Evolution of diabetes management in the 21st century:
the contribution of quality of life measurement in Asians
Author:Shereen Giap Kah Goh MBBS, Bin Nordin Rusli MBBS,
Keywords:quality of life, Asians, diabetes mellitus
Abstract:Diabetes mellitus (DM) is a complex and chronic disease with multiple complications leading to increased mortality and poor quality of life. Current studies have shown that lowering glycosylated haemoglobin (HbA1c) confers protection against microvascular complications. However, with more intensive glucose control to achieve
HbA1c of less than 6.5%, there seems to be a significant increased risk of mortality and cardiovascular events.
The current recommendation worldwide is for “tailoring” of DM management to risk and also quality of Life
(QOL) which is a crucial component in determining the success or failure of DM management. I n Asia, DM has
become a health crisis but there is a lack of QOL assessment tool that is specific for Asians with wide spectrum of
ethnicity, languages, religions and socio-economic differences. I n this review, we discuss the evolution of DM
management over the decade and the issues pertaining to QOL among people living with diabetes in Asia.
Asia Pac J Clin Nutr. 2015;24(2):190-198.doi: 10.6133/apjcn.2015.24.2.04
>>Abstract
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Food system advances towards more nutritious and
sustainable mantou production in China
Author:Xinzhong Hu PhD, Xialu Sheng MSc, Liu Liu PhD, Zh
Keywords:mantou, whole-grain, shelf life, starch retrogradation, hot packaging
Abstract:Mantou, a traditional Chinese food, is widely consumed in the North China due to its nutritional value and good
mouth-feel. However, its current family-st yle production is impeded due to short shelf-life caused by mold and
starch retrogradation. The current packaging and storage methods are not efficient enough for mantou preservation. Recently, a novel, hot online package technology has attracted attention due to its high processing efficiency
and low cost. Most importantly, by using this methodology, secondary contamination by microbes can be avoided
and starch retrogradation can be markedly delayed, with mantou shelf-life under room temperature extended from
a few to at least 90 days without any additives. I n this review, the mechanisms of mantou quality deterioration are
explained and the advantages of hot package technology addressed and compared with other packaging methods,
such as frozen chain storage. I n this way, not onl y wheat, but also other grains (including whole-grains) and ingredients may be mantou constituents, to enhance nutrition of traditional mantou. There is now a technological
opportunity for mantou to become a more nutritious, sustainable and affordable foodstuff in local communities.
Asia Pac J Clin Nutr. 2015;24(2):199-205.doi: 10.6133/apjcn.2015.24.2.21
>>Abstract
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Clinical application of the fast track surgery model
based on preoperative nutritional risk screening in
patients with esophageal cancer
Author:Jin-Yi Wang MD, Xuan Hong MD, Guo-Han Chen MM, Qin
Keywords:esophageal cancer, perioperation, nutrition risk screening, fast track surgery, postoperative indicator
Abstract:Objectives: To investigate the clinical application of the fast track surgery (FTS) model based on preoperative
nutritional risk screening (NRS) in patients with esophageal cancer. Methods: 180 patients with esophageal cancer who underwent surgery between January 2008 and April 2014 were randomly divided into study and control
groups based on matched-pairs. The study group underwent assessment using the NRS 2002 and received treatment before surgery and the control group was treated by the conventional method. Postoperative indicators including time to first exsufflation, time to defecation, time to chest tube removal, hospitalization duration, and
postoperative complications were examined after surgery. Results: Compared with the control group, the postoperative indicators including time to first exsufflation (88.4±2.76 vs 57.83±2.68 hours), time to first defecation
(4.68±1.71 vs 3.28±1.34 days), time to chest tube removal (4.30±0.25 vs 2.70±0.33 days), postoperative hospitalization durations (11.71±1.39 vs 9.00±0.78 days), and total complication rate (18.9% [17/90] vs 6.67% [6/90])
were all significantly reduced in the study group (p<0.05). Conclusions: The FTS model based on NRS can effectively promote postoperative rehabilitation of patients, reduce the incidence of postoperative complications,
and shorten hospital stay.
Asia Pac J Clin Nutr. 2015;24(2):206-211.doi: 10.6133/apjcn.2015.24.2.18
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Risk of regurgitation and aspiration in patients infusedwith different volumes of enteral nutrition
Author:Shaozhen Chen BA 1 , Wenbiao Xian MS 1 , Shouzhen
Keywords:stroke, enteral nutrition, gastroesophageal reflux, aspiration, gastric residual volume
Abstract:Background: Patients with stroke suffer from nutrition impairments and often rely on enteral nutrition (EN),
which is associated with respiratory complications such as regurgitation and aspiration. Objective: To evaluate
the incidence of regurgitation and aspiration in patients with severe stroke infused with different volumes of EN.
Methods: A randomized controlled trial was conducted on 210 patients with severe stroke undergoing EN therapy. Patients were randoml y assigned into two groups. Subjects in the treatment group received EN with an initial
rate defined according to the total volume and the infusion rate was adjusted based on gastric residual volume
(GRV) assessed every 4 hours. Subjects of the control group received EN without monitoring the GRV and
reached the target infusion volume within 72 hours. The incidence of reflux and aspiration was recorded. Results:
The incidences of regurgitation and aspiration were significantly lower in treatment group (6.3% and 7.9%, respectively) than control group (18.8% and 17.5%, respectively). In the treatment group, 1 patient developed regurgitation while 2 developed aspiration when EN was 500 mL. When EN increased to 1000 mL, 2 patients developed regurgitation and 2 developed aspiration, and 5 patients developed regurgitation and 6 had aspiration
when EN was 1500 mL. There was no significant difference in the risk of reflux and aspiration when total volume
of EN increased from 500 to 1500 mL. Conclusions: During EN therapy for patients with stroke, using feeding
pump with a continuous infusion for 20 hours and adjusting infusion rate based on GRV could reduce the incidence of respiratory complications.
Asia Pac J Clin Nutr. 2015;24(2):212-218.doi: 10.6133/apjcn.2015.24.2.12
>>Abstract
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Optimal timing for introducing enteral nutrition in the
neonatal intensive care unit
Author:Jie Liu MD, Kaimeng Kong MD, Yexuan Tao PhD, MD, W
Keywords:neonates, feed introduction, intensive care unit, enteral nutrition, parenteral nutrition
Abstract:Objective: To identify the optimal time for introducing enteral nutrition to critically ill neonates. Methods: This
prospective cohort study included all eligible critically ill neonates who were admitted to a multidisciplinary tertiary neonatal intensive care unit (NI CU) between 1
st
June and 30
th
November 2013. Nutrient intake and clinical
outcomes during NI CU stay were recorded. The effect of early (<24 hours after NI CU admission) and delayed
(≥24 hours) enteral nutrition introduction on clinical outcomes was assessed. Results: Energy deficit in criticall y
ill neonates was frequent: 84.7% could not achieve the caloric goal during the NI CU stay. Growth retardation was
common especially among the preterm: the frequency of neonates whose weight was below the 10
th
percentile increased significantly from 21.6% on admission to 67.6% at discharge. Compared with delayed enteral nutrition,
early enteral nutrition was associated with better median time to starting weight gain (0 vs 6 days, p=0.0002), a
lower chance of receiving parenteral nutrition (41.7% vs 95.9%, p<0.0001), shorter NI CU stays (196 vs 288
hours, p=0.0001), fewer hours on mechanical ventilation and a lower chance of developing pulmonary infection
(37.5% vs 56.0%, p=0.005). The accumulated energy deficit to the subjects who were exposed to delayed nutrition could not be compensated by subsequent nutrition. Neonates who underwent mechanical ventilation had
suboptimal nutrient delivery: they took longer to gain weight and were more likely to develop respiratory distress
and receive parenteral nutrition. Conclusions: Early enteral nutrition initiation (<24 hours) is recommended. Neonates with mechanical ventilation should be monitored with particular attention.
Asia Pac J Clin Nutr. 2015;24(2):219-226.doi: 10.6133/apjcn.2015.24.2.14
>>Abstract
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Early parenteral nutrition alone or accompanying
enteral nutrition in critically ill patients: a systematic
review and meta-analysis
Author:Xiao Wan BS, Xuejin Gao BS, Feng Tian BS, Chao Wu
Keywords: early, parenteral nutrition, critically ill, enteral nutrition, mortality
Abstract:Background: Although several large-scale clinical trials shave examined the relationship between early parenteral nutrition (ePN) and critically ill patients, a consensus has not been reached. I n addition, no meta-analysis in
this area has yet been published. The objective of this meta-analysis was to examine the effect of ePN, alone or
accompanying enteral nutrition, in critically ill patients. Methods: A meta-analysis was performed to evaluate
risk ratios (RR) and mean differences with 95% confidence intervals (CI s) between the ePN and control groups.
Subgroup analyses were conducted to evaluate combinations of early enteral nutrition (eEN). Results: Five randomized control trials (RCTs) were included. Compared with controls, ePN had no effect on mortality (RR: 1.05,
95% CI: 0.96, 1.16). Secondary outcomes were variable: compared with the control group, the ePN group required fewer days of ventilation (p=0.007, RR: -0.95, 95% CI: -1.64, -0.27), but a longer hospital stay (p<0.001,
RR: 3.76, 95% CI: 2.25, 5.28). Conclusion: Overall, this meta-analysis from RCTs indicates that provision of
ePN within 24-48 hours has no benefit on the survival rate in critically ill patients. Thus, provision of ePN in patients is not needed in those who have contraindications to enteral nutrition or can tolerate a low volume of enteral nutrition.
Asia Pac J Clin Nutr. 2015;24(2):227-233.doi: 10.6133/apjcn.2015.24.2.07
>>Abstract
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Survey of iodine nutritional status in 2011, Zhejiang,
China
Author:Guangming Mao BA, Gangqiang Ding PhD, Xiaoming Lou
Keywords:iodine deficiency disorder (IDD), universal salt iodization (USI), urinary iodine concentration (UIC), dietary iodine intake, iodine excess
Abstract:Background: Universal salt iodization (USI ) was introduced in China in 1995, but whether the iodine status is
optimal is questionable. This study was conducted to assess the iodine nutrition among Zhejiang population in
coastal regions in China. Methods: A cross-sectional survey for iodine nutritional status was conducted with
general population (n=10,350), including pregnant and lactating women (n=450 each) selected by stratified multi stage sampling. I odine content in drinking water, table salt and urine, were determined using arsenic-cerium catalytic spectrophotometry, the direct titration and the arsenic-cerium catalytic spectrophotometry, respectively, and
daily iodine intake was estimated by 3 days of 24-hour recall method. Results: The median iodine content in
drinking water was 2.46 μg/L, Zhejiang belonged to the region of iodine deficiency in outer environment according to China standard. The median iodine content in table salt was 27.9 mg/kg, conforming to the standard requirements; the household coverage rate of qualified iodized salt reached 76.8%, which does not reach the standard requirement of WHO >90%. The dietary iodine intake of a reference individual averaged 379 μg/d, which indicated that the current iodine intake in diet was appropriate. I n addition, the median urinary iodine concentration
(UI C) was 162 μg/L in general population, and 130 μg/L in pregnant women, which didn’t reach the standard requirements. Conclusion: The current dietary iodine intake in Zhejiang was generally sufficient and safe, but there
is a risk of iodine deficiency among pregnant women and the population who do not consume iodized salt.
Asia Pac J Clin Nutr. 2015;24(2):234-244.doi: 10.6133/apjcn.2015.24.2.08
>>Abstract
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Calcium intake and the risk of stroke: an up-dated
meta-analysis of prospective studies
Author:Dan-yang Tian MD, Jie Tian MD, Chang-he Shi MD, Bo
Keywords:stroke, calcium intake, meta-analysis, prospective cohort studies, dose-response
Abstract:Background and Purpose: Calcium intake has been associated with stroke risk in a prior meta-analysis, however, newly published results are inconsistent. Dairy food benefits on stroke incidence may invol ve a calciumrelated mechanism. We have therefore updated this meta-analysis with particular references to any possibility of a
calcium-mediated dairy food risk reduction of stroke risk. Methods: We searched multiple databases and bibliographies for prospective cohort studies. Reports with multivariate- adjusted relative risk (RR) and corresponding
95% confidence intervals (CI ) for the association of calcium intake with stroke incidence were considered. Results: Ten studies with 371,495 participants and 10,408 stroke events were analyzed. The pooled analysis showed
no statistically significant association of the risk of total stroke (RR=0.96; 95% CI: 0.89-1.04) and stroke subtypes with the highest and lowest calcium intake quantiles. Nevertheless, high dairy calcium intake was significantly associated with an approximately 24% reduction of stroke risk. (RR=0.76; 95% CI: 0.66-0.86). Furthermore, a long-term follow-up (≥14 years) was helpful to reduce the risk of stroke (RR=0.67; 95% CI: 0.51-0.88).
Additionally, a non-linear dose-response relationship was predicted between calcium intake and stroke risk. Conclusions: Dairy calcium intake is inversely associated with stroke incidence. There is a non-linear dose-response
relationship between calcium intake and stroke risk. However, when the follow-up time is long enough, the inverse relationship is independent of dose. Additional large cohort studies are required to illustrate this relationship
in detail.
Asia Pac J Clin Nutr. 2015;24(2):245-252.doi: 10.6133/apjcn.2015.24.2.22
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Anemia in Cambodia: a cross-sectional study of anemia,
socioeconomic status and other associated risk factors in
rural women
Author:Christopher V Charles PhD, Cate E Dewey PhD, DVSc,
Keywords:anemia, socioeconomic status, meat consumption, Cambodia, risk factor
Abstract:I ron deficiency and associated anemia are severe public health problems, which are prevalent in the developing
world. We conducted a cross-sectional survey , comprised of written interview questions and laboratory analysis
of blood biomarkers, in Kandal Province, Cambodia. The objective of this study is to examine possible factors
that are associated with anemia in rural Cambodia. Data on socioeconomic status, water source/treatment practices, and meat consumption was also collected. Of the 297 women surveyed, 51.2% were anemic. Of those women
found to be anemic, iron deficiency was implicated in 9.7% of cases (SF <15 ng/L), with an additional 18.5% reported to be borderline iron deficient (serum ferritin=15-30 ng/L). Meat consumption was very low, with nearl y
one-half of the women consuming meat one time per month or less. This study highlights the multi-faceted etiology of anemia in Cambodia and emphasizes the need for comprehensive nutrition surveying in order to better inform prevention and treatment programming and policy development.
Asia Pac J Clin Nutr. 2015;24(2):253-259.doi: 10.6133/apjcn.2015.24.2.09
>>Abstract
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Diagnostic value of maternal anthropometric
measurements for predicting low birth weight in
developing countries: a meta-analysis
Author:Eita Goto MD, MM, MPH
Keywords:anthropometry, low birth weight, meta-analysis, pregnant women, sensitivity and specificity
Abstract:Objective: Weighing scales are often lacking at home birth in developing countries. Therefore, simple, reliable,
and inexpensive methods for detecting low birth weight especially before birth would be useful. This study was
performed to evaluate the diagnostic value of maternal anthropometric measurements for predicting low birth
weight. Methods: Bivariate diagnostic meta-analysis was conducted to construct hierarchical summary receiver
operating characteristic curves. All English language studies included in the meta-analysis enrolled apparently
healthy pregnant women and provided the data necessary to construct two-by-two tables (i.e., true positive, false
positive, false negative, and true negative values). Ten data bases, including PubMed, were searched to identi fy
these studies. Results: A sufficient number of studies involving 309,419 women paired with their newborns in
Africa, Asia, Europe, Latin America, the Middle East, and Oceania, included data on maternal height, weight,
arm circumference, body mass index, and weight gain during pregnancy (n=85, 80, 23, 51, and 16, respectively)
to provide generalizable findings. However, sensitivity of 0.46 (95% confidence interval (CI )=0.35-0.56) to 0.63
(95% CI =0.54-0.71), specificity of 0.55 (95% CI =0.42-0.67) to 0.71 (95% CI =0.61-0.80), and diagnostic odds ratios of 2 (95% CI =2-2) to 4 (95% CI =3-5) were not sufficiently high for primary screening. The generalizabilit y
of abdominal circumference data could not be guaranteed due to the limited sample (one article). Conclusions:
Maternal anthropometric measurements are unsuitable for predicting low birth weight.
Asia Pac J Clin Nutr. 2015;24(2):260-272.doi: 10.6133/apjcn.2015.24.2.05
>>Abstract
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Maternal zinc status is associated with breast milk zinc
concentration and zinc status in breastfed infants aged
4-6 months
Author:Oraporn Dumrongwongsiri MD, Umaporn Suthutvoravut
Keywords:zinc deficiency, breastfeeding, breast milk zinc, infant zinc status, lactating women
Abstract:Breast milk provides adequate nutrients during the first 6 months of life. However, there are some reports of zinc
deficiency in breastfed infants. This study was conducted to determine the prevalence of zinc def iciency in infants
aged 4-6 months and the associated factors. Healthy infants aged 4-6 months and their mothers were enrolled.
They were classified by feeding types as breastfed (BF), formula-fed (FF), and mixed groups (MF). Data
collection included demographic data, perinatal data, given diets, and anthropometric measurement. Blood from
infants and lactating mothers, and breast milk samples were collected to assess plasma and breast milk zinc
concentrations. From 158 infants, the prevalence of zinc deficiency (plasma level below 10.7 mol/L) was 7.6%,
and according to feeding groups 14.9%, 5.3%, and 2.9% in the BF, the FF, and the MF groups, respectively.
Breastfed infants with zinc deficiency had significantly lower maternal zinc concentrations compared with those
without zinc deficiency. There was a higher proportion of maternal zinc deficiency in zinc-deficient infants than
those without zinc deficiency (66.7% vs 16.2%, p=0.02). There was a positive correlation between zinc
concentrations in breast milk and plasma zinc concentrations of infants (r=0.62, p=0.01) and plasma zinc
concentrations of lactating mothers (r=0.56, p=0.016). Using the regression analysis, infant zinc status was
associated with maternal plasma zinc concentrations among breastfed infants. The results of this study suggest
that breastfed infants aged 4-6 months may have a risk of zinc deficiency and that risk is associated with maternal
zinc status and breast milk zinc concentrations.
Asia Pac J Clin Nutr. 2015;24(2):273-280.doi: 10.6133/apjcn.2015.24.2.06
>>Abstract
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Nonalcoholic fatty liver disease prevalence in urban
school-aged children and adolescents from the Yangtze
River delta region: a cross-sectional study
Author:Xiaomin Zhang MD, Yanping Wan MD, PhD, Shijun Zhan
Keywords:fatty Liver, children, obesity, prevalence, risk factors
Abstract:Purpose: To determine the prevalence of nonalcoholic fatty liver disease (NAFLD) and explore the relationship
of NAFLD with anthropometric parameters among school children from the Yangtze River delta region. Methods: A cross sectional study on childhood NAFLD was conducted using the stratified cluster sampling method in
four regions of the Yangtze River delta in September 2009 to October 2011. I n all, 7,229 students, aged 7-18
years, from 12 primary, middle and high schools participated in the study. Height, weight, and waist circumference were measured; body mass index (BMI ) and waist to height ratio (WHtR) were calculated and liver ultrasonography was performed. Results: The overall NAFLD prevalence was 5.0%; 7.5% in boys, 2.5% in girls, 5.6%
in subjects with peripheral obesity, 12.9% in those with abdominal obesity and 44.8% in those with mixed obesity.
The prevalence was also increased with regional difference. Binary logistic regression analysis showed that
WHtR was the major independent risk factor for childhood NAFLD, causing a 14.4-fold increase in NAFLD risk.
Receiver operating characteristic curve analysis also showed that WHtR was the best obesity index to evaluate
the presence of NAFLD in Chinese schoolchildren with the optimal cutoff of 0.47. Conclusions: Mixed obesit y
had the strongest association with NAFLD. Male gender and regional urbanization also inf luenced NAFLD prevalence among schoolchildren. WHtR may be an effective indicator to predict NAFLD.
Asia Pac J Clin Nutr. 2015;24(2):281-288.doi: 10.6133/apjcn.2015.24.2.13
>>Abstract
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Low physical activity and energy dense Malaysian foods
are associated with non-alcoholic fatty liver disease in
centrally obese but not in non-centrally obese patients
with diabetes mellitus
Author:Wah-Kheong Chan MBBS, MRCP, Alexander Tong-Boon Ta
Keywords:diet, physical activity, non-alcoholic fatty liver disease, diabetes mellitus, obesity
Abstract:Objective: To study the dietary intake and level of physical activity (PA) of patients with diabetes mellitus and
the association with non-alcoholic fatty liver disease (NAFLD). Methods: Consecutive adult patients with type 2
diabetes mellitus seen in our hospital diabetes clinic were enrolled. The Global Physical Activity Questionnaire
and a semi-quantitative food-frequency questionnaire were used to assess PA and dietary intake, respectively. Diagnosis of NAFLD was ultrasound-based and following exclusion of significant alcohol intake and other causes
of chronic liver disease. Results: Data for 299 patients were analyzed (mean age 63.3±10.5 years old, 41.1%
male). Prevalence of NAFLD was 49.2%. Patients with low PA were more likely to have NAFLD (OR=1.75,
95% CI =1.03-2.99, p=0.029). There was no significant difference in energy intake, intake of macronutrients and
percentage energy intake from each macronutrient, high sugar food, high cholesterol food and high SFA food between patients with and without NAFLD. Among centrally obese patients, patients with low PA and in the highest quartile of percentage energy intake from fat (OR=4.03, 95% CI=1.12-15.0, p=0.015), high cholesterol food
(OR=3.61, 95% CI =1.37-9.72, p=0.004) and high SFA food (OR=2.67, 95% CI =1.08-6.67, p=0.019) were most
likely to have NAFLD. Among those who were not centrally obese, PA and percentage energy intake from fat,
high cholesterol food and high SFA food was not associated with NAFLD. Conclusion: Low PA and high percentage energy intake from fat, high cholesterol food and high SFA food is associated with NAFLD in centrall y
obese but not in non-centrally obese patients with diabetes mellitus.
Asia Pac J Clin Nutr. 2015;24(2):289-298.doi: 10.6133/apjcn.2015.24.2.15
>>Abstract
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Comparison of fast food consumption and dietary
guideline practices for children and adolescents by
clustering of fast food outlets around schools in the
Gyeonggi area of Korea
Author:Soonnam Joo MSc, Seyoung Ju PhD 2 , Hyeja Chang Ph
Keywords:distribution map, fast food outlets, fast food consumption, dietary guideline practices, Green Food Zone
Abstract:Objectives: This study investigated the distribution density of fast food outlets around schools, and the relationship between dietary health of children and adolescents and the density of fast food outlets in Korea. Methods: A
distribution map of fast food outlets was drawn by collecting information on 401 locations of 16 brands within a
15-minute walk (800 meter) of 342 elementary and secondary schools in Suwon, Hwaseong and Osan. A questionnaire was used to gather data on the dietary life of 243 sixth and eighth grade students at eight schools.
Schools in the upper 20% and lower 20% of the fast food outlet distribution were classified as high-density and
low-density groups, respectively. The practice rate of dietary guidelines published by the Health and Welfare
Ministry and the fast food consumption pattern of children and adolescents from low and high density groups
were determined. Results: The number of schools with a fast food outlet within 200 meters or in the Green Food
Zone around its location was 48 of 189 (25.4%) in Suwon and 14 of 153 (9.2%) in Hwaseong and Osan. Students
in the low-density group visited fast food outlets less often than those in the high-density group (p<0.01). Dietary
guideline practice scores for children did not show a significant difference between the two groups. Conclusion:
The distribution map of fast food outlets within 200 meters of schools was useful for identifying the effectiveness
of the Green Food Zone Act and nutrition education programs.
Asia Pac J Clin Nutr. 2015;24(2):299-307.doi: 10.6133/apjcn.2015.24.2.03
>>Abstract
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Improvement in the technological feasibility of a
web-based dietary survey system in local settings
Author:Hyun Ju Jung PhD, Sang Eun Lee MS, PhD, Dongwoo Ki
Keywords:feasibility, dietary survey tool, computer program, automatic data processing, community survey
Abstract:The feasibility of a dietary survey tool is crucial for successful nutritional assessment via a community survey
and for nutritional epidemiology. I n 2012, we identified a newly developed computerized dietary survey system,
the Diet Evaluation System (DES), which could be successfully applied to a community survey delivered during
home visits using notebook computers when the internet environment was adequate, using either a WiBro modem
or a smartphone as a tethered modem. I n 2013, we retested DES feasibility using various mobile devices and in a
larger number of subjects. We conducted a total of 430 interviews, representing two for each of 215 subjects of
various ages, using tablet personal computers (PCs) and laptops. In addition, a group discussion with the interviewers was conducted. The interview success rate was improved to 84% (compared to 67% in 2012). Completing each interview took 14 min 1 s, and data processing was conducted automatically. The subjects’ age, gender,
and the type of mobile device used influenced the DES interview time. This study implies that the DES is an effective one-stop dietary survey system for use in a local setting. The interviewers’ group discussion revealed that
a one-stop system using the DES is convenient and that DES optimization for tablet PCs and continued database
updating is needed.
Asia Pac J Clin Nutr. 2015;24(2):308-315.doi: 10.6133/apjcn.2015.24.2.20
>>Abstract
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The biomarker-based validity of a brief-type diet history
questionnaire for estimating eicosapentaenoic acid and
docosahexaenoic acid intakes in pregnant Japanese
women
Author:Mie Shiraishi PhD, Megumi Haruna PhD, Masayo Matsu
Keywords:diet history questionnaire, docosahexaenoic acid, eicosapentaenoic acid, pregnant women, validation
Abstract:Objectives: Maternal docosahexaenoic acid (DHA) intakes is important for brain development in fetuses. Accurate assessment of EPA and DHA intakes is required in clinical settings to identify women with def iciency of
these nutrients and provide an appropriate intervention for them. We examined the validity and reproducibility of
a brief-type self-administered diet history questionnaire (BDHQ) for evaluating EPA and DHA intakes of pregnant Japanese women, to establish an easily administered dietary assessment tool. Methods: A total of 105 women in the second trimester and 102 women in the third trimester were studied at a university hospital in Tokyo,
between November 2010 and February 2012. The reference values for the validation study were plasma concentrations of EPA and DHA. For the reproducibility study, 54 women completed the BDHQ twice, within a 4-week
period in the second trimester. Results: Energy-adjusted intakes of EPA, DHA, and EPA+DHA were significantly associated with the corresponding plasma concentrations (rs
=0.354, rs
=0.305, and rs
=0.327 in the second trimester; rs
=0.391, rs
=0.316, and rs
=0.358 in the third trimester, respectively). I ntraclass correlation coefficients for
the two-time BDHQ were 0.543 (EPA), 0.611 (DHA), and 0.581 (EPA+DHA). I n the Bland-Altman plots, the intakes of EPA, DHA, and EPA+DHA in the two-time BDHQ showed that the values for most participants were in
the accepted range of agreement. Conclusions: BDHQ has an acceptable validity level for assessing EPA and
DHA intakes among Japanese women in the second and third trimesters.
Asia Pac J Clin Nutr. 2015;24(2):316-322.doi: 10.6133/apjcn.2015.24.2.10
>>Abstract
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Genetic variants of FADS gene cluster, plasma
LC-PUFA levels and the association with cognitive
function of under-two-year-old Sasaknese Indonesian
children
Author:Umi Fahmida PhD, Min Kyaw Htet PhD, Chris Adhiyan
Keywords:cognitive function, FADS, Indonesia, LC-PUFA, under-two-year-old children
Abstract:Background/Aims: Long-chain polyunsaturated fatty acids (LC-PUFA) are regarded as essential for child
cognition. Genetic variation in fatty acid (FA) desaturase enzyme (FADS) has been recognized as an important
effect modifier in the relation between LC-PUFA and child cognitive function. This study aimed to identify the
distribution of genetic variant (genotype) SNP rs174468 and to assess plasma FA and developmental outcome by
the genotype among under-2 year old Sasaknese I ndonesian children. Methods: Data was collected at baseline of
a randomized trial (NUPI CO, clinicaltrials.gov NCT01504633) in East Lombok district, I ndonesia. Breastfed, 12-17 month old children were recruited and 240 subjects were included in the study. Child cognition was assessed
as Bayley Mental Developmental I ndex (MDI ). Results: From 206 subjects whose blood samples can be
collected, only two genot ypes were found (90.3% GG homozygot es, 9.7% AG heterozygotes), and minor allele
AG was significantly associated with higher level of arachidonic acid (20: 4 n-6), n-6 LC-PUFA and FADS1
index. MDI score was associated with a FADS2 index (DHA: EPA ratio) but not genotype (Adjusted R-square=
0.043). Conclusions: FADS2 index was associated with cognitive function. No difference was found between
children with GG and AG genot ypes who were all breastfed and not low birth weight.
Asia Pac J Clin Nutr. 2015;24(2):323-328.doi: 10.6133/apjcn.2015.24.2.17
>>Abstract
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Effects of Fok-I polymorphism in vitamin D receptor
gene on serum 25-hydroxyvitamin D, bone-specific
alkaline phosphatase and calcaneal quantitative
ultrasound parameters in young adults
Author:Rieko T anabe MSc, Y uka Kawamura MSc, Naoko T su
Keywords:vitamin D receptor Fok-I polymorphism, bone-specific alkaline phosphatase, 25-hydroxyvitamin D3, 1-alpha, 25- dihydroxyvitamin D3, quantitative ultrasound
Abstract:Several genes have been implicated as genetic determinants of osteoporosis. Vitamin D receptor (VDR) is an intracellular hormone receptor that specifically binds to the biologically active form of vitamin D, 1-alpha, 25-dihydroxyvitamin D3 [1, 25(OH)2D], and mediates its effects. One of the most frequently studied single nucleotide polymorphisms is the restriction fragment length polymorphism (RFLP) Fok-I (rs2228570). The presence of
a Fok-I site, designated f, allows protein translation to initiate from the first ATG. An allele lacking the site
(ATG>ACG: designated F), initiates from a second ATG site. I n the present study, we explored the effect of the
VDR Fok-I genotype on associations among serum bone-specific alkaline phosphatase (ALP), 25-hydroxyvitamin D3 [25(OH)D], 1, 25(OH)2D, and the dietary nutrient intake in healthy young Japanese subjects
(n=193). Dietary nutrient intakes were calculated based on 3-day food records before the day of blood examinations. Quantitative ultrasound (QUS) parameters at the right calcaneus (heel bone) were measured. The allele frequencies were 0.622 for the F allele and 0.378 for the f allele in all subjects. Grouped by the VDR genotype, a
significant positive correlation between the levels of serum bone-specific ALP and 25(OH)D was observed in the
FF-type (p=0.005), but not in the ff-type. I n addition, there was a significant positive correlation between the level of serum 25(OH)D and osteo-sono assessment index (OSI ) in the FF-type (p=0.008), but not in the ff-t ype.
These results suggest that the level of circulating 25(OH)D is an important factor when assessing the VDR Fok-I
pol ymorphism to prevent osteoporosis.
Asia Pac J Clin Nutr. 2015;24(2):329-335.doi: 10.6133//apjcn.2015.24.2.01
>>Abstract
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Guidelines for parenteral and enteral nutrition support
in geriatric patients in China
Author:Junmin Wei MD, Wei Chen MD, Mingwei Zhu MD, Weixin
Keywords:guidelines, parenteral nutrition, enteral nutrition, nutrition support, geriatric patients
Abstract:The mortality and morbidity of geriatric patients is much higher than for younger patients, especially when criti cally ill. This may be attributed to a lower reserve capacity in most organs and systems, reduced ability to deal
with physical stress and the presence of acute or chronic co-mobidities. Parenteral and enteral nutrition support
can improve the clinical condition of the elderly patient and result in better outcomes, such as lower mortality, reduced hospital stay and reduced medical costs. There is a need to standardize nutrition screening and assessment,
and the implementation of appropriate evidence based nutritional support of geriatric patients in China. The Chinese Medical Association’s Group of Geriatric Nutrition Support has developed guidelines by researching the
present situation in Chinese hospitals and by referring to the guidelines from both American Society for Parenteral and Enteral Nutrition (ASPEN) and the European Society for Clinical Nutrition and Metabolism (ESPEN).
Asia Pac J Clin Nutr. 2015;24(2):336-346.doi: 10.6133/apjcn.2015.24.2.11
>>Abstract
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Attitudes toward the American nutrition guidelines for
the critically ill patients of Chinese intensive care
physicians
Author:Xiao-ling Xu MD, Jian-cang Zhou MD, Kong-han Pan M
Keywords:nutrition therapy, clinical practice guidelines, intensive care units, survey, China
Abstract:Nutrition therapy is essential for the management of critically ill patients. Some guidelines have been published
to standardize and optimize the nutrition therapy. However, there are still many controversies in nutrition practice
and there is a gap between guidelines and clinical nutrition therapy for patients in intensive care units (I CUs).
This study aimed to assess attitudes and beliefs toward nutrition therapy of Chinese intensive care physicians by
using the American guidelines as a surrogate. A questionnaire was sent to 45 adult I CUs in China, in which surveyed physicians were asked to rate their attitudes toward the American guidelines. A total of 162 physicians
from 45 I CUs returned the questionnaires. Physicians were categorized into groups according to their professional seniority, hospital levels and whether they were members of Chinese Society for Parenteral and Enteral Nutri tion (CSPEN). Overall, 94% of the respondents thought that nutrition therapy for critically ill patients was very
important, and 80% mentioned that they used the American guidelines. There was diversity of opinion on the
recommendations pertaining to nutrition assessment, supplemental parenteral nutrition and cutoff values for gastric residual volume, negative or neutral attitudes about these recommendations were 43%, 59% and 41%, respectively. Members of CSPEN were more likely to select a greater strength of recommendation than non-members.
I n conclusion, the overall attitudes of Chinese intensive care physicians toward the American guidelines were
positive. Nevertheless, given the great guideline-practice gap, nutrition-focused education is warranted for many
intensive care physicians in China.
Asia Pac J Clin Nutr. 2015;24(2):347-358.doi: 10.6133/apjcn.2015.24.2.02
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