Nutrition and earthquakes: experience and
recommendations
Author:Nobuyo Tsuboyama-Kasaoka PhD, RD, Martalena Br Pu
Keywords:insufficient intake, malnutrition, vulnerable people, preparedness, food for special dietary uses
Abstract:I n order to sustain life during the occurrence of a natural disaster, it is vital to ensure that people’s intake of water
and food is adequate (prioritizing first energy, then protein and water-soluble vitamins). I nfants, pregnant women,
patients, and the elderly are particularly vulnerable to insufficiencies in food intake, even if they are provided
with the same quantity of food as others, and providing them with dietary and nutritional support becomes a high
priority as their insufficient intake of energy and protein becomes long term. I t is necessary to have a system in
place for identifying those who are vulnerable and in need of support and providing them with the items (food)
and nutritional care that they require. Eating is equivalent to living, and if the vulnerable themselves recognize
the importance of food and nutrition, this will help improve the nutritional situation of the entire population. I t is
recommended that measures be taken in non-emergency periods such as stockpiling food for special dietary uses.
Asia Pac J Clin Nutr. 2014;23(4):505-513.doi: 10.6133/apjcn.2014.23.4.23
>>Abstract
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National nutrition surveys in Asian countries:
surveillance and monitoring efforts to improve global
health
Author:SuJin Song PhD, Won O Song PhD
Keywords:national nutrition survey, surveillance, monitoring, Asia, global health
Abstract:Asian regions have been suffering from growing double burden of nutritional health problems, such as undernutrition and chronic diseases. National nutrition survey plays an essential role in helping to improve both national
and global health and reduce health disparities. The aim of this review was to compile and present the information on current national nutrition surveys conducted in Asian countries and suggest relevant issues in implementation of national nutrition surveys. Fifteen countries in Asia have conducted national nutrition surveys to
collect data on nutrition and health status of the population. The information on national nutrition survey of each
country was obtained from government documents, international organizations, survey website of governmental
agencies, and publications, including journal articles, books, reports, and brochures. The national nutrition surve y
of each country has different variables and procedures. Variables of the surveys include sociodemographic and
lifestyle variables; foods and beverages intake, dietary habits, and food security of individual or household; and
health indicators, such as anthropometric and biochemical variables. The surveys have focused on collecting data
about nutritional health status in children aged under five years and women of reproductive ages, nutrition intake
adequacy and prevalence of obesity and chronic diseases for all individuals. To measure nutrition and health status of Asian populations accurately, improvement of current dietary assessment methods with various diet evaluation tools is necessary. The information organized in this review is important for researchers, policy makers, public health program developers, educators, and consumers in improving national and global health.
Asia Pac J Clin Nutr. 2014;23(4):514-523.doi: 10.6133/apjcn.2014.23.4.09
>>Abstract
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The economic consequences of malnutrition in
Cambodia, more than 400 million US dollar lost
annually
Author:Jack Bagriansky MSc, Ngy Champa MBA, Kimchoeun Pak
Keywords:malnutrition, Cambodia, stunting, micronutrient, behaviour
Abstract:Background: Cambodia is among the 28 worst countries globally with the highest rates of childhood malnutrition. The aim of the assessment was to apply published evidence associating malnutrition and a variety of functional consequences to project economic implications of this high rate of childhood malnutrition. Such information is vital to advocate for appropriate programs and action plan to reduce malnutrition (from severe stunting
to micronutrient deficiencies). Methods: This exercise used a “consequence model” to apply these “coefficients
of loss” established in the global scientif ic literature to Cambodia health, demographic and economic data to develop a national estimation of the economi c losses link to malnutrition. Results: The impact of the indicators of
malnutrition analysed represent a burden to the national economy of Cambodia estimated at more than $400 million annually -2.5% of GDP. Micronutrient def iciencies suggest deficits in the quality of the diet - representing a
national burden of more than $200 million annually while breastfeeding behaviours account for 6% of the burden.
57% of the losses emerge from indicators measured in children, while 43% of losses are from indicators independent of childhood measurements - indicators of maternal behaviour along with maternal and adult nutrition.
Conclusions: Given the low cost of interventions and the high baseline losses, investment in nutrition programs
in Cambodia is likely to offer high returns and attractive benefit cost ratios. Since nearly half the losses are determined prior to the birth of the child, this has implications for targeting and timing of programs.
Asia Pac J Clin Nutr. 2014;23(4):524-531.doi: 10.6133/apjcn.2014.23.4.08
>>Abstract
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Low all-cause mortality despite high cardiovascular risk
in elderly Greek-born Australians: attenuating potential
of diet?
Author:Antigone Kouris-Blazos PhD, Catherine Itsiopoulos
Keywords:morbidity mortality paradox, all-cause mortality, CVD risk factors, Mediterranean diet, microbiome
Abstract:Elderly Greek-born Australians (GA) consistently show lower rates of all-cause and CVD mortality compared
with Australian-born. Paradoxically, however, this is in spite of a higher prevalence of CVD risk factors. This paper reviews the findings from the Food Habits in Later Life (FHILL) study, other studies on Greek migrants to
Australia and clinical studies investigating dietary mechanisms which may explain the “morbidity mortality paradox”. The FHI LL study collected data between 1988 and 1991 on diet, health and psycho-social variables on 818
people aged 70 and over from Sweden, Greece, Australia (Greeks and Anglo-Celts), Japan and were followed up
for 5-7 years to determine survival status. The FHILL study was the first to develop a score which captured the
key features of a traditional plant-based Mediterranean diet pattern (MDPS). A higher score improved overall
survival in both Greek and non-Greek elderly reducing the risk of death by 50% after 5-7 years. Of the 5 cohorts
studied, elderly GA had the lowest risk of death, even though they had the highest rates of obesity and other CVD
risk factors (developed in the early years of migration with the introduction of energy dense foods). GA appeared
to be “getting away” with these CVD risk factors because of their continued adherence in old age to a Mediterranean diet, especially legumes. We propose that the Mediterranean diet may, in part, be operating to reduce the
risk of death and attenuate established CVD risk factors in GA by beneficially altering the gut microbiome and its
metabolites.
Asia Pac J Clin Nutr. 2014;23(4):532-544.doi: 10.6133/apjcn.2014.23.4.16
>>Abstract
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Australasian Society for Parenteral and Enteral
Nutrition guidelines for supplementation of trace
elements during parenteral nutrition
Author:Emma J Osland MPhil, AdvAPD, Azmat Ali AdvAPD, El
Keywords:trace elements, guidelines, parenteral nutrition, manganese, selenium
Abstract:Background: This work represents the f irst part of a progressive review of AuSPEN’s 1999 Guidelines for Provision of Micronutrient Supplementation in Adult Patients receiving Parenteral Nutrition, in recognition of the
developments in the literature on this topic since that time. Methods: A systematic literature review was undertaken and recommendations were made based on the available evidence and with consideration to specific elements of the Australian and New Zealand practice environment. The strength of evidence underpinning each recommendation was assessed. External reviewers provided feedback on the guidelines using the AGREE II tool.
Results: Reduced doses of manganese, copper, chromium and molybdenum, and an increased dose of selenium
are recommended when compared with the 1999 guidelines. Currently the composition of available multi-trace
element formulations is recognised as an obstacle to aligning these guidelines with practice. A paucity of available literature and limitations with currently available methods of monitoring trace element status are acknowledged. The currently unknown clinical impact of changes to trace element contamination of parenteral solutions
with contemporary practices highlights need for research and clinical vigilance in this area of nutrition support
practice. Conclusions: Trace elements are essential and should be provided daily to patients receiving parenteral
nutrition. Monitoring is generally onl y required in longer term parenteral nutrition, however should be determined
on an individual basis. I ndustry is encouraged to modify existing multi-trace element solutions available in Australia and New Zealand to reflect changes in the literature outlined in these guidelines. Areas requiring research
are highlighted.
Asia Pac J Clin Nutr. 2014;23(4):545-554.doi: 10.6133/apjcn.2014.23.4.21
>>Abstract
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Energy expenditure measured using indirect calorimeter
after minimally invasive esophagectomy in ventilated
postoperative patients
Author:Tomoaki Yatabe MD, PhD, Hiroyuki Kitagawa MD, PhD,
Keywords:minimally invasive esophagectomy, indirect calorimetery, Harris-Benedict equation, intensive care unit, resting energy expenditure
Abstract:Minimally invasive esophagectomy has recently become popular af ter the laparoscopic technique was developed.
However, the postoperative energy expenditure in patients undergoing this procedure has not been evaluated.
Therefore, we hypothesized that postoperative resting energy expenditure (REE) following minimally invasive
esophagectomy is lower than that estimated using the Harris-Benedict equation. Fifteen patients who underwent
esophagectomy by thoracoscopy in the prone position were analyzed. After esophagectomy, an indirect calorimeter measured the energy expenditure during ventilation in the I CU. These values and the estimated basal energy
expenditure values were compared using the paired t test. The mean age was 66±10 years and mean duration of
ventilator use in the I CU was 697±70 mins. The acute physiology and chronic health evaluation II (APACHE II)
and sequential organ failure assessment (SOFA) scores at the time of I CU admission were 13±4 and 2±1, respectively. The average temperature, heart rate, and respiratory rate during ventilation were 36.2±0.6°C, 67±9
beats/min, and 12±2/min, respectively. The average REE during ventilation was 985±167 kcal/day (18.1±3.4
kcal/kg/day). The estimated REE was 1191±159 kcal/day. The average REE measured using the indirect calorimeter during ventilation was significantly lower than the estimated REE (83±10% of the estimated REE, p<0.001).
I n conclusion, the REE measured by an indirect calorimeter after minimally invasive esophagectomy at early
postoperative stage under sedation was significantly lower than the REE estimated using the Harris-Benedict
equation.
Asia Pac J Clin Nutr. 2014;23(4):555-559.doi: 10.6133/apjcn.2014.23.4.20
>>Abstract
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Prognostic validity of 3-Minute Nutrition Screening
(3-MinNS) in predicting length of hospital stay,
readmission, cost of hospitalisation and mortality: a
cohort study
Author:Su Lin Lim BSc (Hons), PhD, Coryn Jingmin Lee BSc,
Keywords:nutrition risk, 3-Minute Nutrition Screening (3-MinNS), prognostic validity, outcomes, mortality
Abstract:I t is important to identify patients who are at risk of malnutrition upon hospital admission as malnutrition results
in poor outcomes such as longer length of hospital stay, readmission, hospitalisation cost and mortality. The aim
of this study was to determine the prognostic validity of 3-Minute Nutrition Screening (3-MinNS) in predicting
hospital outcomes in patients admitted to an acute tertiary hospital through a list of diagnosis-related groups
(DRG). I n this study, 818 adult patients were screened for risk of malnutrition using 3-MinNS within 24 hours of
admission. Mortality data was collected from the National Registry with other hospitalisation outcomes retrieved
from electronic hospital records. The results were adjusted for age, gender and ethnicity, and matched for DRG.
Patients identified to be at risk of malnutrition (37%) using 3-MinNS had significant positive association with
longer length of hospital stay (6.6±7.1 days vs 4.5±5.5 days, p<0.001), higher hospitalisation cost (S$4540±7190
vs S$3630±4961, p<0.001) and increased mortality rate at 1 year (27.8% vs 3.9%), 2 years (33.8% vs 7.2%) and
3 years (39.1% vs 10.5%); p<0.001 for all. The 3-MinNS is able to predict clinical outcomes and can be used to
screen newly admitted patients for nutrition risk so that appropriate nutrition assessment and early nutritional intervention can be initiated.
Asia Pac J Clin Nutr. 2014;23(4):560-566.doi: 10.6133/apjcn.2014.23.4.19
>>Abstract
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Effect of daily milk supplementation on serum and
umbilical cord blood folic acid concentrations in
pregnant Han and Mongolian women and birth
characteristics in China
Author:Yun-feng Li PhD, Na-shun Hu M.S.Med, Xiao-bin Tian
Keywords:folic acid, milk, neonatal birth weight, birth defects, umbilical cord blood
Abstract:Many studies have demonstrated the efficacy of folic acid (FA) supplementation in prevention of neural tube defects (NTDs), although the extent of NTDs varies among individuals of different races and ethnic origin. China is
a multi-ethnic country with no standard practice for FA-fortified food. Milk is consumed by women, but little is
known about the effects of milk on folate concentration in maternal blood and neonatal umbilical cord blood in
Han and Mongolian women after stopping taking the supplement f or a month and five month, respectively. The
objective of this study was to determine whether only daily consumption of liquid milk can increase the blood folate concentration in pregnant women and whether there are differences in blood folate concentrations between
Han and Mongolian women after cessation of FA supplementation. Of the 4052 women enrolled in the parallel
group design study. Three thousand five hundred and twenty-six women had confirmed pregnancies and were
randomized to receive liquid milk or not until delivery. Women who consumed the liquid milk had significantl y
increased serum folate concentrations at 16 and 32 weeks of gestation as well as cord blood at birth compared to
control groups in both ethnic groups. I nfants born to women drinking milk also had better the term birth weight
and height, which may be related to the increased concentration of folate. I n conclusion, daily consumption of
milk can increase the serum folate concentration in pregnant Han and Mongolian women in China (differences in
the efficacy of FA and milk supplementation) and may enhance birth outcomes.
Asia Pac J Clin Nutr. 2014;23(4):567-574.doi: 10.6133/apjcn.2014.23.4.18
>>Abstract
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Efficacy of probiotic therapy in full-term infants with
critical illness
Author:Yu Wang MD, Li Gao MD, Yu-hua Zhang MB, Chang-song
Keywords:intestinal microbiota, multiple organ dysfunction syndrome, intensive care, nosocomial pneumonia, infant
Abstract:Background: Probiotics are microbial supplements that have shown efficacy in a wide range of applications. To
assess the safety and effects of enteral probiotics in critically ill neonates. Methods: A double-blind, randomized
controlled trial was conducted in 100 full- term infants with critical illness according to scores of neonatal acute
physiology. Fifty neonatal intensive care patients were randomly assigned to receive probiotics three times dail y
after birth for 8 days, and fifty patients were not given probiotics, but who received a placebo. The incidence of
sepsis, multiple organ dysfunction syndrome (MODS), nosocomial pneumonia, and necrotizing enterocolitis were
recorded. The prognosis of probiotic treatment was determined based on the rate of recovery and hospital days.
Serum I gA, IgG, and I gM concentrations were measured on days 4 and 8. Results: I nfants in the probiotics group
showed a significantly reduced rate of nosocomial pneumonia (18% versus 36%) and multiple organ dysfunction
syndrome (6% versus 16%) compared with the placebo group (p<0.05). Significant results were demonstrated in
favour of the probiotics for days of hospital stay (13±3.5 d versus 15.8±5.3 d) (p<0.05). However, there were no
significant differences in the occurrence of sepsis, necrotizing enterocolitis, and recovery rate. Patients given probiotics had significantly greater levels of I gA than those in the placebo group (p<0.05). No serious adverse effects
in the study population were noted. Conclusions: Supplements of probiotics to critically ill neonates could enhance immune activity, decrease occurrence of nosocomial pneumonia and MODS, and reduce days in hospital.
Asia Pac J Clin Nutr. 2014;23(4):575-580.doi: 10.6133/apjcn.2014.23.4.14
>>Abstract
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Turmeric improves post-prandial working memory in
pre-diabetes independent of insulin
Author:Meei-Shyuan Lee DrPH , Mark L Wahlqvist MD, Yu-Chi
Keywords:cognition, Alzheimer’s disease, curcumin, cinnamon, insulin resistance
Abstract:Background and Objectives: Cognitive impairment develops with pre-diabetes and dementia is a complication
of diabetes. Natural products like turmeric and cinnamon may ameliorate the underlying pathogenesis. Methods:
People ≥60 years (n=48) with newly-recognised untreated pre-diabetes were randomised to a double-blind metabolic study of placebo, turmeric (1 g), cinnamon (2 g) or both (1 g & 2 g respectively), ingested at a white bread
(119 g) breakfast. Observations were made over 6 hours for pre- and post-working memory (WM), glycaemic and
insulin responses and biomarkers of Alzheimer’s disease (AD)(0, 2, 4 and 6 hours): amyloid precursor protein
(APP), γ-secretase subunits presenilin-1 (PS1), presenilin-2 (PS2), and glycogen synthase kinase (GSK-3β). Differences between natural product users and non-users were determined by Students t and chi square tests; and between pre-test and post-test WM by Wilcoxon signed rank tests. I nteraction between turmeric and cinnamon was
tested by 2-way ANOVA. Multivariable linear regression (MLR) took account of BMI , glycaemia, insulin and
AD biomarkers in the WM responses to turmeric and cinnamon. Results: No interaction between turmeric and
cinnamon was detected. WM increased from 2.6 to 2.9 out of 3.0(p=0.05) with turmeric, but was unchanged with
cinnamon. WM improvement was inversely associated with insulin resistance (r=-0.418, p<0.01), but not with
AD biomarkers. With MLR, the WM responses to turmeric were best predicted with an R
2
of 34.5%; and with
significant turmeric, BMI and insulin/glucose AUC beta-coeffici ents. Conclusions: Co-ingestion of turmeric
with white bread increases working memory independent of body fatness, glycaemia, insulin, or AD biomarkers.
Asia Pac J Clin Nutr. 2014;23(4):581-591.doi: 10.6133/apjcn.2014.23.4.24
>>Abstract
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Management trajectories in the type 2 diabetes
Integrated Delivery System project in Taiwan:
accounting for behavioral therapy, nutrition
education and therapeutics
Author:Hsing-Yi Chang DrPH, Mark L Wahlqvist MD, Wen-Lin
Keywords:glycemic control, diabetes complications, metabolic memory, trajectory, DMIDS
Abstract:Background and aim: Glycated hemoglobin (HbA1c) assessment is basic to diabetes management. Little is done
to describe the whole spectrum of the trajectory, its related temporal patterns of metabolic indices, and comorbidities. Methods and Results: This was a longitudinal study. I n the Diabetes Management through I ntegrated
Delivery System project in Taiwan, enrollees had diabetes, but no major comorbidities. They were randomized
into intensive or conventional education (health, diet and exercise) groups. HbA1c was classified by a groupbased trajectory model on the basis of repeated six-monthly measurements. We analyzed data from 1091 subjects
who had at least two measurements on HbA1c. HbA1c exhibited three distinct ranges of low (42-53 mmol/mol),
intermediate (64-75 mmol/mol) and high (97 mmol/mol), all of which persisted for 4.5 years regardless of receiving intensive education or not. Temporal changes and a time-group interaction were found for triglycerides, total
cholesterol, HDL-C and LDL-C. The high trajectory was associated with the major co-morbidities of retinopathy,
nephropathy, neuropathy, stroke, hypogl ycemia, and ketoacidosis. Patients in the intensive education group
(62.4%), which were equally distributed in the three trajectories, had significantly lower HbA1cs (-0.14%= -1.5
mmol/mol, p=0.026). The intermediate trajectory patients with intensive education had HbA1cs higher than the
low trajectory patients with conventional education (=0.189, p=0.033). Though not significant, a similar pattern
was found for DM education in the high group (=0.223, p=0.154). Conclusions: Novel strategies beyond current education and pharmacotherapeutic regimens are needed to lower HbA1c at least 11 mmol/mol for the high
HbA1c group to minimize comorbidities.
Asia Pac J Clin Nutr. 2014;23(4):592-606.doi: 10.6133/apjcn.2014.23.4.06
>>Abstract
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Early enteral nutrition after total gastrectomy for
gastric cancer
Author:Wei Chen MD, Zheng Zhang MM, Maoming Xiong MD, Xia
Keywords:gastric cancer, enteral nutrition, parenteral nutrition, total gastrectomy, complications
Abstract:Objective: To assess the difference between early enteral nutrition (EEN group) and total parenteral nutrition
(TPN group) after total gastrectomy for gastric cancer. Method: The nutrition index, liver function, patientgenerated subjective global assessment (PG-SGA) score, the post- operation complications, the hospital stay and
hospitalization expense of the postoperative patient after total gastrectomy, admitted to our Department of
Surgery from May 2011 to May 2013 were analyzed retrospectively. Results: A total of 72 patients including 37
cases in the EEN group and 35 cases in the TPN group were recruited. Hypoalbuminemia gradually improved in
the EEN group about 3-5 days, but it did not increase until average 21 days in the TPN group. The body weight
decreased in the EEN group during the first 2 weeks and recovered gradually in 21 days; body weight in the TPN
group was significantly lower than the EEN group at 21 days (p<0.05). There were significant differences in both
the groups (p<0.05) in nutrition indicators. The incidence of complications in the EEN group and TPN group
were 8.1% and 25.7% respectively, with no significant differences (p>0.05). The days of hospital stays in the
EEN and in the TPN group were up to 12.2±2.5 d vs 14.9±2.9 d (p<0.05) and the hospitalization expenses were
36472±4833 CNY vs 40140±3927 CNY (p<0.05), respectively. Conclusion: Compared with TPN, EEN was safe
and well tolerated and can shorten the hospital stay as well as reduce costs incurred with total gastrectomy for
gastric cancer.
Asia Pac J Clin Nutr. 2014;23(4):607-611.doi: 10.6133/apjcn.2014.23.4.15
>>Abstract
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Pattern and predictors of dairy consumption during
adolescence
Author:Bamini Gopinath BTech PhD, Victoria M Flood BSc
Keywords:dairy, adolescence, milk, cohort, Sydney Childhood Eye Study
Abstract:We aimed to prospectively assess dairy intake among adolescents, and determine the predictors of adequate dairy
consumption during adolescence. 634 Sydney schoolchildren (351 girls and 283 boys) who had dietary data at
both age 12 and 17 were included for analyses. Dairy consumption was assessed from validated semi-quantitative
food frequency questionnaires. At age 12, mean total dairy intake was 1.62 serves/day which decreased to 1.40 by
age 17 (p<0.0001). Mean serves/day of milk decreased from 1.11 to 0.92 during adolescence. Moreover, 90% of
the decrease in serves/day of total dairy was due to reduced milk consumption. At age 12, 8.5% of children consumed ≥3.5 serves/day of total dairy and this decreased to 6.2%, 5 years later at age 17 (p=0.001). A lower proportion of girls compared with boys consumed ≥3 serves/day of total dairy at both ages 12 (p=0.005) and 17
(p=0.01). Participants with tertiary qualified parents at baseline were 85% more likely to have intakes of the dairy
food group above the median during the 5 years, OR 1.85 (95% CI 1.18-2.91). Frequent flavored milk consumption (≥2 serves/week) at baseline was associated with ~5-fold greater likelihood of maintaining intakes of dairy
foods above the median during adolescence. Dairy food consumption decreased significantly during adolescence,
driven primarily by a decrease in milk consumption. Most adolescents did not meet national recommended guidelines for the dairy food group intake. These f indings highlight the need for further research into intervention strategies aimed at sustaining dairy consumption.
Asia Pac J Clin Nutr. 2014;23(4):612-618.doi: 10.6133/apjcn.2014.23.4.05
>>Abstract
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Assessment of muscle mass and its association with
protein intake in a multi-ethnic Asian population:
relevance in chronic kidney disease
Author:Boon Wee Teo MB, BCh, BAO, B Med Sci, FASN, FACP,
Keywords:Asian Continental Ancestry Group, protein, kidney failure, chronic diet, nutrition assessment
Abstract:Background: Clinical practice guidelines recommend objective nutritional assessments in managing chronic kidney disease (CKD) patients but were developed while referencing to a North-American population. Specific recommendations for assessing muscle mass were suggested (mid-arm circumference, MAC; corrected mid-arm
muscle area, cAMA; mid-arm muscle circumference, MAMC). This study aimed to assess correlation and association of these assessments with dietary protein intake in a multi-ethnic Asian population of healthy and CKD patients. Methods: We analyzed 24-hour urine collections of selected participants to estimate total protein intake
(TPI ; g/day). I deal body weight (I DW; kg) was calculated and muscle assessments conducted. Analyses involved
correlation and linear regression, taking significance at p<0.05. Results: There were 232 stable CKD patients and
103 healthy participants comprising of 51.0% male, 38.5% Chinese, 29.6% Malay, 23.6% I ndian, and 8.4% others. The mean TPI was 58.9±18.4 g/day in healthy participants and 53.6±19.4 g/day in CKD patients. When normalized to ideal body weight, TPI -I DW (g/kg/day) was similar in healthy and CKD participants. Overall, TPI was
associated with MAC (r=0.372, p<0.001), cAMA (r=0.337, p<0.001), and MAMC (r=0.351, p<0.001). TPI -I DW
was also associated with MAC (r=0.304, p<0.001), cAMA (r=0.202, p<0.001), and MAMC (r=0.200, p<0.001)
but not for TPI normalized to actual body weight. When examined separately, TPI was associated with MAC,
cAMA, and MAMC in both CKD and healthy participants, but was associated with TPI -I DW onl y in CKD patients. Conclusion: Total protein intake was associated with muscle assessments in all participants. TPI normalized to I DW should only be used in CKD patients.
Asia Pac J Clin Nutr. 2014;23(4):619-625.doi: 10.6133/apjcn.2014.23.4.01
>>Abstract
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Assessment of iodine status and associated factors in
vulnerable populations in Henan Province, China, in
2012
Author:Jin Yang MS, Heming Zheng MS, Xiaofeng Li BS, Lin
Keywords: iodine, reproduction, pregnancy, lactation, child
Abstract:Background: I odine content in table salt was adjusted from 30-50 mg/kg to 21-39 mg/kg from March of 2012 in
Henan Province, China. The vulnerable population may be at risk of iodine deficiency. Objectives: To determine
whether the iodine intake was sufficient in vulnerable populations and to investigate what factors may be associated with iodine status in these vulnerable populations in Henan Province, China. Methods: A cross-sectional
survey was conducted in 17 cities in Henan Province, China, from April 2012 to December 2012 to assess the iodine status in vulnerable populations, including women of reproductive-age (n=2648), pregnant women
(n=39684), lactating women (n=6859), infants <2 years of age (n=16481), and children aged 8-10 years (n=3198).
Questionnaires (n=4865) related to demographic and dietary factors were collected from the investigated women
to identify factors that were related to iodine intake and iodine status. Results: The median urinary iodine concentrations (mUI Cs) were 205 μg/L, 198 μg/L, 167 μg/L, 205 μg/L and 200 μg/L, respectively, in reproductiveage, pregnant and lactating women, infants <2 years of age and children aged 8-10 years. Higher income, and
consuming more poultry and fish in the diet had positive impact on UI C levels. Low salt intake, consuming more
rice and vegetables in the diet were negative factors for UI C. Conclusions: I odine status of the vulnerable populations was generally adequate in Henan Province, China, according to WHO criteria. But the mUI Cs were slightly above the adequate level in reproductive-age women and children aged 8-10 years. I t’s important to monitor
the iodine status in vulnerable populations after the adjustment on iodine content in table salt.
Asia Pac J Clin Nutr. 2014;23(4):626-633.doi: 10.6133/apjcn.2014.23.4.03
>>Abstract
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Feeding patterns before 6 months of age: the relative
validity of recall from interviews of mothers of
Guatemalan infants and toddlers
Author:Marieke Vossenaar PhD, Ilse van Beusekom MSc, Col
Keywords:infant and young child feeding, infant and young child nutrition, dietary assessment, exclusive breastfeeding, Guatemala
Abstract:The WHO recommends exclusive breastfeeding during the first 6 mo of life; however, deviations from this recommendation are widespread. The objective of the current study was to evaluate exclusive and predominant
breastfeeding rates, as defined by the WHO, in a cross-sectional sample of Guatemalan children using retrospective records on the temporal pattern of introducing foods and beverages before 6 mo. Mothers of 150 infants,
aged 6 to 23 mo, attending a public health clinic were interviewed about early life feeding practices with a structured questionnaire. I n addition, the plausibility of the reported offering of liquids and foods, other than breast
milk, since birth was checked against reported current feeding practices. We observed that estimated exclusive
breastfeeding was rare with 14% of infants receiving exclusive breastfeeding for 5 mo, and only 9% for the recommended 6 mo. The proportion of infants with predominant breastfeeding, which allows certain liquids such as
water, juices and ritual fluids, was 33% through 5 mo and 23% through 6 mo. One-quarter of mothers (n=38) reported implausible answers concerning age-of-introduction of liquids and foods. Nevertheless, retrospective reports at up to 2 y give credible outcomes for estimations of feeding pattern at 6 mo of age. Our findings match the
findings of other studies conducted in Guatemala. Overall adherence to the WHO guidelines for feeding in the
first semester of infancy was much less than ideal and in need of strengthening.
Asia Pac J Clin Nutr. 2014;23(4):634-640.doi: 10.6133/apjcn.2014.23.4.07
>>Abstract
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Retrospective tracking of young obese children back to
birth in Japan: special attention to the relationship with
parental obesity
Author:Rena Kato MS, Masaru Kubota MD, PhD, Yuka Yasui MS
Keywords:body mass index, obesity, parental obesity, tracking, young children
Abstract:Objective: Childhood obesity is tracked to adulthood at a high rate. However, longitudinal studies of obesity in
early childhood remain limited. This study aimed at tracking young obese children back to birth in comparison
with normal-weight children, and investigating the relationship with parental obesity. Methods: A total of 2,678
(1,353 boys) young children attending kindergarten or nursery school in Nara Prefecture, Japan, were enrolled.
The present heights and weights of children and parents were obtained by a questionnaire, and children’s heights
and weights at birth, 1.5, and 3.5 years were obtained from mother-child health notebooks. Using body mass index (BMI ), child and parental obesity were defined as ≥90th percentile based on the reference values for Japanese
children and ≥25 (kg/m²), respectively. Results: The overall prevalence of obesity at birth was 10.2%, and decreased to 5.6% at 5 years. I n the retrospective tracking, obese children at 5 years exhibited significantly higher
weight z-scores and BMI percentiles consistently from birth than in normal-weight children. The increased velocity of weight gain as judged by their z-score during three periods; birth-1.5, 1.5-3.5, and 3.5-5 years were significantly associated with an increased risk for the obesity at 5 years of age. Only maternal obesity was found to be
associated with daughters’ obesity in the analysis of association of parents-children obesity. Conclusions: I t is
important to manage body weight from early infancy for reducing the occurrence of obesity at 5 years. Where
there is maternal obesity, greater attention may be required, especially for daughters.
Asia Pac J Clin Nutr. 2014;23(4):641-650.doi: 10.6133/apjcn.2014.23.4.17
>>Abstract
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Body satisfaction, emotional intelligence, and the
development of disturbed eating: a survey of Taiwanese
students
Author:Yueching Wong PhD, RD, Jing-Shan Lin MS, Yu-Jhen
Keywords:body satisfaction, emotional intelligence, disturbed eating, EAT-26, senior high school student
Abstract:Purpose: This study explored the relationship between adolescents’ emotional intelligence and the tendency to
develop an eating disorder. Methods: Senior high school students in Taiwan were recruited for the study. A 3-part anonymous questionnaire measured demographic information, body weight satisfaction, and expectation of
body weight. Students also completed the Adolescent Emotional I ntelligence Scale and the Eating Disorders Attitude-26 Test (EAT-26). Height and weight were also measured. Results: The mean of EAT-26 score was
8.66±7.36, and 8.6% students were at high risk to develop eating disorders. Gender, body weight, body dissatisfaction and the expected body shape were significantly related to disturbed eating attitudes and behaviours.
Scores of EAT-26 were positively correlated with emotional perception, emotional expression, and emotional application. Conclusions: Disturbed eating behaviours exist among adolescents in Taiwan, and these behaviours
may be related to emotional intelligence. However further studies with larger samples are needed.
Asia Pac J Clin Nutr. 2014;23(4):651-659.doi: 10.6133/apjcn.2014.23.4.02
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Water and nutrient intake in pregnant New Zealand
women: association with wheeze in their infants at 18
months
Author:Patricia Ellyett Watson MHSc, Barry William McDona
Keywords:pregnancy, water, nutrients, infant, wheezing
Abstract:The association between water and nutrient intake in pregnant women, and wheeze in their 18 month old infants,
was investigated in a prospective study. Volunteers (n=369) recruited f rom northern New Zealand were visited in
months 4 and 7 of pregnancy. At each visit anthropometric measurements were taken, diet assessed by 24-hour
recall and 3-day food records and questionnaires determining personal details administered. Eighteen months after birth, infants were measured, and questions on infant feeding and wheeze asked. Overall, mothers reported
32% of their infants had wheezed in the last 12 months. After adjusting for significant covariates and energy intake, higher maternal intakes of dietary water (p=0.009) and manganese (p=0.024) were associated with decreased wheeze, and glucose (p=0.003) with increased wheeze. Prevalence of infant wheeze decreased 18.5%
from the lower to the upper quartile of water intake, and 17.4% from the lower to the upper quartile of manganese
intake. Wheeze was more common in Polynesian than European infants (41.8% vs 28.9%). Polynesian mothers
consumed signif icantly less dietary water (median 451 g less) and manganese (median 1374 g less) than European mothers per day. Glucose was only significant because of strong association with infant wheeze at extremely high maternal intakes of >40 g/day in ~10% of the subjects. There was no association between maternal dietary
supplement intake and wheeze. Mothers estimated at high risk of infant wheeze consumed less tap water, whole
grains, tea, fruit; and more fruit juice, soft drink, processed meat and fish products, and refined grain products.
This is the first study to report an intergenerational association between maternal water, and glucose intake with
infant wheeze.
Asia Pac J Clin Nutr. 2014;23(4):660-670.doi: 10.6133/apjcn.2014.23.4.13
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Evaluating the micronutrient status of women of
child-bearing age living in the rural disaster areas one
year after Wenchuan Earthquake
Author:Caixia Dong PhD, Pengfei Ge MS, Xiaolan Ren BS, Xi
Keywords:women of child-bearing age, micronutrient, women, earthquake, emergency
Abstract:Populations with special physiologi cal state, such as pregnant, nursing and women of child-bearing age, have
been identified as nutritionally vulnerable during natural disaster. The objective of this survey was to evaluate the
prevalence of anaemia and micronutrient status of women of reproductive age in April 2009 one year after the
Whenchuan Earthquake. The survey recruited 58 pregnant, 66 lactating and 242 women of child-bearing age f rom
19 to 45 years. The concentrations of haemoglobin in whole blood and ferritin and micronutrients in serum were
assayed. Among the three groups (pregnant, nursing and child-bearing women), respectively, the prevalence of
anaemia was 29.1%, 25.5% and 28.8%; that of iron deficiency was 45.4%, 49.0% and 52.9%; and that of zinc deficiency was 45.4%, 23.0% and 33.5%. The sum of vitamin D deficiency and insufficiency was more than 90% in
each group, and the total vitamin B12 deficiency and marginal deficiency prevalence percentages were 47.3%,
17.7% and 35.7%, respectively. The prevalence of vitamin A deficiency and marginal deficiency was 1.8% and
9.1% in pregnant women, 6.1% and 15.2% in nursing women and 8.6% and 21.3% in women of child-bearing
age, respectively. Our findings indicated that the micronutrient status of women of reproductive age was poor in
the disaster areas. Therefore, improving the micronutrient status of these women should be an urgent priority in
these areas.
Asia Pac J Clin Nutr. 2014;23(4):671-677.doi: 10.6133/apjcn.2014.23.4.22
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Development and validity of a 3-day smartphone
assisted 24-hour recall to assess beverage consumption
in a Chinese population: a randomized cross-over study
Author:Lindsey P Smith MPH, Jenna Hua MPH, Edmund Seto Ph
Keywords:diet assessment, nutrition epidemiology, mobile technology, sugar sweetened beverages, China
Abstract:This paper addresses the need for diet assessment methods that capture the rapidly changing beverage consumption patterns in China. The objective of this study was to develop a 3-day smartphone-assisted 24-hour recall to
improve the quantification of beverage intake amongst young Chinese adults (n=110) and validate, in a small
subset (n=34), the extent to which the written record and smartphone-assisted recalls adequately estimated total
fluid intake, using 24-hour urine samples. The smartphone-assisted method showed improved validity compared
with the written record-assisted method, when comparing reported total f luid intake to total urine volume. However, participants reported consuming fewer beverages on the smartphone-assisted method compared with the
written record-assisted method, primarily due to decreased consumption of traditional zero-energy beverages (i.e.
water, tea) in the smartphone-assisted method. I t is unclear why participants reported fewer beverages in the
smartphone-assisted method than the written record -assisted method. One possibility is that participants found
the smartphone method too cumbersome, and responded by decreasing beverage intake. These results suggest that
smartphone-assisted 24-hour recalls perform comparably but do not appear to substantially improve beverage
quantification compared with the current written record-based approach. I n addition, we piloted a beverage
screener to identify consumers of episodically consumed SSBs. As expected, a substantially higher proportion of
consumers reported consuming SSBs on the beverage screener compared with either recall type, suggesting that a
beverage screener may be useful in characterizing consumption of episodically consumed beverages in China’s
dynamic food and beverage landscape.
Asia Pac J Clin Nutr. 2014;23(4):678-690.doi: 10.6133/apjcn.2014.23.4.10
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Coffee consumption patterns in Korean adults: the
Korean National Health and Nutrition Examination
Survey (2001-2011)
Author:Youjin Je ScD, Seonghyun Jeong MA, Taeyoung Park
Keywords:brewed coffee, cross-sectional study, dietary intake, instant coffee mix, Korean population
Abstract:We examined coffee consumption patterns over the past decade among Korean adults. This study was based on
seven different cross-sectional data from the Korean National Health and Nutrition Examination Survey
(KNHANES) between 2001 and 2011 (17,367 men and 23,591 women aged 19-103 y, mean 48.1 y). I nformation
on frequency and type of coffee consumption was derived from frequency questionnaires or 24-hour recalls. For
the study period, the prevalence of daily coffee consumption increased by 20.3% (from 54.6 to 65.7%; p<0.001).
For those who consumed 2 or more cups of coffee daily, it dramatically increased by 48.8% (from 29.1 to 43.3%;
p<0.001). The instant coffee mix was consumed the most frequently by Korean adults, and it was on the increasing trend among people who were middle aged or older (≥40 y), while it was on the slowdown in young men or
on the declining trend in young women. Brewed coffee consumption had an increasing trend by all age groups in
recent years. Especially, there was a rapid increase in brewed coffee consumption among young women (strongly) and young men. The instant coffee mix that contains non-dairy creamer and/or sugar still takes up a significant portion of coffee consumption in Korea, which may result in weight gain and insulin resistance, and potential benefits of coffee may be offset. Given high prevalence of coffee consumption in Korea, nutrition education
should be conducted to help people (especially the elderly) to make healthy coffee drinking habits.
Asia Pac J Clin Nutr. 2014;23(4):691-702.doi: 10.6133/apjcn.2014.23.4.11
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Geographic factors as determinants of food security: a
Western Australian food pricing and quality study
Author:Christina Mary Pollard PhD, Timothy John Landriga
Keywords:food, affordability, quality, geographic factors, food security
Abstract:Food affordability and quality can influence food choice. This research explores the impact of geographic factors
on food pricing and quality in Western Australia (WA). A Healthy Food Access Basket (HFAB) was cost and a
visual and descriptive quality assessment of 13 commonly consumed fresh produce items was conducted in-store
on a representative sample of 144 food grocery stores. The WA retail environment in 2010 had 447 grocery stores
servicing 2.9 million people: 38% of stores the two major chains (Coles® Supermarkets Australia and Woolworths® Limited) in population dense areas, 50% were smaller independently owned stores (IndependentGrocers Association®) in regional areas as well, and 12% Indigenous community stores in very remote areas. The
HFAB cost 24% (p<0.0001) more in very remote areas than the major city with fruit (32%, p<0.0001), vegetables
(26.1%, p<0.0005) and dairy (40%, p<0.0001) higher. Higher price did not correlate with higher quality with only
80% of very remote stores meeting all criteria for fresh produce compared with 93% in Perth. About 30% of very
remote stores did not meet quality criteria for bananas, green beans, lettuce, and tomatoes. With increasing geographic isolation, most foods cost more and the quality of fresh produce was lower. Food affordability and quality
may deter healthier food choice in geographically isolated communities. Improving affordability and quality of
nutritious foods in remote communities may positively impact food choices, improve food security and prevent
diet-sensitive chronic disease. Policy makers should consider influencing agriculture, trade, commerce, transport,
freight, and modifying local food economies.
Asia Pac J Clin Nutr. 2014;23(4):703-713.doi: 10.6133/apjcn.2014.23.4.12
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Home food availability is associated with multiple
socio-economic indicators in 50 year olds from
Canterbury, New Zealand
Author:Renée Wilson MDiet, Richard B Gearry PhD, Emily Gr
Keywords: socio-economic status, New Zealand, food choice, home environment
Abstract:Financial restraints and poverty lead to poor diets and poor health outcomes. Limited research shows that socioeconomic status is related to home availability of certain foods. However, studies in this area have used different
socio-economic indicators, which may not equally influence eating-related behaviors. Using multiple indicators
of socio-economic status may provide a more accurate picture of these relationships. The aim of this study was to
investigate whether several socio-economic indicators are independently associated with home availability of selected foods known to influence chronic disease risk in 50 year olds from Canterbury, New Zealand, participating
in the CHALICE study. Participants were selected randomly from health research extracts from Canterbury. Data
from 216 participants (110 females, 106 males) were included. The presence (but not quantity) of
foods/beverages in the home was measured by a validated home food inventory. Linear regression analyses were
performed for the following home food inventory scores: fruit, vegetables, lower fat dairy, obesogenic foods and
sweetened beverages with household income, standard of living and education using multivariate models. Higher
household income and standard of living were individually associated with a 2% to 3% higher fruit and vegetables (3 to 5 types/forms) and total food scores (6 to 9 types/forms) (p<0.03). Higher education level was associated with a 2.5% increase in fruit and vegetables score (4 types/forms) and an 8% decrease in sweetened beverages
score (0.4 beverages) (p<0.02). These results suggest that using only one measure of socio-economic status cannot accurately capture the effects of social inequalities in food availability. Those experiencing the most social
disadvantage had a lesser availability of fruit and vegetables which may be detrimental to good health.
Asia Pac J Clin Nutr. 2014;23(4):714-722.doi: 10.6133/apjcn.2014.23.4.04
>>Abstract
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