Instant noodles made with fortified wheat flour to
improve micronutrient intake in Asia: a review of
simulation, nutrient retention and sensory studies
Author:Kayla L Bronder MD, MPH1, Sarah L Zimmerman BA, An
Keywords: instant noodles, fortification, wheat flour, Asia, micronutrient
Abstract:Background and Objectives: Consumption of foods made with wheat flour, particularly instant noodles, is increasing in Asia. Given this trend, fortifying wheat flour with vitamins and minerals may improve micronutrient
intake in the region. The objective of this review was to understand what is known about fortifying wheat flour
used to make instant noodles. Methods and Study Design: A literature review of seven databases was performed
using the search terms “noodle” and (“Asian” or “instant”). Grey literature was requested through a food fortification listserv. Articles were title screened first for relevance and duplicity, with exclusion criteria applied during
the second round of abstract-level screening. This review considered studies examining simulation, retention,
sensory, bioavailability, efficacy, and effectiveness of instant noodles made with fortified wheat flour. Results:
Fourteen relevant documents were reviewed for simulation (n=1), retention (n=11), and sensory studies (n=3).
The documents revealed that instant noodles produced from fortified wheat flour have potential to improve nutrient intakes, have high retention of most nutrients, and provoke no or minimal changes in sensory characteristics.
Conclusions: The available literature indicates that using fortified wheat flour for instant noodle production results in retention of the added nutrients, except thiamin, with no significant sensory change to the final product.
Given the rising consumption of instant noodles, production of this item with fortified wheat flour has potential to
improve nutrient intakes in Asia. This review provides a resource for the design of a wheat flour fortification
program in countries where a large proportion of wheat flour is consumed as instant noodles.
Asia Pac J Clin Nutr. 2017;26(2):191-121.doi: 10.6133/apjcn.122015.06
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Taking action against malnutrition in Asian healthcare
settings: an initiative of a Northeast Asia Study Group
Author:Takashi Higashiguchi MD, PhD, Hidenori Arai MD, Ph
Keywords:disease-related malnutrition, hospital, community, nutrition, oral nutritional supplements
Abstract:Malnutrition is common in Asia, especially among people who are critically ill and/or older. Study results from
China, Japan, and Taiwan show that malnutrition or risk of malnutrition is found in up to 30% of communitydwelling people and as much as 50% of patients admitted to hospitals—with prevalence even higher among those
older than 70 years. In Asia, malnutrition takes substantial tolls on health, physical function, and wellbeing of
people affected, and it adds huge financial burdens to healthcare systems. Attention to nutrition, including protein
intake, can help prevent or delay disease- and age-related disabilities and can speed recovery from illness or surgery. Despite compelling evidence and professional guidelines on appropriate nutrition care in hospital and community settings, patients’ malnutrition is often overlooked and under-treated in Asian healthcare, as it is worldwide. Since the problem of malnutrition continues to grow as many Asian populations become increasingly
“gray”, it is important to take action now. A medical education (feedM.E.) Global Study Group developed a strategy to facilitate best-practice hospital nutrition care: screen—intervene—supervene. As members of a newly
formed feedM.E. Northeast Asia Study Group, we endorse this care strategy, guiding clinicians to screen each patient’s nutritional status upon hospital admission or at initiation of care, intervene promptly when nutrition care is
needed, and supervene or follow-up routinely with adjustment and reinforcement of nutrition care plans, including post-discharge. To encourage best-practice nutrition in Asian patient care settings, our paper includes a simple,
stepwise Nutrition Care Pathway (NCP) in multiple languages.
Asia Pac J Clin Nutr. 2017;26(2):202-211.doi: 10.6133/apjcn.022016.04
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Total Diet Score as a valid method of measuring diet
quality among older adults
Author:Joanna C Russell MPH, PhD, Victoria M Flood MPH, P
Keywords:validation, diet quality, older adults, biomarkers, Total Diet Score
Abstract:Background and Objectives: This study aimed to determine the accuracy of a diet quality measurement tool, the
Total Diet Score (TDS) using two validation methods; firstly the TDS calculated from a food frequency questionnaire (FFQ) was compared to the TDS calculated from weighed food records (WFRs); secondly the TDS was
compared to a number of dietary biomarkers. Methods and Study Design: Data were collected from a population based cohort study located in the Blue Mountains region of Sydney, Australia. To compare dietary assessment tools, a sub sample of 75 subjects (aged 63 to 83 years) completed the FFQ and three, four-day WFRs at
baseline. Fasting blood samples were collected from 2897 subjects at the first follow up in 1997-1999. TDS
scores were calculated from both WFRs and FFQs. Methods to compare FFQ TDS scores to WFR TDS scores
included paired t-tests, Pearson correlations, Bland-Altman plots, joint classification quartiles and weighted kappa
scores. Linear regression analyses were used to assess the relationship between TDS and biomarkers. Results: No
significant mean difference was found between FFQ TDS and WFRs TDS (p=0.63) with a significant positive
correlation seen between the two methods (r=0.75, p<0001). The Bland-Altman method found no linear trend between the differences and means of TDS scores between the FFQ and WFR (p=0.38). A significant trend for
higher serum vitamin B-12, serum folate, homocysteine and lower total cholesterol was found with increasing
TDS. Conclusions: These findings suggest that the TDS is a useful tool for assessing diet quality in an older population.
Asia Pac J Clin Nutr. 2017;26(2):212-219.doi: 10.6133/apjcn.122015.08
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Development of a self-assessment score for metabolic
syndrome risk in non-obese Korean adults
Author:Youjin Je ScD, Youngyo Kim BS, Taeyoung Park PhD
Keywords:metabolic syndrome, risk score, lifestyle factors, dietary intake, Korean population
Abstract:Background and Objectives: There is a need for simple risk scores that identify individuals at high risk for metabolic syndrome (MetS). Therefore, this study was performed to develop and validate a self-assessment score for
MetS risk in non-obese Korean adults. Methods and Study Design: Data from the fourth Korea National Health
and Nutrition Examination Survey (KNHANES IV), 2007-2009 were used to develop a MetS risk score. We included a total of 5,508 non-obese participants aged 19-64 years who were free of a self-reported diagnosis of diabetes, hyperlipidemia, hypertension, stroke, angina, or cancer. Multivariable logistic regression model coefficients were used to assign each variable category a score. The validity of the score was assessed in an independent population survey performed in 2010 and 2011, KNHANES V (n=3,892). Results: Age, BMI, physical activity, smoking, alcohol consumption, dairy consumption, dietary habit of eating less salty and food insecurity were
selected as categorical variables. The MetS risk score value varied from 0 to 13, and a cut-point MetS risk score
of ≥7 was selected based on the highest Youden index. The cut-point provided a sensitivity of 81%, specificity of
61%, positive predictive value of 14%, and negative predictive value of 98%, with an area under the curve (AUC)
of 0.78. Consistent results were obtained in the validation data sets. Conclusions: This simple risk score may be
used to identify individuals at high risk for MetS without laboratory tests among non-obese Korean adults. Further studies are needed to verify the usefulness and feasibility of this score in various settings.
Asia Pac J Clin Nutr. 2017;26(2):220-226.doi: 10.6133/apjcn.012016.02
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Serum zinc evolution in dysphagic patients that
underwent endoscopic gastrostomy for long term
enteral feeding
Author:Carla Adriana Santos MSc, Jorge Fonseca MD, PhD, M
Keywords:dysphagia, serum zinc, endoscopic gastrostomy, malnutrition
Abstract:Background and Objectives: Patients undergoing endoscopic gastrostomy (PEG) present with protein-energy
malnutrition (PEM) but little is known about zinc status. Our aim was to evaluate serum zinc, its relationship with
serum proteins and with the nature of the underlying disorder, during the first 3 months of PEG feeding. Methods
and Study Design: Prospective observational study during a 3-month period after gastrostomy. Data was collected at initial PEG procedure (T0), after 4 (T1) and 12 weeks (T3). Initial evaluation included: age, gender, disorder
causing dysphagia, Neurological Dysphagia (ND) or Head and Neck Cancer (HNC), NRS-2002, BMI, albumin,
transferrin, zinc. At T1 and T3, a blood sample was collected for zinc, albumin, transferrin. Serum zinc evaluation
was performed with ICP-AES – Inductively Coupled Plasma-Atomic Emission Spectroscopy. Patients were fed
with homemade meals. Results: A total of 146 patients (89 males), 21-95 years were studied: HNC-56, ND-90
and low BMI in 78. Initial low zinc in 122; low albumin in 77, low transferrin in 94; low values for both proteins
in 66. Regarding the serum protein evolution, their levels increase T0-T3, most patients reaching normal values.
zinc has a slower evolution, most patients still displaying low zinc at T3. Significant differences between the 3
moments for zinc (p=0.011), albumin (p<0.0001) and transferrin (p=0.014). Conclusion: PEG patients are prone
to PEM and zinc deficiency. Most patients present decreased zinc, suggesting that zinc deficiency is common in
PEG candidates and is not corrected during 3 months of enteral feeding. Zinc deficiency should be expected and
teams taking care of PEG patients should use zinc supplementation.
Asia Pac J Clin Nutr. 2017;26(2):227-233.doi: 10.6133/apjcn.022016.03
>>Abstract
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The influence of protein provision in the early phase of
intensive care on clinical outcomes for critically ill
patients on mechanical ventilation
Author:Joo Han Song MD, Ho Sun Lee RD, Song Yee Kim MD, E
Keywords:protein provision, nutrition, intensive care, mechanical ventilation, respiratory failure
Abstract:Background and Objectives: Mechanically ventilated patients often face progressive and rapid losses of body
mass and muscle because of hypermetabolism and increased protein catabolism. To investigate the impact of adequate nutritional provision during the early phase of intensive care unit (ICU) admission on the clinical outcomes in patients with medical illnesses receiving mechanical ventilation support. Methods and Study Design:
Two hundred and eleven mechanically ventilated patients admitted to a 30-bed medical ICU were included. Three
groups, based on nutrition intake, were examined: adequate protein intake (aPI), n=34; insufficient protein intake/
adequate energy intake (iPI/aEI), n=25; insufficient protein and energy intake (iPI/iEI), n=152. Results: Patients’
mean age was 65±14 years; body mass index, 22±4; Acute Physiology and Chronic Health Evaluation II score,
24±7. The aPI group had significantly lower rates of in-ICU (14.7%) and in-hospital (23.5%) mortality than patients with insufficient protein intake: in-ICU mortality, iPI/aEI, 36%; iPI/iEI, 44.1% (p=0.006); in-hospital mortality, iPI/aEI, 56.0%; iPI/iEI, 52.0% (p=0.008). In the multivariate analysis, the hazard ratios (95% confidence
intervals) for 60-day survival were 2.59 (1.02-6.59; p=0.046) and 2.88 (1.33-6.26; p=0.008) for the iPI/aEI and
iPI/iEI groups, respectively. Conclusions: Despite possible selection bias owing to the retrospective nature of the
study, achievement of >90% of target protein intake was associated with improved ICU outcomes in mechanically ventilated critically ill patients, based on real-world clinical circumstances.
Asia Pac J Clin Nutr. 2017;26(2):234-240.doi: 10.6133/apjcn.032016.01
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Is low serum 25-hydroxyvitamin D a possible link
between pulmonary tuberculosis and type 2 diabetes?
Author:Qiuzhen Wang PhD, Aiguo Ma PhD, Xiuxia Han BD, Hui
Keywords:25-hydroxyvitamin D, pulmonary tuberculosis, link, type 2 diabetes, body mass index
Abstract:Background and Objectives: Although vitamin D is implicated in the generation of anti-microbial peptide
cathelicidin, which plays a key role against pulmonary tuberculosis (PTB), and may have an inverse association
with the risk of type 2 diabetes (DM), its role in the co-existence of these two diseases (PTB-DM) is still uncertain. This study explored the association of vitamin D status with prevalent PTB, PTB-DM and DM. Methods
and Study Design: We randomly selected 130 PTB patients, 90 PTB-DM, 91 DM and 134 controls. Serum
25(OH)D was determined. A structured questionnaire and anthropometric measurements were administered. Results: Serum 25(OH)D in PTB and PTB-DM were 12.2±2.2 ng/mL and 12.9±2.5 ng/mL, respectively, which
were lower than those in DM and control groups. Odds ratios of PTB and PTB-DM comparing extreme quartiles
of 25(OH)D (lower than 8.6 ng/mL versus ≥26.6 ng/mL) were 3.26 and 2.27, respectively. These associations
remained after adjustment for possible risk factors [OR (95% CI)=4.73 (2.04-10.9) and 2.50 (1.04-6.02), respectively]. A synergistic interaction was observed between low 25(OH)D and underweight in respect to prevalent
PTB-DM [OR=24.6 vs 2.50 for lowest quartile of 25(OH) D and 4.59 for underweight]. Conclusions: Odds ratios of low serum 25(OH)D for PTB and PTB-DM were greater than 1.0, and were even much greater when combined with underweight. However, since the association of serum 25(OH)D with PTB was stronger than with
PTB-DM, we could not draw the conclusion that vitamin D is a link between PTB and DM.
Asia Pac J Clin Nutr. 2017;26(2):241-246.doi: 10.6133/apjcn.032016.02
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Health insurance or subsidy has universal advantage for
management of hospital malnutrition unrelated to GDP
Author:Stanislaw Klek MD, PhD, Michael Chourdakis MD, PhD
Keywords: health insurance, subsidy, malnutrition, hospital malnutrition, nutritional management
Abstract:Background and Objectives: Protein-energy and micronutrient malnutrition are global public health problems
which, when not prevented and severe, require medical management by clinicians with nutrition expertise, preferably as a collectively skilled team, especially when disease-related. This study aimed to investigate barriers and
facilitators of clinical nutrition services (CNS), especially the use of oral, enteral (EN) and parenteral (PN) nutrition in institutional and home settings. Methods and Study Design: An international survey was performed between January and December 2014 in twenty-six countries from all continents. Electronic questionnaires were
distributed to 28 representatives of clinical nutrition (PEN) societies, 27 of whom responded. The questionnaire
comprised questions regarding a country’s economy, reimbursement for CNS, education about and the use of EN
and PN. Results: The prevalence of malnutrition was not related to gross domestic product (GDP) at purchasing
power parity (PPP) per capita (p=0.186). EN and PN were used in all countries surveyed (100%), but to different
extents. Reimbursement of neither EN nor PN use depended on GDP, but was associated with increased use of
EN and PN in hospitals (p=0.035), although not evident for home or chronic care facilities. The size of GDP did
not affect the use of EN (p=0.256), but it mattered for PN (p=0.019). Conclusions: A worldwide survey by nutrition support societies did not find a link between national economic performance and the implementation of medical nutrition services. Reimbursement for CNS, available through health insurance systems, is a factor in effective nutrition management.
Asia Pac J Clin Nutr. 2017;26(2):247-254.doi: 10.6133/apjcn.122015.07
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Association between fruit, vegetable, seafood, and dairy
intake and a reduction in the prevalence of type 2
diabetes in Qingdao, China
Author:Jiwei Liang MD, Yanlei Zhang PhD, Aili Xue MD, Jia
Keywords:dietary intake, type 2 diabetes, prevalence, adult, Chinese
Abstract:Background and Objectives: Fruit, vegetable, seafood, and dairy intake may reduce the risk of type 2 diabetes, but
this relationship is unclear. We aimed to examine the associations between fruit, vegetable, seafood, and dairy intake
and type 2 diabetes prevalence in a Chinese population. Methods and Study Design: A total of 4,343 individuals aged
35-74 years participated in a population-based cross-sectional study in Qingdao, China. The frequency and quantity of
fruit, vegetable, seafood, and dairy intake were determined using a standard food frequency questionnaire. Diabetes
was classified according to the WHO/IDF 2006 criteria. Logistic regression analysis was employed to estimate odds ratio (OR) for type 2 diabetes in relation to fruit, vegetable, seafood, and dairy intake in a multivariable model. Results:
The multivariate-adjusted ORs (95% confidence interval) for the presence of type 2 diabetes were 0.68 (0.46-0.98),
0.50 (0.37-0.68), and 0.91 (0.66-1.25), respectively, for the highest versus the lowest groups regarding total fruit and
vegetable, fruit or vegetable intake in women. The ORs for type 2 diabetes prevalence regarding the quantity of fruit
and vegetable, fruit, and yogurt intake were 0.88 (0.78-0.99), 0.71 (0.61-0.82), and 0.56 (0.32-0.98) in women, but not
in men. Seafood consumption was inversely associated with diabetes risk in men, but not in women; the corresponding
figures were 0.58 (0.35-0.96) and 0.92 (0.63-1.36), respectively. Conclusions: Fruit, vegetable, and yogurt intake in
women and seafood intake in men were inversely associated with type 2 diabetes prevalence in this Chinese population.
These findings require confirmation in a prospective study
Asia Pac J Clin Nutr. 2017;26(2):255-261.doi: 10.6133/apjcn.012016.03
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Identification of dietary patterns and their relationships
with general and oral health in the very old
Author:Yusuke Osawa PhD, Yasumichi Arai MD, PhD, Michiyo
Keywords:food choice, Japan, oral function, principal component analysis, very old
Abstract:Little is known about the dietary patterns of Asian populations aged ≥85 years and their associated factors. Thus,
we aimed to (1) identify these dietary patterns and (2) clarify the relationships between the dietary pattern and
health outcomes in a community-dwelling very old population. The Tokyo Oldest Old Survey on Total Health
study is an observational cohort study comprising 512 Japanese subjects (women, n=288; men, n=224; age,
87.8±2.2 years). Dietary patterns were assessed by principal component analysis using a brief self-administered
diet history questionnaire. Barthel index, Mini-Mental State Examination, and oral health status [maximum occlusal force (MOF), denture use, and dentulous / edentulous state] were also measured. Two dietary patterns were
identified. The first factor component “traditional Japanese” was characterized by a high consumption of vegetables, seaweed, legumes, and fish. The second factor component “noodles and confectioneries” was characterized
by a high consumption of noodles, confectioneries, and non-alcoholic beverages. Multivariable analysis showed
that the “traditional Japanese” dietary pattern was inversely associated with dentulous state (OR: 0.53; 95% CI:
0.34–0.82), the lowest tertile of MOF (OR: 0.64; 95% CI: 0.42–0.99), and denture use (OR: 2.42; 95% CI: 1.26–
4.63) even after adjustment for potential confounders. Furthermore, the “noodles and confectioneries” dietary pattern was inversely associated with the lowest tertile of MOF (OR: 0.62; 95% CI: 0.40–0.94). However, there were
no significant associations between these dietary patterns and disability or cognitive function. We identified two
dietary patterns in the very old population, which were associated with oral health status.
Asia Pac J Clin Nutr. 2017;26(2):262-270.doi: 10.6133/apjcn.022016.02
>>Abstract
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Association of dietary vitamin E intake with risk of lung
cancer: a dose-response meta-analysis
Author:Yong-Jian Zhu MD, Ya-Cong Bo MD2, Xin-Xin Liu PhD,
Keywords:vitamin E, lung cancer, dietary intake, meta-analysis, dose-response
Abstract:Background and Objectives: Several epidemiological studies investigating the association between dietary vitamin E intake and the risk of lung cancer have demonstrated inconsistent results. Hence, a meta-analysis was
conducted to summarise evidence of the association of dietary vitamin E intake with the risk of lung cancer.
Methods and Study Design: In this meta-analysis, a systematic literature search of PubMed and Web of Science
was conducted to identify relevant studies published from 1955 to April 2015. If p<0.05 or I2 >50%, a random effect model was used to estimate overall relative risks (RRs) and 95% confidence intervals (CIs). Otherwise, a
fixed effect model was applied. Publication bias was estimated using the funnel plot and Egger’s test. The doseresponse relationship was assessed using the method of restricted cubic splines with 4 knots at percentiles 5, 35,
65, and 95 of the distribution. Results: The pooled RR of lung cancer for the highest versus lowest categories of
dietary vitamin E intake was 0.84 (95% CI=0.76-0.93). With every 2 mg/d increase in dietary vitamin E intake,
the risk of lung cancer statistically decreased by 5% (RR=0.95, 95% CI =0.91-0.99, plinearity=0.0237). Conclusions: Our analysis suggests that higher dietary vitamin E intake exerts a protective effect against lung cancer.
Asia Pac J Clin Nutr. 2017;26(2):271-277.doi: 10.6133/apjcn.032016.04
>>Abstract
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‘Her shape’ intervention programme for obese women
with high breast adiposity
Author:Norsham Juliana PhD, Suzana Shahar PhD, Mohd Azman
Keywords: body mass index, caloric restriction, physical activity, EIT, home-based intervention
Abstract:Background and Objectives: Nutrition and physical activity interventions is beneficial in reversing obesity.
However far too little attention has been paid to the effect of these interventions on breast tissues. Thus, the aim
of this study was to explore the effect of a home-based dietary and physical activity intervention (the Her Shape
Program) on metabolic parameters, blood biomarkers and adiposity at the breast. Methods and Study Design: A
randomized controlled study was conducted on obese women with high breast adiposity (<0.1 Sm−1), aged 40-60
years in Klang Valley, Malaysia. Subjects were assigned to intervention (n=16) and control group (n=15). Inter
vention group received a home based health education package with close monitoring weekly, personal diet con
sultation and physical training in group. Assessment was ascertained at three time points; baseline, weeks 8 and
16. Outcome measures were the energy intake, physical activity, body composition, blood tests, blood biomarkers
and electrical impedance tomography (EIT) quantitative values. Analyses were done using 2-way repeated
measures ANOVA. Results and Conclusions: All subjects completed the program without any drop-out. The
HSI group had 100% compliance towards the intervention program; their energy intake was reduced for approxi
mately 35% and their activity score was increased for approximately 11%. A significant interaction effect was
found in body weight, body mass index (BMI), total cholesterol/HDL, vitamin C intake and matrix metallopepti
dase 9 (MMP-9) (p<0.05). Interestingly, their EIT extremum values were also significantly increased indicating a
reduction of breast adiposity. The intervention program was successful in improving body composition, physical
activities, MMP9 and breast adipose tissue composition.
Asia Pac J Clin Nutr. 2017;26(2):278-286.doi: 10.6133/apjcn.122015.05
>>Abstract
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Serum 25-hydroxyvitamin D in pregnant women during
preterm labor
Author:Nalina Bhupornvivat MD, Vorapong Phupong MD
Keywords: vitamin D, deficiency, pregnancy, preterm labor, 25-hydroxyvitamin D
Abstract:Background and Objectives: Pregnancy complications hypothesized to be related to vitamin D include
preeclampsia, gestational diabetes, low birth weight, preterm delivery, Cesarean section and infectious disease.
There have been a few studies which have demonstrated maternal serum vitamin D to be associated with preterm
labor. The objective was to evaluate the serum vitamin D concentrations in Thai pregnant women with and without preterm labor and to find the prevalence of vitamin D deficiency and insufficiency in both groups. Methods
and Study Design: Blood samples were collected from pregnant women with and without preterm labor
(matched for gestational age). Serum 25-hydroxyvitamin D (25-OHD) concentrations were measured by chemiluminescence method. Results: A total of 60 pregnant women were included into the study, 30 patients in the
preterm labor group and another 30 patients in the control group. The serum 25-OHD concentration was 21.07.5
ng/mL and the prevalence of vitamin D deficiency was 48.3% in total group of pregnant women. The serum 25-
OHD concentrations were not different between the preterm labor and the control groups (20.9±8.4 vs 21.2±6.7
ng/mL, p=0.91). The prevalence of vitamin D deficiency and insufficiency were not different between the preterm labor and the control groups (53.3% vs 43.3%, p=0.44 and 83.3% vs 90%, p=0.45, respectively). Conclusion: The serum 25-hydroxyvitamin D concentrations and the prevalence of vitamin D deficiency and insufficiency were not different between the preterm labor and the control groups. The serum 25-OHD could not predict
preterm labor in this Thai population.
Asia Pac J Clin Nutr. 2017;26(2):287-290.doi: 10.6133/apjcn.112015.11
>>Abstract
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Maternal and cord blood fatty acid patterns with
excessive gestational weight gain and neonatal
macrosomia
Author:Kaiyong Liu PhD, Kui Ye B.S.Med, Yanping Han MS, J
Keywords: saturated fatty acid, polyunsaturated fatty acid, gestational weight gain, macrosomia, birth weight
Abstract:Background and Objectives: This study evaluated the association of maternal excessive gestational weight gain
with saturated and polyunsaturated fatty acid concentrations in maternal and cord serum. Methods and Study
Design: We included 77 pairs of women and their newborns and classified them into three groups as follows:
mothers with normal gestational weight gain and their babies with normal birth weight in group I (30 pairs),
mothers with excessive gestational weight gain and their babies with normal birth weight in group II (30 pairs),
and mothers with excessive gestational weight gain and their macrosomic babies in group III (17 pairs). Serum
fatty acid concentrations were determined through gas chromatography–mass spectrometry. Results: No remarkable difference in maternal dietary intake was observed among the three groups. C16:0, C18:0, eicosapentaenoic
acid, and docosahexaenoic acid concentrations were significantly higher in group III mothers than in group I
mothers. Compared with group I neonates, total saturated and polyunsaturated fatty acid concentrations were significantly lower but total n-3 polyunsaturated fatty acid and docosahexaenoic acid concentrations were significantly higher in group II neonates (p<0.05). The n-6: n-3 ratio in maternal and cord serum was approximately
10:1 and 1.5:1, respectively. Conclusion: Women with excessive gestational weight gain who deliver a macrocosmic neonate tend to have higher total saturated fatty acid concentrations but lower docosahexaenoic acid concentrations in their neonate cord serum. Fatty acid concentrations in maternal and cord serum are not associated
with maternal dietary pattern.
Asia Pac J Clin Nutr. 2017;26(2):291-297.doi: 10.6133/apjcn.012016.11
>>Abstract
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Diet quality and eating behavioural patterns in
preschool children in Hong Kong
Author:Pui-Sze Yip MPH, RD, Vivian Wai-Yen Chan BS, Queen
Keywords:diet quality, feeding, children, eating behaviour, Hong Kong
Abstract:Background and Objectives: To assess the diet quality and eating behaviour of preschool children, investigate
parents’ feeding practices, and obtain information on the kindergarten nutrition environment of Hong Kong children aged 30-60 months. Methods and Study Design: Dietary information was obtained using multiple 24-hour
recalls. Questionnaires were developed to obtain information on children’s eating behaviour, parents’ feeding
practices and preschool nutrition environment. Results: A total of 302 children and 23 local kindergartens from
three regions of Hong Kong were surveyed. The results showed consumption of vegetable, fruit, and grain were
adequate; however, consumption of meat were excessive, while milk and dairy intakes were inadequate. On average, the children consumed 1,280 kcal per day, or 92% of the Chinese Nutrition Society’s energy recommendation.
For macronutrients, the mean percentages of energy from carbohydrate, protein and fat were 55%, 17% and 28%,
respectively, which are within the United States Acceptable Macronutrient Distribution Ranges. The mean intakes
of carbohydrate and protein were 175 g and 53.4 g, respectively. For micronutrients, the mean intakes of vitamin
D, calcium, iron and zinc were significantly lower than the reference nutrient intake or adequate intake (p<0.05),
but those of sodium and niacin were significantly higher than the tolerable upper intake levels (p<0.05). Conclusion: This study showed that diet quality among children in Hong Kong needs to be improved, as some nutrients
are consumed in excess whereas others are consumed in inadequate amounts. Other results on children’s eating
behaviour, parent’s feeding practices and school nutrition environment are also reported.
Asia Pac J Clin Nutr. 2017;26(2):298-307.doi: 10.6133/apjcn.122015.09
>>Abstract
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Meal services after the Great East Japan Earthquake at
nursery schools in a tsunami-affected town: focus group
observations
Author:Yukiko Amitani MS, RD, Noriko Sudo PhD, RD, Nobuyo
Keywords:The Great East Japan Earthquake, tsunami-affected town, nursery school, feeding manual in disaster, The
Abstract:Background and Objectives: This study aimed to collect information on experiences in the Great East Japan
Earthquake (hereafter, 3.11), current preparedness, and barriers to building up stockpiles in nursery schools in affected areas. Based on the needs heard from the staff, we decided what contents should be included in our manual
developed with the Japan Dietetic Association. Methods and Study Design: A group interview was held in September 2012. We interviewed a principal, nurses, and registered dietitians working for a public and a private
nursery school in Town A. We also invited an administrative dietitian who was an employee of Town A. Results:
One of the barriers to building up stockpiles was that they did not have any idea of what and how many items
they should store. To deal with this situation, we developed a formula that could be used to calculate the quantity
of stockpiles for their facilities in a newly developed feeding manual. In terms of current preparedness, the registered dietitians were not prepared for alternative menus in emergencies or how to manage garbage when the garbage collection was disrupted by disasters. The manual recommends to obtain the services of at least two food
service personnel and spare space for storing filled garbage bags until garbage collection resumes. Conclusion:
Some improvements in stocks were found in both of the public and private nursery schools. To improve the situation further, more financial support and detailed guidelines should be provided by the local government and authoritative organizations. Our manual should be a great asset for all nursery schools to improve their stockpiles.
Asia Pac J Clin Nutr. 2017;26(2):308-312.doi: 10.6133/apjcn.012016.05
>>Abstract
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Information exposure and growth monitoring favour
child nutrition in rural Indonesia
Author:Paulus D Sahanggamu MSc, Lupi Purnomosari MSc, Dru
Keywords:nutritional status, nutritional information exposure, growth monitoring, under-five children, Indonesia
Abstract:Background and Objectives: Malnutrition is a health problem among under-five children in Indonesia. The
mothers’ knowledge on nutrition and health in addition to growth monitoring program are essential components
that may influence nutritional status of children under-five. The objective was to observe the importance of maternal information exposure along with growth monitoring program to the nutritional status of children in rural
areas. Methods and Study Design: A cross sectional study of 233 randomly selected mothers of under-five children from different geographical rural settings in Indonesia were interviewed and observed as to their exposure to
nutrition and health information, growth monitoring program and nutritional status of the children. Results: The
prevalence of underweight, stunting, and wasting was 50.5%, 18.0%, and 28.4%, respectively. The mean of
height-for-age z score was similar across villages, however, the mean of weight-for-age (p=0.039) and weightfor-height (p=0.047) were significantly lower in Kenduren compared with Karangrejo village. The possession of
a growth monitoring card in Kenduren was significantly lower compared with Karangrejo (p<0.001) or Buko villages (p<0.001). The prevalence of underweight (p=0.001) or stunting (p=0.021) was higher among children who
did not possess a growth monitoring card. The prevalence of stunting was higher among children who did not
routinely go to Posyandu (Integrated Health Post) in the last 3 months (p=0.018). Conclusion: Maternal exposure
to nutrition and health information, along with growth monitoring programs, contribute to the prevalence of underweight and stunting among rural children who are under-five years old.
Asia Pac J Clin Nutr. 2017;26(2):313-316.doi: 10.6133/apjcn.012016.0
>>Abstract
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Household dietary diversity and child stunting in East
Java, Indonesia
Author:Trias Mahmudiono SKM, MPH (Nutr.), GCAS, PhD, Sri
Keywords:dietary diversity, child stunting, malnutrition, food pattern, Indonesia
Abstract:Background and Objectives: More than one-quarter of under-five children in the developing world are stunted,
and those with poor nutrient intake are at risk of irreversible cognitive impairment. The purpose of this study was
to determine the relationship between dietary diversity and child stunting in an Indonesian context. Methods and
Study Design: Dietary diversity was assessed using a maternal-reported checklist of 12 food groups, summed as
a Household Dietary Diversity Score. Stunting was defined as ≤-2.0 height-for-age z-score by WHO-Anthro 2005.
Trained interviewers administered the household dietary diversity questionnaire to 768 households with children
aged <5 years in East Java, Indonesia. Logistic regression models were constructed to test the association between dietary diversity and child stunting. Results: The prevalence of child stunting was 39.4%, and the percentage of households consuming food groups high in protein and calcium, like dairy products (41%), and
meat/poultry, (65%) was lower compared with other food groups. The unadjusted model revealed that higher dietary diversity scores were associated with lower likelihood of child stunting (OR=0.89; 95% CI=0.80–0.98). This
relationship remained significant after adjustment for family size, maternal literacy, food expenditure, breastfeeding, energy, and protein intake (OR=0.89; 95% CI=0.80–0.99). Conclusions: The dietary diversity score was
moderate, with consumption of dairy products and meat/poultry lowest among 12 food groups. Hence, population
interventions should focus on promoting food groups currently lacking in maternal and child diet, including those
rich in growth-promoting nutrients like dairy, meat/poultry. These results, from an Indonesian context, confirm
the widely observed protective relationship between dietary diversity and child stunting
Asia Pac J Clin Nutr. 2017;26(2):317-325.doi: 10.6133/apjcn.012016.01
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Associations between socio-demographic characteristics
and pubertal status with disordered eating among
primary school children in Selangor, Malaysia
Author:Lin Siew Chong MSc, Yit Siew Chin PhD, Wan Ying Ga
Keywords: children, disordered eating, ethnicity, pubertal status, Malaysia
Abstract:Background and Objectives: To determine the associations between socio-demographic characteristics and pubertal status with disordered eating among primary school children. Methods and Study Design: Using a stratified multi-stage sampling, a total of 816 children (282 boys and 534 girls) aged 10 to 11 years from 12 selected
primary schools in the state of Selangor, participated in this study. Data were collected on socio-demographic
characteristics, pubertal status and disordered eating behaviors. The Pubertal Development Scale and the Children's Eating Attitudes Test (ChEAT) were used to assess pubertal status and disordered eating, respectively. Logistic regression analysis was conducted to determine the risk factors of disordered eating. Results: The prevalence of disordered eating was 30.8% (32.8% in boys and 29.7% in girls). However, the sex difference in the
prevalence was not statistically significant. Age, ethnicity and pubertal status were significantly associated with
disordered eating in univariate logistic regression analysis. Multivariate logistic regression analysis showed that
among boys, being either in an advanced or post-pubertal stage (adjusted OR=8.64) and older age group (adjusted
OR=2.03) were risk factors of disordered eating. However, among girls, being a Malay (adjusted OR=3.79) or
Indian (adjusted OR=5.04) in an advanced or post-pubertal stage (adjusted OR=2.34) and older age group (adjusted OR=1.53) were risk factors of disordered eating. Conclusion: This study found one in three children had
disordered eating. Since ethnicity and pubertal status were identified as risk factors, ethnicity-specific intervention programs on the prevention of disordered eating among children should take into consideration their pubertal
status.
Asia Pac J Clin Nutr. 2017;26(2):326-333.doi: 10.6133/apjcn.012016.10
>>Abstract
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Serum uric acid levels in non-alcoholic steatosis patients:
a meta-analysis
Author:Fan Huang MD, Anding Liu MD, Haoshu Fang PhD, Xiao
Keywords:serum uric acid, non-alcoholic fatty liver disease, fatty liver, SUA, NAFLD
Abstract:Background and Objectives: Experimental and observational studies suggest a role for increased uric acid in
non-alcoholic fatty liver disease (NAFLD). This study aimed to systematically review the association between serum uric acid (SUA) levels and NAFLD. Method and Study Design: We used PubMed, and the EMBASE database to identify all applicable studies through November 2015. We used the weighted mean difference (WMD) to
demonstrate the differences between the control and NAFLD groups in continuous data. We calculated the odds
ratios (ORs) for dichotomous data using the Mantel-Haenszel method. A total of 16 observational studies were
identified and used for the analysis of continuous data, and 4 studies were analyzed for dichotomous data. Results:
The WMD was 52.3 (95% CI: 39.0, 65.5, p<0.00001). The pooled OR in observational studies was 2.08 (95% CI:
1.93-2.24, p<0.00001). The results were heterogeneous for the comparison of continuous data and homogeneous
for the comparison of dichotomous data. The SUA cutoff value for the occurrence of NAFLD was 308, with a
sensitivity of 94.12% [71.3-99.9] and specificity of 70.6% [44.0-89.7]. Conclusion: We observed a positive association between increased SUA levels and the diagnosis of NAFLD in all analyses. Our results suggest that
SUA is upregulated in patients with NAFLD and might be related to the pathogenesis of NAFLD.
Asia Pac J Clin Nutr. 2017;26(2):334-342.doi: 10.6133/apjcn.092016.04
>>Abstract
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Positive association between metabolic syndrome and
serum uric acid in Wuhan
Author:Yuan-Qing Fu PhD, Hong Yang MD, Ju-Sheng Zheng PhD
Keywords:metabolic syndrome, uric acid, cardiovascular risk, Wuhan population
Abstract:Background and Objectives: The objective was to determine whether serum uric acid concentrations were associated with metabolic syndrome in a population from Wuhan. Methods and Study Design: 5,628 subjects (2,838
men, 2,790 women) aged 18-80 years were recruited in Wuhan, China. Biochemical parameters of venous blood
were measured by standard methods and metabolic syndrome was defined by Chinese Diabetes Society criteria.
Association analysis was performed by logistic regression. Results: 8.2% of the included subjects were confirmed as having metabolic syndrome and 14.4% were confirmed as having hyperuricemia. After multivariable
adjustment, logistic regression showed the odds ratios of metabolic syndrome for subjects in the highest quartile
of serum uric acid concentration was 2.84 (95% CI: 2.09-3.86) compared with those in the lowest quartile and no
gender difference was found. For each component of metabolic syndrome, subjects in the highest quartile of serum uric acid concentrations had increased multivariable odds ratios for high BMI (OR: 3.29, 95% CI: 2.71-3.98),
for hypertension (OR: 3.54, 95% CI: 2.93-3.86), for dyslipidemia (OR: 2.49, 95% CI: 1.98-3.14), but not for hyperglycemia (OR: 1.21, 95% CI: 0.87-1.67). Conclusions: Odd ratio of metabolic syndrome was significantly
positively associated with serum uric acid concentration among the present sample of 5,628 subjects in Wuhan.
Asia Pac J Clin Nutr. 2017;26(2):343-350.doi: 10.6133/apjcn.012016.06
>>Abstract
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How do health behaviours relate to dietary practice
patterns among Japanese adults?
Author:Gita D Mishra PhD, Jung Su Lee PhD, Kunihiko Hayas
Keywords:dietary practice patterns, habitual physical exercise, health behaviours, Japan, smoking
Abstract:Background and Objectives: To identify dietary practice patterns for Japanese adults and investigate the links
between health behaviours and these patterns. Methods and Study Design: A random sample, stratified according to area, sex, and age, of 4570 adults aged 20-80 years completed a survey conducted in 2011 in a city, in
Yamagata Prefecture, Northeast Japan. Results: Cluster analysis of 16 dietary practice items revealed four patterns labelled as: low fat, sugar, or salt; emphasis on nutrition; regular breakfast and staples; and meals not
snacks. Findings from multiple linear regression analyses showed that those not engaged in habitual physical exercise had lower scores on low fat, sugar, or salt (beta coefficient -0.22: 95% confidence intervals -0.30, -0.14);
emphasis on nutrition (-0.17: -0.25, -0.09); meals not snacks; (-0.38: -0.46, -0.3) that other participants. Current
smokers had lower scores than never smokers on low fat, sugar, or salt (-0.23: -0.32, -0.14); emphasis on nutrition (-0.28: -0.37, -0.19); regular breakfast and staples (-0.42: -0.51, -0.33) patterns. Compared with nondrinkers, those who had reduced their consumption of alcohol had higher scores on low fat, sugar, or salt (0.19:
0.09, 0.29) and emphasis on nutrition (0.17: 0.07, 0.27). These relationships were adjusted for other dietary practice patterns, sociodemographic factors, body mass index, and the presence of major illness or pain. Conclusions:
Findings support an integrated and targeted approach as part of public health policy by considering links between
dietary practices and other health behaviours, such as habitual exercise and smoking behaviour that may facilitate
changes in dietary practices.
Asia Pac J Clin Nutr. 2017;26(2):351-357.doi: 10.6133/apjcn.022016.01
>>Abstract
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Where is Nepal in the nutrition transition?
Author:Yagya Prasad Subedi MA, MBA, Debbi Marais PhD, Dav
Keywords: nutrition transition, economic, demographic, epidemiology, Nepal
Abstract:Background and Objective: Nutrition transition is rapid in developing countries, but Nepalese transition is relatively unknown. This study aimed to describe nutrition transition in Nepal over the past 40 years by identifying
the shifts in the Nepalese diets and nutritional status and the underlying shifts associated with this. Methods and
Study Design: Popkin’s framework was used to identify shifts in Nepalese diet and the inter-relationship of diet
with epidemiological, demographic and economic shifts. The current study used quantitative methodology including secondary data analysis based on food balance sheets, economic surveys and the government databases. Results: The Nepalese diet is shifting away from agricultural staple based foods to modern processed foods with
higher total energy, total fat, and sugar. The prevalence of overweight/obesity and diet related non-communicable
diseases are increasing. Urbanisation is rapid and nutrition transition already advanced in urban area. The Nepalese economic structure has also changed shifting away from agricultural food supply system towards modern
processing based food supply system. These changes in the Nepalese diet are triggered by income and urbanisation. The trade liberalisation has made processed foods, edible oil and sugar easily available at supermarkets and
fast food outlets. Conclusion: It is clear that Nepal has now entered into the fourth stage of nutrition transition
according to Popkin’s framework. As a result, overweight, obesity and the prevalence of many noncommunicable diseases are all rapidly growing. A further study is recommended to identify whether urban versus
rural, rich versus poor and educated versus uneducated families are experiencing the transition in similar way.
Asia Pac J Clin Nutr. 2017;26(2):358-367.doi: 10.6133/apjcn.112015.10
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APOE and CETP TaqIB polymorphisms influence
metabolic responses to Hibiscus sabdariffa L. and
Gynostemma pentaphyllum Makino tea consumption
in hypercholesterolemic subjects
Author:Nutjaree Jeenduang PhD, Boonnisa Sangkaew BSc, Pac
Keywords:APOE, CETP TaqIB, Gynostemma pentaphyllum Makino, Hibiscus sabdariffa L., Polymorphisms
Abstract:Background and Objectives: Hibiscus sabdariffa L. (HS) and Gynostemma pentaphyllum Makino (GP) have
been used as traditional medicines to treat diabetes and hypercholesterolemia. Nevertheless, there is interindividual variation in the metabolic responses to HS and GP consumption. This may be due to genetic factors.
The aim of this study was to investigate the effects of HS and GP tea consumption on anthropometric data, fasting blood glucose (FBG), and lipid concentrations in hypercholesterolemia subjects with different genotypes of
the APOE and CETP TaqIB polymorphisms. Methods and Study Design: Forty-eight subjects with hypercholesterolemia were given either HS or GP tea for 30 days. Anthropometric and biochemical variables were determined, and APOE and CETP TaqIB polymorphisms were analyzed using the polymerase chain reaction–
restriction fragment length polymorphism (PCR-RFLP). Results: E4 (p=0.008) and homozygous B1B1 (p=0.010)
carriers had significantly decreased HDL-C concentrations after HS consumption; in addition, B2 carriers who
consumed HS showed significantly decreased triglyceride (TG) concentrations (p=0.039). Regarding GP consumption, non-E4 carriers had significantly decreased HDL-C (p=0.009) and FBG (p=0.042) concentrations. Furthermore, B2 carriers had significantly decreased total cholesterol (TC) (p=0.045), HDL-C (p=0.004), and FBG
(p=0.026) concentrations. Conclusions: HS consumption may have beneficial effects with respect to TG concentrations in the B2 carriers, but it may adversely affect HDL-C concentrations in homozygous B1B1 and E4 carriers. In contrast, GP consumption may have favorable effects on TC and FBG concentrations but not on HDL-C
concentrations for B2 and/or non-E4 carriers.
Asia Pac J Clin Nutr. 2017;26(2):368-378.doi: 10.6133/apjcn.122015.04
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Thiamin and folic acid deficiency accompanied by
resistant electrolyte imbalance in the re-feeding
syndrome in an elderly patient
Author:Sibel Ocak Serin MD, Gulsah Karaoren MD, Yildiz Ok
Keywords:malnutrition, thiamin, folic acid, electrolyte imbalance, re-feeding syndrome
Abstract:Introduction: Re-feeding Syndrome (RS) is a deadly complication, which can be encountered during “refeeding” of malnourished patients. In these patients, thiamin deficiency may develop and “risk awareness” is the
most significant factor in the management of these patients. In this case report, the treatment is presented of an
elderly patient who was diagnosed with RS and followed-up in the intensive care unit (ICU) due to resistant fluidelectrolyte imbalance. Case: An 87-year-old elderly woman was admitted to the hospital due to aspiration pneumonia. On day 4, during parenteral nutrition (30 kcal/kg/day), severe electrolyte imbalance developed. Total parenteral nutrition (TPN) was stopped, and enteral feeding together with potassium (90 mmol/day, i.v.) were started.
During follow-up, plasma potassium values remained less than 3 mmol/L. Despite replacement therapy, hypoalbuminemia, hypomagnesemia, hypocalcemia, and hypophosphatemia persisted. Considering the parenteral nutrition (30 kcal/kg/day) during the hospitalization period, a diagnosis of RS was made. On day 10, thiamin (200
mg/day, i.v.) and folic acid (5 mg/day) were added, and the patient subsequently responded to electrolyte replacement treatment. The patient was discharged on day26 with a home-care plan. Conclusion: In patients with
malnutrition, thiamin replacement should be given before starting nutrition to prevent RS. Energy intake should
be 10kcal/kg/day at the start, and be gradually increased between days 4-10. Hemodynamic-laboratory parameters
should be closely monitored. All these measures may be life-saving for patients at high risk.
Asia Pac J Clin Nutr. 2017;26(2):379-382.doi: 10.6133/apjcn.012016.04
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