Asia Pacific Clinical Nutrition Society Award for 2012
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Asia Pac J Clin Nutr. 2012;21(1):i.doi:
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The Asia Pacific Journal of Clinical Nutrition: its philosophy and a brief history
Author:Mark L Wahlqvist AO, Co-Founding Editor-in-Chief
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Asia Pac J Clin Nutr. 2012;21(1):1-2.doi:
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Effects of vitamin A, vitamin A plus zinc, and multiple micronutrients on anemia in preschool children in Chongqing, China
Author:Li Chen MD, PhD, Yong-Fang Liu MS, Min Gong MD, Ph
Keywords: anemia, vitamin A, zinc, multiple-micronutrient, supplementation
Abstract:This study is to clarify the impact of vitamin A or vitamin A combined with other micronutrients supplementation
on anemia and growth in preschoolers. In the present study, a total of 290 preschoolers, aged 36-72 months old
were randomly assigned to 3 treatment groups: vitamin A (A group), vitamin A plus zinc (AZ group), and vitamin A combined with additional multiple-micronutrient (AMM group). After 6-month supplementation, the
height and height-for-age z-score gains of the AZ group were significantly higher than the other groups; the
weight gain of the AMM group was greater than the other groups. Compared with baseline values, the concentrations of hemoglobin, and zinc at the end significantly increased in all 3 groups. The incremental concentrations of
hemoglobin in the AMM group were significant higher than in the other two groups. Furthermore, the incremental concentrations of serum retinolin the AMM group, and the increase in serum zinc concentrations in the
AZ group were significantly higher, respectively, than inthe other groups. These 3 kinds of supplements in the
present study are effective in enhancing height gains and are effective in reducing the prevalence of anemia. Supplementation of zinc plus vitamin A is a better way for improving children’s height and height-for-age z-score.
Vitamin A combined with multiple-micronutrient is moreeffective in improving the hemoglobin concentrations
in preschool children.
Asia Pac J Clin Nutr. 2012;21(1):3-11.doi:
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Glycemic and oxidative status of patients with type 2 diabetes mellitus following oral administration of alphalipoic acid: a randomized double-blinded placebo controlled study
Author:Supatra Porasuphatana PhD, Suthi Suddee MD, Atinuc
Keywords:alpha-lipoic acid (ALA), diabetes, PGF2α-Isoprostanes (F2α-IsoP), 8-Hydroxy-2’-deoxyguanosine (8-OHdG), oxidative stress
Abstract:Despite well-controlled blood glucose levels, diabetic complications still inevitably take place via several mechanisms including excessive generation of free radicals in patients who suffer from diabetes mellitus (DM). A randomized double-blind placebo-controlled clinical trial to investigate the effectiveness of oral supplementation of
DL-alpha-lipoic acid (ALA) on glycemicand oxidative status in DM patients was conducted. Thirty eight outpatients with type 2 DM were recruited and randomly assigned to either placebo or treatment in various doses of
ALA (300, 600, 900, and 1200 mg/day) for 6 months. Following the treatment, all subjects were evaluated for
glucose status and oxidative biomarkers. Results showed that fasting blood glucose, HbA1c trended to decrease
in a dose-dependent manner. Increase of urinary PGF2α-Isoprostanes (F2α-IsoP) was noted in placebo but not
ALA-treated groups, indicating possible suppressing action of ALA on lipid peroxidation in DM subjects. 8-Hydroxy-2’-deoxyguanosine (8-OHdG) levels, however, weresimilar in both placebo and ALA groups as well as
urinary microalbumin and serum creatinine. Safety evaluation was monitored and treatment was found to be well
tolerated despite some minor side effects. Results from thisstudy reflected the benefits of ALA in glucose status
with slight efficiency on oxidative stress-related deterioration in DM patients.
Asia Pac J Clin Nutr. 2012;21(1):12-21.doi:
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Behavioral change during weight loss program and oneyear follow-up: Saku Control Obesity Program (SCOP) in Japan
Author:Makiko Nakade PhD, Naomi Aiba PhD, Naomi Suda MS,
Keywords:behavior therapy, body weight changes, randomized controlled trial, follow-up studies, diet
Abstract:This study evaluated effects of a behavioral approach which placed emphasis on tailored behavior counseling, diet, weight loss and weightmaintenance. A one-year randomized controlled trial was conducted among 235 overweight/obese adults in Japan. The intervention group (n=119) received individual-based counseling using a behavioral approach and the changes made in the diet and physical activity were dependent on each participant as
much as possible. One year later, the intervention group lost significantly more weight than the control group (-5.0 kg vs. 0.1 kg for men and -3.9 kg vs. -0.2 kg for women). Compared to the control group, the male intervention group reduced overall energy, cereals and dairy products consumption significantly, while increasing green
and yellow vegetable intake, and the female intervention group significantly reduced intake of dairy products.
Regarding behaviors, both male and female intervention groups increased the number of walking steps and women improved their irregular eating habitscompared to those in the control groups. Behavior changes were related
to weight loss; participants who maintained the action/maintenance stage or moved to later stages lost significantly more weight than participants who remained in the pre-contemplation/contemplation/preparation stages or
regressed to earlier stages. After one-year follow-up, the intervention group maintained significantly lower
weights, lower energy intakes and improvements in irregular eating habits. Our behavioral approach led to diet
and behavior modification, weight loss and maintenance. Because modified variables differed between men and
women, gender-specific approaches may be necessary.
Asia Pac J Clin Nutr. 2012;21(1):22-34.doi:
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Rice intake, weight change and risk of the metabolic syndrome development among Chinese adults: the Jiangsu Nutrition Study (JIN)
Author:Zumin Shi MD, PhD, Anne W TaylorPhD, Gang Hu MD, P
Keywords:rice intake, weight change, the metabolic syndrome, Chinese, cohort study
Abstract:Objectives: To examine the association between rice intake, staple food patterns (measured by percentage of rice
in staple food (PRS)), weight changeand the risk of the metabolic syndrome development. Methods: We followed 1231 adults, aged 20 and older, from 2002 to 2007. Food intake was assessed using a food frequency questionnaire. Body weight, height, waist circumference, blood pressure and fasting plasma glucose and lipids were
measured. The metabolic syndrome was defined according to the International Diabetes Federation definition.
Results: Rice consumption of ≥401 g/day was associated with less weight gain (-2.08 kg, 95%CI: -2.75, -1.41,
p<0.001), and 42% less risk of hypertension, as compared to rice consumption of <200 g/day (p=0.024). A strong
linear association between rice intake and hyperglycemia was found: the odd ratios for incident hyperglycemia
across rice intake <200, 201-400, ≥401 g/day were: 1, 1.96, 2.50 (95%CI: 1.37, 4.57) (pfor trend 0.005). A positive association between rice intakeand incident abnormal high-density lipoprotein was observed. There was no
association between rice intake and incident high triglycerides. Every 10% increase in PRS was associated with a
0.28 kg less in weight gain, 22% increase in hyperglycemia risk and 9% decrease in hypertension risk. Rice intake and PRS were not associated with the risk of the metabolic syndrome. Conclusion: Rice intake and PRS
were inversely associated with weight gain, and PRS was inversely associated with hypertension, but positively
associated with fasting blood glucose elevation. No association between rice intake and PRS with the metabolic
syndrome was found.
Asia Pac J Clin Nutr. 2012;21(1):35-43.doi:
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Decline in anthropometric evaluation predicts a poor prognosis in geriatric patients
Author:Rie Tsutsumi PhD, Yasuo M. Tsutsumi MD, PhD, Yousu
Keywords:anthropometric measurements, geriatrics, serum albumin, mortality, decubitus ulcer
Abstract:Objective: Malnutrition is frequent inthe geriatric population and is often undetected and untreated. Although we
often use serum albumin as a nutritional marker, it has limitations in elderly patients in terms of predicting diseases and infections. Anthropometric measurements are not commonly used, despite their simple, easy, and effective characteristics. We evaluated the associations between anthropometric measurements with other nutritional
factors and examined its relationship with mortality, decubitus ulcer, length of hospital stay and antibiotic usage.
Research methods and procedures: We enrolled 223 patients, performed anthropometricmeasurements and then
followed them for a mean of 24 months. Results: Patients with hypoalbuminemia but with normal body measurements tended to increase serum albumin levels over the next 24 months and had more favorable outcomes including being discharged. Patients with normal albumin butdecreased body measurements resulted in a progressive drop in serum albumin and had a higher mortality rate. Additionally, patients with hypoalbuminemia had
higher antibiotic usage than patients without hypoalbuminemia. Decreases inanthropometric measurements were
related to mortality, length of hospital stay, and decubitus ulcer. Conclusions: Anthropometric measurements are
easily obtained and closely associated with mortality, decubitus ulcer, and length of hospital stay. Anthropometric
measurements used in conjunction with serum albumin are more predictive of patient outcome then serum albumin alone.
Asia Pac J Clin Nutr. 2012;21(1):44-51.doi:
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Low aglycone content in commercial soy drink products
Author:Huong TT Nguyen MD, Mo Pourian BSc, Birgitta Bystr
Keywords:isoflavones, HPLC, soy drink, osteoporosis, Vietnam
Abstract:The effectiveness of soy isoflavones to prevent bone loss in postmenopausal women iscontroversial. While consumption of soy in Vietnam is very high, we recently reported a prevalence of osteoporosis comparable to that of
many Western populations. In the present study, we analyzed the isoflavone content of soy drink products commercially available in Vietnam and Sweden, and we also compared these products to “home-made” soy drink
from beans of different origin. The amounts of the bioactive aglycones (daidzein, glycitein and genistein) and
their glycoside isomers were quantified by high-pressureliquid chromatography. We found that the total isoflavone content was low in all preparations, around 70-100 mg/L and of this only 10% were bioactive aglycones. Of
these, the Vietnamese products contained significantly lower levels of glycitein than the products from Sweden
and “home-made” soy drink preparations. The results show that consumption of several liters of soy drink per day
would be needed to achieve threshold levels for a protective effect on bone. There was no significant association
between total protein and isoflavone content in different products. Accuratelabeling of soy drink and other products eg of aglycone and glycoside content would allow health professionals and researchers to better explore the
possible benefits of soy in dietary intervention studies.
Asia Pac J Clin Nutr. 2012;21(1):52-56.doi:
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Preferences of healthy and unhealthy foods among 3 to 4 year old children in Mexico
Author:Cynthia De Lira-García MSc, Montserrat Bacardí-Gas
Keywords:food preferences, preschool children, over-weight, obesity, Mexico
Abstract:Objective: To evaluate the preference of healthy and unhealthy foods among pre-school children attending daycare and its association with that oftheir parents, body mass index and socio-demographic variables. Methodology: We asked children and parents to depict their food preferences through 54 pictures of different food items.
The association between the preferences and socio-demographic variables was done using the Phi correlation,
chi-squared, Fisher’s correlation, as well as univariate and multivariable logistic regression. Results: Twohundred and sixty-five parent-child pairs participated in the study. Ice cream, potato chips and lollypops were the
foods most preferred by children. On the other hand, quince jelly, coffee and avocado were the least preferred.
Overweight and obese children had a higher preference for quince jelly, preserved fruits, and vegetable soup.
With univariate logistic regression, children of low-income homes (OR= 2.56, p=0.007) and attending public
daycare centers (OR= 6.2, p=0.0001) preferred less healthy fruits. Whenthe father’s education was added in a
multivariable model including family income, only children whose fathers had ≤9 years of education showed a
higher preference for less healthy food. When parent’s education, family income, and parent’s preference for
healthy foods were included to the model only children attending public daycares weremore likely to prefer
healthy foods. Conclusion: The foods most preferred by children have a high caloric density. The children’s body
mass index, their parent’s monthly income, the father’s education and the type of daycare they attended were associated with the preference of healthy or unhealthy foods.
Asia Pac J Clin Nutr. 2012;21(1):57-63.doi:
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Interactive effects of family socioeconomic status and body mass index on depression in school-aged children
Author:Fu-Gong Lin PhD, Yu-hsin Hsieh MPH, Ho-Jui Tung Ph
Keywords:depression, socioeconomic status, body massindex, interaction, elementary school
Abstract:Depression is an important health problem in children and the onset of depression is occurring at a younger age
than previously suggested. The associations of being overweight and low socioeconomic status in childhood depression have been well documented; nevertheless few studies have addressed the combined effects of socioeconomic status and body weight, with depression in school-age children. We intended to examine if the relationship between socioeconomic status and childhood depression could be modified by abnormal body weight. A
cross-sectional study was performed with a total of 559 subjects from 29 elementary schools in Taiwan. A depression scale was used to determine the depression status. Children receiving governmental monetary assistance
for after-school class were categorized as being in the lower socioeconomic group. Data for depression-related
demographic characteristics, family and school variables werecollected. Children in the lower socioeconomic
status group have a higher prevalence of depression (23.5%) than those in higher socioeconomic status
groups(16.4%). Being overweight demonstrates the opposite effect on depression risk in the different socioeconomic groups. In lower socioeconomic families, the riskof depression in overweight children is three times
higher than that for normal weight children; whereas in higher socioeconomic families, overweight children have
a lower risk for depression than normal weight children. We concluded that a qualitative interactive effect existed between being overweight and socioeconomic status with childhood depression. More attention should be
paid to overweight children from lower socioeconomic status families to prevent depression in school-age children.
Asia Pac J Clin Nutr. 2012;21(1):64-72.doi:
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Risk of asthma associated with energy-dense but nutrient-poor dietary pattern in Taiwanese children
Author:Shu-Chen Lee MS, Yao-Hsu Yang MD, PhD, Shao-Yuan C
Keywords:asthma, children, dietary pattern, risk factors, reduced rank regression
Abstract:Childhood asthma has rapidly increased over the past few decades, possibly due to changes in lifestyle and dietary patterns. We aimed to determine associations between dietary patterns and asthma in schoolchildren in Taiwan. The Nutrition and Health survey in Taiwan Elementary School Children was carried out by using a multistaged complex sampling design. A total of 2,082 elementaryschool children with complete data on dietary, lifestyle, demographics and asthma were included in the analysis. We used a Chinese version of the International
Study of Asthma and Allergies in Childhood questionnaire togenerate an asthma symptom score and to define
asthma outcomes. Dietary intake was assessed by a food frequency questionnaire. Reduced rank regression (RRR)
was used to identify the dietary pattern associated with the asthma symptoms score. Asthma outcomes included;
current asthma, current severe asthma, nocturnal cough, exercise-induced wheeze and asthma ever. The RRRderived dietary pattern was characterized by high consumption of fast foods, high-fat snacks, candy, and cheese;
and low consumption of fruit, vegetables and rice. The RRR-derived dietary pattern was associated with an increased risk of current asthma (OR [95% CI]) (2.42 [1.19-4.93] for Q4/Q1, p-for-trend=0.01), current severe
asthma (3.21 [1.11-9.25] for Q3/Q1, 4.45 [1.59-12.5] for Q4/Q1; p-for-trend=0.003), and nocturnal cough (1.79
[1.06-3.05] for Q2/Q1, 1.74 [1.02-2.97] for Q3/Q1, 1.82 [1.07-3.11] for Q4/Q1; p-for-trend=0.049). Our results
suggest that a diet with a high intake of fat and simple sugars and low intake of fruit, vegetables and rice is associated with an increased risk of asthma in Taiwanese children.
Asia Pac J Clin Nutr. 2012;21(1):73-81.doi:
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Associations of the pre-pregnancy body mass index and gestational weight gain with pregnancy outcomes in Taiwanese women
Author:I-Hsien TsaiMS, Chih-Ping ChenMD,Fang-Ju Sun MS, C
Keywords:body mass index (BMI), pre-pregnancy weight, gestational weight gain (GWG), pregnancy outcomes, low birth weight
Abstract:BACKGROUND:Pre-pregnancy weight and gestational weight gain (GWG) are important factors in both maternal and infant outcomes. Little information is available inrelation to different levels of pre-pregnancy body mass
index (BMI) and body weight gain on obstetric outcomes in Taiwan. This study investigated the associations between pregnancy complications with pre-pregnant BMI and GWG, in Taiwanese women. METHODS: Data were
extracted from a delivery room information bank on all women delivering singleton babies in a medical center.
Eight hundred and sixty pregnant women were included. The collected variables included basic information,
GWG, and pregnancy and neonatal outcomes. Pregnant women were categorized according to their pre-pregnant
BMI and GWG to evaluate the impacts of pre-pregnant BMI and maternal weight gain on the risk of pregnancy
complications. Univariate and multivariable logistic regression analyses were performed, and odds ratios were
calculated. RESULTS: Pre-pregnancy BMI≥24 kg/m
2
increased the risks of gestational diabetes mellitus, preeclampsia, and preterm labor. Preeclampsia and Cesarean delivery were positively associated with high weight
gains (>18 kg), whereas a low birth weight and preterm labor were strongly associated with low weight gains
(<10 kg). A higher birth weight was found with a GWG of >14 kg in women who were underweight and normal
weight before pregnancy. CONCLUSION: Anappropriate maternal BMI (18.5-24 kg/m
2
) at conception followed
by a suitable gestational weight gain (10-14 kg) has substantial impact on the overall health of pregnant women
and would lead to better obstetricmanagement for Taiwanese women.
Asia Pac J Clin Nutr. 2012;21(1):82-87.doi:
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Continuous metabolic syndrome risk score for predicting cardiovascular disease in the Chinese population
Author:Guo-Dong Kang MD, Lu Guo MD, Zhi-Rong Guo PhD, Xia
Keywords: the metabolic syndrome, cardiovascular disease, risk factors, prospective study, receiver operating characteristic curve
Abstract:Although the metabolic syndrome (MetS) is a predictor of cardiovascular disease (CVD), the current dichotomous definition of MetS cannot be used to evaluate context-specific identification or for efforts to reduce the risk
of CVD in the population. In this study, we assigned MetS a continuous risk score for predicting the development
of CVD. In total, 3,598 participants recruited from the Jiangsu Province of China were followed for a median of
6.3 years. A total of 82 participants developed CVD during the follow-up period. Receiver operating characteristic (ROC) curve was used to analyze the association between components of MetS and CVD. The results show
that systolic blood pressure (SBP) was associated with CVD more intimately (area under receiver-operator characteristic curve (AUC)=0.72, 95% confidence interval (CI), 0.66-0.77) than other features of MetS. When each
MetS component was assigned according to the magnitude of regression coefficients in the Cox regression hazard
model, the AUC of the continuous MetS risk score (AUC=0.80, 95% CI, 0.75-0.84) exceeded that of the dichotomized definition of MetS (AUC=0.63, 95% CI, 0.56-0.69) (p<0.01). The incidence of CVD increased with
the MetS risk score. This prospective cohort study suggests that the use of continuous MetS risk score would significantly improve the capability for predicting the development of CVD compared to current definition of MetS.
Further, the appropriate cut-off points need to be verified in other races and regions.
Asia Pac J Clin Nutr. 2012;21(1):88-96.doi:
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Validity and reproducibility of a food frequency questionnaire (FFQ) for dietary assessment in Malay adolescents in Malaysia
Author:Abdullah Nurul-Fadhilah BSc, Pey Sze Teo BSc, Leng
Keywords:Food frequency questionnaire (FFQ), 24-hours dietary recall, validity, reproducibility, adolescents
Abstract:Background: Food frequency questionnaire (FFQ) must be tailored to the target populations because dietary habits vary within the populations due to differences in cultural and lifestyles practices. Limited information is available to assess the validity of FFQ used among Malaysian adolescents. Objective: To construct the validity and reproducibility of a newly developed FFQ in assessing habitual nutrients intake over the past year of 170 Malay adolescent boys and girls in Kelantan, Malaysia. Methods: The FFQthat consisted of 124 food items was assessed,
whereas three days of 24-hours dietary recalls (DR) was administered as the standard criteria method. Results:
Estimated mean intake for most nutrients assessed by the FFQ were higher as compared to the three DRs
(p<0.05). Pearson correlation coefficients for energy-adjusted nutrients intake between both methods were ranged
from 0.22 (zinc) to 0.68 (calcium) with a median r-value of 0.43. The cross classification of quartile analysis
showed that most nutrients were classified into the same or adjacent quartiles (median=52.7%). For the reproducibility of FFQ, the correlation of nutrients ranged from 0.43 for caroteneto 0.86 for total fat intake (median=0.67), after adjusting for total energy intake. Conclusion: The newly developed dietary FFQ is a relatively
good and valid tool in assessing habitual nutrients intake for the past year among Malay adolescents in Malaysia.
Asia Pac J Clin Nutr. 2012;21(1):97-103.doi:
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Symposium on nutrition and cognition: towards research and application for different life stages
Author:David Benton DSc , Pattanee Winichagoon PhD, Tze P
Keywords:aging, brain development, cognition, cognitive decline, nutrition
Abstract:A Symposium on Nutrition and Cognition: Towards Research and Application for Different Life Stages was held
on October 2010 in Malaysia. The influence of diet and nutrition on the cognitive development of the child and
on cognitive decline in later life was reviewed. Central to the study of such topics is the assessment of cognitive
functioning. Cognitive functioning falls into six main areas: executive functioning, memory, attention, perception,
psychomotor and language skills, although each domain can be further subdivided. As it is in the nature of human
functioning that the performance on any cognitive test can reflect aspects of many of these domains, ideally a battery of tests should be used to establish the basis ofany difference in performance. In intervention studies, frequently there has been a failure to demonstrate a beneficial influence of changes in diet. A possible reason is that
studies have failed to acknowledge the time scale and critical ages over which diet has an impact. Diet may have
a slow and progressive influence makingit difficult for short-term studies toshow an improvement. In addition,
as many factors influence human behaviour, dietary interventions should onlybe one part of a coordinated approach; the effect of diet will depend on the social and psychological context in which an individual lives. Placing
diet into a broader social and psychological context greatly increases the chance of generating significant findings.
This report highlights and reviews presentations and discussions at the symposium.
Asia Pac J Clin Nutr. 2012;21(1):104-124.doi:
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Overview of nutrition education program for national health promotion in Asian countries: current situation and future direction
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Asia Pac J Clin Nutr. 2012;21(1):127.doi:
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Present status and issues of school nutrition programs in Korea
Author:Jihyun Yoon PhD, Sooyoun Kwon PhD, Jae Eun Shim Ph
Keywords: school nutrition, school lunch, school meals, nutrition education, nutrition teacher
Abstract:School nutrition programs are essential for children’s long-term nutrition and health promotion. The last decade
has been the most dramatic years in the history of school nutrition programs in Korea. The percentage of schools
serving school lunches reached almost 100% in 2003. In 2006, School Meals Actwas significantly revised after
serial outbreaks of food-borne illness among students having eaten school lunches. The safety and nutritional
quality of school meals had remained as the biggest issue until the middle of 2000s, and then eco-friendly and
universal free school lunches have become the main issues related to school meal service and are still under debate. Implementation of the Nutrition Teacher System in 2006 was the turning point of school-based nutrition education in Korea. In addition, two new laws, Special Act on Children’s Dietary Life Safety Management of 2008
and Dietary Life Education Support Actof 2009, started to make meaningful changes in school nutrition environment and practices. The next decade is expected to be very critical in the development of school nutrition programs in Korea as the new systems and laws are to be settled. Significant effort is needed from both the academia
and the field to make the related issues to be debated and answered to progressive direction for the school nutrition programs in Korea.
Asia Pac J Clin Nutr. 2012;21(1):128-133.doi:
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The practices and needs of dietitian in school lunch program in Taiwan
Author:Yueching Wong PhD, RD, Yu-Jhen Chang MS, RD
Keywords:dietitian, school-age children, school lunch program, nutritional education, Taiwan
Abstract:Nutrition-related problems among school-age children nowadays become potentially serious. In order to prevent
obesity and other nutritionally related diseases in the young generation, a school lunch program has been proposed and conducted in Taiwan. It is to ensure that students’ nutritional intake meets the daily requirement and to
help students develop correct eating habits and maintain a healthy lifestyle. A professional dietitian who has a
clear concept regarding food material utilization, cooking methods and nutritional values thus becomes important.
However, the majority of schools in Taiwan are unable tooffer the post of dietitian due to budgetary constraints
and lack of organization. The responsibility of a dietitian is usually held by teachers, school nurses and other administrative staff. This problem has hindered the nutritional education in schools and made school lunches less
beneficial to the children’s nutritional needs. For the current status of dietitians inschools, a large gap is found
between the currently supplied school lunches and the nutritionally standardized school lunches. It also exists in
relation to education and hygiene. One of the solutions requires an infrastructure to support plans and policy, reasonable adequate budget, well human affairs establishment and coordination ofall aspects. While the needed infrastructure is being proposed, an access to the professionalism of the currently employed dietitians can be strategically explored by constructing an education system. Through the system, schools without on-campus dietitians
will be able to utilize their expertise with which the improvement of school lunches can be expectedly accomplished.
Asia Pac J Clin Nutr. 2012;21(1):134-138.doi:
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School meal program in Ho Chi Minh city, Vietnam: reality and future plan
Author:Duc Son Nguyen Trung Le MD, PhD
Keywords: School meal program, school kitchen, elementary school, dietary intake, Vietnamese children
Abstract:The socio-economic status in Vietnam has developed during the past decades. People become busier for work,
and thus they do not have enough time to prepare meal for their children. The school meal program, organized by
Department of Education, was first implemented at a kindergarten in 1977, which has been extended to elementary school since 1980. Up to date, 100% of kindergarten and approximately 90% of elementary schools have
school meal programs. The purposes of this program are to provide appropriate meals for students, and to serve as
education and communication tool for students. About 90% of school meals are prepared in the school’s kitchen
and the rest are provided by food companies. The weekly menu provides approximately 30% of recommended
dietary allowances (RDA) for students. To date, there has been is no official dietitian training school in Vietnam.
The head of school kitchen, who is notdietitian, is required to participate in a short-term training course, where
s/he learns basic nutrition, nutrition requirements and food hygiene and safety. The food companies, which provide meals to school, must be approved for the hygiene and safety condition by the Human Health Services Department of Ho Chi Minh City. In the next plan of national nutrition strategy, establishing dietitian training
schools will be prioritized. In addition, the regular nutritional surveillance for school-aged students will be introduced in school system thus we can develop and evaluate the school meal program in terms of nutrients, food
safety and nutrition education.
Asia Pac J Clin Nutr. 2012;21(1):139-143.doi:
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Nurturing healthy dietary habits among children and youth in Singapore
Author:Letty Kwok Chong Shiu MNutrDiet,BSc, Wong Mun Loke
Keywords:health, diet, children, youth, health promotion
Abstract:Healthy diet is a key tenet in the prevention of many chronic diseases. Nurturing healthy dietary habits is especially
important in childhood as this is a critical period of growth and development. Furthermore, dietary habits are
shaped from an early age with many of them forming evenbelow the age of 5 years. Therefore, the importance of
nurturing healthy dietary habits during a child's formative years cannot be underestimated. Reducing fat, salt and
sugar intake and at the same time, advocating the consumption of adequate whole-grains, fruit and vegetables
among the population remain the cornerstone of the Singapore Health Promotion Board's (HPB) key nutrition
initiatives. To achieve this, HPB adopts a multi-pronged approach comprising various strategies to promote healthy
eating among children and youth in Singapore. This article provides an overviewof these strategies and the broad
range of nutrition education efforts targeted at the young.
Asia Pac J Clin Nutr. 2012;21(1):144-150.doi:
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School Lunch Program in India: background, objectives and components
Author:Alka Mohan Chutani RD PhD
Keywords:Mid Day Meal Scheme, malnutrition, education, India, literacy
Abstract:The School Lunch Program in India (SLP) is the largest food and nutrition assistance program feeding millions of
children every day. This paper provides a review of the background information on the SLP in India earlier
known as national program for nutrition support to primary education (NP-NSPE) and later as mid day meal
scheme, including historical trends and objectives and components/characteristics of the scheme. It also addresses
steps being taken to meet challenges being faced by the administrators of the program in monitoring and evaluation of the program. This program was initially started in1960 in few states to overcome the complex problems
malnutrition and illiteracy. Mid Day Meal Scheme is the popular name for school meal program. In 2001, as per
the supreme court orders, it became mandatory to give a mid day meal to all primary and later extended to upper
primary school children studying in the government and government aided schools. This scheme benefitted 140
million children in government assisted schools across India in 2008, strengthening child nutrition and literacy. In
a country with a large percent of illiterate population with a high percent of children unable to read or write; governmental and non-governmental organizations have reported that mid day meal scheme has consistently increased enrollment in schools in India. One of the main goals of school lunch program is to promote the health
and well-being of the Nation’s children.
Asia Pac J Clin Nutr. 2012;21(1):151-154.doi:
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School lunch program for health promotion among children in Japan
Author:Nobuko Tanaka RD, Miki Miyoshi RD MPhil
Keywords:school lunch program, The School Lunch Act, Shokuiku, Diet and Nutrition Teacher, Japan
Abstract:In Japan, the present school lunch program has been implemented under the “School Lunch Act” enacted in 1954.
The main purpose of the school lunch program is to promote healthy development ofthe minds and bodies of
school children. Later, “The SchoolLunch Act” was revised in 2008 and its aim was changed to “promoting Shokuiku”. As of May 2009, approximately 10 million school children participate in the school lunch program. This
program itself is an educational activity. School children are responsible for serving lunch and clearing the dishes.
They could also learn proper manners, by having meals together with classmates. Furthermore, understanding of
balanced diet and food culture can be enhanced through learning the menu of each meal. Recently, as eating disorders and obesity increase among adultsand school children, there is rising concern on development of lifestylerelated diseases. Under this circumstance, the Basic Law on Shokuiku was enacted in 2005. Besides, in order to enhance Shokuikuto school children, the Ministry of Education, Culture, Sports, Science and Technology established
the Diet and Nutrition Teacher System in April 2007. It isreprted that, in those schools with Diet and Nutrition
Teachers, a positive impact has been observed in terms of awareness and interest in diet among teachers and guardians. It is also reported that proportion of children skipping breakfast has decreased, and quality of life has been improved. In this way, the Japanese school lunch program system is essential for fostering healthy mind and bodies
for the next generation.
Asia Pac J Clin Nutr. 2012;21(1):155-158.doi:
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School-based “Shokuiku” program in Japan: application to nutrition education in Asian countries
Author:Miki Miyoshi RD MPhil, Nobuyo Tsuboyama-Kasaoka RD
Keywords:Shokuiku, food and nutrition education, dietitian, registered dietitian, Japan
Abstract:This paper provides the overview of “Shokuiku” in Japan, and discusses the future perspective on application of
its concepts to nutrition education in other Asian countries. In Japan, there has been a growing concern on increase of obesity and the metabolic syndrome among middle-aged men. Additionally, child obesity has also become one of the important health problems. The increased obesity among them is possibly associated with inappropriate dietary habits (eg skipping breakfast, excessivefat intake and insufficient vegetable). Under this circumstance, the “Basic Law on Shokuiku” was enacted in 2005, which was the first law that regulates one’s diets
and eating habits. For effective implementation of Shokuikuprogram, dietitians and registered dietitians would
play important roles in various settings. Japan has a long history of dietitiansystem as well as school-lunch programs. Later, in order to further enhance the school-based Shokuikuprograms, the Diet and Nutrition Teacher
System was established in April 2007. From an international point of view, “nutrition education” programs aim to
improve dietary practices so as to ensure adequate energy or nutrient intake and also to reduce obesity and lifestyle-related diseases, whereas the concepts of Shokuikuhave very wide approaches. Shokuiku’s efforts expand to
support food culture, especially through school-based programs, as well as to improve food environment by providing information on appropriate diets. These approaches can be introduced in nutrition education in other Asian
countries, not only to improve one’s health and nutritional status but also to secure food culture and food safety in
each country.
Asia Pac J Clin Nutr. 2012;21(1):159-162.doi:
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