Central obesity and risk of cardiovascular disease in the Asia Pacific Region
Author:Asia Pacific Cohort Studies Collaboration
Keywords:abdominal obesity, waist circumference,waist hip ratio, cardiovascular diseases, cohort studies, Asia
Abstract:This paper compares body mass index, waist circumference, hip circumference, and waist-hip ratio as risk
factors for ischaemic heart disease and stroke in Asia Pacific populations. We undertook a pooled analysis
involving six cohort studies (45 988 participants) and used Cox proportional hazards regression to assess the
associations of the four anthropometric indices with stroke and ischaemic heart disease by age, sex and region.
During a mean follow-up of six years, 346 stroke and 601 ischaemic heart disease events (fatal and non-fatal)
were documented. Overall, a one-standard deviation increase in index was associated with an increase in risk of
ischaemic heart disease of 17% (95% CI 7-27%) for body mass index, 27% (95% CI 14-40%) for waist
circumference, 10% (95% CI 1-20%) for hip circumference, and 36% (95% CI 21-52%) for waist-hip ratio.
There were no significant differences between age groups, sex, and region. None of the four anthropometric
indices had a strong association with risk of stroke. These data indicate that measures of central obesity such as
waist circumference and waist-hip ratio are strongly associated with risk of ischaemic heart disease in this
region. Therefore, we suggest that, along with calculation of body mass index, measures of central obesity such
as waist circumference and waist-hip ratio should be undertaken routinely.
Asia Pac J Clin Nutr. 2006;15(3):287-292.doi:
>>Abstract
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Defining obesity by body mass index in the Thai population: an epidemiologic study
Author:Chatlert Pongchaiyakul MD, Tuan V Nguyen PhD, Vong
Keywords:BMI, percentage body fat, epidemiology, Thailand,Asian
Abstract:The objective of this study was to develop cut-off values and evaluate the accuracy of body mass index(BMI)
in the definition of obesity in the Thai population. A cross-sectional, epidemiologic study in 340 menand 507
women aged 50 ± 16 yr (mean ± SD; range: 20-84 yr),were sampled by stratified clustering sampling method.
Body composition, including percentage body fat (%BF), was measured by dual energy X-ray absorptiometry
(GE Lunar Corp, Madison, WI). BMI was obtained by dividing weight (in kg) by height (in m
2
). The “golden
standard” for defining obesity was %BF ≥ ≥≥ ≥ 25% in men and %BF ≥ ≥≥ ≥35% in women. The %BF-based prevalence
of obesity in men and women was 18.8% and 39.5%, respectively. However, using the BMI cut-off of ≥ ≥≥ ≥30,
only 2.9% of men and 8.9% of women were classified as obese. In the cubic regression model, BMI was a
significant predictor of %BF, such that in men a BMI of 27 kg/m
2
would predict a %BF of 25%, and in women
a BMI of 25 kg/m
2
would correspond to a %BF of 35%. The area under the receiver operating characteristic
curve for BMI was approximately 0.87 (95% CI: 0.82-0.92) and 0.86 (95% CI: 0.83-0.90) in men and women,
respectively. In conclusion, for the Thai population, BMI is a reasonably useful indicator of obesity; however,
the cut-off values of BMI for diagnosing obesity should be lowered to 27 kg/m
2
in men and 25 kg/m
2
in
women.
Asia Pac J Clin Nutr. 2006;15(3):293-299.doi:
>>Abstract
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Relation of anthropometric parameters to the functional assessment of HDL particle size in three ethnic cohorts
Author:Hamidreza Zakeri MD Jiri J Frohlich MD and Scott A
Keywords:anthropometry; lipoproteins, HDL; Asians
Abstract:The purpose of this study was to characterize the association between HDL particle size (assessed by fractional
esterification rate in apo B depleted plasma (FER
HDL
)), and anthropometric measures in men and women of
Chinese, European and South Asian origin and to determine if ethnic background is a modifier of this
relationship. A convenience sample of apparently healthy men and women of Chinese (n=56), European
(n=66) or South Asian (n=76) descent were recruitedand assessed for body mass index, waist circumference,
blood pressure, lipids, insulin, glucose and FER
HDL. Univariate correlations with FERHDL
were determined
within each ethnic–gender group. Regression analysis was used to determine if ethnicity was a significant
modifier of the relationship between FERHDL and waist circumference. FERHDL
was significantly correlated
with various anthropometric measures within the ethnic and gender groups. The relationship between waist
circumference and FER
HDL
was significantly different between the European, and Chinese and South Asian
groups combined in women, but not in men. After adjustment for age, body mass index and insulin, ethnicity
was no longer a significant predictor. However, ethnic background (European vs. Chinese/South Asian) was a
significant predictor (P=0.034) of the relationship between FER
HDL
and waist circumference adjusted for age,
gender, body mass index and insulin in the entire cohort. Increasing adiposity in Chinese and South Asian men
and women is associated with a less protective HDL particle profile. Ethnic background (Asian compared to
European) is a significant modifier of the relationship between FERHDL
and waist circumference.
Asia Pac J Clin Nutr. 2006;15(3):300-306.doi:
>>Abstract
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Use Of [ 14 C]-sodium bicarbonate/urea to measure total energy expenditure in overweight men and women before and after low calorie diet induced weight loss
Author:Natalie D Luscombe PhD, Christopher TsopelasPhD, M
Keywords:energy expenditure, thermic effect of feeding, weight loss, low calorie diet, clinical intervention
Abstract:The aim of this study was to evaluate the use of the [
14
C]-sodium bicarbonate/urea technique to measure the
change in total energy expenditure after weight loss and a period of weight maintenance. Eleven healthy
subjects (6 men and 5 women aged 50 ± 3 yrs, BMI 34.1 ± 2.1 kg/m
2
, body fat 38.7 ± 3%) underwent 8 weeks
of energy restriction using a combination of ‘Modifast™’ formula and one small meal per day (≈3.3 MJ/day).
For an additional 2-weeks, subjects resumed a solidfood diet that contained enough energy to stabilize body
weight at the newly reduced level. Body composition, total energy expenditure (TEE), resting energy
expenditure (REE) and the thermic effect of a 2.7 MJtest meal (TEF) were measured at both weeks 0 and 10.
At week 10 as compared to week 0, body weight decreased by 12.2 ±1.6 kg (12.5%) (P< 0.001). Total fat and
lean mass decreased by 8.4 ±1.0 kg (20.4%) and 3.8 ±0.7 kg (6.7%), respectively (P< 0.001). REE decreased
by 500 ±128 kJ/day (5.6 ±1.3%) (P< 0.002). Decreases in the TEE (0.18 ±3.7%) and TEF (1.4 ±0.9%) were
not significant. In conclusion, although [
14
C]-sodium bicarbonate/urea was well tolerated and did not interfere
with normal daily activities, it did not have sufficient sensitivity to accurately measure weight loss induced
changes in TEE in the range of 0.1-10%.
Asia Pac J Clin Nutr. 2006;15(3):307-316.doi:
>>Abstract
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Validity and reliability of BodyGem for measuring resting metabolic rate on Taiwanese women
Author:Tsan-Hon Liou MD, Ching-Min Chen RN DNS, Wan-Yu Ch
Keywords:women, reliability, validity, resting metabolic rate, indirect calorimeter, Harris-Benedict equations, Taiwan
Abstract:Resting metabolic rate (RMR) accounts for about two thirds of total energy expenditure. The widely used
Harris-Benedict equations systematically overestimate RMR. This study assessed overall reliability and
validity of a handheld indirect calorimeter, BodyGem, on a sample of women. Thirty healthy nurses
participated in this study with an age of 41.9 ± 9.0 years old and a body mass index of 24.0 ± 2.8 kg/m
2
. The
Deltatrac Metabolic Monitor was used as the criterion method to validate BodyGem. Reliability was estimated
by repeated measures of BodyGem to test internal consistency and stability. Analysis indicated that
measurements of Deltatrac and BodyGem are well correlated (r = 0.76, P < 0.001). The correlation coefficients
of two BodyGem RMR measurements were of large statistical significance (r = 0.96, P <0.001, mean
difference = 15.8±55.8 Kcal/d). A significant difference (F = 3.81, P= 0.04) in repeated measures ANOVA and
post hoc revealed a difference between BodyGem and Deltatrac. There was a systematic difference between
both methods (mean difference between BodyGem and Deltatrac = 36.4~52.2 Kcal/d). After adjustment of
additional energy demand by holding BodyGem in position, the difference became non-significant (F = 1.62, P
= 0.22). Bland-Altman plots revealed that there was no significant trend in both methods, and repeated
measurements of Bodygem. In conclusion, RMR obtained using the BodyGem has a high degree of
reproducibility and an acceptable validity compared to the Deltatrac. Further validity research is needed in
Taiwanese women.
Asia Pac J Clin Nutr. 2006;15(3):317-322.doi:
>>Abstract
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Nutrition education in medical schools in Japan: results from a questionnaire survey
Author:Hideo Orimo MD, PhD, Toshiro ShimuraMD, PhD and Ta
Keywords:nutrition education, medical schools, Japan, questionnaire, curriculum
Abstract:Diet is known to play a critical role in the pathogenesis of major age-related chronic diseases, whichare rapidly
becoming more common in Japan and other industrialized countries. However, traditional medical education
has not provided adequate knowledge of nutrition. To understand the current status of nutrition education in
Japan, we sent a questionnaire to all Japanese medical schools to survey their nutrition curricula. The
questionnaire was sent to 79 medical schools in Japan, which includes all medical schools except for that of the
authors. We also used a questionnaire to survey second year medical students just after they receiveda short
nutrition course at Nippon Medical School. Fifty-seven medical schools (72.2%) responded to the
questionnaire: 12 (21.1% of the responding schools) offered a “nutrition” course and 3 (5.4%) offered a
“clinical nutrition” course. Including “nutrition”and “clinical nutrition” courses, 14 of the responding medical
schools (24. 6 %) offered stand-alone nutrition courses in their undergraduate education. Although a total of 48
of the responding medical schools (84.2%) offered some nutrition topics, only 8 of the responding schools
(14.0%) may have offered substantial nutrition education. No special postgraduate course in medical or clinical
nutrition was offered by any of the schools. Despite this, more than 80% of the students that appeared to be
interested in a nutrition course recognized the importance of nutrition education in medical school. This survey
showed that nutrition education in Japanese medicalschools remains inadequate and changes are necessary.
Asia Pac J Clin Nutr. 2006;15(3):323-328.doi:
>>Abstract
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Nutritional status of pregnant women in Northeast Thailand
Author:Christoph U Andert, Pattara Sanchaisuriya PhD, Kan
Keywords:nutritional status, pregnancy, vitamin A, iron, carotenoids
Abstract:A comparative study on the nutritional status of primiparous and multiparous women in the first trimester of
pregnancy was conducted in the northeastern province of Thailand, Khon Kaen, to investigate differences in
protein-energy-malnutrition, iron deficiency anaemia, vitamin A deficiency and carotenoid status between both
parity groups. 94 subjects were recruited at first attendance of antenatal clinic. Data about weight, height,
haemoglobin and haematocrit were obtained from hospital records. Anthropometric measurements of midupper arm circumference and triceps skinfold were done on a sub sample. Retinol, carotenoids and
α-tocopherol were analysed using a reversed-phase high-performance liquid chromatography method. Ferritin,
transthyretin and retinol-binding protein were determined by enzyme–linked immunosorbent assay. Primiparous women showed lower body mass index, mid-upper arm circumference, corrected arm muscle area
(P <0.001) as well as lower retinol, cholesterol and triceps skinfold (P <0.05). After adjusting for age and
socio-economical status the significant difference persisted for all parameters but triceps skinfold. No
significant differences of α-tocopherol, serum proteins, carotenoids and iron indices could be observed, even
though a tendency to higher values for ferritin, haemoglobin and haematocrit was shown in multiparous
women. Prevalence of protein-energy-malnutrition (body mass index <18.5 kg/m
2
) in the primiparous group
was significantly higher compared to the multiparous group (P<0.05). Prevalence of protein-energymalnutrition, iron deficiency anaemia and vitamin Adeficiency were 15.1%, 6.3 % and 3.3%, respectively, in
the total study population. No differences between parity groups could be observed for prevalence of iron
deficiency anaemia and vitamin A deficiency.
Asia Pac J Clin Nutr. 2006;15(3):329-334.doi:
>>Abstract
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Which mothers take folic acid and folate containing foods?
Author:Colin Binns MBBS MPH PhD, Jane Scott MPH PhD, Nkeo
Keywords:folic acid, folate, pregnancy, Australia, socio-economic group
Abstract:This study documented the prevalence (proportion) of mothers taking folic as supplements or as fortified foods
and explored the factors that determined whether folic acid was taken. A cross sectional analysis of the
baseline data of mothers who participated in the Perth Infant Feeding Study was performed. A total of587
mothers who delivered at the two hospitals in the study completed baseline questionnaires. The factors
associated with the decision to take folic acid supplements or fortified foods were investigated using
multivariate logistic regression. Main outcome measures were the percentage of mothers taking folic acid or
folic acid fortified foods. A total of 455 (78%) mothers stated that they took folic acid supplements before or
during the first three months of their pregnancy. Of the 132 who did not take folate supplements only35 (6%
of all participating mothers) claimed to have taken folate fortified food or beverages. In the highest income
group, 87% of mothers took folic acid supplements compared to 64% in the poorest group. The significant
factors independently associated with not taking folic acid supplements or fortified food were “years of
education” (OR ‘10 years or less’ 0.45 (0.23-0.88)),“family income” (OR <$25000 0.40(0.20-0.80)), and for
taking folic acid “the timing of the pregnancy.” (OR ‘actively trying’ 2.01 (0.1.04-0.3.87)). There was a
significant proportion of mothers who did not take folic acid periconceptually. The mothers who were not
taking folic were less educated, from lower socio-economic groups and were not actively trying to fallpregnant
at the time they became pregnant. The results suggest that in order to reach all Australian mothers, mandatory
fortification of foods with folic acid should be required.
Asia Pac J Clin Nutr. 2006;15(3):335-340.doi:
>>Abstract
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Dietary and blood folate status of Malaysian women of childbearing age
Author:Geok Lin Khor PhD, G Duraisamy MBBS, Su Peng Loh P
Keywords:blood folate, neural tube defects, dietary intake, women, Malaysia
Abstract:The protective role of folic acid taken during the periconceptual period in reducing the occurrence ofneural
tube defects (NTD) has been well documented by epidemiological evidence, randomized controlled trials and
intervention studies. Much of the evidence is derived from western populations while similar data on Asian
subjects is relatively nascent. Baseline data on folate status of Malaysian women is lacking, while NTD
prevalence is estimated as 10 per 10,000 births. This study was conducted with the objective of determining the
dietary and blood folate status of Malaysian women of childbearing age. A total of 399 women comprising 140
Malay, 131 Chinese and 128 Indian subjects were recruited from universities and worksites in the suburbs of
Kuala Lumpur. Inclusion criteria were that the subjects were not pregnant or breastfeeding, not taking folic
acid supplements, not habitual drinkers or smokers. Based on a 24-hour recall, the median intake level for
folate was 202.4µg (59.4-491.8 µg), which amounts to 50.6% of the Malaysian Recommended Nutrient Intakes
level. The median (5-95
th
percentiles) values for plasma and red cell folate (RBC) concentrations were 11
(4-33) nmol/L and 633 (303-1209) nmol/L respectively. Overall, nearly 15.1% showed plasma folate
deficiency (< 6.8 nmol/L), with Indian subjects having the highest prevalence (21.5%). Overall prevalence of
RBC folate deficiency (< 363 nmol/L) was 9.3%, and an almost similar level prevailed for each ethnic group.
Only 15.2% had RBC concentration exceeding 906 nmol/L,which is associated with a very low risk of NTD.
The result of this study point to the need for intervention strategies to improve the blood folate status of women
of childbearing age, so that they have adequate protection against the occurrence of NTD at birth.
Asia Pac J Clin Nutr. 2006;15(3):341-349.doi:
>>Abstract
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Anaemia and iron deficiency anaemia among young adolescent girls from peri urban coastal area of Indonesia
Author:Yustina Anie Indriastuti Kurniawan MD, MSc, PhD, S
Keywords:iron, deficiency, anaemia, adolescent, girls, urban,Indonesia
Abstract:Anaemia due to iron deficiency is still a widespread problem. Among adolescent girls, it will bring negative
consequences on growth, school performance, morbidity and reproductive performance. This cross sectional
study aimed to identify the different nutritional and iron status characteristics of young adolescent girls 10 – 12
years old with iron deficiency anaemia and anaemia without iron deficiency in the rural coastal area of
Indonesia. Anaemic girls (N = 133) were recruited out of 1358 girls from 34 elementary schools. Haemoglobin, serum ferritin, serum transferrin receptor and zinc protophorphyrin were determined for iron status,
whilst weight and height were measured for their nutritional status. General characteristics and dietary intake
were assessed through interview. Out of 133 anaemic subjects, 29 (21.8%) suffered from iron deficiency
anaemia, which was not significantly related to ageand menarche. About 50% were underweight and stunted
indicating the presence of acute and chronic malnutrition. The proportion of thinness was significantly higher
(P<0.05) among subjects who suffered from iron deficiency anaemia (51.7% vs. 29.8%). Furthermore, thin
subjects had a 5 fold higher risk of suffering from iron deficiency anaemia (P< 0.05) than non-thin subjects
(OR: 5.1; 95%CI 1.34 -19.00). Further study was recommended to explore other factors associated with
anaemia and iron deficiency anaemia, such as the thalassemia trait and vitamin A deficiency. The current ironfolate supplementation program for pregnant women should be expanded to adolescent girls.
Asia Pac J Clin Nutr. 2006;15(3):350-356.doi:
>>Abstract
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Goitre prevalence and the state of iodine nutritionin sundarban delta of north 24-parganas in West Benegal
Author:Amar K Chandra PhD, Smritiratan Tripathy MSc, Dish
Keywords:endemic goiter, goitrogens, school children, urinaryiodine, urinary thiocyanate, West Bengal
Abstract:The main objective of this study was to assess the iodine nutritional status among school children (6-12 yrs) of
Sundarban delta in North 24- Parganas district of West Bengal in eastern India. A total of 2050 children were
clinically examined for goiter and 240 urine samples were analyzed for iodine and thiocyanate respectively;
iodine content in 48 water samples and 210 salt samples were also measured. Results indicate that the studied
region is clinically severely goiter endemic havinggoiter prevalence 33.1 % (grade 1: 30.4 %; grade 2: 2.7%),
median urinary iodine level 200 µg/l indicating no biochemical iodine deficiency, 65.2 % salt samples contain
recommended level of iodine and the iodine content in drinking water is sufficient while mean urinary
thiocyanate level was 0.708±0.38 mg/dl. In spite of the consumption of adequate iodine, the existing goiter
prevalence may be for the consumption of dietary goitrogens/antithyroid substances that possibly come through
food and water.
Asia Pac J Clin Nutr. 2006;15(3):357-361.doi:
>>Abstract
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Determination of discretionary salt intake in an iodine deficient area of East Java-Indonesia using three different methods
Author:Annasari Mustafa SKM, MSc, Siti Muslimatun Ir MSc
Keywords:lithium marker technique, 24-hour salt recall, salt weighing, discretionary salt intake
Abstract:As salt is a potential vehicle for delivering iodine to a population, study on salt intake is important. Many
methods have been used to measure iodised-salt intake, but the methods were suspected to be inaccurate. A
new method, called a lithium-marker technique, has been considered as suitable and safe; hence it has been
proposed as a gold standard for measuring the actual salt intake of an individual. We conducted a study to
determine discretionary salt intake using the lithium marker technique. The study shows that the total salt
intake for children (N =15) and mothers (N =15) were 5.4±2.1 g/d and 5.8±1.7 g/d respectively in which
48.5±17.1% and 50.5±17.3% were discretionary salt. The discretionary salt intake measured using lithium
marker (2.53 ± 1.2 g/d for children and 2.99 ± 1.5g/d for mother) were significantly lower than using 24-hour
salt recall (7.01±2.44 g/cap/d) and salt weighing (6.00±1.8 g/cap/d) (P<0.001). In conclusion, the discretionary
salt intake by 24-hour salt recall and salt weighing were over estimated as compared to the lithium-labelled salt
measurement. It is recommended that the level of iodine fortification in salt be increased up to 80-100 ppm of
KIO3
to provide iodine intake of 150µg/d
.
Asia Pac J Clin Nutr. 2006;15(3):362-367.doi:
>>Abstract
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Effects of probiotic or prebiotic supplemented milk formulas on fecal microbiota composition of infants
Author:Oscar Brunser MD, Guillermo Figueroa R.Tech, Marti
Keywords:breastfeeding, milk formula, fructooligosaccharides, infants, intestinal microbiota, Lactobacillus johnsonii La1, prebiotic, probiotic
Abstract:The aim of the study was to evaluate whether supplementation of milk-formulas with prebiotic fructooligosaccharides or a probiotic, Lactobacillus johnsoniiLa1 (La1), could modulate the composition of the fecal
microbiota of formula-fed infants, compared to breastfed (BF) infants. Ninety infants close to 4 monthsof age
were randomized into one of three groups to be blindly assigned to receive for 13 weeks: a) an infant formula
(Control), b) the same formula with fructo-oligosaccharides (Prebio), or c) with La1 (Probio). At the end of this
period, all infants received the control formula for 2 additional weeks. Twenty-six infants, breastfedthroughout
the study, were recruited to form group BF. Fecal samples were obtained upon enrolment and after 7 and 15
weeks. Bacterial populations were assessed with classical culture techniques and fluorescent in situ
hybridisation (FISH). Seventy-six infants completedthe study. On enrolment, higher counts of Bifidobacterium
and Lactobacillusand lower counts of enterobacteria were observed in BF compared to the formula-fed infants;
these differences tended to disappear at weeks 7 and 15. No major differences for Clostridium, Bacteroides or
Enterococcuswere observed between the groups or along the follow up. Probio increased fecal Lactobacillus
counts (P<0.001); 88% of the infants in this group excreted live La1 in their stools at week 7 but only 17% at
week 15. Increased Bifidobacterium counts were observed at week 7 in the 3 formula groups, similar to BF
infants. These results confirm the presence of higher counts of bifidobacteria and lactobacilli in the microbiota
of BF infants compared to formula-fed infants beforedietary diversification, and that La1 survives in the infant
digestive tract.
Asia Pac J Clin Nutr. 2006;15(3):368-376.doi:
>>Abstract
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A population-based survey on infant feeding practice (0-2 years) in Hong Kong: breastfeeding rate and patterns among 3,161 infants below 6 months old
Author:Warren T K Lee, PhD, RD (UK), Susan SH Lui, PhD, R
Keywords:breastfeeding, breastmilk, infant formulae, infants, Hong Kong
Abstract:The prevalence of breastfeeding for the first 6 months in infants has been low in Hong Kong since the 1970s.
In order to develop effective breastfeeding policies and promotion programs, an appraisal of feeding practices
and factors related to initiation and early cessation of breastfeeding is necessary. A survey with a populationbased representative sample was conducted to determine social-demographic, personal and cultural factors that
influenced decision, duration and practice of infant feeding among infants 0-24 months old. This paperfocuses
on infants below 6 months old to study factors related to decision, duration and practice of breastfeeding. In
1993, 7,298 healthy infants were recruited from 46 Maternal-and-Child-Health-Clinics (MCHC) throughout
Hong Kong, of whom 3161 were below 6 months old. The mother reported her feeding decision, duration and
practice in a questionnaire. Breastfeeding rate was found to be very low (8.4%) for infants below 6 months old.
Only 50.9% infants were breastfed. Infant formulaewere widely given among partiallybreastfed infants. 45%
mothers were full-time employed. Most mothers wereaware of the benefits of breastfeeding to the infants and
themselves. Husbands (43.3%) were regarded the most influential on initiation and duration on breastfeeding.
Restricted food varieties (54%), sore nipple and breast engorgement (67%), perceived home confinement
(41.5%) and perceived inadequate milk supply (31.7%) were major concerns upon breastfeeding. Furthermore,
76.9% mothers turned to MCHC staff for advice when they encountered difficulties during breastfeeding. In
conclusion, the survey collected population-based representative data on factors determining initiation and
early cessation of breastfeeding in Hong Kong in 1993. The findings will serve as a cornerstone in
understanding the evolution of breastfeeding practice in Hong Kong. It merits further study to investigate how
the confounders interplay to modulate initiation, duration and patterns of breastfeeding.
Asia Pac J Clin Nutr. 2006;15(3):377-387.doi:
>>Abstract
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Diet, nutritional knowledge and health status of urban middle-aged Malaysian women
Author:LW Pon MSc, MY Noor-Aini PhD, FB Ong PhD, N Adee
Keywords:food frequency, perimenopause, knowledge, health, middle-aged, women, urban, Malaysia
Abstract:The objective of the study was to assess nutritional and health status as well as nutritional knowledge in urban
middle-aged Malaysian women. The impact of menopause on diet and health indices was also studied. The study
included 360 disease free women, non users of HRT, aged ≥45 years with an intact uterus recruited from
November 1999 to October 2001. Personal characteristics, anthropometric measurements and blood sample were
acquired followed by clinical examination. Nutrient intake and nutritional knowledge was determined by a
quantitative FFQ and KAP. The findings showed that urban middle-aged women, aged 51.65±5.40 years had
energy intakes (EI) 11% below RDA, consisting of 53% carbohydrates, 15% protein and a 32% fat which
declined with age. The sample which comprised of 42.5% postmenopausal women had a satisfactory diet and
healthy lifestyle practices. Premenopausal women consumed more dietary fat (6%) with other aspects ofdiet
comparable to the postmenopausal women. Iron intake was deficient in premenopausal women, amounting to
56% RDA contributing to a 26% prevalence of anaemia.Overall, calcium intake reached 440mg daily but dairy
products were not the main source. The postmenopaused had a more artherogenic lipid profile with significantly
higher total cholesterol (TC) and LDL-C, but more premenopausal women were overweight/obese (49% versus
35%). EI was the strongest predictor for BMI and waist circumference (WC), with WC itself an independent
predictor of fasting blood sugar and TC with BMI strongly affecting glucose tolerance. High nutritional
knowledge was seen in 39% whereas 20% had poor knowledge. Newspapers and magazines, followed by the
subject's social circle, were the main sources of nutritional information. Nutritional knowledge was positively
associated with education, household income, vitamin/mineral supplementation and regular physical activity but
inversely related to TC. In conclusion, middle-aged urban women had an adequate diet with low iron and
calcium intakes. Nutritional knowledge was positively associated to healthier lifestyle practices andlower TC.
A comparable nutrient intake and lifestyle between pre and postmenopausal women suggested that health
changes associated with menopause was largely independent of diet.
Asia Pac J Clin Nutr. 2006;15(3):388-399.doi:
>>Abstract
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Good oral health, adequate nutrient consumption and family support are associated with a reduced risk of being underweight amongst older Malaysian residentsof publicly funded shelter homes
Author:Renuka Visvanathan FRACP, MBBS, PhD and Zaiton Ah
Keywords:Body mass index, oral health, nutrition, social support, poverty, homeless, elderly, shelter homes, Malaysia
Abstract:A low body mass index in older people has been associated with increased mortality. The main objectiveof
this study was to identify factors associated with low body mass indices [BMIs] (< 18.5 kg/m
2
) in older
residents of shelter care facilities in Peninsular Malaysia. 1081 elderly people (59%M) over the age of 60 years
were surveyed using questionnaires determining baseline demographics, nutritional and cognitive status,
physical function and psychological well being. Body mass index was also determined. Subjects were
recruited from publicly funded shelter homes in Peninsular Malaysia. 14.3% of residents had BMIs < 18.5
kg/m
2
. Multivariate analyses (adjusted for age and sex)revealed that having no family (RR 1.98 [95%CI 1.40-2.82], P<0.001) and negative responses to statement 3 [I eat few fruits or vegetables or milk products] (RR
0.62 [95% CI 0.42-0.90]; P=0.013) and statement 5 [I have tooth or mouth problems that make it hard for me
to eat] (RR 0.69 [95%CI 0.50-0.96]; P=0.023) of the ‘Determine Your Nutritional Health Checklist’ were
independently associated with low BMIs (<18.5 kg/m
2
). Older people with no family support were at riskof
becoming underweight. Older people who consumed fruits, vegetables or milk or had good oral health were
less likely to be underweight. Nutrient intake, oral health and social support were important in ensuring
healthy body weight in older Malaysians.
Asia Pac J Clin Nutr. 2006;15(3):400-405.doi:
>>Abstract
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Structured triglyceride for parenteral nutrition: metaanalysis of randomized controlled trials
Author:Yong Zhou MD, Xiao-Ting Wu MD 1 , Ni Li MD, Wen Zh
Keywords:structured triglyceride, parenteral nutrition, meta-analysis, randomized controlled trials
Abstract:This study assessed the safety and efficacy of structured triglyceride (ST) for parenteral nutrition. A metaanalysis of all the relevant randomized controlled trials (RCTs) was performed. Clinical trials were identified
from the following electronic databases: MEDLINE, EMBASE, the Cochrane Controlled Trials Register,
Chinese Bio-medicine Database. The search was undertaken in March 2005. Language was restricted to
Chinese and English. Literature references were checked at the same time. Only RCTs were extracted and
evaluated by two reviewers independently of each other. The statistical analysis was performed by RevMan4.2
software which was provided by the Cochrane Collaboration. A Pvalue of <0.05 was considered statistically
significant. Ten RCTs involving 236 patients were included. Eight of them compared ST with the long-chain
triglyceride (LCT), and the combined results showed that the ST had significant effect on resting energy
expenditure (weighted mean difference [WMD] = 1.54, 95%CI [1.26, 1.82], P<0.00001), plasma glycerol
(WMD = 0.14, 95%CI [0.06, 0.22], P=0.0007), free fatty acids (WMD = 0.24, 95%CI [0.10,0.37], P=0.0006),
and β-hydroxybutyric acid (WMD = 0.14, 95%CI [0.06, 0.22], P=0.0007), but no differences was found
regarding nitrogen balance (standardized mean difference [SMD] = 0.64, 95%CI [-0.30, 1.59], P= 0.18),
respiratory quotient (WMD = -0.02, 95%CI [-0.04, 0.01], P=0.18), and plasma triglycerides (WMD = -0.10,
95%CI [-0.30, 0.10], P=0.32). Only two RCTs compared ST with the physical mixture of medium- and longchain triglyceride (MCT/LCT), data from trials were not combined due to clinical differences between trials,
and conclusions can not be drew from the present data. ST appeared to be safe and well tolerated. Further trials
are required, especially compared with the MCT/LCT, with sufficient size and rigorous design.
Asia Pac J Clin Nutr. 2006;15(3):406-411.doi:
>>Abstract
>> Download PDF
The Glycemic Index of standard and diabetes-specific enteral formulas
Author:Zandrie Hofman MSc, Jenneke D.E. van Drunen MSc an
Keywords:diabetes, hyperglycemia, clinical nutrition, glycemic index, nutritional treatment
Abstract:A recent meta-analysis showed that foods with a lowGlycemic Index (GI) have a clinically useful effect on
glycemic control in patients with diabetes. Although diabetes-specific enteral formulas are commonly used for
diabetic patients with insufficient oral intake, not much is known about the GI of these formulas. Therefore the
purpose of this study was to assess the GI of several diabetes-specific formulas and to compare them with
standard formulas. The randomised, double blinded, crossover study included twelve products which were
tested in 7 – 10 individuals from a pool of 14 healthy volunteers. After an overnight fast, volunteers were given
a portion of a product containing 25 grams of carbohydrate or the reference feed (200 ml containing 25gram
glucose) on different occasions in random order. Postprandial blood glucose levels were measured in venous
whole blood for two hours after intake of the products and positive incremental area under the curve (AUC)
was calculated for both the products and the reference feed. The GI of the test products was determined by
dividing AUC (test products) by the AUC (reference feed). Enteral formulas varied widely in their GI values
with the diabetes-specific enteral formulas being characterized by a significant (P=0.004) lower GI (average
±SEM: 19.4 ± 1.8) than standard formulas (42.1 ± 5.9). However, there was an overlap between the two types
of formulas. Three of the diabetes-specific formulas had significantly lower GI than 3 of the standardproducts.
Although there is some overlap with the GI of diabetes-specific and standard formulas, certain diabetes-specific
formulas had very low GI values, which may be clinically beneficial due to better glycemic control. Therefore
the use of diabetes-specific formulas with a low GI should be the preferred option for the nutritional
management of diabetic patients in need of nutritional support.
Asia Pac J Clin Nutr. 2006;15(3):412-417.doi:
>>Abstract
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Low dose supplementation with two different marine oils does not reduce pro-inflammatory eicosanoids and cytokines in vivo
Author:Karen J Murphy PhD, Karen Galvin PhD, Mairead Kiel
Keywords:NZGLM; fatty acids; n-3 LCPUFA; eicosanoid; cytokine, gas chromatography
Abstract:In view of the reported potential anti-inflammatory activity of the New Zealand green lipped mussel
(NZGLM), we aimed to compare the effect of low dose marine oil supplementation, from mussels and fish, in
reducing blood markers of inflammation. Thirty apparently healthy males and females were recruited from the
general public in Melbourne, Australia to participate in a double blind, randomised, parallel intervention study.
Subjects were consuming approximately 73 mg of omega-3 long chain polyunsaturated fatty acids (n-3
LCPUFA) daily in their background diet prior to the commencement of the intervention. Subjects were
randomly assigned to consume either 2 mL/day of theNZGLM oil preparation (mixed with olive oil and dl-α-tocopherol) or fish oil preparation (also mixed with olive oil and dl-α-tocopherol) for six weeks. Two mL of
the oils contained 241 mg and 181 mg of n-3 LCPUFA, respectively. Neutrophil phospholipid fatty acids,
serum thromboxane B2 (TXB
2), stimulated monocyte production of prostaglandin E
2
(PGE
2
), interleukin-1β
(IL-1β) and tumor necrosis factor α(TNFα) were measured. During the intervention, the total intakes of n-3
LCPUFA from the background diet and the supplements were 199 mg/d and 173mg/day for the NZGLM and
FO groups, respectively. Following six weeks of supplementation, both groups showed a small, but significant
increase in neutrophil phospholipid proportion of eicosapentaenoic acid. The NZGLM group also showed a
significant increase in docosahexaenoic acid levels. There were no significant changes with time or treatment
for TXB2
, PGE
2
, IL-1βor TNFα. This study showed that low dose supplementation with n-3 LCPUFA from
two different marine oil preparations showed no difference in inflammatory markers in this group of healthy
individuals. Further studies are warranted including dose response trials and studies in populations with
inflammatory conditions.
Asia Pac J Clin Nutr. 2006;15(3):418-424.doi:
>>Abstract
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Evaluation of Rhodiola crenulata andRhodiola roseafor management of Type II diabetes and hypertension
Author:Young-In Kwon MS Hae-Dong JangPhD and Kalidas Shet
Keywords:Rhodiola, tyrosol, salidroside, antioxidants, amylase, glucosidase, angiotensin converting enzyme, enzyme inhibitors, type 2 diabetes, hypertension
Abstract:In the current study, we investigated 2 species of the genus Rhodiola for the inhibition of α-amylase,
α-glucosidase and angiotensin converting enzyme (ACE) inhibitory activity. Water extracts of Rhodiola
crenulatahad the highest α-amylase inhibitory activity (IC50, 98.1 µg total phenolic/ml) followed by ethanol
extract of R.crenulata(IC50, 120.9 µg total phenolic/ml) and ethanol extract of R.rosea(IC50, 173.4 µg total
phenolic/ml). Ethanol R.rosea(IC50, 44.7 µg total phenolic/ml), water extract of R.rosea(IC50, 52.3 µg total
phenolic/ml), water extract of R.crenulata(IC50, 60.3 µg total phenolic/ml) and ethanol extract of R.crenulata
(IC50, 60.2 µg total phenolic/ml) also showed significant α-glucosidase inhibitory activity. The α-glucosidase
inhibitory activity of the extracts was compared to standard tyrosol, which was significantly detected in the
extracts using HPLC. Tyrosol had strong α-glucosidase inhibitory activity (IC50, 70.8 µg total phenolic/ml) but
did not have any inhibitory effect on the α-amylase activity. Results suggested that α-glucosidase inhibitory
activities of both Rhodiolaextracts correlated to the phenolic content, antioxidant activity and phenolic profile
of the extracts. The ability of the above Rhodiola extracts to inhibit rabbit lung angiotensin I-converting
enzyme (ACE) was investigated. The ethanol extracts of R.roseahad the highest ACE inhibitory activity (38.5
%) followed by water extract of R.rosea(36.2 %) and R.crenulata(15.4 %).
Asia Pac J Clin Nutr. 2006;15(3):425-432.doi:
>>Abstract
>> Download PDF
