Fructans in the first 1000 days of life and beyond, and
for pregnancy
Author:Agus Firmansyah MD PhD, Nalinee Chongviriyaphan MD
Keywords: review, inulin, infant, pregnancy, gut microbiota
Abstract:Inulin-based prebiotics are non-digestible polysaccharides that influence the composition of the gut microbiota in
infants and children, notably eliciting a bifidogenic effect with high short chain fatty acid levels. Inulin, a generic
term that comprises β-(2,1)-linked linear fructans, is typically isolated from the chicory plant root, and derivatives
such as oligofructose and long chain inulin appear to have different physiological properties. The first 1000 days
of a child’s life are increasingly recognized as a critical timeframe for health also into adulthood, whereby nutrition plays a key role. There is an ever increasing association between nutrition and gut microbiota composition
and development, with life health status of an individual. This review summarizes the latest knowledge in the infant gut microbiota from preterms to healthy newborns, as well as in malnourished children in developing countries. The impact of inulin or mixtures thereof on infants, toddlers and young children with respect to intestinal
function and immunity in general, is reviewed. Possible benefits of prebiotics to support the gut microbiome of
malnourished infants and children, especially those with infections in the developing world, are considered, as
well as for the pregnant mothers health. Importantly, novel insights in metabolic programming are covered, which
are being increasing recognized for remarkable impact on long term offspring health, and eventual potential beneficial role of prebiotic inulins. Overall increasing findings prompt the potential for gut microbiota-based therapy
to support health or prevent the development of certain diseases from conception to adulthood where inulin
prebiotics may play a role.
Asia Pac J Clin Nutr. 2016;25(4):652-675.doi: 10.6133/apjcn.092016.02
>>Abstract
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Optimal nutrition therapy in paediatric critical care in
Asia-Pacific and the Middle East: a consensus
Author:Jan Hau Lee MRCPCH1, Elizabeth Rogers APD, Yek Kee
Keywords:Asia Pacific, children, critical care, Middle East, nutrition
Abstract:Background and Objectives: Current practices and available resources for nutrition therapy in paediatric intensive care units (PICUs) in the Asia Pacific-Middle East region are expected to differ from western countries. Existing guidelines for nutrition management in critically ill children may not be directly applicable in this region.
This paper outlines consensus statements developed by the Asia Pacific-Middle East Consensus Working Group
on Nutrition Therapy in the Paediatric Critical Care Environment. Challenges and recommendations unique to the
region are described. Methods and Study Designs: Following a systematic literature search from 2004-2014,
consensus statements were developed for key areas of nutrient delivery in the PICU. This review focused on evidence applicable to the Asia Pacific-Middle East region. Quality of evidence and strength of recommendations
were rated according to the Grading of Recommendation Assessment, Development and Evaluation approach.
Results: Enteral nutrition (EN) is the preferred mode of nutritional support. Feeding algorithms that optimize EN
should be encouraged and must include: assessment and monitoring of nutritional status, selection of feeding
route, time to initiate and advance EN, management strategies for EN intolerance and indications for using parenteral nutrition (PN). Despite heterogeneity in nutritional status of patients, availability of resources and diversity
of cultures, PICUs in the region should consider involvement of dieticians and/or nutritional support teams.
Conclusions: Robust evidence for several aspects of optimal nutrition therapy in PICUs is lacking. Nutritional
assessment must be implemented to document prevalence and impact of malnutrition. Nutritional support must be
given greater priority in PICUs, with particular emphasis in optimizing EN delivery.
Asia Pac J Clin Nutr. 2016;25(4):676-696.doi: 10.6133/apjcn.012016.07
>>Abstract
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Melamine-contaminated milk formula and its impact on
children
Author:Jian Guo Wen MD, PhD, Xin Jian Liu MSc, Zhi Min Wa
Keywords:melamine, mechanism, clinical features, detection, follow up
Abstract:The melamine contaminated milk powder contamination scandal occurred in China in 2008. Its main consequences so far have been urinary stone formation in children with associated renal damage and increased child
mortality. Eight years have passed, but food safety issues still remain of concern in the daily lives of millions of
Chinese. Vigilance is required to ensure no recurrence of such food safety problems. Ongoing studies focus on
the early detection of food industry malpractice, mechanisms whereby these toxic substances induce disease and
how its advent may be prevented and better managed. Melamine undergoes renal excretion, but is metabolized
slowly and excreted largely unchanged in the urine. Urinary melamine measurement may provide a rapid and inexpensive way to identify exposure to melamine adulterated food items. Although most patients with melaminerelated urinary stones (MUS) have been responsive to conservative treatment, longer time follow-up is needed to
assess chronic effects. Aside from MUS, melamine is a recognized carcinogen and can induce urinary tract tumours. Very little is known about the effects of excessive exposure to melamine contaminated milk powder in infants on growth, adolescent and adult health, although short-term effects have become apparent during the scandal.
Asia Pac J Clin Nutr. 2016;25(4):697-705.doi: 10.6133/apjcn.072016.01
>>Abstract
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Future food
Author:Mark L Wahlqvist MD (Adelaide), MD (Uppsala), FRAC
Keywords:food systems, food security, econutrition, ecosystem health disorders (EHD), personalised nutrition, peopleless food outlets, clinical nutrition
Abstract:Food systems have changed markedly with human settlement and agriculture, industrialisation, trade, migration
and now the digital age. Throughout these transitions, there has been a progressive population explosion and net
ecosystem loss and degradation. Climate change now gathers pace, exacerbated by ecological dysfunction. Our
health status has been challenged by a developing people-environment mismatch. We have regarded ecological
conquest and innovative technology as solutions, but have not understood how ecologically dependent and integrated we are. We are ecological creatures interfaced by our sensoriness, microbiomes, shared regulatory (endocrine) mechanisms, immune system, biorhythms and nutritional pathways. Many of us are ‘nature-deprived’. We
now suffer what might be termed ecological health disorders (EHD). If there were less of us, nature’s resilience
might cope, but more than 9 billion people by 2050 is probably an intolerable demand on the planet. Future food
must increasingly take into account the pressures on ecosystem-dependent food systems, with foods probably less
biodiverse, although eating in this way allows optimal health; energy dysequilibrium with less physical activity
and foods inappropriately energy dense; and less socially-conducive food habits. ‘Personalised Nutrition’, with
extensive and resource-demanding nutrigenomic, metabolomic and microbiomic data may provide partial health
solutions in clinical settings, but not be justified for ethical, risk management or sustainability reasons in public
health. The globally prevalent multidimensional malnutritional problems of food insecurity, quality and equity
require local, regional and global action to prevent further ecosystem degradation as well as to educate, provide
sustainable livelihoods and encourage respectful social discourse and practice about the role of food.
Asia Pac J Clin Nutr. 2016;25(4):706-715.doi: 10.6133/apjcn.092016.01
>>Abstract
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Children with atopic dermatitis in Daejeon, Korea:
individualized nutrition intervention for disease severity
and nutritional status
Author:Seong Hee Kim MSc, Jae Ho Lee MD, PhD, Sun Yung Ly
Keywords:atopic dermatitis, individualized nutrition intervention, SCORAD index, growth, nutritional status
Abstract:Background and Objectives: Atopic dermatitis is one of the most common pediatric chronic inflammatory skin
diseases, and certain food allergens and nutrients are closely related to the development and severity of atopic
dermatitis. While avoidance of the causative foods is considered the mainstay of treatment, unverified excessive
restriction might induce unnecessary limitations in the food intake, consequently leading to nutritional deficiencies and poor growth. This study aimed to identify the characteristics and nutrient intake status in children with
atopic dermatitis and to investigate the effects of individualized nutrition intervention. Methods and Study Design: We retrospectively reviewed electronic medical records of 77 pediatric patients with atopic dermatitis who
received 4 months of individualized nutrition intervention combined with an elimination diet. The patient characteristics, nutrient intake status, and clinical status were examined before and after the intervention. Results: Before the intervention, 5 children had a weight for height z-score below -2.0, and 48.1% had experienced food restriction; these children showed a significantly higher SCORing of Atopic Dermatitis index than those without
experiences, with the number of restricted foods before the intervention positively correlating with the disease severity. The intakes of n-6 and n-3 fatty acids, calcium, folate, and vitamin D were lower than the recommended
nutrient intakes for Koreans. After the intervention, the weight for height z-score of 35 children was significantly
increased and their SCORing of Atopic Dermatitis index was significantly reduced (p<0.05). Conclusions: Individualized nutrition intervention appears useful for alleviating the severity of atopic dermatitis and improving the
growth status by improving the nutrient intake.
Asia Pac J Clin Nutr. 2016;25(4):716-728.doi: 10.6133/apjcn.092015.31
>>Abstract
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Simultaneous coffee caffeine intake and sleep
deprivation alter glucose homeostasis in Iranian men:
a randomized crossover trial
Author:Behrouz Rasaei PhD, Ruzita Abd Talib PhD, Mohd Ism
Keywords:Behrouz Rasaei PhD, Ruzita Abd Talib PhD, Mohd Ismail Noor PhD, Majid Karandish PhD, Norimah A Karim PhD
Abstract:Background and Objectives: Sleep deprivation and coffee caffeine consumption have been shown to affect glucose homeostasis separately, but the combined effects of these two variables are unknown. Methods and Study
Design: Forty-two healthy Iranian men, aged 20-40 years old, were assigned to three groups in a randomised
crossover trial involving three treatments with two-week washout periods. Subjects were moderate coffee consumers (≤3 cups/day), and had a Pittsburgh Sleep Quality Index ≤5. Each treatment involved three nights of deprived sleep (4 hrs. in bed) plus 3×150 cc/cup of boiled water (BW treatment), decaffeinated coffee (DC treatment, without sugar, 99.9% caffeine-free), and caffeinated coffee (CC treatment, without sugar, 65 mg caffeine/cup). DC and CC treatments were blinded. At the end of each treatment, fasting serum glucose (using enzyme assays) and insulin (using electrochemiluminescence immunoassay) were measured and, again, two hours
after an oral glucose tolerance test (OGTT). Insulin resistance was quantified with the homeostasis model. Results: Repeated measures ANOVA indicated no significant difference between the treatments in fasting serum
glucose (p=0.248) or insulin resistance (p=0.079). However, ANOVA demonstrated differences between treatments in fasting serum insulin (p=0.004) and glucose, as well as insulin after OGTT (p<0.001). Pairwise comparisons test (within subjects) showed that the CC treatment yielded higher serum glucose and insulin after OGTT
(p<0.001), higher fasting serum insulin (p=0.001), and increased insulin resistance (p=0.039) as compared to the
DC treatment. Conclusions: Thus caffeinated coffee was more adverse for glucose homeostasis compared to decaffeinated coffee in individuals who were simultaneously sleep deprived.
Asia Pac J Clin Nutr. 2016;25(4):729-739.doi: 10.6133/apjcn.092015.46
>>Abstract
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Enteral nutrition preference in critical care:
fibre-enriched or fibre-free?
Author:Hatice Yagmurdur MD, Figen Leblebici MD
Keywords: fibre-enriched nutrition, volume ratio, diarrhoea, enteral nutrition, gastric residual volume
Abstract:Background and Objectives: This study’s main aim was to observe the effects of a fibre-enriched nutrition solution on requisite feeding volume, which is directly proportional to energy intake in mechanically ventilated patients with enteral nutrition. Methods and Study Design: Some 120 patients who required mechanical ventilation and enteral nutrition with a nasogastric tube were studied. Upon ICU admission, the patient’s age, gender,
weight, height, comorbidities, diagnosis and APACHE II score were recorded. We assigned two diets to the patients randomly. The control group received the fibre-free nutrition solution. The study group, received the fibreenriched nutrition solution. Prescribed feeding volume and administered feeding volume, gastric residual volume
(GRV), volume ratio (VR), diarrhoea score and gastrointestinal complications (GIC) were recorded, along with
daily biochemistry. Results: The two groups did not differ with respect to age, sex, weight, BMI, APACHE II
score, target caloric intake or GRV (p>0.05). On days four and five, the study group had higher VR values
(p<0.05). Seventy-one (59%) patients had at least one gastrointestinal complication; 44 (73%) of them were controls and 27 (45%) of them study patients. The most commonly observed GIC was diarrhoea. Thirty-eight patients had diarrhoea in control group, and twenty-two patients had diarrhoea in study group, and this difference
was statistically significant (p<0.001). There were no significant differences between the groups about vomiting
and regurgitation. Conclusions: We suggest that ICU staff initiate enteral nutrition with fibre-enriched formulas
rather than fibre-free formulas to avoid frequent feeding interruptions that cause protein energy malnutrition in
ICU patients.
Asia Pac J Clin Nutr. 2016;25(4):740-746.doi: 10.6133/apjcn.122015.12
>>Abstract
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Combined chromium and magnesium decreases insulin
resistance more effectively than either alone
Author:Mei Dou PhD, Yan Ma MS, Ai Guo Ma MD, Lei Han MM,
Keywords:insulin resistance, trivalent chromium, magnesium, glucose transporter 4, T lymphocytes
Abstract:Background and Objectives: Peroral supplementation with trivalent-chromium (Cr) or magnesium (Mg) has
been shown to improve insulin resistance (IR). The objective of this study was to determine whether combined
peroral supplementation with Cr and Mg improves IR more effectively than Cr or Mg alone. Methods and Study
Design: Subjects (n=120, age range 45-59 years old) and diagnosed with IR were randomly divided into four
groups and monitored for a period of 3 months: group 1 (the placebo control group), group 2 (160 μg/d Cr), group
3 (200 mg/d Mg), and group 4 (160 μg/d Cr plus 200 mg/d Mg). Fasting blood glucose (FBG), fasting insulin
(FIns), erythrocyte Cr and Mg content, and glucose-transporter-4 (GLUT4) and glycogen-synthase-kinase-3β
(GSK3β) mRNA levels in activated T-lymphocytes were measured, and insulin resistant index (IRI) was calculated. Results: Significant decreases between the baseline and study conclusion values of FBG (0.37 mmol/L,
p<0.01), FIns (2.91 μIU/mL, p<0.01) and IRI (0.60, p<0.01) were observed in group 4, but not groups 1-3. Similarly, compared with baseline, significant changes in GLUT4 (2.9-fold increase, p<0.05) and GSK3β (2.2-fold decrease, p<0.05) mRNA levels in activated T-lymphocyte were observed at the study’s conclusion in group 4, but
not in groups 1-3. Conclusions: Our results indicate that combining peroral supplementation with Cr and Mg improves IR more effectively than Cr or Mg alone, and this may be attributable to increased induction and repression, respectively, of GLUT4 and GSK3β expression.
Asia Pac J Clin Nutr. 2016;25(4):747-753.doi: 10.6133/apjcn.092015.48
>>Abstract
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25 hydroxy vitamin D is higher when a renal
multivitamin is given with cholecalciferol at
hemodialysis
Author:Hadil S Subih MS, PhD, Janaye Behrens MS, RDN, LD,
Keywords:cholecalciferol, hemodialysis, vitamin D, calcium, supplementation
Abstract:Background and Objectives: Seventy six hemodialysis (HD) patients were used in a prospective randomized
and clinical trial to determine if a multivitamin with vitamin D (cholecalciferol 12,000 IU/week) given during dialysis would improve the vitamin D status of hemodialysis subjects. Methods and Study Design: Subjects were
randomly assigned to two groups: 37 subjects were in the renal multivitamin without vitamin D (MV) group and
39 subjects were in a multivitamin route with vitamin D (MVD) group (12,000 IU of cholecalciferol per week).
All subjects were given 2 multivitamin tablets at their 3 HD sessions each week for 20 weeks. Serum 25(OH)D,
calcium (Ca), and phosphorus (P) levels were evaluated. Results: At baseline, mean serum 25(OH)D were below
adequate (<30 ng/mL) in the MV group (23.5±12.2 ng/mL) and in the MVD group (20.8±10.3 ng/mL). A significant increase was seen in serum 25(OH)D levels (37.7±11.4 ng/mL; p<0.001) in the MVD group after vitamin D
supplementation with no rise in the MV group value (21.7±11.4 ng/mL; p=0.06). Prior to supplementation, 17.9%
of patients in the MVD group had adequate serum 25(OH)D level and post supplementation 76.9% in the MVD
group had adequate serum 25(OH)D. In the MV group, 18.9% subjects had adequate serum 25(OH)D levels at
baseline with 18.9% having 25(OH)D >30 ng/mL at the end of the study. There were no significant differences in
group values for serum Ca and P. Conclusion: The majority of HD subjects given a multivitamin with cholecalciferol at dialysis had improvement in their vitamin D status.
Asia Pac J Clin Nutr. 2016;25(4):754-759.doi: 10.6133/apjcn.012016.08
>>Abstract
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Cod skin peptide reduces chemotherapy-induced toxicity
in gastric cancer patients
Author:Li-Ping Wu MM, Xiao-Fei Hu BM, Hui-Ping Wan BM, Ya
Keywords:cod skin peptide, gastric cancer, chemotherapy, toxicity
Abstract:Background and Objectives: The present study was conducted to evaluate the effect of cod skin peptide (CSPE)
on chemotherapy-induced toxicity in gastric cancer patients. Methods and Study Design: A cohort of 60 gastric
cancer patients for chemotherapy was randomly divided into two groups (n=30 per group), who were orally treated with either supplemental CSPE or placebo apart from chemotherapy. The hematologic and gastrointestinal toxicities experienced by the patients, as well as their Karnofsky Performance Status (KPS) as an index of quality of
life was evaluated. Results: Leukocyte counts and haemoglobin levels were significantly reduced in the group
treated with peptide (p<0.05), while gastrointestinal toxicity was not affected (p>0.05). KPS consists of 11 categories of quality of life, and the score denoted in deciles ranges from 100 (asymptomatic, normal function) to 0
(death). The KPS score is used to evaluate a cancer patient’s ability to function at work and home, the severity of
symptoms, and the patient’s need for personal and medical care. Treatment with CSPE significantly improved the
quality of life of patients, as indicated by increased KPS scores (p<0.05). Conclusions: CSPE can potentially be
considered as a food supplement that can be used to improve the quality of life of cancer patients.
Asia Pac J Clin Nutr. 2016;25(4):760-766.doi: 10.6133/apjcn.092015.27
>>Abstract
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Coffee consumption is associated with lower serum
aminotransferases in the general Korean population and
in those at high risk for hepatic disease
Author:Myueng Guen Oh MD, PhD, Mi Ah Han MD, PhD, Man Woo
Keywords:adult, alanine transaminase, aspartate aminotransferases, coffee, risk factors
Abstract:Background and Objectives: The favourable effects of coffee on liver enzymes have been reported worldwide.
This study investigated the association between coffee consumption and serum aminotransferase concentration in
Korean adults. Methods and Study Design: Data were obtained from the fourth and fifth Korea National Health
and Nutrition Examination Surveys. Elevated alanine aminotransferase (ALT) and aspartate aminotransferase
(AST) concentration were defined as >30 IU/L for men and >19 IU/L for women. The risk of elevated ALT and
AST according to general characteristics and frequency of coffee consumption were tested by chi-square tests and
multiple logistic regression analyses. Results: The prevalence of elevated ALT was 27.4%, 27.8%, and 26.9% in
subjects who drank <1, 1, and ≥2 times/day, respectively. The proportions of individuals with elevated AST were
32.5%, 33.1%, and 26.7% in subjects who drank <1, 1, and ≥2 times/day, respectively. The aORs for elevated
ALT and AST were significantly lower in subjects who drank ≥2 times of coffee/day than in those who drank <1
time/day (ALT: aOR=0.86, 95% CI=0.79-0.94; AST: aOR=0.83, 95% CI=0.76-0.91). In subgroup analysis, consumption of ≥2 times/day was associated with lower ORs for elevated ALT in the high-risk group overall and in
the viral hepatitis and obesity subgroups, respectively. In sensitivity analysis, reduced frequency of coffee consumption was associated with an increased risk for elevated liver enzymes, although an association between coffee consumption and elevated ALT was not observed in women or current smokers. Conclusions: Higher coffee
consumption was associated with lower risk of elevated aminotransferase concentration in Korean adults.
Asia Pac J Clin Nutr. 2016;25(4):767-775.doi: 10.6133/apjcn.092015.36
>>Abstract
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Habitual dietary calcium intakes and calcium
metabolism in healthy adults Chinese: a systematic
review and meta-analysis
Author:Ai-Ping Fang PhD, Ke-Ji Li MD, Hao-Yu Shi MM, Jing
Keywords:calcium metabolism, Chinese adults, plant-based diets, meta-analysis, systematic review
Abstract:To investigate the metabolic differences of calcium requirements between Chinese and Westerners, we examined
systematically the characteristics of calcium metabolism in Chinese adults with habitual dietary calcium intakes.
We searched PubMed, Cochrane Library, SinoMed, and National Index to Chinese Newspapers & Periodicals,
from inception to March 17, 2015, as well as the bibliographies of any relevant papers and journals, for trials assessing calcium metabolism in healthy Chinese adults within 18-60 years of age on the typical Chinese diet. We
extracted a standardized dataset from metabolic studies that reported intake, retention, urinary excretion, faecal
excretion and/or fractional absorption of calcium. We pooled data with a random effects meta-analysis. Of 2,046
citations identified by the search strategy, 12 studies (comprising 137 participants, 13 aggregate data deriving
from 257 individual data) met the inclusion criteria. Metabolic data with self-chosen or typical Chinese diets were
analyzed. Mean daily intakes of calcium ranged between 288 and 948 mg. Mean calcium retentions of each study
were between 13 and 294 mg/d. The overall pooled value for dietary intake, urinary excretion, faecal excretion,
retention and fractional absorption of calcium were 583 mg/d, 117 mg/d, 381 mg/d, 72 mg/d and 33.3%. Dietary
calcium intake and faecal calcium excretion explained almost 85% of the heterogeneity of calcium retention.
Chinese adults could maintain a positive calcium balance with plant-based diets at calcium intakes as low as 300
mg/d through increasing fractional calcium absorption and decreasing calcium excretion in urine and faeces.
Asia Pac J Clin Nutr. 2016;25(4):776-784.doi: 10.6133/apjcn.092015.30
>>Abstract
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Population-based association between urinary excretion
of sodium, potassium and its ratio with albuminuria in
Chinese
Author:Liuxia Yan MS, Xiaolei Guo MS, Huicheng Wang MS, J
Keywords: albuminuria, China, potassium, sodium, 24-h urine
Abstract:Background and Objectives: Albuminuria is a risk factor for cardiovascular and renal disease. However, little is
known about the association of 24 h urinary sodium and potassium excretion with albuminuria in China. The aim
of this study was to examine this association by analyzing the data from 1,975 Chinese adults living in north China. Methods and Study Design: Excretion of urinary sodium, potassium and albumin was assessed in a single
24-h urine sample for each participant. Height, weight, waist circumference and blood pressure were measured
and body mass index was determined as weight divided by square height. Fasting blood sample was collected and
fasting glucose was measured. Results: The average 24-h urinary sodium and potassium excretion were 232
mmol and 40.8 mmol, resulting a mean sodium to potassium ratio of 6.7. The median (Q1-Q3) 24-h urinary albuminuria excretion was 6.1 mg (4.5-8.7 mg). Overall, urinary sodium excretion was positively associated with
albumin excretion (β=0.029, p<0.001). This association was independent of major cardiovascular risk factors including age, gender, systolic blood pressure, body mass index, fasting glucose, waist circumference, hypertensive
drug treatment, and smoking. Moreover, the relation of sodium and albumin was similar in the subgroups stratified by gender, adiposity and diabetic status. No significant associations of potassium excretion or sodium to potassium ratio with urinary albumin excretion were observed. Conclusions: In cross-sectional analyses, high sodium intake was shown to be associated with increased urinary albuminuria in the general Chinese adult population,
supporting salt restriction for renal and cardiovascular health benefit.
Asia Pac J Clin Nutr. 2016;25(4):785-797.doi: 10.6133/apjcn.092015.33
>>Abstract
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Truncal and leg fat associations with metabolic risk
factors among Chinese adults
Author:Min Yang MD, PhD, Jie Lin PhD, Xiaoguang Ma MD, Ph
Keywords:truncal fat, leg fat, metabolic risks, Chinese, adults
Abstract:Background and Objectives: To examine the associations of regional body fat distribution with metabolic risk
factors among Chinese. Methods and Study Design: Truncal fat (TF) and leg fat (LF) were measured by dualenergy X-ray absorptiometry (DXA) among 947 adults, and abdominal visceral fat (VAT) and subcutaneous fat
(SAT), upper leg SAT were measured by magnetic resonance image (MRI) among 103 adults during 2008-2013.
Metabolic risk factors included fasting blood glucose, total triglyceride, total cholesterol, low-density lipoprotein
cholesterol, high-density lipoprotein cholesterol, and metabolic syndrome (MetS). Results: TF showed adverse
effect while LF showed beneficial effect on metabolic risk factors, and all these effects were independent of body
mass index (BMI) (mostly p<0.01). Individuals with higher TF and lower LF experienced the highest risk of
MetS compared to other subgroups of combination of TF and LF (all p<0.05). Abdominal VAT was positively
associated with risk of MetS (men: odds ratio (OR)=4.45, 95% confidence interval (CI): 1.18, 16.8; women:
OR=6.54, 95% CI: 1.08, 39.6) and serum triglyceride (men: beta (β)=0.379, 95% CI: 0.090, 0.667; women:
β=0.700, 95% CI: 0.327, 1.07). Upper leg SAT showed an opposite association with most metabolic factors compared to abdominal SAT and VAT, however, the association was not statistically significant. Conclusion: TF and
LF showed opposite effects on metabolic risk factors among Chinese adults. Abdominal VAT, but not abdominal
SAT, was positively associated with serum triglyceride and risk of MetS. Future studies are warranted to examine
the potential mechanism of the opposite effects between TF and LF on metabolic risk factors among Chinese.
Asia Pac J Clin Nutr. 2016;25(4):798-809.doi: 10.6133/apjcn.092015.35
>>Abstract
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Pre-pregnancy body mass index and gestational weight
gain in Thai pregnant women as risks for low birth
weight and macrosomia
Author:Tippawan Pongcharoen PhD, Sueppong Gowachirapant P
Keywords:pre-pregnancy body mass index, gestational weight gain, low birth weight, macrosomia, pregnant women
Abstract:Background and Objectives: Maternal pre-pregnancy body mass index (BMI) and gestational weight gain
(GWG) have been reported to be associated with pregnancy outcomes. Due to the nutrition transition in Thailand,
the double burden of malnutrition is increasing and this may have negative consequences on birth outcomes. This
study aimed to investigate the relationship between pre-pregnancy BMI and GWG with the risks of low birth
weight and macrosomia. Methods and Study Design: We performed a secondary analysis of data obtained from
an iodine supplementation trial in mildly iodine-deficient Thai pregnant women. Pre-pregnancy BMI was classified using the WHO classification. GWG was categorized using the IOM recommendation. Binary and multinomial logistic regressions were performed. Results: Among 378 pregnant women, the prevalence of pre-pregnancy
underweight (BMI<18.5 kg/m2) and overweight (BMI≥25 kg/m2) were 17.2% and 14.3%, respectively. Normal
weight women had the highest median GWG [15.0 (12.0, 19.0) kg] when compared to overweight women [13.2
(9.0, 16.3) kg]. Forty-one percent of women had excessive GWG, while 23% of women gained weight inadequately. Women with a high pre-pregnancy BMI had a 7-fold higher risk of having a macrosomic infant. Women
who had excessive GWG were 8 times more likely to deliver a newborn with macrosomia. Conclusions: Both
high pre-pregnancy maternal weight and excessive weight gain during pregnancy increase risk of infant macrosomia. Therefore, maintaining normal body weight before and throughout pregnancy should be recommended in
order to reduce the risk of excessive infant birth weight and its associated complications.
Asia Pac J Clin Nutr. 2016;25(4):810-817.doi: 10.6133/apjcn.092015.41
>>Abstract
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An on-line database for human milk composition in
China
Author:Shi-an Yin PhD, Zhen-yu Yang PhD
Keywords:human milk, composition, database, lactating women, China
Abstract:Background and Objectives: Understanding human milk composition is critical for setting nutrient recommended intakes (RNIs) for both infants and lactating women. However, nationwide human milk composition remains
unavailable in China. Methods and Study Design: Through cross-sectional study, human milk samples from 11
provinces in China were collected and their compositions were analyzed. Nutritional and health status of the lactating women and their infants were evaluated through questionnaire, physical examination and biochemical indicators. Results: A total of 6,481 breast milk samples including colostrum (1,859), transitional milk (1,235) and
mature milk (3,387) were collected. Contents of protein, fat, lactose, total solid and energy of more than 4,500
samples were analyzed using a human milk analyzer. About 2,000 samples were randomly selected for 24 mineral
analyses. Free B-vitamins including thiamin, riboflavin, pyridoxal, pyridomine, pyridoxamine, nicotinamide, nicotinic acid, flavin adenine dinucleotide (FAD), biotin and pantothenic acid were analyzed in 1,800 samples. Amino acids (~800) and proteins (alpha-lactoalbumin, beta-casein, and lactoferrin) were analyzed. In addition, serum
retinol and carotenoids, 25(OH)D, vitamin B12, folic acid, ferritin and biochemical indicators (n=1,200 to 2,000)
were analysed in the lactating women who provided the breast milk. Ongoing work: Fatty acids (C4-C24), fatsoluble vitamins and carotenoids, are on-going analysis. Conclusions: A regional breast milk compositional database is at an advanced stage of development in China with the intention that it be available on-line.
Asia Pac J Clin Nutr. 2016;25(4):818-825.doi: 10.6133/apjcn.092015.47
>>Abstract
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Obesity, non-communicable disease (NCD) risk factors
and dietary factors among Chinese school-aged children
Author:Carmen Piernas PhD, Dantong Wang PhD, Shufa Du PhD
Keywords:obesity, cardiometabolic risk, dietary intake, children, China
Abstract:Background and Objectives: China’s nutrition transition is characterized by dramatic increases in overweight
and cardiometabolic (CM) risk. The burden of obesity, CM risk factors and dietary intake among Chinese children were explored. Methods and Study Design: Children 7-12 y old from the 2009 China Health and Nutrition
Survey with available dietary intake data, anthropometry, blood pressure, and fasting blood samples were included (n=663). CM risk prevalence was calculated; logistic regression was used to investigate the association of nutrient intakes with CM risk, adjusting for age, gender, physical activity, area of residence and income. Results:
14% of Chinese school-aged children and ~20% of those from urban areas and higher income households had
overweight/obesity (p<0.05). The prevalence of prehypertension was ~20% while hypertension was 14%. Around
20% of all children and ≥30% of those from urban areas and higher income households had impaired glucose/HbA1c (p<0.05). More than half of the studied children had pre-dyslipidemia (i.e. at least one lipid measurement above borderline levels) and 21% of children had dyslipidemia. Approximately 30% of all children had
energy intakes above requirements and 38% of them had excessive proportions of dietary fat and saturated fat.
Children with higher intakes of total daily energy and total and added sugars had a greater likelihood of having
impaired blood pressure and glucose/HbA1c. Conclusions: Childhood overweight and CM risk is prevalent in
urban and rural areas of China and across different socioeconomic groups although disparities between classes
still pervade. Several dietary factors such as sugars were significant correlates of CM risk.
Asia Pac J Clin Nutr. 2016;25(4):826-840.doi: 10.6133/apjcn.092015.37
>>Abstract
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An internet-based food frequency questionnaire for a
large Chinese population
Author:Ren-nan Feng MD, Shan-shan Du MD, Yang Chen MSc, Z
Keywords:validation, internet, food frequency questionnaire, nutrients, China
Abstract:Background and Objectives: National dietary surveys are needed and difficult to conduct in China. The current
study aims to develop and validate an internet-based diet questionnaire for Chinese (IDQC) to assess intakes in
Northern China. Methods and Study Design: We recruited 292 city residents by email and telephone in Harbin
to obtain the IDQC and 3-day diet diaries. The food group and nutrient intakes from the IDQC were validated
against those from the 3-day diet diaries. Paired sample t-tests were used to compare the methodological differences, and repeatability was estimated using Pearson’s correlations. Cross-classification was used to calculate the
percentage agreement in quartiles for all food groups and nutrients. Results: Positive correlations were found between the IDQC and 3-day diet diaries for all food groups after energy adjustment (from 0.28 for seeds and nuts
to 0.63 for dairy products). Positive correlations were observed for all nutrients between the IDQC and 3-day diet
diaries, with correlations ranging from 0.37 for folic acid to 0.98 for iodine. The overall agreements for food
groups and nutrients were above 69.2%, indicating satisfactory consistency between the IDQC and 3-day diet diaries. Conclusions: The IDQC can be used to estimate the food and nutrient intakes in a Northern China population for both clinical nutrition epidemiological and public health nutritional purposes. The questionnaire system
IDQC (v1.0) is freely available at http://www.yyjy365.org/diet/.
Asia Pac J Clin Nutr. 2016;25(4):841-848.doi: 10.6133/apjcn.092015.26
>>Abstract
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Dietary attitudes and behaviours of women in China
after the 2008 Wenchuan earthquake in three
seismically different zones
Author:Ping Hu MM, Ling-li Han MM, Feng-gang Hou MM, Xian
Keywords:disaster, earthquake, women, dietary attitudes, dietary behaviours
Abstract:Background and Objectives: The sudden occurrence of the 2008 Wenchuan Earthquake not only devastated
people’s health, but also may have impacted on the psychological and dietary attitudes and behaviours of the survivors. Although the influence of natural disaster on people’s health has been extensively investigated, there is a
lack of information about the effects on people’s dietary attitudes and behaviours. Our aim was to evaluate the influence of the Wenchuan earthquake on the dietary attitudes and behaviours of adult women from different zones
of China in July 2008. Methods and Study Design: 736 women, aged 18-55 years old, were randomly selected
and interviewed after the earthquake. Women were selected from three zones: the earthquake zone (n=206), the
shaking zone (n=326), and the non-seismic zone (n=204). Results: Although nutrition knowledge mean scores of
women in the three zones were relatively low, the women in the earthquake zone became more vigilant about the
nutritional value and acceptability of food than women in the other two zones. Nevertheless, women in the earthquake zone also developed some arguably untoward, if understandable, behaviour after the disaster. They increased their consumption and tendency to stock instant food and snack items. That said, these findings were
modulated by other factors such as age, residence, Body Mass Index (BMI), and nutrition knowledge itself, as
were post-earthquake eating behaviours, as judged by the ordinal logistic regression analyses performed. Conclusions: The major Wenchuan earthquake was associated with differentials in dietary attitudes and behaviours
among women by seismic zone.
Asia Pac J Clin Nutr. 2016;25(4):849-857.doi: 10.6133/apjcn.092015.29
>>Abstract
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Comparison of the prevalence and characteristics of
food hypersensitivity among adolescent and older women
Author:Anri Fujimori MS, Tomomi Yamashita MS, Masaru Kubo
Keywords:food hypersensitivity, questionnaire, prevalence, adolescent women, older women
Abstract:Background and Objectives: Although food hypersensitivity is a public health concern, its documentation
among the elderly is limited. The current study aims to compare the prevalence and characteristics of food hypersensitivity among adolescent women between aged 18-24 with among older women >50 years of age. Methods
and Study Design: 660 female university students between the ages of 18 and 24 who volunteered were enrolled
as adolescent subjects. 470 women >50 years old who visited the Health Care Centre of Kyoto Katsura Hospital
for health check-ups were enrolled as the older subjects. A questionnaire created by ourselves asking the presence
of food hypersensitivity, symptoms, causative food, personal or family history of other allergic disorders was distributed. Results: The prevalence of food hypersensitivity was statistically similar between adolescent (8.2%) and
older women (8.9%). Among them, only 24.1% of the adolescent women and 26.2% of the older women had
been diagnosed by physicians as having food allergy. The main causative foods (fruits, shellfish and fish) and the
manifestations relating to food hypersensitivity were almost identical between adolescent and older women. In
both adolescent and older women, food hypersensitivity positive group showed significantly higher prevalence of
personal or family history of allergic disorders than that in food hypersensitivity negative group. Conclusions:
These data indicate that food hypersensitivity in older women should be given more attention because the prevalence of this condition was as common as that in adolescent women
Asia Pac J Clin Nutr. 2016;25(4):858-862.doi: 10.6133/apjcn.092015.39
>>Abstract
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Middle-class household food providers’ views and
experiences of food marketing in Vietnam
Author:Quynh TH Pham PhD, Anthony Worsley PhD
Keywords:Vietnam, food marketing, household food providers, nutrition transition, food advertising communication
Abstract:Background and Objectives: Food marketing has been identified as a target for intervention in the prevention of
childhood overweight and obesity within countries and globally, and promotion of healthy diets has been classified as a key strategy to reduce the burden of non-communicable diseases and health inequalities. The present
study aims to investigate how Vietnamese middle-class household food providers are impacted by food advertising communications, their views of food marketing and the ways they think the government can control food
marketing to assist people to consume healthier diets. Methods and Study Design: 810 household food providers
participated in the online survey. Frequency counts were calculated using IBM SPSS version 21. Results: Many
respondents had been exposed to food marketing; 82.8% had seen food advertising in magazines at least once a
month, 65.1% had received free food samples in public places, 68.0% had received food advertising information
via email. Many household food providers appeared to support food marketing; 73.3% approved of nutrition education in schools or on television being provided by soft drink or fast food companies, 63.7% supported the marketing of infant formula milk. There were mixed views about what actions the government could implement to
control food marketing; 88.2% supported clearer food content on food labels, 84.1% believed that children should
learn how to purchase and cook foods at school. Conclusions: A substantial majority of Vietnamese middle-class
household food providers appeared unaware of the adverse effects of food marketing. Education and policy leadership in food and nutrition are urgently required.
Asia Pac J Clin Nutr. 2016;25(4):863-870.doi: 10.6133/apjcn.092015.45
>>Abstract
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Salty food preference is associated with osteoporosis
among Chinese men
Author:Zhong-Hua Liu GP, Zi-Hui Tang MD, PhD, Ke-Qin Zhan
Keywords:salty food preference, osteoporosis, Chinese men, association, large scale
Abstract:Background and Objectives: The main purpose of this study was to evaluate the associations between salty food
preference and osteoporosis (OP) in general Chinese men. Methods and Study Design: We conducted a largescale, community-based, cross-sectional study to estimate the associations by using self-report questionnaire to
evaluate the salty food preference. The total of 1,092 men was available to data analysis in this study. Multiple
regression models controlling for confounding factors to include salty food preference variables were employed
to explore the relationships for OP. Results: We found negative correlations between preference for salty food
and T-score (p=0.006). Multiple regression analysis showed that the preference for salty food was significantly
positively associated with OP (p<0.05 for all). The men with preference for salty food habits had a higher prevalence of OP. Conclusion: The findings indicated that salty food preference was independently and significantly
associated with OP. The prevalence of OP was more frequent in Chinese men preferring salty food habits.
Asia Pac J Clin Nutr. 2016;25(4):871-878.doi: 10.6133/apjcn.102015.06
>>Abstract
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Comparison of salt taste thresholds and salt usage
behaviours between adults in Myanmar and Korea
Author:Hyungjin Cho MD, So Mi Kim PhD, Seong Su Jeong, So
Keywords:dietary sodium, hypertension, taste threshold, Myanmar, Korea
Abstract:Background and Objectives: Excessive oral salt intake can induce hypertension. According to previous studies,
the prevalence of hypertension is higher in Myanmar than in Korea. We postulated that Myanmar adults had
higher salt taste thresholds and eat much saltier food. This study aimed to compare salt taste thresholds and salt
usage behaviour scores between adults in Myanmar and Korea. Methods and Study Design: This cross-sectional
study enrolled patients who visited volunteer medical service clinics at Ansung in Korea and Hlegu and Bago in
Myanmar in August 2014. We measured the vital signs, heights, and weights of each patient and evaluated detection thresholds, recognition thresholds, and salt preferences. All patients underwent urinalysis and spot urine Na
tests. Additionally, they each completed a salt usage behaviour questionnaire. Results: A total of 131 patients
were enrolled, including 64 Myanmarese patients and 67 Korean patients. Blood pressure was significantly higher
in the Myanmarese than in the Koreans. Detection and recognition thresholds, salt preferences, and spot urine sodium and salt usage behaviour scores were also higher in the Myanmarese than in the Korean subjects. We calculated correlation coefficients between systolic blood pressure and parameters that were related to salt intake. The
detection and recognition thresholds were significantly correlated with systolic blood pressure. Conclusion: All
parameters related to salt intake, including detection and recognition thresholds, salt preference, salt usage behaviour scores and spot urine sodium concentrations, are significantly higher in Myanmarese than in Korean individuals.
Asia Pac J Clin Nutr. 2016;25(4):879-884.doi: 10.6133/apjcn.092015.32
>>Abstract
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Vitamin D status of Māori and non-Māori octogenarians
in New Zealand: a Cohort Study (LiLACS NZ)
Author:Catherine J Bacon PhD, Ngaire Kerse PhD, Karen J H
Keywords:calciferol, seasonal variation, ethnic groups, aged 80 and over, elderly
Abstract:Background and Objectives: This study assessed vitamin D status and its determinants in a cohort of octogenarians living within New Zealand’s Bay of Plenty and Lakes Districts. Methods and Study Design: Serum 25-
hydroxyvitamin D [25(OH)D] concentration was measured in 209 Māori (aged 80-90 years) and 357 non-Māori
(85 years), along with demographic, lifestyle, supplement use and other health data. Results: Mean [95% CI]
25(OH)D concentration was 69 [67 to 72] nmol/L, with 15% >100 nmol/L and 6 individuals >150 nmol/L. Concentrations in Māori (59 [55 to 62] 4 nmol/L) were lower than in non-Māori (75 [72 to 78] nmol/L; p<0.001), a
difference maintained when adjusted for day-of-year measured. Vitamin D supplementation was reported by 98
participants (18%): including a greater proportion of women (24%) than men (11%; p<0.001) and of non-Māori
(24%) than Māori (7%; p<0.001). Of those taking vitamin D, 49% took high oral doses (≥25 µg/day or equivalent) and five individuals took >50 µg/day. Vitamin D supplement use strongly and independently predicted seasonally-adjusted 25(OH)D concentration and was associated with 28 nmol/L higher levels than non-use. Other
predictors included Māori ethnicity (10 nmol/L lower concentration than for non-Māori), and female gender (11
nmol/L lower). Conclusions: Vitamin D status in New Zealand octogenarians appears higher than previously reported, particularly in non-Māori compared to Māori. Prescribed and non-prescribed oral vitamin D supplementation is prevalent in this group and a strong indicator of vitamin D status.
Asia Pac J Clin Nutr. 2016;25(4):885-897.doi: 10.6133/apjcn.092015.42
>>Abstract
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The physical examination content of the Japanese
National Health and Nutrition Survey: temporal
changes
Author:Hisako Tanaka PhD, Shino Imai MSc, Makiko Nakade P
Keywords: national nutrition survey in Japan, national health and nutrition survey, physical examination, survey items, national survey
Abstract:Background and Objectives: Survey items of the Japan National Nutrition Survey (J-NNS) have changed over
time. Several papers on dietary surveys have been published; however, to date, there are no in-depth papers regarding physical examinations. Therefore, we investigated changes in the survey items in the physical examinations performed in the J-NNS and the National Health and Nutrition Survey (NHNS), with the aim of incorporating useful data for future policy decisions. Methods and Study Design: We summarized the description of physical examinations and marshalled the changes of survey items from the J-NNS and NHNS from 1946 to 2012.
The physical examination is roughly classified into the following six components: some are relevant to anthropometric measurements, clinical measurements, physical symptoms, blood tests, lifestyle and medication by interview, and others. Results: Items related to nutritional deficiency, such as anaemia and tendon reflex disappearance, and body weight measurements were collected during the early period, according to the instructions of the
General Headquarters. From 1989, blood tests and measurement of physical activity were added, and serum total
protein, total cholesterol, triglycerides, HDL-cholesterol, blood glucose, red blood corpuscles and haemoglobin
measurements have been performed continuously for more than 20 years. Conclusions: This is the first report on
the items of physical examination in the J-NNS and NHNS. Our research results provide basic information for the
utilization of the J-NNS and NHNS, to researchers, clinicians or policy makers. Monitoring the current state correctly is essential for national health promotion, and also for improvement of the investigation methods to apply
country-by-country comparisons.
Asia Pac J Clin Nutr. 2016;25(4):898-910.doi: 10.6133/apjcn.092015.34
>>Abstract
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Endemic fluorosis in Henan province, China: ERα gene
polymorphisms and reproductive hormones among
women
Author:Guo-Yu Zhou MM, Li-Jun Ren MM, Jia-Xiang Hou MM, L
Keywords:fluoride, ERα, gene polymorphism, women, reproductive hormones
Abstract:Background and Objectives: The aim of this study was to explore the influence of fluoride exposure and ERα
gene polymorphisms on reproductive hormone concentrations of women in accordance with endemic fluorosis
residence. Methods and Study Design: A cross sectional study was conducted in Tongxu county, Henan Province, China. A total of 679 women were recruited using cluster sampling and each subject provided fasting blood
and an associated urine sample. We measured the concentrations of serum gonadotropin releasing hormone
(GnRH), follicle-stimulating hormone, luteinizing hormone, and estradiol and urinary fluoride. Results: In the
defluoridation project group (DFPG), serum GnRH was lower in women carrying C/C genotype compared to in
those carrying C/T and T/T genotypes of ERα gene rs3798577 (p<0.05). In the endemic fluorosis group (EFG),
serum GnRH was lower in women carrying Pp genotype compared to in those carrying PP and pp genotypes of
ERα PvuII (p<0.05). Serum GnRH in women from EFG who carried Pp, pp, Xx and xx genotypes in ERα gene
PvuII and XbaI was lower than in those in the control group (CG) who carried same genotypes (p<0.05). Furthermore, serum GnRH in women from EFG was significantly lower than in those in CG, regardless of whether
the women were carrying C/C, C/T or T/T genotypes of ERα rs3798577 (p<0.05). Serum estradiol concentrations
in EFG were significantly lower than in CG when the women were carrying the Pp, Xx and T/T genotypes in ERα
gene (p<0.05). Conclusion: Interaction of ERα gene and fluoride exposure may influence women’s serum reproductive hormone concentrations.
Asia Pac J Clin Nutr. 2016;25(4):911-919.doi: 10.6133/apjcn.062016.01
>>Abstract
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