Simplified malnutrition tool for Thai patients
Author:Surat Komindr MD, Thanwarin Tangsermwong MS, CDT,
Keywords:nutrition screening tool, malnutrition, nutritional assessment, prevalence, malnutrition risk
Abstract:Malnutrition in hospitals often goes unrecognized. At present, no nutrition screening tool provides satisfactory results in identifying nutritional risk. Most tools depend on weight and height as criteria for diagnosing malnutrition.
Weight is not recorded in many patients and some tools are time-consuming. An inclusive nutrition screening
form (Nutrition Alert Form, NAF) was developed and validated. NAF was modified from the original version of
Subjective Global Assessment (SGA) by adding in two standard laboratory tests. The severity of the symptom
and laboratory changes were scored. NAF was validated in 210 hospitalized Thai patients at Ramathibodi hospital
by an experienced clinical nutritionist (physician) at Ramathibodi hospital. Cross validation was carried out between the dietitian and nurse in another 90 patients. Most of the time nurses could complete the nutrition screening in a patient within 5 minutes. One out of four patients could not be weighed on admission. The scores of 5
and 11 were selected as the cut-off scores of different malnutrition levels due to their high sensitivity, specificity
and accuracy and scores of 6 to 10 were defined as moderate malnutrition. The diagnostic agreement between the
dietitian and nurse for “normal to mild malnutrition”, “moderate malnutrition”, and “severe malnutrition” were
85%, 70% and 72%, respectively . NAF for screening of malnutrition in hospitalized Thai patients is easy to use,
concise, does not require nutrition expertise and can be used whether or not body weight is taken.
Asia Pac J Clin Nutr. 2013;22(4):516-521.doi: 10.6133/apjcn.2013.22.4.06
>>Abstract
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Development and validation of anthropometric prediction equations for estimation of body fat in Indonesian men
Author:Janatin Hastuti MKes, Masaharu Kagawa BSc(Hons),
Keywords:anthropometry, prediction equation, deuterium oxide dilution, body fat, Indonesia
Abstract:Body composition of 292 males aged between 18 and 65 years was measured using the deuterium oxide dilution
technique. Participants were divided into development (n=146) and cross-validation (n=146) groups. Stature,
body weight, skinfold thickness at eight sites, girth at five sites, and bone breadth at four sites were measured and
body mass index (BMI), waist-to-hip ratio (WHR), and waist- to-stature ratio (WSR) calculated. Equations were
developed using multiple regression analyses with skinfolds, breadth and girth measures, BMI, and other indices
as independent variables and percentage body fat (%BF) determined from deuterium dilution technique as the
reference. All equations were then tested in the cross-validation group. Results from the reference method were
also compared with existing prediction equations by Durnin and Womersley (1974), Davidson et al (2011), and
Gurrici et al (1998). The proposed prediction equations were valid in our cross-validation samples with r=0.77-0.86, bias 0.2-0.5%, and pure error 2.8-3.6%. The strongest was generated from skinfolds with r=0.83, SEE 3.7%,
and AIC 377.2. The Durnin and Womersley (1974) and Davidson et al (2011) equations significantly (p<0.001)
underestimated %BF by 1.0 and 6.9% respectively, whereas the Gurrici et al (1998) equation significantly
(p<0.001) overestimated %BF by 3.3% in our cross-validation samples compared to the reference. Results suggest that the proposed prediction equations are useful in the estimation of %BF in Indonesian men.
Asia Pac J Clin Nutr. 2013;22(4):522-529.doi: 10.6133/apjcn.2013.22.4.14
>>Abstract
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Glutamine supplementation in preterm infants receiving parenteral nutrition leads to an early improvement in liver function
Author:Ying Wang PhD, MD, Wei Cai PhD, MD, Ye-Xuan Tao Ph
Keywords:parenteral nutrition, glutamine, premature infant, liver function , neonate
Abstract:Objective: The aim of study was to confirm the protective effects of parenteral glutamine supplementation on liver injury in premature infants and determine how quickly effects became evident. Methods: We performed a double-blind, randomized, controlled clinical study to assess the effect of parenteral nutrition (PN) supplemented
with glutamine in premature infants. Thirty infants from two children’s centers, were randomly assigned to either
a control group (Standard PN; n=15) or a glutamine-supplemented group (GlnPN; n=15). The primary endpoint
was hepatic function. The secondary endpoints were total duration of PN, weight and head circumference gain,
length of hospitalization, and days on a ventilator. Results: The serum level of alkaline phosphatase (AKP) after
parenteral nutrition for 14 days was significantly higher (p<0.05) in the control group. But in the glutaminesupplemented group, the serum concentration of aspartate aminotransferase (AST) and gamma glutamyltransferase (GGT) significantly decreased after PN for 7 days and 14 days (p<0.05), and the level of alkaline phosphatase
(AKP) showed no increase. The levels of AKP and GGT were significantly different with time by group interaction. Levels of AKP was higher in control group than glutamine-supplemented group, and GGT level was lower
in glutamine-supplemented group compared with controls. There were no significant differences between the
groups in terms of total duration of PN, weight gain (g/d), increase in head circumference (cm/w), length of hospitalization, and duration of mechanical ventilation. Conclusion: The longer the duration of parenteral nutrition,
the more severe hepatic dysfunction became. Parenteral glutamine supplementation suggested a hepatoprotective
effect.
Asia Pac J Clin Nutr. 2013;22(4):530-536.doi: 10.6133/apjcn.2013.22.4.18
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Influence of early enteral nutrition (EEN) on insulin resistance in gastric cancer patients after surgery
Author:Kai Yao MM, Xueli Zhang MD, Zhongming Huang MB, Xi
Keywords:early enteral nutritional, gastric cancer, insulin resistance, insulin sensitivity, Glucose tolerance
Abstract:Objective: To evaluate the benefits of reducing insulin resistance by early enteral nutrition (EEN) in gastric cancer patients after surgery. Methods: Gastric cancer patients were managed to randomly accept traditional total
parenteral nutrition (group A) or EEN (group B) after surgical treatment. The patients in group B were fed by
tubes with 250-500 mL 5% sodium chloride and glucose injection at 24 h post-surgery, and were fed enteral nutritional emulsion with constant infusion by pump slowly increasing from 20 mL/h to 100 mL/h from 48 h, and
then transiting to total enteral nutrition. Insulin sensitivity of patients was detected by Quicki method before operation and at 24 h, 48 h, 72 h, 120 h and 168 h post-surgery. Results: A total of 77 patients were enrolled, with
42 patients in group A, and 35 patients in group B. Baseline characteristics, biochemical indexes and operational
characteristics were well balanced between two groups. The time- insulin sensitivity curves of the two groups indicated that IR was present early (day 1 to day 7) in gastric cancer patients and was significantly different between patients who had undergone surgical treatment and those who had not. Insulin sensitivity (SI) of patients in
group B were higher than patients in group A with adjusting BMI, age and SI preoperative at 72 h, 120 h and 168
h post-surgery. Conclusions: The management of EEN can alleviate insulin resistance in gastric cancer patients
with surgical treatment.
Asia Pac J Clin Nutr. 2013;22(4):537-542.doi: 10.6133/apjcn.2013.22.4.02
>>Abstract
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Early initiation of enteral nutrition improves outcomes in burn disease
Author:Vesna Kovacic Vicic MD, PhD, Maja Radman MD, PhD,
Keywords:burn, enteral nutrition, inflammation, albumins, infections
Abstract:Background: Burned patients have increased level of mortality, possibly due to late introduction of enteral feeding. The aim of this study was to compare the benefits and safety of very early enteral nutrition introduction compared to the normal diet among burns patients in an intensive care unit. Participants and Methods: Participants
consisted of 101 patients, aged 20-76 years (mean age 48 years), 49 men and 52 women, with burns that covered
more than 20% of the body. The intervention group consisted of 52 subjects fed via introduced nasojejunal probe
that started within four hours after admission to the hospital. The control group consisted of fifty patients fed in
standard manner per os (three standard hospital meals) immediately after the first wound dressing. Results: The
average decline BMI in control group was 2.27±0.56 kg/m
2
, while the average reduction in BMI in the intervention group was 1.77±0.38 kg/m
2
(p<0.001). The largest drop of albumin concentration in the control group was
28.5%, whereas in the intervention group was 23.8%. (p<0.001). The greatest decrease of transferrin concentration in the control group was 31.1%, while the average reduction in the intervention group was 18.3%. (p<0.001).
C-reactive protein values were statistically higher in control group (p<0.001). Intervention group had lower rate
of complications and infection rates. Conclusion: Enteral nutrition in burned patients should begin within few
hours of burn onset. Such approach leads to better outcomes, reduces complications, and improves nutritional
profile.
Asia Pac J Clin Nutr. 2013;22(4):543-547.doi: 10.6133/apjcn.2013.22.4.13
>>Abstract
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Effects of a nutrition support team on clinical outcomes, metabolic complications and electrolyte abnormalities in patients receiving parenteral nutrition
Author:Pei Feng Chong M Pharm, Thomas Paraidathathu PhD
Keywords:parenteral, nutrition, support, team, multidisciplinary
Abstract:The effectiveness of the Nutrition Support Team (NST) at Hospital Sungai Buloh, a large public hospital
in Kuala Lumpur, Malaysia, in optimising parenteral nutrition (PN) has not been evaluated. To evaluate
the effects of this NST in optimising patient outcomes, treatment outcomes, and adherence to biochemical
monitoring guidelines, two groups of patients, those given PN before (n = 106) NST intervention and
those given PN after (n= 106) NST intervention, were retrospectively compared. Intervention by the NST
significantly reduced metabolic abnormalities, reducing sodium abnormalities from 67% to 44% (p<0.01);
potassium abnormalities from 42% to 15% (p<0.01); magnesium abnormalities from 13% to 3% (p<0.05)
and phosphate abnormalities from 21% to 9% (p=0.01). Intervention by the NST also significantly reduced the incidence of hypertriglyceridemia from 68% to 45% (p=0.002) and significantly improved adherence to biochemical monitoring guidelines from 46% to 72% (p<0.01). However, the length of hospital stay, patient mortality, and duration of PN were similar in both groups. This study failed to demonstrate that the establishment of a NST gave better outcomes in terms of the common measures of effectiveness. In conclusion, although management by an NST significantly reduced metabolic abnormalities
and improved adherence to biochemical monitoring guidelines, the NST did not improve patient mortality
rates and length of hospital stay.
Asia Pac J Clin Nutr. 2013;22(4):548-556.doi: 10.6133/apjcn.2013.22.4.15
>>Abstract
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Reducing effect of calcium in combination with magnesium and lactulose on body fat mass in middle-aged Japanese women
Author:Nobuo Seki MSc, Yuzou Asano PhD, Hiroshi Ochi MSc,
Keywords:calcium, magnesium, lactulose, fat mass, Japanese women
Abstract:Background: It has been reported that adequate calcium intake decreases body fat and appropriate intakes of
magnesium suppress the development of the metabolic syndrome. Furthermore, lactulose increases the absorption
of calcium and magnesium. An optimal combination of calcium, magnesium and lactulose may therefore reduce
body fat mass. Methods: An open-label randomized controlled trial was conducted to investigate the body fatreducing effects of a test food containing 300 mg calcium, 150 mg magnesium, and 4.0 g lactulose. Body composition parameters and blood hormone and urine mineral concentrations were measured at baseline and at 6 and
12 months thereafter. Whole-body fat mass was measured with dual-energy x-ray absorptiometry. Results: Seventy -six middle-aged Japanese women (47.5±4.7 years) were randomized to the intake group (n=48) or the nonintake control group (n=28). At 12 months the difference in body fat mass change between the two groups (intake
group – control group) was -0.8 kg (95% CI: -1.5 - 0.0 kg, p=0.046), although there were no differences in anthropometric data between the two groups. Body fat percentage at 12 months tended to be lower in the intake
group, but the difference was not significant (p=0.09). Conclusions: These findings may suggest that calcium in
combination with magnesium and lactulose can reduce body fat mass in middle-aged Japanese women. However,
the contribution of magnesium and lactulose are unclear in this study. Further studies are needed toclarify these
contributions.
Asia Pac J Clin Nutr. 2013;22(4):557-564.doi: 10.6133/apjcn.2013.22.4.07
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Effect of traditional Arabic coffee consumption on the glycemic index of Khalas dates tested in healthy and diabetic subjects
Author:Juma Alkaabi MD, Bayan Al-Dabbagh PhD, Hussein Saa
Keywords:coffee, glycemic index, postprandial hyperglycemia excursion, dates, type 2 diabetes mellitus
Abstract:The consumption of dates with coffee is common among Arabs and may affect postprandial hyperglycemia excursion. The study aimed to determ ine the effect of coffee on the glycemic index of a common variety of dates
(Khalas) tested in healthy and type 2 diabetes mellitus individuals. Study subjects were thirteen healthy volunteers (mean age: 40.2±6.7 years) and ten diabetic participants with a mean HbA1c of 6.6±(0.7%) and a mean age
of 40.8±5.7 years. Each subject participated in five days of tests with 50 g of glucose and 50 g equivalent of
available carbohydrates from the dates (with/without coffee). Capillary glucose was measured in the healthy subjects at 0, 15, 30, 45, 60, 90 and 120 min, and for the diabetics at 0, 30, 60, 90, 120, 150 and 180 min. Glycemic
indices were determined as ratios of the incremental areas under the response curves for the interventions. Statistical analyses were performed using the independent samples and paired t-tests. Mean±SE glycemic indices of the
Khalas dates for the healthy individuals were 55.1±7.7 and 52.7±6.2 without and with coffee consumption, respectively . Similar values were observed for those with diabetes (53.0±6.0 and 41.5±5.4). Differences between
glycemic indices of Khalas with or without coffee were not significant (p=0.124). There were no significant differences in glycemic index between the diabetic and healthy subjects (p=0.834 and p=0.202 without and with coffee respectively). In conclusion, at least in the short term, coffee does not adversely affect capillary glucose levels
following Khalas dates consumption in healthy and diabetic volunteers.
Asia Pac J Clin Nutr. 2013;22(4):565-573.doi: 10.6133/apjcn.2013.22.4.09
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Impact of diet and weight loss on iron and zinc status in overweight and obese young women
Author:Hoi Lun Cheng BSc Nutrition (Hons), Hayley J Griff
Keywords: obesity, weight loss, young adult, iron, zinc
Abstract:Young overweight women are at risk of iron and zinc deficiency. This study assessed iron, zinc and inflammatory
status during a 12-month weight loss trial in young women (18-25 y; BMI ≥27.5 kg/m
2
) randomised to a higher protein (HP: 32% protein; 12.2 mg/day iron; 11.7 mg/day zinc) or lower-protein (LP: 20%; 9.9 mg/day; 7.6
mg/day respectively) diet with contrasting haem iron and zinc content. In completers (HP: n=21; LP: n=15), HP
participants showed higher median ferritin (52.0 vs 39.0 µg/L; p=0.021) and lower median soluble transferrin receptor-ferritin index (sTfR-F; 0.89 vs 1.05; p=0.024) although concentrations remained within normal range for
both diets. Median C-reactive protein (CRP; HP: 3.54; LP: 4.63 mg/L) and hepcidin (HP: 5.70; LP: 8.25 ng/mL)
were not elevated at baseline, and no longitudinal between-diet differences were observed for zinc and CRP.
Compared to those with <5% weight loss, HP participants losing ≥10% weight showed lower median sTfR-F
(0.76 vs 1.03; p=0.019) at six months. Impact of ≥10% weight loss on iron was more apparent in LP participants
who exhibited greater mean serum iron (20.0 vs 13.5 µmol/L; p=0.002), transferrin saturation (29.8% vs 19.4%;
p=0.001) and lower sTfR (1.24 vs 1.92 mg/L; p=0.034) at 12 months. Results show normal iron and zinc status
can be maintained during 12 months of energy restriction. In the absence of elevated baseline inflammation and
hepcidin, a more favourable iron profile in those with ≥10% weight loss may reflect stronger compliance or the
potential influence of iron regulatory mechanisms unrelated to inflammatory hepcidin reduction.
Asia Pac J Clin Nutr. 2013;22(4):574-582.doi: 10.6133/apjcn.2013.22.4.08
>>Abstract
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Relationship between skipping breakfast and bone mineral density in young Japanese women
Author:Tatsuhiko Kuroda PhD, Yoshiko Onoe PhD, Remi Yoshi
Keywords:skipping breakfast, bone mineral density, nutrient intake, physical activity, younger women
Abstract:Back ground and aims: It is well known that insufficient nutrient intake leads to poor bone status. To find
a simple evaluation method for prevention of nutrition intake disorder, a cross-sectional study with 275
healthy Japanese female students aged 19-25 was conducted. Methods: Anthropometric parameters, bone
mineral density (BMD) at lumbar and total hip, bone metabolic markers and physical activity were measured in study participants and the frequency of skipping meals (breakfast, lunch, supper), and absolute
values for nutrient intakes were assessed using a Diet History Questionnaire. Results: The frequency of
skipping breakfast significantly correlate to total energy intake (ρ= -0.276, p<0.001). BMI, total intake
of energy, intake of protein, intake of phosphate, and energy expenditure positively correlated significantly to BMD at lumbar and total hip (p<0.05) using simple linear regression. BMI (regression coefficient
(b))=0.088, p<0.001), bone alkaline phosphatase (b= -0.050, p=0.012), total energy expenditure (b=0.019,
p<0.001), and frequency of skipping breakfast (b= -0.018, p=0.048) were independent risk factors for
lower total hip BMD by multiple regression analysis. The total hip BMD in participants who skipped
breakfast three or more times was significantly lower than in those who did not skip breakfast (p=0.007).
Conclusions: In conclusion, managing the frequency of skipping breakfast and reducing it to <3 times per
week may be beneficial for the maintenance of bone health in younger women.
Asia Pac J Clin Nutr. 2013;22(4):583-589.doi: 10.6133/apjcn.2013.22.4.10
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Prevalence and determinants of hyperuricemia in type 2 diabetes mellitus patients with central obesity in Guangdong Province in China
Author:Jiao Wang PhD, Rong-Ping Chen MD 1 , Lei Lei PhD,
Keywords:prevalence, risk factors, hyperuricemia, type 2 diabetes mellitus, central obesity
Abstract:This study investigated the prevalence and determinants of hyperuricemia in Chinese type 2 diabetes mellitus
(T2DM) patients with central obesity. A multicentric hospital-based cross-sectional study was carried out in
Guangdong Province between August 2011 and March 2012. At each hospital, Chinese T2DM patients with central obesity who were aged over 20 years, whose serum uric acid levels were measured, and who had lived in
Guangdong Province for ≥1 year, were recruited. Hyperuricemia was defined as serum uric acid >420 µmol/L in
men and >360 μmol/L in women. Binary logistic regression was used to assess associated risk factors for hyperuricemia. A total of 2,917 T2DM patients with central obesity took part. The overall prevalence of hyperuricemia
was 32.6% (36.1% for women, 28.4% for men). Binary logistic regression analyses demonstrated that women
(OR: 1.576; 95% confidence interval (CI): 1.231, 2.018), high BMI (OR: 1.228; 95% CI: 1.094, 1.379), waist circumference (OR: 1.135; 95% CI: 1.009, 1.276), hypertension (OR: 1.603; 95% CI: 1.263, 2.035), high total cholesterol (OR: 1.133; 95% CI: 1.002, 1.281), triglycerides (OR: 1.134; 95% CI: 1.069, 1.203), low HDLcholesterol (OR: 0.820; 95% CI: 0.677, 0.995) and low estimated glomerular filtration rate (OR: 0.840; 95% CI:
0.815, 0.866) were risk factors associated with hyperuricemia. Hyperuricemia is prevalent in ChineseT2DM patients with central obesity and is significantly positively associated with women, cardiovascular risk factors such
as obesity, hypertension and dyslipidemia, and low eGFR.
Asia Pac J Clin Nutr. 2013;22(4):590-598.doi: 10.6133/apjcn.2013.22.4.16
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Leisure time physical activities and dietary quality of the general and indigenous Taiwanese populations are associated with fat distribution and sarcopenia
Author:Po-Huang Chiang PhD,, Mark L Wahlqvist MD, Lin-Yua
Keywords:obesity, exercise, energy expenditure, body composition, muscle
Abstract:Indigenous peoples are at greater risk of obesity-related health problems for various reasons. These have
been explored in the adulthood (19 yrs) section of the nationally-representative Nutrition and Health
Survey in Taiwan (NAHSIT) for 2005-2008 in Indigenous mountain-dwelling (IndT) (n=226) and general
(mainly Han Chinese) (GenT) (n=1486) Taiwanese. Physical activity, BMI, fat distribution (waist circumference (WC) and triceps skinfold (TSF)) and mid arm muscle circumference (MAMC) have been compared. Leisure- time physical activities (LTPA) were assigned metabolic equivalents (METs). Comparisons
were made by ethnicity-locality. Indigenous men and women were 3.81 and 5.47 times more obese (WHO
criteria BMI 30 kg/m
2
) than the GenT, respectively. Some 55% of the IndT and 34% of the GenT reported no LTPA. All LTPA types were less evident in the IndT. Multivaiable adjusted ORs (95% CIs) against
inactivity as referent were, for sarcopenic MAMC, in Indigenes with MVI-LTPA 0.13 (0.03-0.67) and in
the GenT 0.61 (0.37-1.01); in the GenT with LTPA for BMI ≥30 kg/m
2
and obese TSF, they were 0.53
(0.31-0.91) and 0.77 (0.60-0.98), respectively. Without dietary quality adjustment, the sarcopenia risk in
GenT with LTPA was significant (OR=0.60, 95% CI: 0.37-0.97). Having adjusted for dietary quality , the
significance disappeared. Less sarcopenia was found with ambulation in the GenT (OR=2.07, 95% CI:
1.26-3.43). More over-fatness in an IndT than GenT is associated with less LTPA. LTPA reduces sarcopenic risk irrespective of ethnicity, is partly dependent on diet, and reduces obesity indices in the GenT .
Asia Pac J Clin Nutr. 2013;22(4):599-613.doi: 10.6133/apjcn.2013.22.4.19
>>Abstract
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Prevalence and correlates of zinc deficiency in pregnant Vietnamese women in Ho Chi Minh City
Author:Vinh Quang Nguyen MD, MSc, Aya Goto MD, MPH, PhD,
Keywords:zinc, deficiency, dietary supplement, pregnant women, Vietnam
Abstract:Background: Although Vietnam is a region with a plant-based diet that has a high zinc deficiency, epidemiological data showing how this affects pregnant women are limited. This study explores the prevalence of zinc deficiency and possible correlates in pregnant Vietnamese women in Ho Chi Minh City. Methods: This was a crosssectional study conducted at a general hospital in Ho Chi Minh City, Vietnam. All pregnant women whocame to
their first antenatal care visit from November 2011 to June 2012 were recruited. Those taking a vitamin and/or
mineral supplement were excluded. Serum zinc concentrations, determined by a standard colorimetric method, of
10.7 mol/L-17.5 mol/L (70.0 g/dL-114 g/dL) were classified as normal and under 10.7 mol/L (70.0 g/dL) as
zinc deficient. Results: In total, 254 pregnant women were invited and 107 (42%) participated. The mean age of
participants was 29 years, and mean gestational age was 10 weeks. Median zinc concentration in serum was 13.6
mol/L, and the prevalence of zinc deficiency was 29% (95% CI=21%-39%). The daily intake of a milk product
supplement was the only significant correlate of zinc deficiency of the items investigated (adjusted OR=0.40,
95% CI=0.16-0.99, p=0.049). Discussion: This is the first study reporting that more than 25% of pregnant Vietnamese women in Ho Chi Minh City are zinc deficient. Further academic and clinical input is needed to confirm
the scale of this neglected issue and to investigate the potential of milk product supplementation in this population.
Asia Pac J Clin Nutr. 2013;22(4):614-619.doi: 10.6133/apjcn.2013.22.4.05
>>Abstract
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Evaluating dietary quality in diabetes by the Healthy Eating Index
Author:Şevket Direktör MS, Emel Özer PhD
Keywords: diabetes Mellitus, dietary quality, BMI, nutritional status, nutrient
Abstract:Diabetes and diabetes-induced complications is a rising health concern in Northern Cyprus. Of the adult population in Northern Cyprus, 12.2% has diabetes and 90% of all individuals suffering from cardiovascular disease are
people with diabetes. The aim of this study was to evaluate nutritional habits of people with diabetes in Northern
Cyprus in order to make the necessary recommendations to improve their eating habits to prevent diabetesinduced complications. We used the Healthy Eating Index (HEI) to evaluate dietary quality of people with diabetes in Northern Cyprus based on their 24-hour food intake. A total of 200 participants with diabetes were selected randomly from the out-patient clinic of Dr. Burhan Nalbantoğlu central hospital in Nicosia. Individuals were
asked to complete a questionnaire to determine their 24-hour food intake and frequency of intake of various food
substances. The mean HEI score for the subjects with diabetes was 58.8. The HEI component scores forsaturated fat, vegetables, dairy products and meat consumption were less than 5, whereas average scores for fat, cholesterol, fruits, grains, and sodium consumption were more than 5. The meat component of the HEI had the lowest
mean score (3.3). There was statistical significance between male and female subjects regarding the HEI scores
for meat and nutrient variety intake. In conclusion, the results of the present study suggest that subjects with diabetes in Northern Cyprus should improve their diet by decreasing their intake of saturated fat and by increasing
their intake of vegetables, meat and milk.
Asia Pac J Clin Nutr. 2013;22(4):620-625.doi: 10.6133/apjcn.2013.22.4.03
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Associations of body mass index with incident hypertension in American white, American black and Chinese Asian adults in early and middle adulthood: the Coronary Artery Risk Development in Young Adults (CARDIA) study, the Atherosclerosis Risk in Commu
Author:Eva G Katz PhD, MPH, RD, June Stevens PhD, Kimberl
Keywords:blood pressure, multi-ethnic, obesity, African American, cardiovascular disease
Abstract:The association of body mass index (BMI) with blood pressure may be stronger in Asian than non-Asian populations, however, longitudinal studies with direct comparisons between ethnicities are lacking. We compared the relationship of BMI with incident hypertension over approximately 9.5 years of follow-up in young (24-39 years)
and middle-aged (45-64 years) Chinese Asians (n=5354), American Blacks (n=6076) and American Whites
(n=13451). We estimated risk differences using logistic regression models and calculated adjusted incidences and
incidence differences. To facilitate comparisons across ethnicities, standardized estimates were calculated using
mean covariate values for age, sex, smoking, education and field center, and included the quadratic terms for BMI
and age. Weighted least-squares regression models with were constructed to summarize ethnic-specific incidence
differences across BMI. Wald statistics and p-values were calculated based on chi-square distributions. The association of BMI with the incidence difference for hypertension was steeper in Chinese (p<0.05) than in American
populations during young and middle-adulthood. For example, at a BMI of 25 vs 21 kg/m
2
the adjusted incidence
differences per 1000 persons (95% CI) in young adults with a BMI of 25 vs those with a BMI of 21 was83 (36-130) for Chinese, 50 (26-74) for Blacks and 30 (12-48) for Whites; among middle-aged adults it was 137 (77-198)
for Chinese, 49 (9-88) for Blacks and 54 (38-69) for Whites. Whether hypertension carries the same level of risk
of stroke or cardiovascular disease across national or ethnic groups remains uncertain.
Asia Pac J Clin Nutr. 2013;22(4):626-634.doi: 10.6133/apjcn.2013.22.4.12
>>Abstract
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Cognitive impairment and limited dietary diversity or physical inactivity are conjoint precursors of incident diabetes more so in elderly women than men
Author:Li-Li Xiu ME, Mark L Wahlqvist MD, Meei-Shyuan Lee
Keywords:cognitive impairment, type 2 diabetes, dietary , physical activity , body composition
Abstract:OBJECTIVES: To establish whether elderly people with impaired cognition are at greater risk for the development of type 2 diabetes. DESIGN: Prospective population-based cohort study. SETTING: The Elderly Nutrition and Health Survey in Taiwan (NAHSIT Elderly). PARTICIPANTS: One thousand and
four hundred ninety -three diabetes-free people ≥65 years were followed for incident diabetes in relation to
cognitive status for up to 8 years. MEASUREMENTS: The association between cognitive impairment
and diabetes incidence was analyzed with Cox proportional hazards models with exclusion of people who
had diabetes within one year of cognitive function assessments. RESULTS: Cognitively-impaired women,
but not men, had increased diabetes incidence density (DID). Age, gender, ethnicity and personal behavior adjusted hazard ratios (HR) and 95% confidence intervals (CI) for type 2 diabetes with normal cognition as referent were 2.43 (95% CI: 1.27-4.63) for women and 1.55 (95% CI: 0.48-5.07) for men. These
gender differences and the HR significances remained with adjustments for age, ethnicity, financial status,
dietary quality as a dietary diversity score, physical functioning, physical activity, fasting glucose, indices
of body composition, body mass index, waist circumference, mid-arm muscle circumference, perceived
and mental health status. There were extensive significant interactions with the covariates in women.
CONCLUSION: Cognitive impairment in later life is associated with greater risk of type 2 diabetes in
women and considerable potential risk enhancement
Asia Pac J Clin Nutr. 2013;22(4):635-645.doi: 10.6133/apjcn.2013.22.4.20
>>Abstract
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Effects of gamma-glutamyl carboxylase gene polymorphism (R325Q) on the association between dietary vitamin K intake and gamma-carboxylation of osteocalcin in young adults
Author:Mayu Haraikawa PhD, Naoko Tsugawa PhD, Natsuko Sog
Keywords:vitamin K intake, phylloquinone (PK), menaquinone-7 (MK-7), single nucleotide polymorphisms (SNP), gamma-glutamyl carboxylase (GGCX)·
Abstract:Introduction: It has been demonstrated that single nucleotide polymorphism (SNP) (R325Q, 974G>A) in the
gamma-glutamyl carboxylase (GGCX) gene is associated with the bone mineral density (BMD). In the present
study, we investigated the effect of GGCX polymorphism (974G>A) on the correlations among the vitamin K intake, level of serum vitamin K, and ratio of undercarboxylated osteocalcin (ucOC) to intact osteocalcin (OC) in
healthy young Japanese subjects. Methods: Healthy young adult subjects (n=189) were genotyped for the polymorphism, and we measured the levels of serum vitamin K, intact OC, ucOC, and dietary nutrient intakes. Results: Dietary vitamin K intake from vegetables was significantly correlated with the level of serum phylloquinone (PK), and vitamin K intake from fermented beans, natto, was also significantly correlated with the level of
serum menaquinone-7 (MK-7). Moreover, the total dietary vitamin K intake showed a significant negative correlation with the ratio of ucOC to intact OC. Interestingly, on grouping by the GGCX genotype, there was a significant interaction between the ratio of ucOC to intact OC with vitamin K intake in homozygotes (GG-type) and
heterozygotes (GA-type) (p<0.001). These results suggest that an adequate nutritional strategy is necessary for
people with high-risk genotypes (GG- or GA-type). Conclusions: We demonstrated the effects of SNP (974G>A)
in the GGCX gene on the correlation between dietary vitamin K intake and gamma-carboxylation of serum OC.
Our data may be useful for planning strategies to prevent osteoporosis.
Asia Pac J Clin Nutr. 2013;22(4):646-654.doi: 10.6133/apjcn.2013.22.4.01
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CSPEN guidelines for nutrition support in neonates
Author:W orking group of Pediatrics, Chinese Society of P
Keywords:parenteral nutrition, enteral nutrition, premature infant, neonate, nutrition support
Abstract:In the last few decades, there has been a significant increase in survival rate of preterm infants, especially
very low birth weight infants. The nutrition problems have become particularly relevant in neonates, and
nutrition support is usually required for preterm infants and most sick term infants. The actual amount of
nutrition must be calculated (not estimated) in neonates. The goals of nutrition support are to maintain
development and growth while avoiding nutrition related complications. Nutrition requirements (enteral
nutrition and parenteral nutrition) should be adjusted according to different weights and gestational age.
Parenteral nutrition (PN), which allows the infant’s requirements for growth and development to be met,
is indicated in infants for whom feeding via the enteral route is impossible, inadequate, or hazardous. Enteral nutrition (EN) should be gradually introduced and should replace PN as quickly as possible in order
to minimize any side-effects from exposure to PN. Inadequate substrate intake in early infancy can cause
long-term detrimental effects in terms of metabolic programming of the risk of illness in later life. Optimal nutrition care of the preterm infant offers the opportunity to improve outcomes for children. This
guideline aims to provide proposed advisable ranges for nutrient intakes in neonates. These recommendations are based on a considered review of available scientific reports on the subject, and on expertconsensus for which the available scientific data are considered inadequate.
Asia Pac J Clin Nutr. 2013;22(4):655-663.doi: 10.6133/apjcn.2013.22.4.21
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Case studies and evidence based nutrition
Author:Mark L Wahlqvist MD
Keywords:clinical nutrition practice, nutritional epidemiology, hierarchical evidence, portfolio evidence, econutrition
Abstract:The clinical nutrition case study is a neglected area of activity and publication. This may be in part because it is not regarded as a serious contributor to evidence-based nutrition (EBN). Yet it can play a valuable part in hypothesis formulation and in the cross-checking of evidence. Most of all, it is usually a point
at which the operationalisation of nutrition evidence is granted best current practice status.
Asia Pac J Clin Nutr. 2013;22(4):664-666.doi: 10.6133/apjcn.2013.22.4.22
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Systematic classification of evidence for dietary refer ence intakes for Japanese 2010 (DRIs-J 2010) in adults and future prospects of DRIs in Asian countries
Author:Makiko Nakade PhD, Eri Imai PhD, Megumi Tsubota -U
Keywords:nutrition policy, reference values, diet, Asia, Japan
Abstract:In Asia, the concept of dietary reference values is shifting from recommended dietary allowances (RDAs)
to dietary reference intakes (DRIs). To assist Asian countries that are planning to develop or revise their
own DRIs, this study summarizes the scientific literature used in the development of the latest DRIsfor
the Japanese (DRIs-J 2010): it aims to clarify critical issues on- and discuss future prospects for DRIs in
Asia. The criteria and studies used to determine reference values in DRIs-J 2010 in adults were extracted
from the DRIs-J 2010 report, systematically classified, and summarized for each nutrient in tables according to the type of DRIs. The classification categories were as follows: criteria, subject ethnicity,year of
publication, type of study and study design, number of subjects, and study content. In all, 184 studies
were extracted and some issues in DRIs-J 2010 were clarified: 1) some nutrients were lacking in studies
based on native populations; 2) only a few and relatively old studies determined tolerable upper intake
levels for some nutrients; 3) with the same DRIs, there were inconsistencies among the nutrients in the
study criteria. These were considered common issues when determining DRIs in other Asian countries.
When establishing DRIs, these issues should be considered, in addition to population health status and
country-specific needs.
Asia Pac J Clin Nutr. 2013;22(4):667-682.doi: 10.6133/apjcn.2013.22.4.17
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Salt intakes and salt reduction initiatives in Southeast Asia: a review
Author:Ada Portia M Batcagan-Abueg MD, MPH , Jeanette JM
Keywords: sodium chloride, dietary, nutrition policy, sodium intake, salt
Abstract:Increased dietary sodium intake is a modifiable risk factor for cardiovascular disease. The monitoring of population sodium intake is a key part of any salt reduction intervention. However, the extent and methods used for assessment of sodium intake in Southeast Asia is currently unclear. This paper provides a narrative sy nthesis of the
best available evidence regarding levels of sodium intake in six Southeast Asian countries: Indonesia, Malaysia,
Philippines, Singapore, Thailand, Vietnam, and describes salt reduction measures being undertaken in these
countries. Electronic databases were screened to identify relevant articles for inclusion up to 29 February 2012.
Reference lists of included studies and conference proceedings were also examined. Local experts andresearchers in nutrition and public health were consulted. Quality of studies was assessed using a modified version of the
Downs and Black Checklist. Twenty-five studies fulfilled the inclusion criteria and were included in this review.
Full texts of 19 studies including government reports were retrieved, with most studies being of good quality. Insufficient evidence exists regarding salt intakes in Southeast Asia. Dietary data suggest that sodium intake in
most SEA countries exceeded the WHO recommendation of 2 g/day. Studies are needed that estimate sodium intake using the gold standard 24-hour urinary sodium excretion. The greatest proportion of dietary sodium came
from added salt and sauces. Data on children were limited. The six countries had salt reduction initiatives that
differed in specificity and extent, with greater emphasis on consumer education.
Asia Pac J Clin Nutr. 2013;22(4):683-697.doi: 10.6133/apjcn.2013.22.4.04
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Shiftworking, nutrition and obesity: implications for workforce health- a systematic review
Author:Reza Amani PhD, R Nutr, Tim Gill PhD
Keywords: shift working, nutrition, obesity, workforce, systematic review
Abstract:Background: Shiftworking has long been unrecognised as an occupational health hazard up until now. Methods:
Electronic databases were searched using OVID host as the main search engine for Medline, PUBMED and
CINHAL during the years 1990-December 2010. Combinations of the keywords yielded 35 full papers and abstracts, of which 16 articles were relevant. One paper was not in English, leaving 15 included in this review after
final reconsideration. Studies were categorised into two main titles: studies assessing the association between
shift working and obesity and/or BMI (n=8) and studies assessing the association between shift working and nutritional/dietary patterns (n=7). Type of study was also considered as a part of the search strategy . Results: In total,
one interventional, nine cross-sectional and five cohort studies were retrieved. Seven cross-sectional studies and
one cohort study showed a higher BMI/obesity prevalence in shiftworks. Interventional, one cross-sectional and
three cohort studies showed higher frequency of meal intake or poor nutrition quality/habits in the shift workers
compared with the day-shift workers. Another cross-sectional study showed no difference between workers. Conclusion: In terms of obesity or high BMI, majority of cross-sectional studies indicate that shiftwork increases
weight gain and the prevalence of obesity. On the other hand, half of cohort studies show higher frequency of
meal intake and/or poor nutrition quality in the shift workers. Generally, it is indicated that shift working negatively impacts on health and nutritional status of workforces.
Asia Pac J Clin Nutr. 2013;22(4):698-708.doi: 10.6133/apjcn.2013.22.4.11
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