Advances and gaps in recommendations for adequate water intake in China
Author:Na Zhang, Songming Du, Yuexin Yang, Guansheng Ma
Keywords:water, water intake, hydration, dietary habits, physical activity
Abstract:Water is essential for life survival and development. Water is involved in metabolic function, modulates normal osmotic pressure, maintains electrolyte balance, and regulates body temperature. Both excessive water and insufficient water have negative effects on health, and adequate water intake is necessary for optimal hydration. Water requirements among people vary based on factors such as sex, age, physical activity, dietary factors, environment temperature, and kidney concentration capacity. In recent years, water intake guidelines have been developed in some countries and organizations. In China, however, it is still necessary to develop specific water intake guidelines due to the specific dietary habits, heights, and other environmental conditions. In 2013, adequate water intake guidelines were developed in China, but the scope was somewhat limited and there are still quite specific challenges in formulating such recommendations. Future water-related studies should focus on surveying water intake in infants and toddlers, older adults, and pregnant and lactating women. Furthermore, more studies on water intake of adults and adolescents in different regions and seasons are required, as are studies on the associations between water intake and related diseases. It is imperative to transform scientific theory into action in water-related health education and can be used to inform and evaluate public health programmes.
Asia Pac J Clin Nutr. 2019;28(4):665-674.doi: 10.6133/apjcn.201912_28(4).0001
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Docosahexaenoic acid and the brain– what is its role?
Author:Andrew James Sinclair
Keywords:brain, DHA, PUFA, mechanisms, diet
Abstract:Docosahexaenoic acid (DHA) is a 22-carbon omega 3 PUFA highly enriched in the neuronal cell membranes and
rod outer segment membranes. When DHA is depleted from these cell membranes it is replaced nearly quantitatively by a 22-carbon omega 6 PUFA, docosapentaenoic acid, which has similar, but less potent, biophysical and
physiological properties to DHA. It is speculated that omega 6-docosapentaenoic acid is a buffer to prevent the
possible catastrophic effects of DHA depletion on brain and visual function. The primary insult from the loss of
DHA from cell membrane glycerophospholipids, and replacement by omega 6-docosapentaenoic acid, is on the
flexibility/compression of the membrane lipids which affects the optimal function of integral membrane proteins
(receptors, voltage-gated ion channels and enzymes). This leads to effects on second messenger systems, and subsequently affects neurotransmitter concentrations due to ‘weakened’ signals from the initiating receptors. Remembering there are more than 80 billion neurones and many times more synaptic connections between neurons,
a very small loss of “efficiency” in signal due to altered properties of membrane proteins would likely result in
meaningful changes in brain and visual function. Additionally, impairment of neurotransmission could be due, in
part, to sub-optimal brain energy metabolism (glucose entry into the brain), which is significantly reduced in
omega 3 deficiency. Many studies report that dietary omega 3 deficiency results in changes in learning, coping
with stress, behavioural changes, and responses in visual function. It is thus concluded that DHA is an essential
fatty acid for optimal neuronal function.
Asia Pac J Clin Nutr. 2019;28(4):675-688.doi: 10.6133/apjcn.201912_28(4).0002
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Vitamin D and depression: mechanisms, determination and application
Author:Chunmei Geng, Abdul Sami Shaikh, Wenxiu Han, Dan Chen, Yujin Guo, Pei Jiang
Keywords:depression, vitamin D, pathological mechanisms, neuroactivities, determination
Abstract:Depression is the most common debilitating psychiatric disease, the pathological mechanisms of which are associated with multiple aspects of neural function. While recent evidence has consistently suggested that a suboptimal vitamin D status is frequently observed in patients with depression, the results concerning whether vitamin D insufficiency is a causal factor of depression or is secondary to depressive behavior are conflicting; additionally, the lack of consistency of the method of vitamin D determination between labs has further worsened this confusion. Herein, we reviewed the neuroactivity of vitamin D that may be associated with depression and the current studies and clinical investigations to provide a full overview on the use of vitamin D in the treatment and prevention of depression.
Asia Pac J Clin Nutr. 2019;28(4):689-694.doi: 10.6133/apjcn.201912_28(4).0003
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Percutaneous endoscopic gastrostomy feeding is beneficial in patients with advanced dementia
Author:Halil Rakici, Muhammed Ali Ayvaz
Keywords:percutaneous endoscopic gastrostomy, feeding, advanced dementia, stroke, mortality
Abstract:Background and Objectives: We aimed to show the long-term results of patients who received percutaneous endoscopic gastrostomy (PEG) tubes and to evaluate the usefulness of this method in advanced dementia patients, which is considered to be of controversial benefit in the literature. Therefore, we compared three groups of patients: advanced dementia patients fed via PEG, stroke patients fed via PEG and advanced dementia patients not fed via PEG. Methods and Study Design: In total, 305 files of patients who underwent PEG implantation were screened retrospectively, and 283 were analyzed. A total of 93 advanced dementia patients who were not fed via PEG were included as the control group, and the PEG-fed group was compared in terms of mortality and CRP levels with the advanced dementia control group not fed via PEG. Results: The median length of PEG stay was 9 months. In total, 49 (17.5%) patients developed complications. Mortality (p=0.0002) and CRP levels (p=0.010) were statistically significant in the advanced dementia group not fed via PEG. The group with stroke and the dementia patients were analyzed regarding length of PEG stay, complications and mortality. The length of PEG stay, rate of complications and mortality in the stroke group were not found to be statistically significant in comparison to the dementia group. Conclusions: Mortality and CRP levels were statistically significantly higher in the advanced dementia group not fed via PEG. The mortality and rate of complications in the dementia group were similar to those in the stroke group. Feeding with PEG-tubes is a proper and preferable method for advanced dementia patients.
Asia Pac J Clin Nutr. 2019;28(4):695-700.doi: 10.6133/apjcn.201912_28(4).0004
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Probiotics in preventing and treating chemotherapy-induced diarrhea: A meta-analysis
Author:Dongxue Lu, Jing Yan, Feng Liu, Pinpin Ding, Bingyu Chen,Yin Lu，Zhiguang Sun
Keywords:probiotic preparation, chemotherapy, diarrhea, chemotherapy-induced diarrhea, randomized controlled trial
Abstract:Background and Objectives: To systematically assess the safety and effectiveness of probiotics in preventing and treating chemotherapy-induced diarrhea (CID), so as to provide the evidence-based evidence for clinical practice. Methods and Study Design: Electronic databases, including EMbase, Cochrane Library, pubMed, CNKI, VIP, CBM, and Wanfang databases, were retrieved to search for the randomized controlled trials (RCTs) of CIDs among patients with malignant tumors treated with probiotics as of March 2019. Later, the Rev Man 5.3 statistical software was employed to extract data and assess the quality of the identified literature for meta-analysis. Results: Finally, 13 RCTs involving a total of 1024 patients were included into the current meta-analysis. Results of this meta-analysis showed that the addition of probiotics to conventional symptomatic treatment could evidently reduce the total diarrhea rate in patients with cancer [RR = 0.47, 95% CI (0.35, 0.63), p < 0.00001] and grade III-IV diarrhea [RR = 0.16, 95% CI (0.05, 0.42), p = 0.0008], increase the total effective rate [OR = 4.26, 95% CI (2.55, 7.12), p < 0.00001], and shorten the duration of diarrhea [MD = -1.92, 95% CI (-1.96, -1.88), p < 0.00001]; meanwhile, the difference was statistically significant. But in patients with grade I-II diarrhea [RR = 0.81, 95% CI (0.53, 1.24), p = 0.34], the difference was not statistically significant. Besides, none of the enrolled study had reported adverse reactions. Conclusions: The application of probiotics before or during chemotherapy can effectively prevent the occurrence of CID among cancer patients. Moreover, the combination of probiotics in treating CID can also improve the therapeutic effect on CID, with less adverse events.
Asia Pac J Clin Nutr. 2019;28(4):701-710.doi: 10.6133/apjcn.201912_28(4).0005
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Early intervention with supplemental parenteral nutrition reduces the incidence of granulocytopenia-related infections in patients with lung cancer: a retrospective cohort study
Author:Xiaoguang Qi, Chunyan Qi, Tao Wu, Boyu Qin, Yi Hu
Keywords:myelosuppression, supplemental parenteral nutrition, granulocytopenia, chemotherapy, lung cancer
Abstract:Background and Objectives: The optimal timing for initiating supplemental parenteral nutrition in chemotherapy-induced severe granulocytopenia in patients with lung cancer remains uncertain. Methods and Study Design: A retrospective study was conducted among patients with lung cancer from February 2016 to June 2018. In total, 182 eligible patients were included and divided into 2 groups according to the time of supplemental parenteral nutrition intervention: early initiation (within 72 hours of development of granulocytopenia) and late initiation (over 72 hours). The primary outcomes of the study were bacterial infection and fungal infection, and the secondary outcomes were duration of absolute neutrophil count less than 1.0 × 109 cells/L, length of hospital stay, mortality rate, and rate of chemotherapy (4 cycles) completion. Results: The incidence rates of bacterial infection and fungal infection were significantly lower among patients who received supplemental parenteral nutrition early than among patients who received it late. No significant difference in mortality was observed between the groups. In addition, compared with late supplemental parenteral nutrition, early supplemental parenteral nutrition was associated with a higher rate of completion of 4 chemotherapy cycles and shorter and hospital stays and leukocyte recovery periods in our cohort. Univariate and multivariate logistic regression analyses revealed that the subgroup of patients with an NRS-2002 score of 2 benefited from early supplemental parenteral nutrition. Conclusions: Early supplemental parenteral nutrition after chemotherapy-induced severe granulocytopenia could reduce the risk of infection, improve the likelihood of chemotherapy completion, and shorten hospital stays and leukocyte recovery times
Asia Pac J Clin Nutr. 2019;28(4):711-719.doi: 10.6133/apjcn.201912_28(4).0006
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Effect of exercise therapy combined with branched-chain amino acid supplementation on muscle strength in elderly women after total hip arthroplasty: A randomized controlled trial
Author:Takashi Ikeda, Yuki Matsunaga, Masanori Kanbara, Arinori Kamono, Tadashi Masuda, Minoru Watanabe, Ryosuke Nakanishi, Tetsuya Jinno
Keywords:total hip arthroplasty, muscle strength, branched-chain amino acid, elderly persons, convalescence
Abstract:Background and Objectives: Many patients develop a prolonged decrease of muscle strength after total hip arthroplasty (THA) despite their reconstructed hip joint. Physical exercise combined with branched-chain amino acid (BCAA) supplementation has been reported to improve muscle strength in elderly persons with sarcopenia. However, the effect of BCAA supplementation in patients after THA is unknown. This study examined the effects of BCAA supplementation combined with exercise therapy on the improvement of physical function in elderly patients after THA. Methods and Study Design: The subjects were 31 elderly women who underwent THA. The participants were randomly assigned to two groups: BCAA (n=18) and control (n=13). The combined therapy was carried out for one month after THA. For the exercise intervention, a 3-set physical exercise program was conducted. For the nutritional intervention, the participants consumed 3.4 g of BCAA supplement or 1.2 g of starch immediately after the exercise intervention. Results: BCAA supplementation combined with muscle strengthening exercises had a significant effect on knee extension strength of the contralateral side and on upper arm cross-sectional area. The improvement ratio of knee extension strength before and after intervention on the operated side was also significantly higher in the BCAA group. Conclusions: BCAA supplementation is effective for patients to improve the strength of some muscles when combined with physical exercises, but hip abductor muscle strength of the operated leg did not improve. A future study is needed to determine the efficacy of this combined therapy for hip abductor muscle strength.
Asia Pac J Clin Nutr. 2019;28(4):720-726.doi: 10.6133/apjcn.201912_28(4).0007
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A randomized controlled trial of preoperative carbohydrate drinks on postoperative walking capacity in elective colorectal surgery
Author:Mingkwan Wongyingsinn, Soraya Luangchan, Sawinee Tungsongsawat, Attaporn Trakarnsanga, Varut Lohsiriwat
Keywords:Oral carbohydrate drink, postoperative physical recovery, walking capacity, colorectal surgery, nitrogen balance
Abstract:Background and Objectives: Routine overnight fasting may increase the risk of postoperative complications and delay postoperative recovery. Oral carbohydrate drinks have been shown to reduce glucose utilization and postoperative negative nitrogen balance while preserving muscle mass and strength. This randomized controlled trial aimed to examine whether preoperative oral carbohydrate drinks can enhance postoperative physical recovery in patients undergoing major colorectal surgery. Methods and Study Design: Seventy patients were randomly assigned to receive either a 12.5% oral carbohydrate drink or pure water. Patients in both groups received 800-mL of one of the drinks on the evening before surgery, and another 400-mL drink on the morning of the operative day. The primary outcomes were the distances covered in 2-minute-walk tests at 24, 48 and 72-hours and 6-minute walk tests at 7-10 days postoperatively. The secondary outcomes were the postoperative serum insulin and glucose concentrations, nitrogen balance, duration of hospital stay, and the patient satisfaction scores. Results: There were no significant differences in the characteristics of the two patients-groups. The postoperative 2-minute and 6-minute walk test distances, serum insulin and glucose concentrations of both groups were not statistically different. Patients receiving carbohydrate drink had more positive nitrogen balance than the control group. The duration of hospital stay and patient satisfaction scores were similar for both-groups. Conclusions: There were no statistically significant differences in the postoperative walking capacities of patients receiving a carbohydrate drink or pure water; only the nitrogen balance on postoperative day 3 was higher for patients receiving the carbohydrate drink.
Asia Pac J Clin Nutr. 2019;28(4):727-733.doi: 10.6133/apjcn.201912_28(4).0008
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Recovery of Lactobacillus casei strain Shirota (LcS) from faeces with 14 days of fermented milk supplementation in healthy Australian adults
Author:Amanda J Cox, Hiroshi Makino, Allan W Cripps, Nicholas P West
Keywords:Lactobacillus casei strain Shirota, probiotics, Yakult, faecal
Abstract:Background and Objectives: A key measure for classifying bacteria as a probiotic is the ability to survive gastric transport and be recoverable in faeces. The aim of this study was to determine whether Lactobacillus casei strain Shirota (LcS) could be recovered in the faeces of healthy young Australian adults following ingestion of a fermented milk drink. Methods and Study Design: A cohort of 25 healthy individuals (male/female: 14/11; age: 29.3±6.6 years; BMI: 25.3±2.7 kg/m2, mean±SD) ingested one 65 ml bottle of fermented milk containing 6.5×109 LcS live cells daily for 14 days. Participants provided a faecal sample at day 0, day 7 (mid-supplementation), day 14 (end of supplementation) and 14 days after cessation of the supplement (day 28) for assessment of the number of viable LcS via microbial culture on selective media with confirmation using a colony-direct polymerase chain reaction and species-specific primers. Results: The supplement was well tolerated by participants. No LcS colonies were recovered from participants prior to ingestion of the fermented milk drink. All participants had recoverable LcS colonies at day 7 and day 14, with a mean recovery of 6.5±1.1 and 6.4±1.1 log10 CFU/g of faeces (mean±SD) at each time point respectively. LcS was detectable in only one sample at 14 days following the cessation of supplementation. Conclusions: Live LcS is recoverable in faeces from healthy Australian adults following daily ingestion of a fermented milk drink.
Asia Pac J Clin Nutr. 2019;28(4):734-739.doi: 10.6133/apjcn.201912_28(4).0009
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Effect of green tea consumption on human brain function in
resting-state functional MRI
Author:Hui Wang, Wei Sun, Yan Chang, Zhenzhou Wu, Yajie Xu, Erlei Wang, Lei Wang, Peiwei Yi
Keywords:green tea, resting-state functional MRI, functional connectivity, brain
function, default mode network
Abstract:Green tea is reported to have wide benefits on psychological
states and cognitive functions. However, studies that focus on the underlying neural mechanisms of green tea are limited to its single composition. In this study, we examined the human brain activity changes after drinking natural green tea by using regional homogeneity and functional connectivity based on the resting-state functional MRI technique. Our results revealed that the green tea group exhibited an increased regional homogeneity in the frontal, parietal, and occipital areas of the brain and mainly a decreased functional connectivity in the
default mode network, somatosensory, visual cortex, and parieto-frontal areas compared with the control group. This result indicates that green tea consumption impacts the brain activity
during resting state.
Asia Pac J Clin Nutr. 2019;28(4):740-746.doi: 10.6133/apjcn.201912_28(4).0010
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Association between serum ferritin and non-alcoholic fatty liver
disease among middle-aged and elderly Chinese with normal
weight
Author:Guoju You, Jie Ding, Jingli Shen, Yan Wang, Yongye Sun
Keywords:non-alcoholic fatty liver disease, ferritin, alanine aminotransferase, Chinese, normal weight
Abstract:Background and Objectives: Non-alcoholic fatty liver disease (NAFLD) in normal-weight population is becoming an important health issue. This study aimed to assess the association
between serum ferritin (SF) and NAFLD among middle-aged and elderly Chinese with normal weight. Methods and Study Design: A total of 2029 Chinese adults aged 35-70 years with normal weight were involved in this cross-sectional study. General information, lifestyle factors and laboratory characteristics were collected. The concentrations of serum alanine aminotransferase (ALT) and SF were recorded. Receiver operating characteristic (ROC) was applied to assess predictive performance of SF for NAFLD. Logistic regression analysis was
conducted to evaluate the associations of SF with NAFLD and elevated ALT. Results: Compared with controls, subjects with NAFLD had higher SF concentrations (p<0.001). In multivariate logistic regression analyses, the odds ratios (ORs) with 95% confidence intervals (CIs) of NAFLD were 3.19 (2.07-4.92) for the highest versus lowest quartile of SF. ROC analysis revealed a predictive ability of SF for NAFLD with an area under the curve of 0.660 (95% CI, 0.629-0.692). In addition, higher SF was significantly associated with increased risk of elevated ALT (OR=1.84, 95%CI: 1.32-2.55). In stratified analyses by gender and age, the positive associations of SF with the risk of NAFLD and elevated ALT were only observed in women and 35~49y group. Conclusions: Serum ferritin was positively associated with the
risk of NAFLD and elevated ALT among normal-weight Chinese adults. ROC analysis suggested that SF may serve as an indicator of predicting NAFLD.
Asia Pac J Clin Nutr. 2019;28(4):747-753.doi: 10.6133/apjcn.201912_28(4).0011
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Higher serum magnesium concentration is associated with lower hearing thresholds and risk of hearing loss among a Chinese population
Author:Yifei Cao, Yizhen Zhuang, Chenhui Li, Ying Ren, Yinyin Wu, Xiu Wang, Fei Wang, Haiyan Ma, Lei Yang, Liangwen Xu
Keywords:magnesium, hearing loss, population, cross-sectional study, linear regression analysis
Abstract:Background and Objectives: Hearing loss is a sensory impairment caused by genetic and environmental factors. Previous epidemiological studies of magnesium intake and hearing loss have been conflicting. Methods and Study Design: We investigated the association between serum magnesium concentrations and hearing loss in a population in Zhejiang region in China. A cross-sectional study of 3,267 participants aged 18 years and above from five hospitals was conducted from October 2016 to May 2018. Audiometric examination was conducted, and hearing thresholds as pure-tone averages (PTAs) at speech (0.5, 1, 2, and 4 kHz) and at high frequencies (3, 4, and 6 kHz) were computed. Magnesium concentrations were measured using an inductively coupled plasma mass spectrometer. Results: We found a negative association between magnesium levels and hearing loss from lower PTA to high PTA by linear regression analysis. After adjustment of potential confounders, participants in the highest quartile of magnesium had lower PTA (quartile 4: −1.89%; 95% confidence interval (CI: −3.07 to −0.701; p=0.022) and high PTA (quartile 4: −3.05%; 95% CI: −4.64 to −1.46; p=0.005) than those in the lowest quartile. Logistic regression analysis showed a dose-dependent reduction in the odds of high frequency hearing loss across quartiles of magnesium. In model 3, after adjusting for all potential confounders, participants with the highest quartiles of magnesium had a 54.0% (OR: 0.460; 95% CI: 0.339–0.587) reduction in the odds of high frequency hearing loss. Conclusions: Higher levels of whole blood magnesium in this population were associated with lower hearing thresholds and risk of hearing loss.
Asia Pac J Clin Nutr. 2019;28(4):754-760.doi: 10.6133/apjcn.201912_28(4).0012
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Association between copper levels and heart failure: a meta-analysis
Author:Lei Huang, Ronghuan Shen, Longfei Huang, Jing Yu, Hao Rong
Keywords:copper, Cu, heart failure, meta-analysis
Abstract:Background and Objectives: Copper dyshomeostasis can lead to many diseases, including cardiovascular disease. However, there are conflicting reports on the relationship between serum copper levels and heart failure (HF). To explore the relationship between serum copper levels and HF by performing a meta-analysis. Methods and Study Design: The PubMed and ScienceDirect databases until June 2019 were searched for reports on the association between serum copper levels and HF. Results: A total of thirteen studies including 1504 subjects were chosen for the meta-analysis. The pooled analysis indicated that patients with HF had higher copper levels than the control subjects [standardized mean difference (SMD), 0.982; 95% confidence interval (CI), (0.679, 1.285)]. Subgroup analysis stratified by different geographic locations found that HF patients had higher copper levels than the control subjects in Asia and Europe [Asia: SMD, 0.948 and 95% CI, (0.569, 1.327); Europe: SMD, 1.275 and 95% CI, (0.633, 1.917)], but not in America [America: SMD, 0.637 and 95% CI, (-0.109, 1.383)]. Additionally, subgroup analysis revealed that patients with ischemic cardiomyopathy (ICM) [SMD, 1.171; 95% CI, (0.717, 1.624)], idiopathic dilated cardiomyopathy (IDCM) [SMD, 0.569; 95% CI, (0.097, 1.042)] and other types of HF [SMD, 1.152; 95% CI, (0.594, 1.710)] all had higher copper levels than controls. Further subgroup analysis stratified by Newcastle–Ottawa Scale (NOS) scores also found higher serum copper levels in patients with HF than controls within each subgroup. Conclusions: Our meta-analysis identified a significant association between high copper levels and HF.
Asia Pac J Clin Nutr. 2019;28(4):761-769.doi: 10.6133/apjcn.201912_28(4).0013
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Dietary intakes of fruits and vegetables and lung cancer risk in participants with different smoking status: a meta-analysis of prospective cohort studies
Author:Ting Yang, Chong Wang, Shan Li, Xiao-fei Guo, Duo Li
Keywords:vegetable, fruit, smoking status, lung cancer, meta-analysis
Abstract:Background and Objectives: The results from epidemiological studies are controversial between vegetable and fruit consumption and lung cancer risk in participants with different smoking status. The present meta-analysis aimed to investigate these associations with prospective cohort studies. Meanwhile, the potential dose-response relationship was evaluated. Methods and Study Design: Relevant studies were identified with PubMed and Scopus databases up to June 2019. Multivariate-adjusted relative risks for the highest versus the lowest category and 95% confidence intervals were calculated by using a random-effects model. The dose-response relationship was examined by using restricted cubic spline regression model. Results: Eight prospective studies were included for data synthesis. The summary estimates indicated that higher vegetable and fruit intake was significantly associated with lower risk of lung cancer in participants with current smokers (RR: 0.84, 95% CI: 0.73, 0.95; I2=25.2%). No significant association was found in former smokers (RR: 0.97, 95% CI: 0.88, 1.07; I2=15.0%) and never smokers (RR: 0.90, 95% CI: 0.74, 1.11; I2=6.6%). Dose-response analysis showed that 100 g/day increment of vegetable and fruit intake was associated with a 2% reduction in lung cancer risk among current smokers (95% CI: 0.97, 0.99). Conclusions: The present meta-analysis provides significant evidence of an inverse association between vegetable and fruit intake and lung cancer risk in current smokers.
Asia Pac J Clin Nutr. 2019;28(4):770-782.doi: 10.6133/apjcn.201912_28(4).0014
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Citrus fruit intake and the risk of nasopharyngeal carcinoma
Author:Xin-Xin Feng, Ming-Xu Wang, Ming Li, Xiao Tang, Hong Jiang, Rui Wang, Le Ma, Yue Yin, Chang-Rui Wu
Keywords:citrus fruit consumption, nasopharyngeal carcinoma, dose-response analysis, protective effects, meta-analysis
Abstract:Background and Objectives: Citrus fruit are suggested to be associated with reduced risk of nasopharyngeal carcinoma (NPC), but findings from epidemiologic studies have been inconsistent. We aimed to synthesize the association by conducting a meta-analysis of existing evidence. Methods and Study Design: Databases including Medline, EMBASE, Web of science, and the Cochrane Library were searched for eligible studies up to March 2019 using a series comprehensive searching terms. The adjusted odds ratios (ORs) of citrus fruit intake with NPC risk from each study were extracted to calculate a pooled association estimate with its 95% confidence interval (CI). Results: Nine studies totaling 3304 cases and 3850 controls were included in this analysis. Citrus fruit intake was significantly associated with reduced risk of NPC (OR: 0.72, 95% CI 0.58-0.91, p=0.005). In addition, this association tended to be stronger in Chinese (OR: 0.67, 95% CI 0.54-0.84, p<0.001). Dose-response analysis using cubic splines showed the risk of NPC decreased by 21% for citrus fruit intake of 4 times/week (OR: 0.79, 95% CI 0.66-0.94). Conclusions: The consumption of citrus fruit was associated with a significant reduced risk of NPC, especially in Chinese population.
Asia Pac J Clin Nutr. 2019;28(4):783-792.doi: 10.6133/apjcn.201912_28(4).0015
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Postpartum anemia is a neglected public health issue in China: a cross-sectional study
Author:Ai Zhao, Jian Zhang, Wei Wu, Peiyu Wang, Yumei Zhang
Keywords:underutilized food crops, diet quality, children, food insecurity, complementary feeding
Abstract:Background and Objectives: Anemia impairs the health and wellbeing of women and increases the risk of maternal and neonatal adverse outcomes. The objectives of this study are to determine the prevalence of postpartum anemia among urban lactating women; investigate the predictors of anemia and explore the potential health effects on lactating performance. Methods and Study Design: Multi-stage sampling methods were used to recruit 495 lactating women from 3 cities of China. Blood and breast milk samples were collected to analyze hemoglobin levels and iron content, respectively. The intakes and sources of iron-rich food and nutrients were investigated based on Food Frequency Questionnaire and 24 h dietary recall. Results: The overall prevalence of postpartum anemia was 32.7%; no cases of severe anemia were encountered. Women who living in Guangzhou had a significant higher anemia prevalence. Regards to dietary intake, the amount of iron intake was generally good with a high proportion of heme iron. The animal sources ratio was 23.0%. Total iron intake and the sources of iron were not associated with anemia. Vitamin C intake was significantly higher in non-anemic women (Median (25th, 75th) was (72.6 (38.4, 130.0) mg/d)) than anemic women (54.7 (30.7, 111.3) mg/d). Other nutrient enhancers were not associated with anemia. There were no significant differences in the iron content of breast milk between women with and without anemia (r=0.047, p=0.302). Conclusions: Postpartum anemia is common in urban Chinese women. A combination of interventions, including managing antenatal anemia and correcting inappropriate dietary habits will help to prevent postpartum anemia.
Asia Pac J Clin Nutr. 2019;28(4):793-799.doi: 10.6133/apjcn.201912_28(4).0016
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Colostral and mature breast milk protein compositional determinants in Qingdao, Wuhan and Hohhot: maternal food culture, vaginal delivery and neonatal gender
Author:Biao Liu, Fangjie Gu, Wenhui Ye, Yiping Ren, Shuntang Guo
Keywords: κ-casein; β-casein; lactoferrin; serum albumin; α-lactalbumin
Abstract:Background and Objectives: Breast milk proteins are essential to infants as they provide nutrition and protection. This study evaluated multiple factors that might influence breast milk proteins to identify the determinants that lead to inter-individual and longitudinal differences. Methods and Study Design: Five major breast milk proteins (β-casein, α-lactalbumin, lactoferrin, serum albumin and κ-casein) from breast milk samples collected from 55 mothers in three cities (Hohhot, Wuhan and Qingdao) in China were analyzed using a validated ultraperformance liquid chromatography-mass spectrometry method. Various factors were statistically evaluated for their associations with breast milk proteins: mother’s age, parity, delivery mode, infant gender and infant birthweight. Results: Although decreased in concentrations, the proportions of β-casein and α-lactalbumin increased from colostrum (33.8% and 26.8%) to mature milk (40.3% and 31.6%), respectively. Mothers of older age were found to produce a lower concentration of total protein. Compared with vaginal delivery, caesarean section was associated with lower concentrations of κ-casein, lactoferrin and β-casein in mature milk. Infant gender influenced breast milk proteins in colostrum: mothers who delivered a girl tended to produce more κ-casein, lactoferrin and total protein. Furthermore, regional differences were found, and mothers from Hohhot produced significantly higher concentrations of α-lactalbumin and lactoferrin than those from Qingdao and Wuhan. This regional difference might be linked to the different dietary patterns of these mothers among cities. Conclusions: Our study deepens the understanding of breast milk protein dynamics in Chinese population and provides evidence on potential determinants, which can serve as guidance for infant nutrition optimization.
Asia Pac J Clin Nutr. 2019;28(4):800-811.doi: 10.6133/apjcn.201912_28(4).0017
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The association between parental weight status and risk of hypertension in children aged 6 to 12 years
Author:Liping Lu, Cheng Chen, Pengcheng Xun, Jialu Wang, Yanping Wan, Ka He
Keywords:hypertension, children, parents, weight status, overweight
Abstract:Background and Objectives: Parents may play important roles in the regulation of children’s weight status and consequently the development of childhood hypertension. Thus, this study aimed to examine parental weight status, as a marker of parents’ diet and lifestyle, in relation to risk of hypertension in their children. Methods and Study Design: A total of 1,949 children aged 6 to 12 years (1,012 girls, 52%) and their parents were included. Information on demographics, anthropometrics, lifestyle, diet, and medical history were obtained from the participants and their parents through self-administered questionnaires. Childhood hypertension and elevated blood pressure were defined as SBP and/or DBP ≥95th and ≥90th age- and gender-specific percentile, respectively. Parental overweight was defined as BMI ≥24.0 kg/m2. Results: The prevalence of childhood hypertension was 8.4%, with no significant gender difference (p=0.36). Parents’ weight status, especially maternal, was associated with childhood hypertension. After adjustment for potential confounders, children with two parents being overweight were two times more likely to have hypertension as compared with children who had both parents being of normal weight [multivariable-adjusted odds ratio=2.09; 95% confidence interval: (1.26, 3.46)]. After further adjustment for children’s body mass index, the observed association was substantially attenuated and became statistically non-significant. Conclusions: Findings from this study suggest that parental weight status is associated with the prevalence of hypertension in children presumably through influencing children’s weight. Further studies are needed to establish causal inference. This study highlights the importance of parental lifestyle in children’s health.
Asia Pac J Clin Nutr. 2019;28(4):812-818.doi: 10.6133/apjcn.201912_28(4).0018
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Associations between iron status and insulin resistance in Chinese children and adolescents: findings from the China Health and Nutrition Survey
Author:Junxiang Wei, Xiaoqin Luo, Sirui Zhou, Xin He, Jinge Zheng, Xiaomin Sun, Wei Cui
Keywords:iron status, insulin resistance, HbA1c, children and adolescents, sex
Abstract:Background and Objectives: Iron homeostasis abnormalities are associated with insulin resistance (IR), but studies on such associations in children and adolescents are limited and have contrasting results. The purpose of this study was to determine the associations between indicators of iron status and IR, and assesse if there are sex disparities in these associations. Methods and Study Design: We selected data of 689 children and adolescents (367 boys and 322 girls) aged 6-18 years in the analysis. Serum ferritin, transferrin, and soluble transferrin receptor (sTfR) levels were determined. The level of glycated hemoglobin (HbA1c) was assessed using high-performance liquid chromatography. Homeostasis model assessment of insulin resistance (HOMA-IR) was used to indicate the status of insulin resistance. Stepwise and multivariate logistic regression analyses were computed to evaluate associations between iron status and glucose parameters. Results: The prevalence of IR (HOMA-IR >3.16) and high HbA1c (HbA1c ≥5.7%) were 29.8% and 16.4%, respectively. Serum transferrin and sTfR were significant associated with HbA1c (p<0.001), while serum transferrin was associated with HOMA-IR (p<0.001). Furthermore, the highest transferrin concentrations were associated with higher risks of both HOMA-IR and high HbA1c, while decreased sTfR concentrations were associated with a risk of higher HbA1c in both children and adolescents. Conclusions: Serum transferrin and sTfR were statistically significantly associated with glucose parameters, which may suggest that transferrin and sTfR levels should be taken into consideration when studying IR in both boys and girls.
Asia Pac J Clin Nutr. 2019;28(4):819-825.doi: 10.6133/apjcn.201912_28(4).0019
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Nutritional potential of underutilized food crops to improve diet quality of young children in food insecure prone area of Madura Island, Indonesia
Author:Dini Ririn Andrias, Umi Fahmida, Annis Catur Adi
Keywords:underutilized food crops, diet quality, children, food insecurity, complementary feeding
Abstract:Background and Objectives: Attention is currently given to the nutrition potential of underutilized food crops; however, only few studies have focused on this potential for young children. We investigate the nutrient composition of selected underutilized food crops in Bangkalan District, Madura Island, Indonesia, to determine its potential in meeting the nutritional needs of young children during the complementary feeding period. Methods and Study Design: We obtained data on the availability of underutilized food crops from a cross-sectional study conducted in 2014 in Bangkalan District, Indonesia, and nutrient composition primarily from the Indonesian Food Composition Database. We considered underutilized food crops to hold nutritional potential if they contributed at least 15% per 100 g edible portion recommended nutrient intake for children aged 6–11 months and 12–23 months or 5% recommended nutrient intake per 100 kcal for iron, zinc, calcium niacin and folate. Results: We identified nutritionally potential underutilized food crops from several food groups, including Sorghum bicolor, Canna edulis, Colocasia esculenta (the starchy roots and leaves), Plectranthus rotundifolius, Amorphophallus paeoniifolius, Moringa oleifera (the leaves and pods), Limonia acidissima, and Benincasa hispida—all of which can be utilized for formulating the complementary feeding diet of young children. Conclusions: In a food insecure area where malnutrition is prevalent, underutilized food crops have potential to improve the nutrient intake of young children in their complementary feeding period. These should be promoted through the creation of acceptable recipes and formulation of complementary feeding recommendations, which include these underutilized nutrient-dense crops.
Asia Pac J Clin Nutr. 2019;28(4):826-836.doi: 10.6133/apjcn.201912_28(4).0020
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Relationship of sociodemographic and anthropometric characteristics, and nutrient and food intakes with osteoarthritis prevalence in elderly subjects with controlled dyslipidaemia: a cross-sectional study
Author:Youngseok Jeong, Si-woo Lee, Yeonjoon Kim, Kyuhwan Kim, Unkyo Seo, Kwang-Ho Bae
Keywords:dyslipidaemia, osteoarthritis, vitamin C, fish, seaweed
Abstract:Background and Objectives: Several studies have suggested that abnormal levels of serum cholesterol may be a major risk factor for osteoarthritis. However, no studies have been conducted to prevent osteoarthritis under controlled conditions of serum cholesterol. This study aimed to examine the relationship of sociodemographic and anthropometric characteristics, and nutrient and food intakes with osteoarthritis prevalence in Korean elderly subjects with controlled dyslipidaemia. Methods and Study Design: This study included 314 subjects aged ≥65 years who were diagnosed and treated for dyslipidaemia (data from the Seventh Korea National Health and Nutrition Examination Survey, 2016). Among them, 108 were also diagnosed with osteoarthritis. Sociodemographic, health, and nutritional data were analysed. Results: Osteoarthritis prevalence was higher in females, higher-educated subjects, unmarried subjects, non-smokers, and subjects with high body mass index (p<0.05). After adjusting for the multiple variables, the non-osteoarthritis group had significantly higher vitamin C intake (132±11.0 vs 93.1±11.1 mg/day), fish intake (172±30.0 vs 79.0±12.9 g/day), and seaweed intake (93.7±19.3 vs 38.3±13.4 mg/day) than the osteoarthritis group. Furthermore, the lowest vitamin C, fish, seaweed intake group (quartile 1) each had 3.20, 2.76, 9.93 times higher risk of osteoarthritis than the highest vitamin C, fish, seaweed intake group (quartile 4) (p<0.05). Conclusions: Among Korean elderly subjects with controlled dyslipidaemia, those with osteoarthritis had lower vitamin C, fish, seaweed intakes than those without osteoarthritis. Although our results do not prove that low vitamin C, fish, seaweed intakes cause osteoarthritis, such relationship is worth exploring for preventive perspective.
Asia Pac J Clin Nutr. 2019;28(4):837-844.doi: 10.6133/apjcn.201912_28(4).0021
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Salt intake assessed by spot urine samples initiated in the
physical examination population in Hunan, China
Author:Pingting Yang, Zhiheng Chen, Lu Yin, Yaguang Peng, Xiaohui Li, Xia Cao, Yaqin Wang, Saiqi Yang, Xiaoling Zhu, Xue He, Xuelian Liu, Ying Li
Keywords:salt intake, routine physical examination, Tanaka method
Abstract:Background and Objectives: Excessive salt intake is a major public health problem in several countries, especially in China. However, few people are aware of their salt intake. The purpose of this study is to carry out salt intake test in routine physical examination, and to explore the salt intake of different populations and their correlation with diet. Methods and Study Design: Spot urine sample was collected to test urinary sodium and creatinine excretions for each participant recruited from physical examinations at the Third Xiangya Hospital. The Tanaka formula was used to estimate 24-h urinary sodium excretion, which reflects salt intake. In addition to physical and laboratory examination, information including personal details, health-related habits, and self-reported disease histories was obtained from the National Physical Examination Questionnaire. Results: In total, 26,406 people completed the salt intake evaluation. After data cleansing, the average salt intake was 8.39±1.80 g/d. Male, middle-aged, overweight and obese, hypertensive, and dyslipidaemic populations, as well as those with non-cardiovascular diseases were more likely to have excessive salt intake. Dietary sources had an effect on salt intake. Salt intake was lower in those who consumed more milk and fruit (both p and p trend<0.01) but was higher in those who consumed more lean meat (both p and p trend<0.05), fatty meat (both p and p trend<0.01) and animal organs (both p and p trend<0.01). Conclusions: The results showed that the salt intake in this population far surpasses the recommended amount. We strongly recommend salt intake assessment as routine test into physical examination center.
Asia Pac J Clin Nutr. 2019;28(4):845-856.doi: 10.6133/apjcn.201912_28(4).0022
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Associations of dietary diversity with allergic diseases in Japanese workers: a cross-sectional study
Author:Mariko Nakamoto, Mariko Omine, Yuna Yun, Emi Shuto, Akiko Nakamoto, Akiko Hata, Nanako Aki, Yosuke Shikama, Yukiko
Bando, Takako Ichihara, Takako Minamigawa, Ayako Tamura, Yumi Kuwamura, Makoto Funaki and Tohru Sakai
Keywords:allergic diseases, allergic rhinitis, dietary diversity, Japanese workers, cross-sectional study
Abstract:Background and Objectives: The aim of this study was to determine the associations of dietary diversity with prevalences of allergic diseases. Methods and Study Design: The participants were 1,317 men and women aged 20 to 63 years who were living in Tokushima Prefecture, Japan during the period 2012–2013. We obtained anthropometric data and information on life style characteristics and current medical histories of allergic diseases using a self-administered questionnaire. Dietary intake was assessed using a food frequency questionnaire, and dietary diversity was determined using the Quantitative Index for Dietary Diversity (QUANTIDD). The ORs and 95% CIs for each of the allergic diseases with a 1
standard deviation (SD) increase in the QUANTIDD score were estimated, controlling for age, family history of allergic diseases, education, smoking, drinking, physical activity, energy intake and BMI. Results: Higher dietary diversity showed significant inverse dose-response relationships with allergic diseases and allergic rhinitis in women. Multivariate-adjusted ORs(95% CI) for allergic diseases and allergic rhinitis with 1 SD increase in the QUANTIDD score were 0.77 (95% CI: 0.60-0.98, p=0.037) and 0.69 (95% CI: 0.53-0.90, p=0.007), respectively, in women. There were no significant associations between dietary diversity and allergic diseases in men. Conclusions: The results indicate that there is an association between higher dietary diversity and allergic rhinitis in Japanese female workers
Asia Pac J Clin Nutr. 2019;28(4):857-869.doi: 10.6133/apjcn.201912_28(4).0023
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Metabolic syndrome and risks of carotid atherosclerosis and cardiovascular events in community-based older adults in China
Author:Chunxiu Wang, Xianghua Fang, Xiaoguang Wu,Yang Hua, Zhongying Zhang, Xiang Gu, Zhe Tang, Shaochen Guan, Hongjun Liu, Beibei Liu, Xunming Ji
Keywords:metabolic syndrome, cohort study, food patterns, carotid atherosclerosis, myocardial infarction
Abstract:Background and Objectives: Previous studies on the importance of metabolic syndrome (MS) as a cardiovascular risk factor had not focused on older Chinese adults. The present study analyzed the association of MS with carotid atherosclerosis and the risk of cardiovascular events in Chinese adults. Methods and Study Design: Data of a representative cohort study with 5-year follow-up were used. Community-dwelling people (n=1257) aged ≥55 years without cardiovascular disease (CVD) at baseline were followed up from 2009 to 2014. MS was defined based on the Chinese Diabetes Society criteria under the Chinese Medical Association. Multiple regression analyses were performed to examine the associations of MS with atherosclerosis and CVD events, with adjustment for confounding factors. Results: In a multivariate logistic regression model with adjustment, MS was closely related to common carotid artery intima–media thickness (CCA-IMT) (1.62; 95% CI: 1.19–2.21) and carotid plaque presence (1.38; 95% CI: 1.01–1.89), but not with carotid artery stenosis. At the end of the 5-year follow-up, compared with subjects without MS, hazard ratios and 95% confidence intervals for the different risks in subjects with MS were 1.86 (1.02–3.29) for myocardial infarction (MI), 1.39 (1.01–2.05) for stroke, 1.52 (1.02–2.37) for CVD death, and 1.13 (0.62–2.58) for total death, after adjusting for age, gender, smoking, drinking, physical activity, uric acid, high-sensitivity C-reactive protein, dietary factors and carotid atherosclerosis status. Conclusions: MS was significantly associated with IMT and the presence of carotid plaque and with positively increased risks of MI, stroke, and CVD mortality independent of CVD risk factors in older Chinese adults.
Asia Pac J Clin Nutr. 2019;28(4):870-878.doi: 10.6133/apjcn.201912_28(4).0024
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Genetic and epigenetic regulation of BHMT is associated with folate therapy efficacy in hyperhomocysteinaemia
Author:Dankang Li, Jiao Yang, Qinglin Zhao, Chengda Zhang, Bingnan Ren, Limin Yue, Binghui Du, Opolot Godfrey, Xiaowen Huang, Weidong Zhang
Keywords:hyperhomocysteinaemia, BHMT, gene polymorphisms, epigenetic, mediation analysis
Abstract:Background and Objectives: Hyperhomocysteinaemia (HHcy) is an independent risk factors for several disorders, including cardiovascular disease. The understanding of the relationship among genetic, epigenetic and the efficacy of folate therapy for HHcy remain unclear. This study aim to investigate whether betaine-homocysteine methyltransferase (BHMT) single-nucleotide polymorphisms (SNPs) and DNA methylation are related to the efficacy of folate therapy for HHcy and whether BHMT DNA methylation mediates the SNP–folate therapy efficacy association. Methods and Study Design: A total of 638 patients with HHcy were involved in this prospective cohort study. Logistic and linear regression was used to explore associations among SNPs, DNA methylation, and folate therapy efficacy. Finally, mediation analysis was performed to investigate whether DNA methylation of BHMT mediates the association between SNPs and folate therapy efficacy. Results: BHMT rs3733890 was significantly associated with folate therapy efficacy (p<0.05). BHMT and BHMT_1 DNA methylation level was significantly associated with folate therapy efficacy (p=0.017 and p=0.028). DNA methylation of BHMT and BHMT_1 mediated 34.84% and 33.06% of the effect of rs3733890 on folate therapy efficacy, respectively. Conclusions: There has a consistent interrelationship among BHMT genetic variants, methylation levels of BHMT, and folate therapy efficacy. BHMT and BHMT_1 DNA methylation proportionally mediated the effects of rs3733890 SNPs on the efficacy of folate therapy for HHcy.
Asia Pac J Clin Nutr. 2019;28(4):879-887.doi: 10.6133/apjcn.201912_28(4).0025
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