Asia Pacific Clinical Nutrition Society Award for 2013
Author:
Keywords:
Abstract:
Asia Pac J Clin Nutr. 2013;22(1):i.doi:
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Vitamin D status and food security in North-East Asia
Author:Mark L Wahlqvist MD (Adelaide), MD (Uppsala) FRACP
Keywords: vitamin D, climate change, health, pleiotropic functions
Abstract:The functions of vitamin D are pleiotropic affecting all body organs and systems in some way. Its adequacy depends principally on sunshine for UV light to stimulate its synthesis in skin and on foods which contain it, either
animal-derived or obtained from fungi or mushrooms, with the UV-responsive substrates dehy drocholesterol for
vitamin D-3 or ergosterol for vitamin D-2, respectively. Thus, vitamin D health is very environmentally dependent. With ecosytem degradation, whether by atmospheric pollution or food systems which do not derive UV irradiation, as with fish farming or mushroom processing, then this nutrient input into human biology may falter. Vitamin D deficiency is now common and widespread in North-East Asia as elsewhere. When discovered early in
the 20
th
century it was linked to rickets in children and osteomalacia in adults and, for a generation or so, children
were given fish, usually cod, liver oil to prevent bone disease. Now cod as a species and many edible fish are
threatened. Over-exposure to sun-light increases the risk of skin cancer. We may tackle this problem by vitamin
D supplementation with an alternative to fish liver. But the demographic pressures of population size and ageing
(when the skin is less UV responsive) make the clinical and public health decisions and strategies demanding. Vitamin D health has become indicative of food security whose usual indicator is food diversity; such diversity may
allow lesser concentrations to be more effective in organ and system function, but we have little evidence to support this at present.
Asia Pac J Clin Nutr. 2013;22(1):1-5.doi: 10.6133/apjcn.2013.22.1.21
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Thailand nutrition in transition: situation and challengesof maternal and child nutrition
Author:Pattanee Winichagoon PhD
Keywords:mothers, children, early life, nutrition transition, Thailand
Abstract:Double burden of malnutrition (DBMN), the coexistence of under- and overnutrition in the same population, is an
emerging public health concern in developing countries, including Thailand. This paper aims to review the maternal and child nutrition situation and trends as the country moved from a low-income to a middle-income country, using data from large scale national surveys. Protein-energy malnutrition and micronutrient deficiencies predominantly affected mothers and children prior to the 1980s. The situation greatly improved during the 1980s-1990s, with the implementation of multi-sectoral policies and programs focusing on poverty alleviation and primary health care. Economic development, improved access to health services and effective community-based nutrition programs contributed to these positive trends. However, the prevalence of low birth weight remained at 8-10%, while stunting and underweight declined to about 10% by the 1990s, with small change thereafter. The
prevalence of anemia among pregnant women and children decreased by half and vitamin A deficiency is no
longer a public health problem. Iodine deficiency, especially during pregnancy is still a major concern. As the
country progressed in terms of economic and social development, overnutrition among women and children affected all socio-economic levels. Changes in lifestyles, food access and eating patterns are observed both in urban
and rural areas. Although efforts have been made to address these challenges, harmonized policy and strategic
programs that address DBMN in the complex social and economic environment are urgently needed. Early life
undernutrition should be considered along with measures to address obesity and chronic diseases in children.
Asia Pac J Clin Nutr. 2013;22(1):6-15.doi: 10.6133/apjcn.2013.22.1.17
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Eating beef: cattle, methane and food production
Author:Åsa K Wahlquist B.Ag.Sc. (Adelaide)
Keywords:cattle, methane, grassland, grain-fed
Abstract:A number of prominent people have advocated eating less meat or becoming a vegetarian to reduce global warming, because cattle produce the greenhouse gas methane. This raises a number of questions including: what will
happen to the grasslands that much of the world’s cattle currently graze; how will alternate protein be produced,
and what will the greenhouse consequences of that production be? It comes down to production systems. About
70 per cent of the world’s agricultural land is grassland, and the only way to produce food from grasslands is to
graze ruminants on it. If domesticated animals do not graze the grasslands, native or feral ruminants, which also
produce methane, tend to move in. Feeding high quality grain to cattle is much less defensible. Replacing animal
protein with plant proteins like soybeans necessitates more cropping land, water, fuel and chemicalsbeing used.
A more rational food system would raise cattle on grasslands but not feed them high quality grains. Instead more
of the currently grown crop could be devoted to human consumption.
Asia Pac J Clin Nutr. 2013;22(1):16-24.doi: 10.6133/apjcn.2013.22.1.04
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Validation of a self-monitoring device for estimating 24-hour urinary salt excretion
Author:Kenichiro Yasutake PhD Kayoko Sawano BSc Naoko Sho
Keywords:salt intake, urinary salt excretion, self-monitoring device, overnight urine, blood pressure
Abstract:Background: The purpose of this study was to investigate the relationship between salt intake and urinary salt excretion and to examine the validity of a self-monitoring device for estimating 24-h urinary salt excretion from
overnight urine samples. Methods: Twelve young, healthy female volunteers consumed test meals from days 1 to
14 and estimated urinary salt excretion on days 2–15 by using a self-monitoring device. The salt content of the
test meals was as follows: 10 g (days 1–5), 6 g (days 6–8), 13 g (days 9–11), 6 g (day 12), 13 g (day 13), and 6 g
(day 14). Results: The average 24-h urinary salt excretion (the ratio of urinary salt excretion to salt intake of the
previous day) estimated from the overnight urine samples was as follows: 8.01±1.15 g (0.73±0.11) on days 2–6,
5.86±0.85 g (1.01±0.15) on days 7–9, 9.69±1.64 g (0.74±0.13) on days 10–12, 6.51±1.56 g (1.03±0.25) on day 13,
8.60±3.25 g (0.71±0.14) on day 14, and 6.28±1.31 (1.05±0.22) on day 15. Thus, the salt excretion/salt intake ratio
was approximately 0.8 during the high-salt phase and 1.0 during the low-salt phase. Conclusion: The estimation
of 24-h urinary salt excretion from overnight urine samples by using a self-monitoring device is a reasonably valid method in this young and healthy female population for detecting daily changes in salt intake.
Asia Pac J Clin Nutr. 2013;22(1):25-31.doi: 10.6133/apjcn.2013.22.1.03
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The atherosclerotic risk profile is affected differently by fish flesh with a similar EPA and DHA content but different n-6/n-3 ratio
Author:Francesco Sofi MD, PhD, Gianluca Giorgi MSc, PhD,
Keywords: fish intake, cardiovascular disease, inflammation, diet, omega-3
Abstract:The aim of this study was to evaluate the effect of consuming gilthead sea bream fillets, with different n-6/ n-3
ratios, on atherosclerotic biomarkers. Twenty healthy subjects were included in a randomised single-blinded
cross-over trial. Participants were randomized into 2 groups, both of which received approximately 630 g per
week of gilthead sea bream fed with either 100% fishmeal (FM) or partial replacement with plant proteins (PP)
over two consecutive 10 week periods, respectively. Group A consumed firstly the FM fillets followedby the PP
fillets, whereas the reverse order was adopted for group B. Group A reported a significant decrease of 29.3% (∆
= –26 mg/dL) in total cholesterol after the first phase of the intervention, before returning to baseline levels after
the dietary intervention with fish fed with PP. Similarly, in group A, both LDL-cholesterol and triglycerides decreased significantly by 21.6% (∆ = –19 mg/dL) and 11.7% (∆ = –10.7 mg/dL), respectively, before increasing
again after the intervention. Improvements in the inflammatory cytokines, interleukin-6 and -8 were also noted.
Moreover, whole blood viscosity appeared significantly improved in group A, as seen by a significant increase of
7.59% (∆ = +4.59 mPA) for erythrocyte filtration rate. In conclusion, similar EPA+DHA content with different n-6/n-3 ratio fish flesh intake was shown to have varied affects on lipid, inflammatory and haemorheological parameters in a group of healthy subjects.
Asia Pac J Clin Nutr. 2013;22(1):32-40.doi: 10.6133/apjcn.2013.22.1.12
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Iodized salt supplementation and its effects on thyroid status amongst Orang Asli in Hulu Selangor, Malaysia
Author:Kuang Kuay Lim MSc, Ming Wong MBBCh, Wan Nazaimoo
Keywords:iodine deficiency disorder, Orang Asli, iodized salt, hyperthyroidism
Abstract:Background: This research was performed to determine the prevalence of iodine deficiency disorder (IDD) and
the effects of iodized salt supplementation on thyroid status amongst Orang Asli in Hulu Selangor, Malaysia.
Methods: Study respondents were from three target groups, i.e. pre-school children (PSC), primary school-going
children (SGC) and adult women. Each household was supplied with iodized salt fortified with iodate fortificant
for a period of 12 months and the iodine levels in the salt ranged from 20 to 30 µg/L. Samples collected before
and after 6 and 12 months of introduction to iodized salt were urine from all groups, as well as serum samples
from adult women. Results: A total of 200 respondents were recruited; 58 (29.0%) PSC, 65 (32.5%) SGCand 77
(38.5%) adult women. The median urine-iodine concentration (mUIC) in all groups were of moderately low before the iodized salt intervention, but increased significantly in all study groups after 6 and 12 months of intervention. However, at the end of the study, there was an increase in severe iodine deficiency (mUIC <20 µg/L) from
7.5% to 12% and about 9% of PSC and SGC respondents had mUIC level of more than 300 µg/L while the adult
women showed a significant increase in free triiodothyronine (fT3) levels. Conclusion: The study demonstrated
that iodized salt supplementation was able to show an improvement in iodine level amongst Orang Asli. However,
an increase in severe iodine deficiency and iodine excess indicated that the iodized salt programme needs to be
carefully monitored.
Asia Pac J Clin Nutr. 2013;22(1):41-47.doi: 10.6133/apjcn.2013.22.1.02
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Oral carbohydrate loading with 18% carbohydrate beverage alleviates insulin resistance
Author:Takahiko Tamura MD,Tomoaki Yatabe MD, PhD, Hiroyuk
Keywords:carbohydrate loading, insulin resistance, enhanced recovery after surgery, hyperinsulinemic normoglycemic clamp, perioperative management
Abstract:Preoperative 12.6% oral carbohydrate loading is an element of the Enhanced Recovery After Surgery (ERAS)
protocol aimed at alleviating postoperative insulin resistance; however, in Japan, beverages with 18% carbohydrate content are generally used for preoperative carbohydrate loading. We investigated the effect of 18% carbohydrate loading on alleviating insulin resistance. Six healthy volunteers participated in this crossover-randomized
study and were segregated into 2 groups: volunteers in the carbohydrate-loading group (group A) who fasted
from after 9 pm and ingested 375 mL of a beverage containing 18% carbohydrate (ArginaidWater
TM
; Nestle, Tokyo, Japan) between 9 pm and 12 pm, and 250 mL of the same liquid at 6: 30 am. Volunteers in control group
(group B) drank only water. At 8: 30 am, a hyperinsulinemic normoglycemic clamp was initiated. Glucose infusion rate (GIR) and levels of ketone bodies and cytokines (IL-1β, IL-6, and TNF-α) before clamping were evaluated. P<0.05 was considered statistically significant. Levels of blood glucose, insulin, and cytokines at the start of
the clamp were similar in both the groups. The GIR in group A was significantly higher than that in group B
(11.5±2.4 vs 6.2±2.2 mg/kg/min, p=0.005), while blood ketone body levels were significantly lower in group A
(22±4 vs 124±119 µmol/L, p=0.04). Preoperative 18% carbohydrate loading could prevent the decrease in insulin
sensitivity and suppress catabolism in healthy volunteers. Thus, carbohydrate loading with a beverage with 18%
carbohydrate content might contribute to improvements in perioperative management.
Asia Pac J Clin Nutr. 2013;22(1):48-53.doi: 10.6133/apjcn.2013.22.1.20
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A multicentre assessment of malnutrition, nutritional risk, and application of nutritional support among hospitalized patients in Guangzhou hospitals
Author:Shi Fang MD, Jianting Long MD, PhD, Rongshao Tan M
Keywords:nutritional assessment, nutritional status, hospital, malnutrition, nutritional support
Abstract:Background: To assess nutritional status, the prevalence of nutritional risk, and nutritional support in hospitalized
patients in Guangzhou, to determine gender or age associated differences in the prevalence of nutritional risk.
Methods: A total of 2550 patients admitted during April to December 2008 from six departments (Gastroenterology, Pulmonology, Neurology, Nephrology, General Surgery and Thoracic Surgery) of four teaching hospitals
were screened using the Nutritional Risk Screening 2002 tool. Results: Overall prevalence of undernutrition and
nutritional risk was 17.8% and 41.5%, respectively. The department of Pulmonology had the highest prevalence
of undernutrition (28.2%) and nutritional risk (55.9%). The prevalence of nutritional risk was significantly higher
in patients ≥70 years of age than patients <70 years (64.2% vs 32.6%, p<0.001). No gender difference in the
prevalence of nutritional risk was observed in general. In total, 47.6% of “at risk” and 19.4% of “not at risk” patients received nutritional support. Parenteral nutrition accounted for 88.8% of the nutritional support. Conclusions: The present study documented the prevalence of nutritional risk defined by NRS2002 and inappropriate assignment of nutritional interventions in Guangzhou hospitals.
Asia Pac J Clin Nutr. 2013;22(1):54-59.doi: 10.6133/apjcn.2013.22.1.01
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Serum and dietary antioxidant status is associated with lower prevalence of the metabolic syndrome in a study in Shanghai, China
Author:Yanrong Li PhD, Hongwei Guo MD, Min Wu BD, Ming Li
Keywords:human, antioxidant, serum, diet, metabolic syndrome
Abstract:Objective: The aim of our study was to examine the association between the metabolic syndrome (MS) and serum
antioxidant status. Methods: A cross-sectional study was conducted with 221 cases and 329 controls aged 18 to
65 years. Weight, height, body mass index, waist circumference, blood pressure, fasting blood glucose and lipids,
as well as serum superoxide dismutase, glutathione peroxidase, malondialdehide, vitamins A, E, β-carotene and
lycopene were examined. I ntakes of antioxidants were also estimated. Results: Mean serum superoxide dismutase
activity, β-carotene concentrations were significantly lower, malondialdehide was higher (p<0.05) in persons with
the MS (after adjusting for age, sex) than those without. Superoxide dismutase, glutathione peroxidase, and β-carotene also decreased significantly (p<0.05) with increased number of components of the MS. Low levels of serum superoxide dismutase activity and β-carotene concentration appeared to be associated with the MS status.
Moreover, dietary energy, carbohydrate, vitamin C, zinc and copper intake in the MS patients were lower, but fat
intake were higher. Vitamins E, C and manganese intake decreased with the elevated number of the MS components. For zinc and manganese, a lower risk was observed for other quartile of intake compared with the first one.
I nverse links between dietary fat, energy intake and serum antioxidant status were found in MS patients, meanwhile dietary vitamin C was positively related with serum antioxidant level. Conclusions: Serum antioxidant status was associated with a lower prevalence of the MS, and with lower dietary fat, energy intake and higher vitamin C intake.
Asia Pac J Clin Nutr. 2013;22(1):60-68.doi: 10.6133/apjcn.2013.22.1.06
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Regional percent fat and bone mineral density in Korean adolescents: The Fourth Korea National Health and Nutrition Examination Survey (KNHANES IV-3), 2009
Author:Kayoung Lee MD, MPH, PhD
Keywords:percent body fat, bone mineral density, gender, development stage, adolescent
Abstract:The effects of total and regional (trunk, arm, and leg) percent fat on total and regional (arm, leg,rib, thoracic
spine, lumbar spine, proximal femur, and pelvis) bone mineral density (BMD) in Korean adolescents were examined using the Fourth Korea National Health and Nutrition Examination Survey, 2009. Percent fat and BMD were
measured by dual energy X-ray absorptiometry in a population-based sample of 710 Korean adolescents (365
boys and 345 girls), aged 10-19 years. After adjusting for age, height, weight, serum vitamin D, dietary calcium
intake, and menarche for girls in complex sampling linear regression analysis, higher total and regional percent
fat were associated with low total BMD and BMD in all regions in boys aged 13-16 years, while the associations
were inconsistent for early and late adolescent boys. In girls, the inverse associations were more consistent for
those aged 17-19 years than for younger girls. While most of total and regional percent fat were negatively associated with BMD of thoracic and lumbar spine and femur in boys, most of these relationships were not significant
in girls. The negative association with total BMD was consistent for trunk percent fat but variable for arm and leg
percent fat according to age subgroup and gender. In conclusion, the unfavorable effect of regional percent fat on
all regional BMD is more consistent in boys aged 13-16 years and in girls aged 17-19 years, while the relationship appears to be gender and age subgroup-specific.
Asia Pac J Clin Nutr. 2013;22(1):69-73.doi: 10.6133/apjcn.2013.22.1.14
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The association of weight status with cognitive impairment in the elderly population of a Shanghai suburb
Author:Guo-Hong Cui MD, PhD, Hai-Dong Guo PhD, Rui-Fang
Keywords:cognitive impairment, waist circumference, waist-to-hip ratio, BMI
Abstract:Objective: A population-based survey was conducted to analyze the association of under-weight, blood pressure,
glucose and lipid metabolism with cognitive impairment in people, 60 years and over, living in 2 towns of Shanghai.
Methods: Face-to-face interviews were carried out to collect relevant information with questionnaires. Anthropometric indices of height, weight, waist circumference (WC) and hip circumference were measured. Multivariable
logistic regression analyses were performed to evaluate the association of weight status with cognitive impairment.
Results: Cognitive impairment were diagnosed in 198 (7.0%) of the 2 809 participants. Compared to the normal
BMI category, the under-weight category was significantly associated with the risk of cognitive impairment (OR=
2.47, 95%CI: 1.46-5.23). Subjects with a high WC were 1.5 times (OR= 1.42, 95%CI: 1.10-2.67) more likely and
subjects with a high WHR were 1.7 times (OR= 1.68, 95%CI: 1.05-2.84) more likely to be associated with cognitive impairment than the subjects in the reference group. This study demonstrates a significant interaction between
hypertension, lipid disorder and WC or WHR on the risk of cognitive impairment in a rural population in Shanghai.
Conclusions: Central obesity was significantly associated with the risk of cognitive impairment. A low BMI may be
a risk factor for cognitive impairment. A significant interaction between hypertension, lipid disorder and WC or
WHR on the risk of cognitive impairment in Shanghai rural population was found.
Asia Pac J Clin Nutr. 2013;22(1):74-82.doi: 10.6133/apjcn.2013.22.1.18
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Prevalence of inappropriate dietary supplement use among pregnant women in Japan
Author:Yoko Sato PhD, Tomoko Nakanishi RD, Tsuyoshi Chiba
Keywords:dietary supplements, pregnancy, folic acid, information, Japan
Abstract:We investigated the characteristics of dietary supplements and their use by 1,076 Japanese pregnant women, the
majority of whom were in mid- to late pregnancy. The subjects completed a self-reported survey on their
sociodemographic characteristics, supplement use, and attitudes towards diet. The overall prevalence of supplement use did not change before and after pregnancy (75%); however, daily use increased by approximately twofold with pregnancy (20.2% versus 37.2%). After the onset of pregnancy, supplements containing folicacid were
taken for fetal health. Daily users were more likely to be older, have a greater awareness of the risk of neural tube
defects (NTD), view supplement use as acceptable, have less diet anxiety, and have more advisers regarding diet.
Respondents used supplements containing folic acid alone or with other ingredients. Folic acid intake is recommended to reduce the risk of NTD. However, supplement use began after pregnancy recognition, suggesting a
lack of knowledge on the appropriate timing of folic acid use. Information about supplements was obtained mostly from newspapers, magazines, flyers, and stores. These results indicate that more accurate information regarding the optimal timing of folic acid intake and the safety of dietary supplements must be disseminated.
Asia Pac J Clin Nutr. 2013;22(1):83-89.doi: 10.6133/apjcn.2013.22.1.08
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Low body weight gain, low white blood cell count and high serum ferritin as markers of poor nutrition and increased risk for preterm delivery
Author:Wen-Yin Hsu MS, Cheng-Hsuan Wu MD, Charles Tsung-C
Keywords:nutrient intake, maternal weight gain, white blood cells, ferritin, preterm delivery
Abstract:This study determined factors of preterm delivery in Taiwan. Healthy women (n=520, age 29.1±4.2 y) at 8–12
weeks of pregnancy were recruited from prenatal clinics. Background information, anthropometrics, biochemical
parameters, and dietary intake, collected by 24 h-recall were obtained from the first, second, and third trimesters
to delivery. Clinical outcomes of neonates were also collected. The results show that 53.7% of women were
primiparous and that the incidence of preterm delivery was 6.2%. Body weight gains in the first trimester and
throughout pregnancy were significantly lower in mothers with preterm delivery (preterm group) than in mothers
with term delivery (term group, p<0.05). Maternal cholesterol intake, circulating white blood cell counts (WBC)
and serum albumin were significantly lower and that serum magnesium and ferritin were significantly higher in
the preterm group than in the term group. Maternal weight gain was positively correlated with caloric and nutrient
intake (p<0.05). Neonatal birth weight was positively correlated with maternal weight gain and intakes of protein
and phosphate during pregnancy; with intakes of calories, vitamin B-1 and B-2 in the first trimester; and with
intakes of calcium, magnesium, iron and zinc, as well as circulating WBC in the third trimester. However,
neonatal birth weight was negatively correlated with serum iron in the third trimester and with serumiron and
ferritin at the time of delivery. In conclusion, maternal weight gain in early pregnancy and WBC, mineral intake
and iron status in late pregnancy seem to be major factors affecting delivery and neonatal outcomes.
Asia Pac J Clin Nutr. 2013;22(1):90-99.doi: 10.6133/apjcn.2013.22.1.05
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The nutritional status of young children and feeding practices two years after the Wenchuan Earthquake in the worst-affected areas in China
Author:Jing Sun BD,Junsheng Huo PhD, Liyun Zhao MD, Ping
Keywords:young children, child growth, anemia, complementary feeding, earthquake disaster
Abstract:This study was carried out to investigate the nutritional status and feeding practices of young children in the
worst-affected areas of China two years after the Wenchuan Earthquake. The sample consisted of 1,254 children
6-23 months of age living in four selected counties from the disaster-affected provinces of Sichuan, Shaanxi and
Gansu. Length-for-age, weight-for-age, weight-for-length, and hemoglobin concentration were used to evaluate
nutritional status. Interviews with selected children’s caretakers collected basic demographic information, children’s medical history, and child feeding practices. Stunting, underweight, and wasting prevalence rates in children 6-23 months of age were 10.8%, 4.9% and 2.8% respectively, and anemia prevalence was 52.2%. Only
12.3% of children had initiated breastfeeding within the first hour after birth. Overall, 90.9% of children had ever
been breastfed, and 87% children 6-8 months of age had received solid, semi-solid or soft foods the day before
the interview. The diets of 45% of children 6-23 months of age met the definition of minimum dietary diversity,
and the diets of 39% of breastfed and 7.6% non- breastfed children 6-23 months of age met the criteria for minimum meal frequency. The results highlight that a substantial proportion of young children in the earthquake affected disaster areas continue to have various forms of malnutrition, with an especially high prevalence of anemia,
and that most feeding practices are suboptimal. Further efforts should be made to enhance the nutritional status of
these children. As part of this intervention, it may be necessary to improve child feeding practices.
Asia Pac J Clin Nutr. 2013;22(1):100-108.doi: 10.6133/apjcn.2013.22.1.19
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Associations between uterine fibroids and lifestyles including diet, physical activity and stress: a case-control study in China
Author:Yuan He MD, Qiang Zeng MD, Shengyong Dong MD, Liqi
Keywords:uterine fibroid, diet, physical activity, stress, risk factors
Abstract:This study was conducted to investigate the associations between uterine fibroids and lifestyles including diet,
physical activity and stress from October 2009 to April 2011 in China. This case-control study composed of 73
women with uterine fibroids and 210 women without fibroids. Uterine fibroid cases were confirmed by ultrasound diagnosis or hysterectomy surgery. Information on women’s dietary habits, physical activity and stress status were collected with a validated self-administered questionnaire. A logistic regression model was used to estimate the odds ratios (OR) after controlling for age, gravidity and parity. We found that vegetable and fruit intakes
and occupational intensity played positive effects on uterine fibroids. For premenopausal women, vegetable and
fruit intakes (OR = 0.5; 95% CI: 0.3, 0.9) and occupational intensity (OR = 0.2; 95% CI: 0.1, 0.6) significantly
decreased the risk of fibroids; conversely, BMI significantly increased the risk (OR = 1.2; 95% CI: 1.0, 1.4).
However, the associations for postmenopausal women were not significant. Our findings suggested protective
roles for vegetable and fruit intakes and occupational intensity on uterine fibroids, and supported the hypothesis
that high BMI only increased the risk of uterine fibroids in premenopausal women.
Asia Pac J Clin Nutr. 2013;22(1):109-117.doi: 10.6133/apjcn.2013.22.1.07
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Isoflavone consumption and risk of breast cancer: a dose-response meta-analysis of observational studies
Author:Qi Xie MM, Ming-Liang Chen MM, Yu Qin MD, Qian-Yo
Keywords: isoflavone, breast cancer, dose-response, meta-analysis, menopaus
Abstract:Epidemiologic studies that examine whether isoflavone consumption protects against breast cancer have yielded
inconsistent results. The controversy focuses on the effects of the menopausal status and exposure dose of
isoflavone. We aim to conduct a meta-analysis on the association between isoflavone intake and breast cancer
risk by comprehensively assessing isoflavone exposure in the targeted populations. We searched PUBMED and
EMBASE databases for case-control and cohort studies that assess the association between isoflavone intake and
breast cancer risk. We extracted relative risks (RR) and odds ratios (OR) of different reported categories of
isoflavone intake from each study. Fixed- or random-effects models were used to summarize dose-response data.
Twenty-two studies were selected for the meta-analysis. Overall, the results showed that isoflavone reduced the
breast cancer risk (a combined RR/OR of 0.68, 95% CI: 0.52-0.89) in Asian populations rather than Western
populations (a combined RR/OR of 0.98, 95% CI: 0.87, 1.11) for the high-dose category. Further analysis showed
that the intake of isoflavone in postmenopausal Asian women 0.46 (95% CI: 0.28-0.78) was better than
premenopausal 0.63 (95% CI: 0.50-0.80) but similar in postmenopausal Western women 1.00 (95% CI: 0.98-1.02)
and premenopausal 0.99 (95% CI: 0.87-1.12). Exposure to high isoflavone may be associated with a reduced
breast cancer risk in Asian populations, especially in postmenopausal women. However, no significant difference
in the studies of Western populations may be due to the low intake of isoflavone levels.
Asia Pac J Clin Nutr. 2013;22(1):118-127.doi: 10.6133/apjcn.2013.22.1.16
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The association of tea consumption with bladder cancer risk: a meta-analysis
Author:Shihao Wu MM, Fei Li MD, Xiao Huang MD, Qingsheng
Keywords:bladder cancer, overall tea, black tea, green tea, meta-analysis
Abstract:The association between tea consumption and bladder cancer has been confirmed in several animal studies, but
one epidemiological study in 2001 showed no association between them. In order to provide an accurate assessment of this, we conducted a meta-analysis on tea consumption and bladder cancer risk. Studies were identified
by a literature search in PubMed from January 1980 to March 2012 and the reference lists of relevant studies.
Random effect models were used to calculate summary relative risk estimates (RR) and their corresponding 95%
confidence intervals (CI) based on high contrast to low intake values. Twenty-four publications (6 cohort studies
and 18 case-control studies) based on consumption of overall tea, black tea, and green tea to bladder cancer risk
were included in this analysis. For overall tea, the summary RR indicated no association between tea consumption and bladder cancer (RR= 1.09, 95%CI: 0.85-1.40). In subgroup analyses, we found a moderate increase of
bladder cancer risk in smoking group (RR= 1.77, 95%CI: 1.04-3.01). In the black tea group, no statistically significant association was observed (RR= 0.84, 95%CI: 0.70-1.01). Interestingly, in the subgroup of sex, a protective effect was observed between tea consumption and bladder cancer risk in females (RR= 0.61, 95%CI: 0.38-0.98). For green tea group, there was no relationship associated with bladder cancer risk (RR= 1.03, 95%CI: 0.82-1.31). In conclusion, our data suggest that high overall tea intake in smokers increased the risk of bladder cancer,
and high black tea intake in females may reduce the risk of bladder cancer
Asia Pac J Clin Nutr. 2013;22(1):128-137.doi: 10.6133/apjcn.2013.22.1.15
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Changes in the sodium content of Australian ready meals between 2008 and 2011
Author:Anthea Kay Christoforou MIPH, Elizabeth Kalpiaka D
Keywords: sodium, ready-to-eat meals, food reformulation, public health nutrition, cardiovascular disease
Abstract:Australians consume substantially more sodium than recommended. Three quarters of dietary sodium derives
from processed food and the growing ready meal category is a significant contributor. This study examined
changes in sodium levels of Australian ready meal products between 2008 and 2011. Sodium data were systematically collected from all product labels in the same 5 stores each year. Mean sodium levels were calculated overall
and compared between ready meal types, and by major brands. The levels of sodium in new, discontinued and established products were also compared. There were 107 ready meal products in 2008, 313 in 2009, 219 in 2010
and 265 in 2011. Overall mean sodium content was unchanged between 2008 and 2011 (279 vs 277 mg/100g).
There were clear differences between sodium levels of different brands (222 vs 310 mg/100g in McCain Healthy
Choice and McCain products respectively) and marked variation in similar products (240 mg/100g in one brand
of frozen cottage pie product vs 425mg/100g in another). The mean sodium content of recently introduced products was lower than discontinued products (289 vs 309 mg/100g), with the sodium level of established products
remaining stable. The absence of any overall reduction in sodium levels of Australian ready meal products is discouraging. The failure of voluntary industry efforts to reduce the saltiness of these foods suggestsa regulated approach will be required to drive product reformulation.
Asia Pac J Clin Nutr. 2013;22(1):138-143.doi: 10.6133/apjcn.2013.22.1.10
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Nutrition education in Japanese medical schools: a follow-up survey
Author:Hideo Orimo MD, PhD,Takahiro Ueno MD, PhD, Hiroshi
Keywords:nutrition education, medical schools, Japan, questionnaire, curriculum
Abstract:A questionnaire survey was used to determine the status of nutrition education in Japanese medical schools in
2009. A similar survey was conducted in 2004, at which time nutritional education was determined to be inadequate in Japanese medical schools. The current questionnaire was sent to the directors of Centers for Medical Education of 80 medical schools, who represented all medical schools in Japan. Sixty-seven medical schools (83.8%)
responded, of which 25 schools (37.3%) offered dedicated nutrition courses and 36 schools (53.7%) did not offer
dedicated nutrition courses but offered something related to nutrition in other courses; six schools(9.0%) did not
offer any nutrition education. Overall, 61 schools (91.0%) offered at least some nutritional topics in their undergraduate education. Nevertheless, only 11 schools (16.4%) seem to dedicate more than 5 hours to substantial nutrition education as judged by their syllabi. Although the mean length of the course was 11 hours, substantial nutrition education accounted for only 4.2 hours. Of the 25 medical schools that offered dedicated nutrition courses,
seven schools offered the nutrition course as a stand-alone course and 18 schools offered it as an integrated
course. In conclusion, the status of nutrition education in Japan has improved slightly but is still inadequate.
Asia Pac J Clin Nutr. 2013;22(1):144-149.doi: 10.6133/apjcn.2013.22.1.13
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Insulin receptor substrate 1 (IRS1) variants confer risk of diabetes in the Boston Puerto Rican Health Study
Author:Xiang Feng MD, PhD, Laurence D Parnell PhD, Jian S
Keywords:genetic association, IRS1, type 2 diabetes, insulin resistance, DNA damage
Abstract:Objective: Published data concerning associations between IRS1 variants and type 2 diabetes and related traits
have been inconsistent. We examined the relationship between common variants in IRS1, type 2 diabetes, and related traits including insulin resistance, hyperglycemia and DNA damage in the Boston Puerto Rican Health
Study. Methods: We genotyped six common IRS1 variants in an adult Puerto Rican population (n=1132) and tested for association with risk of type 2 diabetes and related traits. Results: SNPs rs934167 and rs1801123 showed
significant association with fasting glucose concentrations (p = 0.005 and p = 0.016, respectively) and rs934167
showed significant association with plasma insulin levels (p = 0.005). Carriers of the rs934167 minor allele had
significantly higher HOMA-IR and lower QUICKI (p = 0.001 and p = 0.001, respectively), and a 40% and 58%
greater likelihood of being hyperglycaemic or hyperinsulinemic (OR = 1.40 and 1.58; p = 0.013 and 0.002, respectively). However, they exhibited only a marginally significant trend towards having type 2 diabetes
(OR=1.27, p = 0.077). Furthermore, carriers of the haplotype C-T of the rs934167 and rs1801123 minor alleles
showed consistent patterns of associations after correction for multiple testing. In addition, the G972R
(rs1801278) minor allele was significantly associated with higher urinary 8-OHdG concentrations (p = 0.020) and
plasma CRP levels (p = 0.035). Conclusions: Our results support IRS1 variants associated with type 2 diabetes
risk in adult Puerto Ricans. Moreover, we report the novel finding that IRS1 variant G972R (rs1801278) may contribute to oxidative DNA damage and inflammation.
Asia Pac J Clin Nutr. 2013;22(1):150-159.doi: 10.6133/apjcn.2013.22.1.09
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Associations between serum bone-specific alkaline phosphatase activity, biochemical parameters, and functional polymorphisms of the tissue-nonspecific alkaline phosphatase gene in a Japanese population
Author:Natsuko Sogabe PhD, Rieko Tanabe MSc, Mayu Har
Keywords:bone-specific alkaline phosphatase, phosphorus, single nucleotide polymorphism, tissue-nonspecific alkaline phosphatase, young adult subjects
Abstract:Introduction: We had demonstrated that single nucleotide polymorphism (787T>C) in the tissue-nonspecific ALP
(TNSALP) gene was associated with the bone mineral density (BMD). BMD was the lowest among TNSALP 787T
homozygotes (TT-type) and highest among TNSALP 787T>C homozygotes (CC-type) in postmenopausal women.
In the present study, we investigated the effects of the TNSALP genotype on associations among serum bonespecific alkaline phosphatase (BAP), serum calcium, and phosphorus in healthy young Japanese subjects. Methods:
Young healthy adult subjects (n=193) were genotyped for the polymorphism, and we measured the levels of serum
BAP, serum calcium, and phosphorus. Dietary nutrient intakes were calculated based on 3-day food records before
the day of blood examinations. Results: Grouped by the TNSALP genotype, a significant negative correlation between serum BAP and phosphorus was observed in 787T>C homozygotes (CC-type), but not in heterozygotes (TCtype), nor in 787T homozygotes (TT-type). Conclusions: In the present study, we revealed that the single nucleotide
polymorphism 787T>C in the TNSALP gene had effects on the correlation between serum BAP and phosphorus in
young adult subjects. These results suggest that variation in TNSALP may be an important determinantof phosphate metabolism. Our data may be useful for planning strategies to prevent osteoporosis.
Asia Pac J Clin Nutr. 2013;22(1):160-165.doi: 10.6133/apjcn.2013.22.1.11
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Vitamin D in North-East Asian clinical nutrition practice
Author:Mark L Wahlqvist MD (Adelaide), MD (Uppsala) FRACP
Keywords:vitamin D deficiency, ethnicity, atmospheric pollution, food, sunlight, diagnosis, food sources
Abstract:Sound clinical nutrition practice is grounded in evidence and stimulated by research. Yet, there are unanswered
questions about food-health relationships. Clinical nutrition involves the identification of nutritional disorders and
the motivation to rectify them with all required care. Vitamin D health exemplifies the biomedical, societal and
environmental dimensions of clinical nutrition, its science and practice. It depends most of all on access to sunshine and food and probably represents a paradigm in human health which is still at its beginning. Nevertheless,
the problem of its deficiency is much more widespread and common than has been thought since it was first identified as a cause of rickets and osteomalacia. It is now known to spare no body organ or system. Theproblem in
North-East Asia is comparable to much of the rest of the world, but the risk profile for it is exaggerated by atmospheric pollution, cultures with sun-avoidance on account of skin colour and potentially mitigated by foodstuffs like fish, eggs, organ meats and mushrooms which can partially offset sunshine-deficiency. Diagnosis requires a high index of suspicion and confirmation by biochemistry which may not be affordable. Therefore a
close working relationship between public health and clinical nutritionist is essential.
Asia Pac J Clin Nutr. 2013;22(1):166-169.doi: 10.6133/apjcn.2013.22.1.22
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