Asia Pacific Clinical Nutrition Society Award for 2008
Author:
Keywords:
Abstract:
Asia Pac J Clin Nutr. 2008;17(1):1.doi:
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The opportunities and challenges of evidence-based nutrition (EBN) in the Asia Pacific region: clinical practice and policy-setting
Author:Mark L Wahlqvist MD, Meei-Shyuan Lee DrPH, Joseph
Keywords:systematic reviews (SRs), clinical nutrition trials, portfolios of evidence, hierarchies of evidence, knowledge, traditional diets, evidence based health policy (EBHP)
Abstract:Evidence–based nutrition (EBN) has gained currency as part of the growing role of evidence-based medicine
(EBM) to increase the validity, utility and cost-effectiveness of both clinical practice and, increasingly, public
health endeavours. Nutritionally-related disorders and diseases (NRD) account for a relatively large proportion of
the burden of ill-health, disease and mortality, especially as the nexus between them and both infectious disease
and so-called chronic disease is understood. As resource allocation is increasingly dependent on the evidence for
preventive or therapeutic effect, the case for nutrition interventions also needs to be underpinned by evidence.
However, feeding studies are not as amenable to the designsfamiliar to clinical trialists and dietary interventions
in public health may be complex in their conduct and interpretation, making other approaches like cohort studies
more attractive even if costly and long in the execution.With a number of food system changes in rapid progress
or imminent, especially in the populousAsia Pacific region, along with changing demographics, changing disease
patterns and concern about present and future food security, a stock-take and scenario analysis of EBN was undertaken by a panel of nutrition scientists, population scientists, agriculturalists, clinicians and policy makers together with consumer and indigenous stake–holders in Taiwan in 2007. They found that clinical practice guidelines and proposals for health and nutrition policies required greater emphasis and expertise in EBN.
Asia Pac J Clin Nutr. 2008;17(1):2-7.doi:
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Cardiovascular pathogenesis in hyperhomocysteinemia
Author:Tao Huang BSc, Gaofeng Yuan MSc, Zhiguo Zhang MSc,
Keywords:Homocysteine, smooth muscle cell, oxidizing stress, teratogenic action, proinflammatory
Abstract:Increased plasma homocysteine (Hcy) is a significant and independent risk factor for cardiovascular disease. It
can cause multi-disease manifestations such as smooth muscle proliferation, premature occlusive vascular disease, progressive arterial stenosis, haemostatic changes, placental vasculopathy, spontaneous early abortion,
birth defects, impaired cognitive function and dementia. This review paper summarizes the role of elevated Hcy
levels in cardiovascular and other diseases and the molecular mechanisms and pathophysiology involved in the
deleterious manifestations of hyperhomocysteinemia. We have collected data from MEDLINE, Current Contents
and scientific journals, which included 112 publications from 1932 to 2007. Cardiovascular pathophysiology in
hyperhomocysteinemia is a complicated process, possibly due to directtoxicity of Hcy on tissues, low Sadenosylmethionine, high S-adenosylhomocysteine or thrombotic events triggered by stimulation of procoagulant factors and suppression of anticoagulant factors and plateletactivation, thereby enhancing oxidative stress,
smooth muscle cell proliferation, formation of reactive oxygen species, hypomethylation, induction of unfolded
protein responses and extracellular matrix modification. The mechanisms involved in the increased risk of cardiovascular disease still remains a mystery in many respects, and more studies are needed to elucidate this association.
Asia Pac J Clin Nutr. 2008;17(1):8-16.doi:
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Effectiveness of Taiwanese traditional herbal diet for pain management in terminal cancer patients
Author:Tsung-Hsiu Wu MSc PhD, Tai-Yuan Chiu PhD MD, Jaw-S
Keywords:Taiwanese traditional herbal diet, terminal cancer patients, verbal numerical scale, pain
Abstract:In addition to modern medicinal therapy, many cancer patients in Taiwan are treated regularly with herbal medicines or prescribed a traditional herbal diet. In this paper, the effect of a Taiwanese traditional herbal diet (TTHD)
on pain in terminal cancer patients was investigated. A total of 2,466 patients diagnosed with a variety of cancers
were included. The most common patient-reported symptoms included troublesome pain (79.2%), weakness
(69.0%), anorexia (46.4%), fever (36.5%), dyspnea (31.1%), and leg edema (30.9%). The 2,466 terminal cancer
patients included in the study were randomly divided into three groups. The TTHD group (n=1044; 42.3%) were
given the TTHD consisting of analgesic herbs (paeony root: licorice root = 1:1) and a Taiwanese tonic vegetable
soup (Lilii bulbus, Nelumbo seed, and Jujube fruit). The remaining patients were divided into a reference group,
given the regular hospital diet, (n=909, 36.9%) and a control group, given the Taiwanese tonic vegetable soup
without analgesic herbs, (n=513, 20.8%). All patients maintained their assigned diets for one week. A verbal
numerical scale was used to assess pain. Results revealed that the patients given TTHD reported enhanced pain
relief (p< 0.05) compared to the reference and control groups. We found that TTHD could alleviate the pain
among terminal cancer patients thereby supporting the supposition that Eastern and Western medicines can be effectively co-administered to enhance terminal patient’s quality of life. Further research is warranted.
Asia Pac J Clin Nutr. 2008;17(1):17-22.doi:
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Protection of myocardium in streptozotocin-induced diabetic rats by water extracts of Hsian-tsao (Mesona procumbens Hemsl.)
Author:Min Yang MD, Zhengping Xu PHD, Ronghua Zhang MD, P
Keywords:rat, Mesona procumbens Hemsl., diabetic cardiomyopathy, Thrombospondin-1, diabetes
Abstract:The myocardial protective effects of water extracts from Hsian-tsao (Mesona procumbensHemsl.) on diabetic
rats were investigated. Thirty Sprague-Dawley male rats were randomly divided into three groups, “control
group” (n=10) with intraperitoneal saline injection, “diabetic group” (n=10) with 60 mg of intraperitoneal streptozotocin injection per kg of body weight and “Hsian-tsao group” (n=10) with intragastric administration of
Hsian-tsao extracts every day for 4 weeks after intraperitoneal streptozotocin injection. Body weight and blood
sugar concentrations were measured before and after model induction in the three groups. Thrombospondin-1
(TSP-1) expressions in the myocardium were monitored by immunohistochemistry and rt-RT-qPCR analysis.
Myocardial ultrastructural changes were also analyzed by using transmission electron microscopy. Our results
demonstrated that diabeticmyocardial ultrastructural changes included myofibrillar disarrangements, mitochondria disruption, and an increase innuclear membrane invaginations. These damages were significantly less severe in the Hsian-tsao group compared with the diabetic group. A significant increase of the TSP-1 expression
was also observed in the hearts of the diabetic rats (p<0.01), but it was relatively lower in the Hsian-tsao group
than in the diabetic group (p <0.01). It suggested that Hsian-tsao treatment in the diabetic rats effectively prevented the pathological alterations in the myocardium and decreased TSP-1 expression.
Asia Pac J Clin Nutr. 2008;17(1):23-29.doi:
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Effect of a lactose-free milk formula supplemented with bifidobacteria and streptococci on the recovery from acute diarrhoea
Author:Meng Mao MD, Tao Yu MD, Ying Xiong MD, Zhiling Wan
Keywords:infants, acute diarrhoea, rotavirus, probiotics, Bifidobacterium lactisBb12
Abstract:Probiotics have been proposed for the management and prevention of acute diarrhoea in infants. A double-blind,
randomised, placebo controlled study was carried out in 224 Chinese infants 6 to 36 months of age with severe
acute diarrhoea and free from moderate or severe malnutrition.After oral or parenteral rehydration, they were allocated to one of three groups: a lactose-free formula (Control); the same formula but with viable 10
8
CFUB.
lactisBb12 and 5x10
7
CFUSt. thermophilusTH4 per gram of powder and, the same formula with the same microorganisms, but with 10
9
CFU/g and 5x10
8
CFU, respectively. Anthropometric parameters, duration of the diarrhoea and rotavirus shedding were evaluated. Eighty seven percent of the episodes were associated with rotavirus infection. The duration of the diarrhoea was not influenced by the intake of probiotics. However, a decrease
of rotavirus shedding was observed in infants fed the formula with 10
9
Bb12/g, a finding of probable epidemiological importance in the transmission of this agent.
Asia Pac J Clin Nutr. 2008;17(1):30-34.doi:
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Glycemic index of common Malaysian fruits
Author:S Daniel Robert MSc, Aziz Al-safi Ismail PhD, Than
Keywords:glucose, durian, papaya, pineapple, watermelon
Abstract:The objective of the present study was to measure the glycemic index of durian, papaya, pineapple and watermelon grown in Malaysia. Ten (10) healthy volunteers (5 females, 5 males; body mass index 21.18±1.7kg/m²)
consumed 50 g of available carbohydrate portions of glucose (reference food) and four test foods (durian, papaya,
pineapple and watermelon) inrandom order after an overnight fast. Glucose was tested on three separate occasions, and the test foods were each tested once. Postprandial plasma glucose was measured at intervals for two
hours after intake of the test foods. Incremental areas under the curve were calculated, and the glycemic index
was determined by expressing the area under the curve after the test foods as a percentage of the mean area under the curve after glucose. The results showed that the area under the curve after pineapple, 232±24
mmol×min/L, was significantly greater than those after papaya, 147±14, watermelon, 139±8, and durian, 124±13
mmol×min/L (p<0.05). Similarly, the glycemic index of pineapple, 82±4, was significantly greater than those of
papaya, 58±6, watermelon, 55±3, and durian, 49±5 (p<0.05). The differences in area under the curve and glycemic index among papaya, watermelon and durian were not statistically significant. We conclude that pineapple
has a high glycemic index, whereas papaya is intermediate and watermelon and durian are low glycemic index
foods. The validity of these results depends on the accuracy of the data in the food tables upon which the portion
sizes tested were based.
Asia Pac J Clin Nutr. 2008;17(1):35-39.doi:
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Iron status among Australian adults: findings of a population based study in Queensland, Australia
Author:Faruk Ahmed PhD, Terry Coyne PhD, Annette Dobson P
Keywords:Serum ferritin, iron status, iron deficiency, elevated serum ferritin, anaemia, prevalence, cross-sectional survey
Abstract:Objectives: To describe the concentrations of serum ferritin among Australian adults by age and sex. Further, the
relationships of various social, lifestyle and health factors with serum ferritin concentrations were explored. Design: A total of 1634 adults aged >25 years from six randomly selected urban centres in Queensland, Australia
participated in the study that was conducted between October and December2000. Results: Prevalence of depleted iron stores, based on low serum ferritin concentration, was 10.6% among females aged <50 years, 2.8%
among females aged >50 years and virtually nil among males. In contrast, 16% of the males and 20% of the females aged >50 years had elevated serum ferritin concentrations. Significantly higher serum ferritin concentrations were found among females of both age groups who consumed alcohol at a rate of >60 drinks/month, and
females aged <50 years who were obese. Lower serum ferritin concentrations were found only among females
aged <50 years, with higher education attainment. In multivariable analysis, only the association between higher
serum ferritin and obesity was consistent across age-sex groups and statistically significant.Conclusion: Iron
deficiency may be a problem among Australian females of reproductive age. Further research is needed to identify the determinants of low iron concentrations in younger females and elevated concentrations of serum ferritin
in males and older females in order to develop preventive measures.
Asia Pac J Clin Nutr. 2008;17(1):40-47.doi:
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Micronutrient deficiencies and anemia among preschool children in rural Vietnam
Author:Nguyen Van Nhien MD MSc, Nguyen Cong Khan MD PhD,
Keywords:hemoglobin, trace element, vitamin A, zinc, selenium, magnesium
Abstract:The prevalence of trace elements deficiencies, vitamin A deficiency, anemia, and their relationships were investigated in a cross sectional study involving 243 children aged from 12 to 72 months in rural Vietnam. Serum levels of copper, zinc, selenium and magnesium were determined by inductively coupled plasma mass spectrometer
and that of retinol by high performance liquid chromatography. Hemoglobin concentration in whole blood was
measured by the cyanmethemoglobin method. The prevalenceof deficiencies in zinc, selenium, magnesium, and
copper was 86.9%, 62.3%, 51.9%, and 1.7%, respectively. On the other hand, 55.6% were anemic and 11.3%
had vitamin A deficiency. Deficiency in two or more micronutrient was found in 79.4% of the children. Parameters associated significantly with anemia were selenium deficiency (OR 2.80 95% CI 1.63-4.80,p= 0.0002) and
serum retinol <1.05 µmol/L (OR 1.83, 95% CI 1.10-3.05,p= 0.021). Magnesium deficiency (OR 3.09 95% CI
1.36-7.03) was found to be a risk factor for zinc deficiency and vice versa. The resultsindicate that micronutrient
deficiencies are prevalent among preschool children in Vietnam. In addition, the results also demonstrate a
strong relationship between selenium deficiency and anemia. Clearly, sustainable strategies are urgently required
to overcome the problems in the country.
Asia Pac J Clin Nutr. 2008;17(1):48-55.doi:
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An assessment of progress toward universal salt iodization in Rajasthan, India, using iodine nutrition indicators in school-aged children and pregnant women from the same households
Author:Eric-Alain AtegboPhD, Rajan Sankar MD, Werner Schu
Keywords:universal salt iodization, urinary iodine excretion, iodine, ban on non-iodized salt
Abstract:Background: In Rajasthan, an Indian State with significant salt production, the sale of non-iodized salt for human consumption was banned in 1992. This study explored the relationships between the use of iodized salt in
Rajasthan and the iodine status of children and pregnant women living in the area. Methods: In a State-wide survey, 30 clusters were selected proportionate-to-population-size and 40 school children, 6 -12 years old, were enrolled by random house-to-house visits ineach cluster. Twelve pregnant women from the same households were
also sampled. Salt used for cooking and a casual urine sample from each child and pregnant woman were collected. The salt iodine content was measured by titration and the urinary iodine concentration (UIC) by a qualityassured colorimetric method. Results: Salt iodine content was ≥15mg/kg in 41.9% of the households, and 23.0%
used non-iodized salt. Median UIC was 139µg/L in children and 127µg/L in pregnant women. In households using non-iodized salt, the median UIC’s were 96µg/L and 100µg/L in children and women, respectively. Disaggregating the UIC distributions by salt iodine levels revealed a consistent, step-wise pattern of UIC in children
with increasing salt iodine content. A similar but less steep pattern was observed in pregnant women. The iodine
status of both children and pregnant women attained the optimal range only when the salt iodine content was
close to 30mg/kg. Conclusion: For optimum iodine status in the population of Rajasthan, the iodization of household salt should be mandated ata higher level than what is practiced at present.
Asia Pac J Clin Nutr. 2008;17(1):56-62.doi:
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Suburban clustering of vitamin D deficiency in Melbourne, Australia
Author:Bircan Erbas MSc PhD, Peter R Ebeling MD FRACP, Di
Keywords:vitamin D, ethnicity, young women
Abstract:Objective: A high prevalence of mild to moderate vitamin D deficiency has been observed in women who have
recently arrived from the horn of Africa and living in inner Melbourne. Vitamin D status of women with differing
age and ethnic distributions residing in other suburbs is unknown. Method: A tertiary referral Women’s hospitalbased survey of serum 25(OH)D concentrations in 2,690 women aged 14-78 years residing in Melbourne between
1 July 2004 and 30 June 2005. We computed odds of serum 25(OH)D concentrations < 50 nmol/L and used tests
of homogeneity across different suburbs in Melbourne, Victoria. Results: Women with moderate vitamin D deficiency from all suburbs were young [29.1 ± 7.2 years (mean± standard deviation)]. The odds of moderate vitamin D deficiency were highest in inner suburbs and Greenvale, Coburg, Pascoe Vale South, Fawkner, Broadmeadows and Campbellfield from the Hume-Moreland municipality (pvalue for homogeneity of odds < 0.001).
Conclusion: Vitamin D deficiency appears to be a growing health concern in Australia and may be more prevalent in younger women in Victoria than anticipated.
Asia Pac J Clin Nutr. 2008;17(1):63-67.doi:
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Effects of vitamin D fortified milk on vitamin D status in Mongolian school age children
Author:Davaasambuu Ganmaa MD PhD, Uush Tserendolgor MD Ph
Keywords:milk, vitamin D deficiency, growth, rickets, Mongolia
Abstract:Mongolians are at high risk for vitamin D deficiency because of their residence at northern latitude, reduced exposure to UV-B rays during the winter months, and a low availability of vitamin-D fortified foods. We performed a pilot study in May 2005 to estimate the prevalence of hypovitaminosis D in Mongolian school age children and to determine the feasibility of conducting a longerand larger trial with fortified milk and vitamin D supplements. In a group of 46 Mongolian children (22 girls and 24 boys) aged 9-11 years, 76% (35) had levels of
25-hydroxyvitamin D (25(OH)D) below 50nmol/L (20ng/mL) and 32% had levels below 37nmol/L (15ng/mL).
After a month of consuming 710 ml of vitamin D-fortified (total 300IU or 7.5µg) milk daily, only 3 of the children were below 50nmol/L (20ng/mL) and none below 37nmol/L (15ng/mL). These results reveal prevalent and
serious 25(OH)D deficiency among Mongolian prepubertal school age children that appears to be ameliorated by
a month of consuming approximately 7.5µg of vitamin D3 in fortified milk.
Asia Pac J Clin Nutr. 2008;17(1):68-71.doi:
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Co-existing micronutrient deficiencies among stunted Cambodian infants and toddlers
Author:Victoria P AndersonMSc,Susan Jack MBChB, Didier Mo
Keywords:anaemia, Cambodia, children, stunted, haemoglobinopathies, iron, zinc, vitamin A
Abstract:The prevalence of malnutrition in Cambodia is among the highest in Southeast Asia, and diarrhea and pneumonia are the leading causes of death among children. Whether these adverse health outcomes are associated with
co-existing micronutrient deficiencies is uncertain. We have determined the prevalence of anaemia, as well as
iron, zinc, and vitamin A deficiency and their co-existence among stunted children (77 females; 110 males) aged
6–36 mos. Non-fasting morning venipuncture blood samples were taken and analyzed for haemoglobin (Hb), serum ferritin (via IMx system), retinol (via HPLC), and Zn(via AAS), C-reactive protein (CRP) (via turbidimetry)
and Hb type (AA, AE, or EE) (via Hb gel electrophoresis). Children with CRP ≥5.0 mg/L (n=34) were excluded.
Zinc deficiency defined as serum Zn <9.9 µmol/L had the highest prevalence (73.2%), followed by anaemia
(71%) (Hb<110 g/L), and then vitamin A deficiency (28.4%) (serum retinol <0.70 µmol/L). Of the anaemic
children, only 21% had iron deficiency anaemia, and 6% had depleted iron stores. Age, log serum ferritin, and
Hb type were significant predictors of Hb in the AA and AE children. Serum retinol was unrelated to haemoglobin or serum zinc. The prevalence of two or more micronutrient deficiencies (low Hb, serum retinol, and/or serum zinc) was 44%. Nearly 10% had low values for all three indices, and 18% had just one low value. In conclusion, anaemia, and deficiencies of iron, zinc, and vitamin A are severe public health problems among these
stunted Cambodian children. Intervention strategies addressing multiple micronutrient deficiencies are needed.
Asia Pac J Clin Nutr. 2008;17(1):72-79.doi:
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Fatty acid profiles of blood lipids in a population group in Tibet: correlations with diet and environmental conditions
Author:Patrizia Risé PhD, Franca Marangoni PhD, Antonella
Keywords:Tibetans, Italians, blood fatty acids, dietary fats, altitude
Abstract:The aim of this study was to compare blood fatty acid profiles of two population groups: Italian and Tibetan, differing with regard to ethnic, life style and environmental aspects. Additionally the collection of two staple foods
provided the opportunity to analyze typical Tibetan dishes. A new, simple, rapid, and substantially non invasive
method for fatty acid (FA) analysis of blood lipids was applied to healthy Italian (n= 14) and Tibetan (n= 13) subjects. Blood drops obtained from the ear lobe of Tibetans orthe fingertip of Italians were adsorbed by a special
strip of paper and processed for fatty acid analysis. The fatty acid profiles of the two groups are different, and environmental factors, such as dietary fats and altitudes of Milan, Italy (a low altitude site), and Lhasa, Tibet (a high
altitude site) appear to contribute tothese differences. More specifically, in Tibetans higher levels of monounsaturated fatty acids, including the 22 and 24 carbon molecules, were found. This appears to be derived mainly from
locally consumed fats (mustard seed oil), and are associated with lower levels of total polyunsaturated fatty acids
and higher levels of selected omega 3 fatty acids, when compared to the Italians. These relatively higher levels of
monounsaturated fatty acids may also indicate means of adaptation to local prooxidant conditions. The observed
differences in blood fatty acid profiles inTibetans vs Italians appear to result both from dietary factors and adaptation to local environmental conditions such asthe high altitude of the Tibetan location.
Asia Pac J Clin Nutr. 2008;17(1):80-85.doi:
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Fish consumption and health in French Polynesia
Author:Eric Dewailly MD PhD, Ludivine Château-Degat PhD 1
Keywords:Seafood, mercury, selenium, omega-3 fatty acids, Polynesia
Abstract:French Polynesians, like other remote maritime populations are intimately connected to the ocean which nourishes their daily life and culture. Their reliance on fish raises the issue of potential exposure to harmful natural
and anthropogenic contaminants as well as providing essential nutrients. The purpose of this study was to assess
the risks and benefits of fish consumption in French Polynesia. This cross-sectional study included 195 adults
aged 18 years old and over from the Tahiti and Moorea islands. Fatty acids, selenium (Se) and mercury (Hg)
blood concentrations were measured in participants and were all very high. Blood concentrationsindicate that Hg,
Se and omega-3 fatty acids have a common origin, i.e. fish consumption. In comparing the Polynesian group with
northern populations, we found that the Polynesian group had levels of Hg similar to those observed in Inuit
populations (geometric mean (range): 90.3 (15-420) nmol/Lvs. Inuit: m(r): 79.6 (4-560) nmol/L). Similar results
were observed with Se blood concentrations. The fatty acidconcentration was also similar to that of the Inuit
population even though the specific profile of fatty acids differed. For the first time, we report very high blood
concentrations of mercury, selenium and omega-3 fatty acids in a fishing population from the South Pacific,
comparable to those reported among fishing populations from the Northern hemisphere. Further work is ongoing
to better substantiate public health nutritional policies.
Asia Pac J Clin Nutr. 2008;17(1):86-93.doi:
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Dietary patterns and food choices of a population sample of adults on Guam
Author:Rebecca S Pobocik PhD RD, Alison Trager MFCS RD an
Keywords:dietary patterns, food, Guam, calcium, Chamorro
Abstract:This study examined dietary patterns of adults on Guam. Four hundred subjects were selected via a multistage
procedure to represent the island’s population. A 24-hour dietary recall was administered via telephone in 1995
to 1996. Diets were computer analyzed. There were 4,913 food items reported, representing 1,042 individual
foods. Most respondents, 51.3%, had a “more-frequent” eating pattern, 36.9% had “regular” and 11.8% had
“less-frequent.” Energy consumption increased (p< 0.05) with eating frequency. Highest levels of all nutrients
(p< 0.05) were at the evening meal. The sexes did not differ in nutrient proportions bymeal. Grains, meats, and
beverages were eaten most frequently. Meat/fish, mixed dishes, and grains supplied 68% of the energy and 47%
to 91% of the micronutrients. Twenty five percent of the carbohydrate was from sweetened drinks and desserts.
Rice was the most frequently consumed food. More than half of the subjects had no fruit, a third had no vegetables, and only 38.5% had dairy foods. Calcium came from multiple sources: dairy (27.6%), mixed dishes
(23.8%), fish (12.6%), desserts (8.5%) and vegetables (6.6%). Most people, 91.8%, had fiesta meals with median
consumption at 6 meals per year (range: 0 to 200). Betel nut was used by12.3% of the sample with median consumption 0 whole nuts per day (range: 0 to 25). Ethnic differences (p< 0.01) were observed in both fiesta meal
and betel nut consumption. The Guamanian diet includes limited use of traditional foods and dietary patterns associated with increased risk for chronic disease.
Asia Pac J Clin Nutr. 2008;17(1):94-100.doi:
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Bone mineral density of vegetarian and non-vegetarian adults in Taiwan
Author:Yuh-Feng Wang MD, Jainn-Shiun Chiu MD, Mei-Hua Chu
Keywords: diet, bone mineral density, osteoporosis, vegetarian, non-vegetarian
Abstract:Diet is thought to be one of the leading causes of bone mineral loss in aging people. In this study, we explored
the potential impact of a vegetariandiet on bone mineral density (BMD) in adult Taiwanese men and women.
This was a cross-sectional study of the relationship between diet (vegetarian versus non-vegetarian) and BMD
and the incidence of osteoporosis. Bonemineral density was determined in a cohort of 1865 adult male and female patients who underwent routine examination in a regional teaching hospital in Taiwan between February
2003 and February 2004. Subjects with definite vertebral problems, known osteopathy, or poor posture were excluded. Dual-energy X-ray absorptiometry (DEXA) was usedto determine BMD, on the right hip in men and on
lumbar vertebrae L2 to L4 in women. The subjects weregrouped according to sex and diet, and were then stratified by age within each of the four groups. The outcome measures were the BMD value and the incidence of osteopenia or osteoporosis according to defined criteria. Bone mineral density gradually declined with increasing
age in Taiwanese men, while Taiwanese women showed a precipitous decrease in BMD after the 5
th
decade.
However, no statistical differences in BMD were observed between vegetarians and non-vegetarians of either
sex. The proportion of subjects with osteopenia or osteoporosis also appeared comparable between vegetarians
and non-vegetarians of either sex. BMD shows an age-related decline in Taiwanese men and women, and eating
a vegetarian diet does not appear to affect this decline.
Asia Pac J Clin Nutr. 2008;17(1):101-106.doi:
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The relative impact of a vegetable-rich diet on key markers of health in a cohort of Australian adolescents
Author:Ross Grant PhD, Ayse Bilgin PhD, Carol Zeuschner M
Keywords:vegetarian, glucose, nuts, BMI, vitamin B12
Abstract:Childhood obesity is a widespread health problem in Australia. Overweight in childhood can lead to adult overweight and the development of risk factors for cardiovascular disease (CVD). Effective strategies for reducing
childhood obesity are urgently required. A vegetarian diet has been shown to bean effective prophylactic to many
lifestyle diseases in the adult population and may therefore be beneficial in children. However the metabolic demands of adolescents are different to adults and the impact of a vegetarian diet on CVD markers in this demographic is not certain. We compared key physiological and biochemical markers of health against responses to a
modified, Schools Physical Activityand Nutrition Survey (SPANS) using one-way and two-way Analysis of
Variance. 215 adolescents (14-15yrs) from 5 Adventist secondary schools in the Sydney and Hunter regions of
New South Wales, Australia, participated in this study. Adolescentsconsuming predominantly vegetarian foods
showed significantly better scores on markers of cardiovascular health, including, body mass index (BMI), waist
circumference, Cholesterol/High density lipoprotein ratio and low density lipoprotein. Adolescents consuming
nuts more than once per week, also showed lower scores for BMI and serum glucose irrespective of their vegetarian status. Markers of general health including haemoglobin and average height were not different between
groups; however a lower serum level of vitamin B12 was apparent in the vegetarian cohort. Surprisingly, exercise
on its own was not statistically associated with any of the risk factors tested suggesting that diet may be the most
significant factor in promoting health in this age group.
Asia Pac J Clin Nutr. 2008;17(1):107-115.doi:
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Application of refractometry to quality assurance monitoring of parenteral nutrition solutions
Author:Wei-Kuo Chang MD PhD, You-Chen Chao MD, Ming-Kung
Keywords:refractometer, refractive index, quality assurance, nutrition, parenteral nutrition
Abstract:Parenteral nutrition (PN) solution contains various concentrations of dextrose, amino acids, lipids, vitamins,
electrolytes, and trace elements. Incorrect preparation of PN solution could lead to patient death. In this study we
used the refractive index as a quality assurance tool to monitor the preparation of PN solution. Refractive indices
of single nutrient components and PN solutions consisting of various concentrations of dextrose, amino acids,
electrolytes, and lipids were measured. A mathematical equation and its linear plot were generated then used to
predict the refractive index of the PN solution. The best-fit refractive index for PN solution (i.e., the predicted refractive index) = 0.9798 × (% dextrose) + 1.2889 × (% amino acids) + 1.1017 × (% lipids) + 0.9440 × (% sum of
the electrolytes) + 0.5367 (r
2
= 0.99). This equation was validated by comparing the measured refractive indices
of 500 clinical PN solutions to their predicted refractive indices. We found that 2 of the 500 prepared samples
(0.4%) had less than the predicted refractive index (< 95%). Refractive index can be used as a reliable quality assurance tool for monitoring PN preparation. Such information can be obtained at the bedside and used to confirm
the accuracy of the PN solution composition.
Asia Pac J Clin Nutr. 2008;17(1):116-122.doi:
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Dynamic shifts in Chinese eating behaviors
Author:Zhihong Wang MS 1,2 , Fengying Zhai MD 2 , Shufa D
Keywords:Socioeconomic status, eating behaviors, trends, diet survey, Chinese
Abstract:The purpose of the study is to examine the dynamic eating behaviors of the Chinese people, focusing on snacking
and the choice of cooking methods, and to identify the influences of socioeconomic factors on these eating behaviors. Data for this study were from the China Healthand Nutrition Survey (CHNS). There were 12808 subjects,
older than two years (y), from the 1991 and 11527 from the 2004 surveys respectively. Logistic regressions of
pooled data were performed to evaluate how socioeconomic status (SES) was associated with two eating behaviors: snacking and consuming excessiveamounts of fried foods. Simulation techniques were used to clarify the
effects of the results that included significant interaction terms. Results showed that the rapid shift in the food and
nutrient profile of the Chinese population is accompanied by equally profound changes in meal and cooking patterns. Snacking behavior is beginning to emerge and there are shifts away from the steaming and boiling of food
to the, less healthy, frying of food. Income is positively associated with the consumption of both snacks and excessive fried food. Urban residents are also more likely to snack and to consume excessive amounts of fried foods
than rural residents. These findings indicate that eating behaviors are beginning to change rapidly toward less
healthy options in China. SES plays a vital role in the early stages of the eating behavior transition in China. Future health promotion programs targeting the higher-SESpopulation will exert far-reaching effects on the improvement of health status in this group.
Asia Pac J Clin Nutr. 2008;17(1):123-130.doi:
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Obesity prevalence and time trend among youngsters in China, 1982-2002
Author:Yanping Li PhD, Evert G Schouten PhD, Xiaoqi Hu MD
Keywords:Chinese youngsters, overweight, obesity, trend, stunting
Abstract:Purpose of present study is to describe the prevalence and trend of overweight and obesity, as well as its coexistence with stunting, among youngsters in China, from 1982 to 2002. Data from children 7-17 years of age
from three cross-sectional national surveys: “1982 China National Nutrition Survey” (5 334 boys and 4 793 girls),
“1992 China National Nutrition Survey” (8 048 boys and 7 453 girls) and “2002 China National Nutrition and
Health Survey” (23 242 boys and 21 638 girls) were usedin this study. Overweight and obesity were defined according to age, sex specific BMI cut-off points from the International Obesity Task Force, while stunting was defined as height-for-age below -2standard deviation from the NCHS/WHO reference median value. Results:
Overweight prevalence of Chinese youngsters was 1.2%, 3.7% and 4.4%, while the obesity prevalence was 0.2%,
0.9% and 0.9% in 1982, 1992 and 2002, respectively. Boththe overweight and obesity prevalence and their increment were higher among boys in urban areas. In 1982, 28.4% of overweight and 69.6% of obese youngsters
were stunted, this decreased to 22.0% and 46.4% in 1992, and then to 5.7% and 7.7% in 2002, respectively.
Conclusion:The prevalence of overweight and obesity in Chinese youngsters were low in 1982. There has been
a rapid increase since then. If this trend continues, overweight will soonreach epidemic proportions. Stunting
among overweight and obese youngsters decreased dramatically at the same time.
Asia Pac J Clin Nutr. 2008;17(1):131-137.doi:
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Risk factors for excess body fatness in New Zealand children
Author:James Scott Duncan MSc (Hons), Grant Schofield PhD
Keywords:obesity, ethnicity, diet, physical activity, sleep
Abstract:Objective:To identify demographic and lifestyle risk factors for excess body fatness in a multiethnic sample of
New Zealand children. Design:Cross-sectional study. Participants:A total of 1229 European, Polynesian, Asian,
and ‘Other’ children aged 5-11 y (603 male, 626 female) living in New Zealand. Measurements:Percentage
body fat (%BF) was measured using hand-to-foot bioelectrical impedance analysis, and overfat participants were
defined as those with a %BF greater than 25% (boys) and 30% (girls). A parent proxy questionnaire was developed for assessing demographic and lifestyle factors, and multiday memory pedometers were used to estimate
physical activity levels over five days. Results:After controlling for differences in sex, age, and socioeconomic
status (SES), Asian children were morelikely to have excess body fat than European children. The adjusted odds
of overfat also increased with age and decreased with SES. Three lifestyle risk factors related to fat status were
identified: low physical activity, skipping breakfast, and insufficient sleep on weekdays. Clustering of these risk
factors resulted in a cumulative increase in the prevalence of overfat. Active transport, sports participation, lunch
bought at school, fast food consumption, sugary drink consumption, and weekend sleep duration were not associated with fat status after adjustment for the selected demographic variables. Conclusion:The findings from this
study enhance our understanding of the risk factors for excess body fatness in New Zealand children, and highlight key demographic and lifestyle priorities for future interventions.
Asia Pac J Clin Nutr. 2008;17(1):138-147.doi:
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Parent’s views of the importance of making changes in settings where children spend time to prevent obesity
Author:David Crawford PhD, Anna Timperio PhD, Karen Campb
Keywords:kindergartens, schools, obesity prevention, perceptions, parents
Abstract:Aim:To examine the kinds of changes parents would like to see in those settings where children spend time
(kindergartens and schools, child care centres and after-school care facilities, and the local neighbourhood) in
policies and practices that impact on children’s risk of obesity, and to establish whether parents might be willing
to advocate for changes in these settings. Materials and Methods:175 parents from five randomly selected primary schools and five randomly selected kindergartens located in suburbs of metropolitan Melbourne completed
a questionnaire in which they rated the importance of a number of potential changes to promote healthy eating
and increase physical activity in their children. Results:Parents of children in kindergarten most commonly rated
changes to the eating environment as important. In contrast, parents of primary school children believed changes
related to both eating and physical activity in school were important. Ninety-five per cent of parents of kindergarten children and 89% of parents of primary school children believed it was possible for parents to bring about
change to provide more opportunities for their child to eat more healthily and be more physically active. One in
four parents reported that they had thought about or had tried to bring about changes in their community. Conclusions:The findings suggest that mobilising parents to take an active role in advocating for change in those settings that have the potential to shape their children’s physical activity and eating behaviours may be feasible.
Asia Pac J Clin Nutr. 2008;17(1):148-158.doi:
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Green tea and gastric cancer risk: meta-analysis of epidemiologic studies
Author:Yong Zhou MD, Ni Li MD, Wen Zhuang MD, Guanjian Li
Keywords: Meta-analysis, green tea, gastric cancer, case-control study, cohort study
Abstract:Objective: To evaluate the association between green tea consumption and the risk of gastric cancer. Methods:
Electronic search of the Cochrane Library, MEDLINE,EMBASE and Chinese Bio-medicine Database, which
have articles published between (1966 and 2006), was conducted to select studies for this meta-analysis. Results:
This meta-analysis included 14 epidemiologic studies, with a total number of 6123 gastric cancer cases and
134006 controls. The combined results based on all studiesshowed that green tea consumption was not associated with the risk of gastric cancer [odds ratio (OR) = 0.98, 95% confidence interval (CI) = 0.77-1.24]. The summary OR from all population-based case–control studies showed a minor inverse association between green tea
consumption and risk of gastric cancer (OR = 0.68, 95% CI = 0.49-0.92), while no associations were noted from
hospital-based case–control studies (OR = 1.12, 95% CI = 0.70-1.77) and cohort studies (OR = 1.56, 95% CI =
0.93-2.60). No associations were noted both in males (OR = 1.10, 95% CI = 0.76-1.60) and females (OR = 0.99,
95% CI = 0.64-1.51). The summary OR from seven studies suggest that the highest consumption level of green
tea was more than 5 cups per day and no associations were noted (OR = 0.99, 95% CI = 0.78-1.27). Conclusions:
The results of this meta-analysis indicated that there is no clear epidemiological evidence to support the suggestion that green tea plays a role in the prevention of gastric cancer.
Asia Pac J Clin Nutr. 2008;17(1):159-165.doi:
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Validity and reproducibility of a semi-quantitative food frequency questionnaire for use among pregnant women in rural China
Author:Yue Cheng MD, Hong Yan MD, Michael John Dibley MB
Keywords:food frequency questionnaire, calibration, pregnancy, diet surveys, China
Abstract:A longitudinal study was conducted tovalidate a 68-item semi-quantitative food-frequency questionnaire (FFQ)
for assessing nutrient intake among pregnant women in rural China. The interview administrated FFQs were conducted at the start of the third trimester (FFQ1) and repeated three months later prior to delivery (FFQ2), and
compared with six repeated 24-hour recalls collected between the FFQs. From June to September 2004, 125
women at 23 to 26 weeks of gestation were recruited into the study in two rural counties in Shaanxi province,
China. Pearson correlation coefficients for crude nutrients assessed by FFQ1 and FFQ2 had a mean of 0.46, and
ranged from 0.31 for thiamin to 0.61 for fat. Pearson correlation coefficients estimated by FFQ2 and 24-hour recalls had a mean of 0.62 for all nutrients, and ranged from 0.53 for cholesterol and carotene to 0.70 for α-vitamin
E and potassium. De-attenuated coefficients had a mean of 0.69 for all nutrients, and ranged from 0.58 for cholesterol to 0.77 for α- vitamin E. Bland-Altman plots revealed significant relationships between the difference and
the average of the two methods with larger differences at higher average intakes. On average, 74% of participants
were classified into the same or adjacent nutrient intake quintiles, while 1% were grossly misclassified to opposite quintiles. In conclusion, this FFQ has adequate reproducibility and validity for most nutrients but would
benefit from the addition of wheat porridge to ensure it is suitable for assessing dietary intake in pregnant women
in rural China.
Asia Pac J Clin Nutr. 2008;17(1):166-177.doi:
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Development of food frequency questionnaires and a nutrient database for the Prospective Urban and Rural Epidemiological (PURE) pilot study in South India: Methodological issues
Author:Ankalmadagu Venkatasubbareddy Bharathi MSc, Anura
Keywords:Databases, nutrient assessment, India, epidemiologic methods, questionnaires
Abstract:Purpose: To develop Food Frequency Questionnaires (FFQs) and nutrient databases for urban and rural Indian
populations with diverse dietary habitsfor the PURE (Prospective Urban and Rural Epidemiological) pilot study.
Procedure: 24 hour dietary recalls were obtained from 84 rural and 60 urban subjects. From a comprehensive
food list, separate FFQs were developed for the two groups. Nutrient analysis of the FFQ required the selection of
foods, development of recipes and application of these to cooked foods to develop a nutrient database. The FFQs
were piloted in 80 urban and 77 rural subjects. Separately for each group, a stepwise regression method was used
to identify foods contributing to a cumulative 90 % of variance to total energy intake. Nutrient and food group intakes were compared using an independent t-test. Main Findings: The urban and the rural FFQs contained 129
and 102 foods respectively, of which 82 foods were common to both. Fourteen urban foods and eight rural foods
explained a cumulative 90% of variance for total energy intake. Daily intakes for most nutrients and food groups
were two to three fold higher in the urban than in the rural group. Conclusions: In Indian populations with diverse dietary habits, using standard methods to develop separate FFQs can capture dietary intakes adequately. To
develop nutrient databases, substitution of local food composition tables with data from other sources using standard methods to match foods can be adopted.
Asia Pac J Clin Nutr. 2008;17(1):178-185.doi:
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