients. In order to detect changes in nutritional status and body composition this study investigates anthropometrical and biochemical parameters among
these patients. This study included women with ovarian cancer and woman without cancer. Body composition
was assessed by bioelectrical impedance analysis (BIA), anthropometrically, and with DXA scan, and total serum
protein, albumin, transferrin, hemoglobin, hematocrit levels and total lymphocyte count was also measured. Data
from DXA scan and body composition as assessed by BIA was collected from thirty -one women. Student t-test
was used to compare differences in means between groups. This study included 120 women, 57 with ovarian cancer and 63 with benign tumors. Both groups of women were overweight. Body fat by skin-fold thickness, arm
circumference, serum albumin, total lymphocytes count, as well as transferrin levels were significantly lower in
the ovarian cancer group (p<0.05). Ovarian cancer women had lower fat reserves by skin-fold thickness and lower serum proteins even though they were overweight. However, further studies need to use a body composition
assessment on all subjects to confirm these results.
Asia Pac J Clin Nutr. 2013;22(3):426-430.doi: 10.6133/apjcn.2013.22.3.12
>>Abstract
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The trans fatty acid content in human milk and its association with maternal diet among lactating mothers in Malaysia
Author:Akmar Zuraini Daud MS, Norhaizan Mohd-Esa PhD, Azr
Keywords:human milk, TFA, elaidic acid, vaccenic acid, linoelaidic acid
Abstract:Excessive intake of trans fatty acids (TFA) could reduce the fat density of human milk and impair the desaturation of essential fatty acids. Because the mammary glands are unable to synthesize TFA, it is likely that the TFA
in human milk come from dietary intake. Thus, the aim of this study was to investigate the sources of TFA intake
for lactating mothers in one of the urban areas in Selangor. In this cross-sectional study, anthropometric measurements, FFQ including 7 food groups and dietary consumption data were collected from 101 lactatingmothers.
Five major TFA isomers (palmitoelaidic acid (16:1t9), petroselaidic acid (18:1t6), elaidic acid (18:1t9), vaccenic
acid (18:1t11) and linoelaidic acid (18:2t9,12) in human milk were measured by gas chromatography (GC). The
relationship between food consumption and TFA levels was assessed using the non-parametric Spearman’s rho
test. The TFA content in human milk was 2.94±0.96 (SEM) % fatty acid; this is considered low, as it is lower
than 4%. The most abundant TFA isomer was linoelaidic acid (1.44±0.60% fatty acid). A sub-experiment (analyzing 3 days of composite food consumption) was conducted with 18 lactating mothers, and the results showed
that linoelaidic acid was the most common TFA consumed (0.07±0.01 g/100 g food). Only 10 food items had an
effect on the total TFA level and the isomers found in human milk. No association was found between TFA consumption and the TFA level in human milk.
Asia Pac J Clin Nutr. 2013;22(3):431-442.doi: 10.6133/apjcn.2013.22.3.09
>>Abstract
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Determinants of breastfeeding at discharge in rural China
Author:Li Tang MSc, Colin W Binns PhD, Chunming Luo MB, Z
Keywords:breastfeeding, China, hospital support, paternal attitude, discharge
Abstract:This study aimed to investigate the rate of breastfeeding at discharge and associated influencing factors in rural
China. A prospective cohort study of infant feeding practices was undertaken during 2010-2011 in Jiangyou city,
Sichuan Province of China. Logistic regression analysis was performed to ascertain pertinent factors affecting the
prevalence of any breastfeeding at discharge. The participants consisted of 695 mothers aged 18-44 years. The
breastfeeding rate at discharge was 93.5% (95% CI: 91.7-95.3). Perceived paternal breastfeeding preference was
positively associated with actual breastfeeding at discharge (OR=4.46, 95% CI: 2.15-9.28). Other significant determinants were ‘receiving breastfeeding support’ from staff during hospital stay (OR=3.41, 95% CI: 1.58-7.34)
and making the decision on feeding method during pregnancy or after childbirth (OR=0.46, 95% CI: 0.22-0.93).
In conclusion, provision of comprehensive breastfeeding support in hospital and education programs targeting
expectant and future parents are recommended to further increase the rate of breastfeeding at discharge in rural
areas of China.
Asia Pac J Clin Nutr. 2013;22(3):443-448.doi: 10.6133/apjcn.2013.22.3.20
>>Abstract
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Seasonal variation in the nutritional status of children aged 6 to 60 months in a resettlement village in West Timor
Author:Jacqueline Miller PhD, Brett Ritchie MB.BS., Bsc(H
Keywords:anthropometry, child, preschool, growth, malnutrition, micronutrients
Abstract:Childhood malnutrition remains a public health issue in Indonesia with a national prevalence of wasting of 13%
and stunting of 36%. In rural areas nutritional status depends on local agriculture and may fluctuate in relation to
harvest time. The aim of this study was to characterise seasonal variations in nutritional status in two resettlement
villages in the Oesao district, Nusa Tenggara Timur. A cross sectional study was conducted in a convenience
sample of children after the wet season (March). Children aged 6 to 60 months were assessed for nutritional status using anthropometric and biochemical measures. A subset of these children was re-assessed for anthropometry after the dry season (November). Weight-for-height z scores improved significantly from mean±SD of -1.7±
0.9 in March to -1.3±0.9 in November (p<0.001). There was no significant change in height between seasons.
Prevalence of wasting, (weight-for-height z score <-2), was 42% in March and 19% in November (p<0.001).
However, stunting rates increased significantly from 42% in March to 45% in November (p<0.001). Thirty six
per cent of children were anaemic (Hb level <11 mg/100 mL), 68% were vitamin A deficient (plasma vitamin A
level <0.8 µmol/L) and 50% were zinc deficient (plasma zinc <9.94 µmol/L). All children except one were positive for intestinal parasites. These data indicate seasonal changes in anthropometry with inconsistent effects depending on the anthropometric index measured. Wasting and stunting were higher than the national average,
alongside high rates of anaemia, zinc and vitamin A deficiencies.
Asia Pac J Clin Nutr. 2013;22(3):449-456.doi: 10.6133/apjcn.2013.22.3.10
>>Abstract
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Relationship of dietary factors and habits with sleep-wake regularity
Author:Miwa Yamaguchi PhD, Hirokazu Uemura MD PhD, Saku
Keywords:sleep-wake regularity, dietary factor, macronutrient, staple foods, cross-sectional study
Abstract:The purpose of this study was to evaluate the associations between dietary factors and sleep-wake regularity in
the Japanese population. We analyzed 1368 eligible subjects (931 men and 437 women) aged 35-69 years who
had participated in the baseline survey of a cohort study in Tokushima Prefecture, Japan. Information on individual lifestyle characteristics, including dietary habits and sleep-wake regularity, was obtained by a selfadministrated questionnaire. Logistic regression analyses were performed to evaluate adjusted associations of the
intake energy ratios of macronutrients, as well as intake frequency, and the amount of staple foods with sleepwake regularity. The lowest quartile of protein intake as well as the highest quartile of carbohydrates showed
significantly higher multivariable-adjusted odds ratios of 2.1 (95% confidence interval, 1.3-3.3) and 2.1 (1.3-3.5),
respectively, for poor sleep-wake regularity compared with the respective second quartile that is thought to be
moderate intake. Regarding intake of staple foods, low weekly intake frequency at breakfast (<5 times/week),
the lowest intake amount (<1 bowl or slice/roll) at breakfast, and the highest intake amount (≥2 bowls or slices/rolls) at lunch and dinner exhibited significantly high adjusted odds ratios for poor sleep-wake regularity. Additionally adjusting for sleep duration, these results did not substantially alter. Our results suggested that low intake energy ratio of proteins and high intake energy ratio of carbohydrates, skipping intake of the staple foodsat
breakfast, and excessive intake amount of the staple foods at lunch and dinner may be associated with poor
sleep-wake regularity.
Asia Pac J Clin Nutr. 2013;22(3):457-465.doi: 10.6133/apjcn.2013.22.3.01
>>Abstract
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Trend in gender disparities of BMI and height between 2004 and 2011 among adolescents aged 17-18 years in Changzhou China
Author:Wenying Chen MD, Zumin Shi MD, PhD
Keywords:Chinese, adolescent, overweight, trend
Abstract:Objectives: to describe the trend in gender disparities of overweight/obesity and underweight, as well as height,
among Chinese adolescents. Methods: the study is based on population-based data from annual health checks of
approximately 7,000 students finishing high school each year between 2004-2011. Height and weight were measured. Overweight/obesity and underweight were defined using International Obesity Task Force (IOTF) criteria.
School level socioeconomic status (SES) was constructed based on real-estate prices near each school. Results:
there was a slight increase in the prevalence of obesity between 2004 and 2011; 3.7% to 4.7% in boys and 1.1%
to 1.5% in girls. The prevalence of overweight was quite stable in both genders (boys: 12%-15%; girls: 7%-10%).
In most years, the prevalence of underweight was above 10%. The prevalence of underweight in girls born after
1991 increased dramatically. However, the opposite trend was seen in boys. School SES was positively associated with overweight and inversely associated with underweight among boys. There was a significant increase in
height in both genders. Height and BMI was positively associated in boys but this relation was inversely associated in girls. Conclusion: between 2004 and 2011, the prevalence of overweight/obesity was plateauing among adolescents finishing high school. A substantial increase in the prevalence of underweight was observedamong girls
born after 1991 but this seemed to be positively associated with high SES.
Asia Pac J Clin Nutr. 2013;22(3):466-473.doi: 10.6133/apjcn.2013.22.3.03
>>Abstract
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Impact of energy intake on the survival rate of patients with severely ill stroke
Author:Maki Wakita RD, PhD, Akatsuki Wakayama MD, PhD, Yu
Keywords:stroke, outcome, energy intake, glasgow coma scale, neurosurgical care unit
Abstract:INTRODUCTION: Stroke accounts for approximately 10% of all deaths. We examined whether energy intakeinfluences the survival rate of severely ill stroke patients. METHODS: We analyzed 86 consecutive severely ill
stroke patients. Patients’ background was compared between survivors and non-survivors. Average energy intakes in seven different periods from day one to seven following neurosurgical care unit (NCU) admission were
compared between two groups, to examine which period is proper to show an energy difference. Groups were
stratified by average total energy intake (group E-I, -II, -III, and -IV; ≤8.25, 8.25-16.5, 16.5-25, and >25
kcal/kg/day, respectively), and cumulative survival rate for 90 days after NCU admission was analyzed. Hazard
ratios (HRs) and 95% confidence intervals (CIs) were calculated to examine the effect of confounder factors. RESULT: Patients’ background did not differ significantly between the two groups. Average daily energy intake for
the first seven NCU days of non-survivors was significantly lower than that of survivors (p=0.034). The survival
rate of group E-II was significantly higher than that of group E-I , which was set as a reference (p=0.030). The adjusted HR of E-II was also significantly lower than that of group E-I (HR=0.19, p=0.047), although E-III did not
show significance (HR=0.52, p=0.279). CONCLUSION: Energy intake assessment should be conducted for at
least seven days following NCU admission. An average total energy intake ranging from 8.25 to 16.5 kcal/kg/day
and enteral feeding increases survival rate in severely ill stroke patients.
Asia Pac J Clin Nutr. 2013;22(3):474-481.doi: 10.6133/apjcn.2013.22.3.16
>>Abstract
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Dietary intakes consistent with the DASH dietary pattern reduce blood pressure increase with age and risk for stroke in a Chinese population
Author:Pao-Hwa Lin PhD, Wen-Ting Yeh MS, Laura P Svetkey
Keywords:dietary pattern, diet, blood pressure, hypertension, stroke
Abstract:The Dietary Approaches to Stop Hypertension (DASH) diet has been proven to effectively lower blood pressure
(BP), and associate with a lower cardiovascular disease and stroke risk in mainly non-Asians. Further, it is unclear if adhering to the DASH target nutrients has similar BP impact as adhering to the recommended DASH
food groups. Associations between adherence to DASH foods or nutrients and BP or stroke risk were assessed in
1420 and 2061 Taiwanese adults from 1989 to 2002, respectively . The DASH food score (p=0.053), dairy
(p=0.030) and calcium (p=0.020) intake were significantly and inversely associated with follow up systolic BP
change in univariate analyses. Both dairy (p=0.020) and calcium (p=0.001) also showed a consistent inverse association with systolic BP change in multivariate analysis. None of the factors examined was associated with diastolic BP change. Both DASH nutrient score and magnesium intakes were significantly associated with the hazard ratio (HR) for total stroke in an inverse relationship. The HR of total stroke comparing the highest to the
lowest tertile was 0.63 (95% CI: 0.41-0.98, p=0.037) for the DASH nutrient score, and 0.62 (95% CI: 0.40-0.97,
p=0.030) for magnesium intake. Similar findings were observed for DASH nutrient score (p=0.011) and magnesium intake (p=0.043) with the HR for ischemic stroke. The HR for total and ischemic stroke for calcium intake
also showed a borderline trend (p=0.071 and 0.051, respectively). In conclusion, adhering to the DASH diet is
beneficial for long term BP control and reduction of stroke risk in this Chinese population.
Asia Pac J Clin Nutr. 2013;22(3):482-491.doi: 10.6133/apjcn.2013.22.3.05
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Clinical decision-making for vitamin K-1 and K-2 deficiency and coronary artery calcification with warfarin therapy: are diet, factor Xa inhibitors or both the answer?
Author:Mark L Wahlqvist MD, Kiyoshi Tanaka MD, Bing-Hsiea
Keywords:vitamin K deficiency syndromes, coronary artery calcification, warfarin therapy, cheese and natto, apixaban
Abstract:Coronary artery calcification is a recognised risk factor for ischaemic heart disease and mortality. Evidence is
now strong that Mönckeberg’s arteriosclerosis, a form of vascular calcification, can be attributable to vitamin K
deficiency, but that vitamin K-2, especially the MK-4 form from foods like cheese can be protective. Warfarin
blocks the recycling of hepatic and peripheral vitamin K leading to secondary vitamin K deficiency with adverse
effects on vasculature, bone, kidneys, brain and other tissues and systems (inflammatory, immune function and
neoplasia at least). There is individual susceptibility to vitamin K deficiency and warfarin sensitivity, partly explicable in terms of genetic polymorphisms, epigenetics, diet and pharmacotherapy. The emergence of extensive
coronary calcification in a man with atrial fibrillation treated for a decade with warfarin is described by way of illustration and to raise the present clinical management conundrums. Finally, a putative set of recommendations is
provided.
Asia Pac J Clin Nutr. 2013;22(3):492-496.doi: 10.6133/apjcn.2013.22.3.21
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Micronutrient deficiencies in obese Thai children
Author:Narumon Densupsoontorn MD, Pipop Jirapinyo MD, Cha
Keywords: ascorbic acid, hepcidin, iron deficiency anemia, obese children, Thiamin deficiency
Abstract:We reported the cases of 3 obese children who presented variously with costochondral beading, numbness of both
hands and feet, and hypochromic-microcytic anemia. Serum ascorbic acid concentration, erythrocyte thiamin pyrophosphate effect, and serum hepcidin concentration were done to investigate these symptoms, respectively,
with findings of ascorbic acid insufficiency, thiamin deficiency, and iron deficiency anemia from poor iron absorption due to a hyper-inflammatory state, respectively. This report indicated that obese children not only have
energy excess but may also risk being micronutrient deficiencies; therefore, weight management with special attention to an adequate intake of vitamins and minerals should be provided.
Asia Pac J Clin Nutr. 2013;22(3):497-503.doi: 10.6133/apjcn.2013.22.3.06
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Tokyo Declaration: Food, Mind and Body APCCN 2013
Author:
Keywords:
Abstract:
Asia Pac J Clin Nutr. 2013;22(3):504.doi:
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