Cutoff value of HbA1c for predicting diabetes and
prediabetes in a Chinese high risk population aged
over 45
Author:Ruyi Zhang MD, Jiao Wang PhD, Jinhua Luo PhD, Xiao
Keywords:cutoff, HbA1c, diabetes, prediabetes, risk
Abstract:Objective: To evaluate the cutoff value of HbA1c for predicting diabetes and prediabetes in a Chinese high risk
population aged over 45. Methods: A total of 619 people aged over 45 without diabetes were randoml y recruited
to complete the Finnish Diabetes Risk Score (FI NDRI SC) questionnaire. 208 high-risk individuals (defined by
Diabetes Risk Score ≥9) had OGTT and HbA1c determined at the same time. Results: I n a Chinese population
aged over 45, the best cutoff values of HbA1c for detecting diabetes and prediabetes were 5.8% and 5.4% respectively. The area under the receiver operating characteristic (AUROC) curve of HbA1c for detecting diabetes was
0.85 (95% CI: 0.80-0.90) and prediabetes was 0.62 (95% CI: 0.54-0.70). The combined use of HbA1c and fasting
blood glucose (FPG) had a larger AUROC than HbA1c alone (0.88, 95%CI: 0.83-0.92 in detecting diabetes vs
0.75, 95% CI: 0.67-0.82 in prediabetes), and had a higher sensitivity in predicting diabetes and higher specificit y
and positive predictive value (PPV) in predicting prediabetes. However, the AUROC between HbA1c alone and
combined use in predicting diabetes was not significantly different (p=0.173). Conclusions: FI NDRI SC is a feasible tool to screen people who are at high risk of diabetes. The cutoff values of HbA1c to diagnose diabetes and
prediabetes in a Chinese high risk population aged over 45 were 5.8% and 5.4%, respectively. The sensitivity and
specificity of HbA1c for detecting diabetes and prediabetes were relatively low, so that the combined use of
HbA1c and FPG may be more effective in prediction.
Asia Pac J Clin Nutr. 2015;24(3):360-366.doi: 10.6133/apjcn.2015.24.3.14
>>Abstract
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Effect of nutritional support on clinical outcomes in
perioperative malnourished patients: a meta-analysis
Author:Jing-xia Zhong BM, Kai Kang MM, Xiao-liang Shu PH
Keywords:malnutrition, perioperative, nutritional support, meta-analysis, prognosis
Abstract:Malnutrition is an independent risk factor for complications, mortality, wound healing, length of hospital stay,
and costs. Associations between nutritional support and surgical patients remain controversial. Databases, including Pubmed, EMBASE, Web of Science, CNKI , VI P, and the Cochrane Library, were searched to find randomized controlled trials (RCTs) that assessed the effect of nutritional support on clinical outcomes in perioperative
malnourished patients. The methodological quality of each included trial was assessed. A meta-analysis was conducted with Rev Man 5.2. Fifteen RCTs, involving 3831 patients, were included in this meta-analysis. Compared
with control group, results showed that nutritional support was more effective in decreasing the incidence of infectious [relative risk (RR): 0.58; 95% CI: 0.50, 0.68; p<0.01] and non-infectious complications (RR: 0.74; 95%
CI: 0.63, 0.88; p<0.01), and shortening the length of hospital stay [weighted mean difference (WMD): -2.64; 95%
CI: -5.13, -0.16; p<0.05]. Moreover, the incidence of infectious complications in the immune nutrition group was
significantly lower than that in the standard nutrition group (RR: 0.75; 95% CI: 0.58, 0.97; p<0.05). However,
changes in hospital costs (WMD: 894; 95% CI: -1140, 2928; p>0.05) and postoperative mortality (RR: 0.77; 95%
CI: 0.41, 1.44; p>0.05) between the nutritional support group and control group were not significantly different.
I n conclusion, perioperative nutritional support was superior in improving clinical outcomes in malnourished patients, which could significantly reduce the incidence of complications and effectively shorten the length of hospital stay.
Asia Pac J Clin Nutr. 2015;24(3):367-378.doi: 10.6133/apjcn.2015.24.3.20
>>Abstract
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Emerging malnutrition during hospitalisation
independently predicts poor 3-month outcomes after
acute stroke: data from a Chinese cohort
Author:Jing Zhang MD, Xingquan Zhao MD, Anxin Wang MD, Yo
Keywords:malnutrition, deterioration, predict, outcome, acute stroke
Abstract:Objective: Questions exist regarding the causal relationship between malnutrition and stroke outcomes. This
study aimed to determine whether nutritional status changes or malnutrition during hospitalisation could predict
3-month outcomes in acute stroke patients. Methods: During a 10-month period, patients who suffered their first
stroke within 7 days after stroke onset were included in this prospective multi-centre study. The demographic pa
rameters, stroke risk and severity factors, malnutrition risk factors and dysphagia were recorded. Nutritional sta
tus was assessed by 3 anthropometric and 3 biochemical indices. Changes in nutritional status were defined by
comparing the admission values with the 2-week values. A Modified Rankin Scale score of 3-6 was defined as a
poor outcome at the 3-month follow-up. Univariate and multiple logistic regression analyses were used to inves
tigate the power of nutritional status changes in predicting poor patient outcomes. Results: Data from 760 pa
tients were analysed. Poor outcomes were observed in 264 (34.7%) patients. Malnutrition prevalence was 3.8% at
admission and 7.5% after 2-weeks in hospital, which could not predict 3-month outcome. Emerging malnutrition
was observed in 36 patients (4.7%) during the 2-week hospitalisation period and independently predicted poor 3-
month outcomes after adjusting for confounding factors (odds ratio 1.37, 95% confidence interval, 1.03-1.83).
Conclusions: Emerging malnutrition during hospitalisation independently predicted poor 3-month outcomes in
acute stroke patients in this study.
Asia Pac J Clin Nutr. 2015;24(3):379-386.doi: 10.6133/apjcn.2015.24.3.13
>>Abstract
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Dietary or enteral medium-chain triglyceride usage in a
Chinese general hospital
Author:Rongrong Li MD, Jiangfeng Mao MD, Kang Yu MD, Lili
Keywords:medium-chain triglycerides, diet, enteral nutrition, indication, outcome
Abstract:Objectives: Medium chain triglycerides (MCTs) are of nutritional interest for their unique properties on ingestion,
absorption and metabolism. However, dietary and enteral MCTs usage in hospitalized patients in China requires
evaluation. Methods: A retrospective analysis was conducted on 46 hospitalized patients who were administered
MCTs therapy between January, 2012 and December, 2013 in Peking Union Medical College Hospital. The clinical parameters of subjects were evaluated 2 weeks after intervention. All indications and outcomes of MCTs therapy underwent evidence-based evaluation. A survey was conducted on a random sample of 77 doctors to clarify
the awareness and knowledge of MCTs therapy among clinicians. Results: Among 46 cases undergoing MCTs
therapy, there were 21 with gastrointestinal dysfunction (with improvement in 15 cases), 15 with lymphatic
anomalies (with improvement in 7 cases), 5 with dyslipidemia (with improvement in 3 cases), 4 with exocrine
pancreatic insufficiency (with improvement in 2 cases) and 1 with epilepsy (without improvement). All indications were evidence -based. Although MCTs were being utilized in an increasing number of patients, the survey
revealed poor knowledge of their physicochemical properties, medical indications and the therapeutic basis of
their use among clinicians. Conclusions: MCTs therapy is of benefit in the management of gastrointestinal malabsorption, pancreatic exocrine insufficiency, intestinal lymphangiectasia and dyslipidemia. However,
randomized controlled trials with adequate sample size and longer follow-up are required to evaluate further their
efficacy, and more educational programs are needed to ensure clinical competence for MCT therapy.
Asia Pac J Clin Nutr. 2015;24(3):387-393.doi: 10.6133/apjcn.2015.24.3.18
>>Abstract
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Glucose absorption in nephropathy patients receiving
continuous ambulatory peritoneal dialysis
Author:Xuezhi Zuo MD, Xiaolei Ye MD, Fangyun Sun MM, Kun
Keywords:glucose absorption, actual measurement, estimating methods, continuous ambulatory peritoneal dialysis, dietary survey
Abstract:Objectives: Peritoneal dialysis patients are at risk of glucose absorption from peritoneal dialysate, not only because of energy imbalance but also the toxic effects of high glucose. The current widely applied formulae may be
not suitable for estimation of glucose absorption in continuous ambulatory peritoneal dialysis (CAPD) patients.
This study examined the actual glucose absorption in a cohort of CAPD patients and compared the results with
estimates from four current formulae. Methods: We conducted a survey of glucose absorption of a cohort of 72
CAPD patients and compared actual dialysate glucose absorbed and estimates using K/DOQI formula, Grodstein
formula, Bodnar formula, or a percentage estimate of 60%. Results: The total dialysate glucose infused each day
varied from 54.4 to 191 g/day with average of 102±27.9 g. The average of glucose absorbed was 65.7 g (ranging
from 19.5 to 131 g) by actual measurements. The mean absorption rate was 64.4% (ranging from 30.6% to
92.4%). The glucose absorbed from dialysate accounted for 13.8% (ranging from 5.0% to 30.1%) of total energy
intake. The average errors of absolute values between actual measurements and estimates were greater than 10 g
or 20 g glucose (p<0.001). The average errors in percentages were greater than 20% or 40%, dependently on estimating methods. Conclusions: The applications of current estimating methods may have limitations. The actual
measurement provides dietitians and doctors with more exact information of absorbed glucose and energy compared to the current estimating methods.
Asia Pac J Clin Nutr. 2015;24(3):394-402.doi: 10.6133/apjcn.2015.24.3.16
>>Abstract
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Effect of vitamin B-12 and n-3 polyunsaturated fatty
acids on plasma homocysteine, ferritin, C-reactive
protein, and other cardiovascular risk factors: a
randomized controlled trial
Author:Tao Huang PhD, Kelei Li BSc, Sailimuhan Asimi MS,
Keywords:homocysteine, vitamin B-12, fish oil, ferritin, C-reactive protein
Abstract:Objectives: Vitamin B-12 and n-3 polyunsaturated fatty acids (PUFA) decrease blood homocysteine (Hcy) concentrations. However, the combined effect of these nutrients on Hcy and ferritin, and C-reactive protein is limited
and inconclusive. The objective was to examine the synergistic effect of vitamin B-12 in combination of n-3
PUFA on plasma Hcy, ferritin, and other biochemical markers. Methods: In a randomized controlled trial, thirty
eligible subjects were randomly divided into three groups, and assigned to receive 1000 μg of vitamin B-12, 2 g
fish oil, or 1000 μg vitamin B-12 and 2 g fish oil, respectively, for 8 weeks. Plasma phospholipids (PL) fatty acids and biochemical markers were determined. This study was registered under ClinicalTrials.gov Identifier:
NCT01762072. Results: Plasma PL 20:5n-3, 22:6n-3 and n-3 PUFA was increased after 4 and 8 week supplementation of fish oil, and vitamin B-12+fish oil. Plasma concentrations of triacylglycerol, uric acid, C-reactive
protein, and ferritin were significantly decreased after 4 and 8 week supplementation of fish oil, and vitamin B-12+fish oil. In all groups, significant changes in plasma Hcy were observed during the study period. Vitamin B-12, fish oil, and vitamin B-12+fish oil supplementation lowered plasma Hcy concentrations by 22%, 19%, and
39%, respectively. Conclusions: The combination of vitamin B-12 and fish oil has a synergistic effect on lowering plasma concentrations of Hcy.
Asia Pac J Clin Nutr. 2015;24(3):403-411.doi: 10.6133/apjcn.2015.24.3.19
>>Abstract
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Effects of supplementation with a combination of
β-hydroxy-β-methyl butyrate, L-arginine, and
L-glutamine on postoperative recovery of quadriceps
muscle strength after total knee arthroplasty
Author:Kanae Nishizaki PT, Hitoshi Ikegami MD, Yukio Tana
Keywords:β-hydroxy-β-methyl butyrate (HMB), nutritional food, quadriceps muscle strength, total knee arthroplasty(TKA), knee osteoarthritis
Abstract:Objectives: Total knee arthroplasty (TKA) performed in knee osteoarthritis patients is reported to be immediatel y
followed by a decrease in quadriceps muscle strength. We investigated the effects of supplementation with a
combination β-hydroxy-β-methyl butyrate, L-arginine, and L-glutamine (HMB/Arg/Gln) on the postoperative recovery of quadriceps muscle strength in patients after TKA. Methods: Study subjects were 23 patients (12 women; mean age: 70.5) who underwent TKA. The patients were randoml y allocated into the control group or the
group that consumed HMB/Arg/Gln supplementation (HMB/Arg/Gln group). HMB/Arg/Gln supplementation or
control food were consumed for 5 days before the surgery and for 28 days after the surgery, and maximal quadriceps strength was measured at 7 days before the surgery, and at 14, 28 and 42 days after the surgery. During the
study, total energy expenditure was measured using a lifestyle recording device. The two groups followed the rehabilitation in the same way. Results: The maximal quadriceps strength was 1.1±0.62 Nm/Kg before surgery and
0.7±0.9 Nm/Kg after surgery 14 days in the control group (p=0.02), and 1.1±0.3 Nm/Kg before surgery and
0.9±0.4 Nm/Kg after surgery 14 days in the HMB/Arg/Gln group. Although the control group experienced a significant loss of muscle strength after the surgery, the HMB/Arg/Gln group did not. There was no significant difference in total energy expenditure between the two groups. Conclusions: Consuming HMB/Arg/Gln supplementation may suppress the loss of muscle strength af ter TKA. I ntervention with exercise and nutrition appears to enable patients to maintain their quadriceps strength.
Asia Pac J Clin Nutr. 2015;24(3):412-420.doi: 10.6133/apjcn.2015.24.3.01
>>Abstract
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Encapsulated green kiwifruit extract: a randomised
controlled trial investigating alleviation of constipation
in otherwise healthy adults
Author:Sophie Kindleysides MSc, Barbara Kuhn-Sherlock PhD
Keywords:actinidin, bowel function, constipation, defecation frequency, kiwifruit extract
Abstract:Objectives: Previous clinical trials have shown bowel function is improved through consumption of whole kiwifruit (Actinidia deliciosa). This study investigated whether encapsulated kiwifruit extract (1 g/day) could alleviate constipation in otherwise healthy adults. Methods: Forty adults with confirmed constipation entered this
trial, of which 32 completed with >80% compliance. Two capsules were self-administered morning and evening
for 2 periods, each of 3 weeks duration, separated by a 3+ week washout in a double blind, randomised, placebo
controlled crossover. I nclusion criteria included constipation with ≤3 bowel movements (BM) per week. Dail y
records of defecation frequency and stool characteristics were obtained throughout treatment, as well as a measurement of gastrointestinal symptoms rating scale (GSRS) and quality of life (QoL) before and after each intervention arm. Results: There was no difference in total BM over 3 weeks (p>0.05) or mean BM during each of
weeks 1, 2 and 3 (p>0.05) between the kiwifruit extract and placebo when assessed from a faecal diary. There
was also no detectable difference in defecation related scores of BM ease of defecation, volume, consistency or
BM type assessed using Bristol stool chart scores. Nor was there a significant change in GSRS or QoL between
pre and post treatment measures, when compared to placebo (p>0.05). Conclusions: This trial showed that improvement in bowel function or comfort was not achieved through supplementation with 1 g/day freeze dried kiwifruit extract. Efficacy from prior kiwifruit powder and whole fruit trials indicate that investigating higher doses
of encapsulated kiwifruit extract may be worthwhile.
Asia Pac J Clin Nutr. 2015;24(3):421-429.doi: 10.6133/apjcn.2015.24.3.15
>>Abstract
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Determinants of dietary self-care behaviours among
Taiwanese patients with type 2 diabetes
Author:Chung-Mei Ouyang PhD, RD, Johanna T Dwyer DSc, RD,
Keywords:type 2 diabetes mellitus, Taiwan, self-care behaviours, patient education, dietary adherence
Abstract:The effects of patient characteristics on reported adherence to dietary self-care behaviours in 184 Taiwanese outpatients 40 years or older with type 2 diabetes was assessed. Patient characteristics included the presence of predisposing factors affecting diabetes adherence (knowledge and attitudes about the disease, self-efficacy, and the
absence of psychological problems), enabling factors (understanding of diabetes and environmental factors affecting it), and reinforcing factors (presence of medical and social support) which were evaluated using a 72 item
self-administered questionnaire with 8 subscales. Adherence was assessed by patients’ reports of carrying out 7
self-care behaviours (following a diabetic meal plan, following the diabetes exchange system, eating meals
providing the same amount of carbohydrate every day, counting carbohydrates, reducing dietary fat, consuming
high f iber foods, and keeping a daily food record). Reported adherence ranged from 17% to 74%. No single predisposing, enabling, or reinforcing factor predicted adherence to all of the dietary self-care behaviours. However,
more self-efficacy, better understanding, and a better attitude toward diabetes were associated with performing
five or more of the dietary self-care behaviours examined. With respect to specific self-care behaviours, women
were more likely than men to count carbohydrates (OR=5.75) and reduce fat in their diets (OR=2.57). Patients
who attended more nutrition education sessions were more likely to follow diabetes meal plans (OR=2.11) and
the diabetes exchange system (OR=3.07). Efforts are needed to encourage providers to teach diabetes self-care
behaviours to patients and to capitalize upon demographic and psychosocial characteristics that can enhance patient adherence.
Asia Pac J Clin Nutr. 2015;24(3):430-437.doi: 10.6133/apjcn.2015.24.3.02
>>Abstract
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Diabetes self-care behaviours and clinical outcomes
among Taiwanese patients with type 2 diabetes
Author:Chung-Mei Ouyang PhD, RD, Johanna T Dwyer DSc, RD,
Keywords:type 2 diabetes mellitus, Taiwan, self-care behaviours, patient education, clinical outcomes
Abstract:We examined the influences of patients’ background characteristics on the frequency of performing five diabetes
self-care behaviours that 185 Taiwanese outpatients reported. All patients had type 2 diabetes diagnosed for more
than a year and attended an outpatient clinic at a large university hospital where they had received at least one dietitian-led individual nutrition education session and one nurse- led diabetes education session during the course
of their care. Seventy nine percent of the patients regularly (defined as responses often or always on the questionnaire) took their medications and over half followed recommended meal plans and exercised, but fewer performed foot care (38%) or checked their blood glucose levels (20%) regularly. The associations between patients’
demographics and disease-related characteristics and their performance of self-care behaviours were assessed
with logistic regression. Although checking blood glucose levels and performing diabetes foot care were unrelated to any clinical outcome examined, patients who took their diabetes medications had lower hemoglobin A1c
levels and fewer chronic complications than those who did not. Furthermore, patients who followed a diabetes meal
plan also had lower hemoglobin A1c
levels, and those who exercised regularly had healthier body mass indices
(BMI ) than those who did not.
Asia Pac J Clin Nutr. 2015;24(3):438-443.doi: 10.6133/apjcn.2015.24.3.03
>>Abstract
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Low haemoglobin levels contribute to low grip strength
independent of low-grade inflammation in Japanese
elderly women
Author:Eriko Yamada NRD, Mika Takeuchi PhD, NRD, Miki Kur
Keywords:grip strength, haemoglobin, height, age, elderly women
Abstract:Muscle strength declines with age. However, factors that contribute to such declines are not well documented and
have not been extensively studied in elderly populations of Asian origin. Correlations of grip strength with a
broad range of factors associated with declines in muscle strength were examined in 202 community-living elderly Japanese women. After adjustment for age, grip strength was positively correlated with body weight, height,
serum albumin, haemoglobin, high-density lipoprotein cholesterol (HDL-C) and serum iron and inversely with
serum copper, and log high-sensitivity C-reactive protein (hsCRP). Multiple linear regression analysis with grip
strength as a dependent variable showed that 47.0% of variability of grip strength could be accounted for by
height, age and haemoglobin in order of increasing R
2
. I n conclusion, low haemoglobin may contribute to low
muscle strength independently of age, anthropometric, nutritional, and inflammatory markers in the elderly, and
may represent an important confounder of the association between grip strength and functional decline in community-living Japanese elderly women.
Asia Pac J Clin Nutr. 2015;24(3):444-451.doi: 10.6133/apjcn.2015.24.3.11
>>Abstract
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Anaemia prevalence over time in Indonesia: estimates
from the 1997, 2000, and 2008 Indonesia Family Life
Surveys
Author:Jonathan S Barkley MPH, Katherine L Kendrick MPH,
Keywords:anaemia, haemoglobin, Indonesia, IFLS, Southeast Asia
Abstract:Objective: To summarize anaemia prevalence data for children, women, and men using data f rom the second,
third and fourth waves of the I ndonesia Family Life Surveys (I FLS), which were conducted in 1997/8, 2000, and
2007/8, respectively. Methods: Anaemia prevalence was determined for children 0 to 5 years, 5 to 12 years, 12 to
15 years, non-pregnant women at least 15 years, pregnant women at least 15 years, and men at least 15 years,
based on haemoglobin adjusted for altitude and smoking status. Results: Compared with 1997/8 estimates, anaemia prevalence estimates were lower in 2007/8 for all groups, with the greatest relative decline occurring in chil dren 5 to 12 years (25.4%). Trend analysis found anaemia signif icantly declined over the survey years for all
groups (χ² p=0.005 for pregnant women, χ² p<0.001 for all other groups). Conclusions: I FLS anaemia estimates
for different population groups decreased between 1997/8 and 2007/8 and were consistent with estimates from
Southeast Asia, and with other studies conducted in I ndonesia. While the prevalence of anaemia consistently decreased in all groups, anaemia remains a moderate public health problem for children 0 to 5 years, children 5 to
12 years, and non-pregnant and pregnant women.
Asia Pac J Clin Nutr. 2015;24(3):452-455.doi: 10.6133/apjcn.2015.24.3.22
>>Abstract
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Intake and major sources of dietary flavonoid in
Korean adults: Korean National Health and Nutrition
Examination Survey 2010-2012
Author:You Jin Kim PhD, Min Young Park MS, Namsoo Chang P
Keywords:flavonoid intake, major food source, adult, major food contributors, national survey
Abstract:With an effort to investigate possible relationship between flavonoids and health, an accurate estimation of flavonoid intake is valuable. We estimated dietary flavonoid intake and identified the major food sources. Subjects
were healthy adults aged ≥19 y (n=11,474) who completed the 24-h dietary recall of the Korean National Health
and Nutritional Examination Survey (2010-2012). The US Department of Agriculture and newly estimated or
published values for typical Korean foods were combined into a Korean-targeted flavonoid database. The mean
intake of total flavonoid was 107±1.47 mg/d, with a higher intake in women than in men after energy-adjustment.
Quercetin, cyanidin, genistein, daidzein, epigallocatechin 3-gallate, epicatechin, hesperetin, and luteolin were
identified as major flavonoid compounds. Across the age range studied, flavonols and flavones showed a reversed
U-shape curve; flavan-3-ol and flavanones showed a decreasing pattern; and anthocyanidins and isoflavones
showed an increasing pattern. Forty-five food items were identified as contributing >2% of at least one flavonoi d
compound’s intake. Kimchi was the major food source of total flavonoids, followed by green tea, persimmons,
and soybeans. Single food items accounting for more than 50% of the intake of a specific flavonoid included persimmons (cyanidin), green tea (epigallocatechin, epicatechin-3-gallate, and epigallocatechin 3-gallate), black tea
(thearubigin), tangerines (hesperetin and naringenin), and onions (isorhamnetin). This study provides information
on Korean flavonoid intake to enable international comparisons, along with insight into how the sources and intake of various flavonoids vary according to age and gender. This work should facilitate future investigations of
the association between flavonoid intake and health.
Asia Pac J Clin Nutr. 2015;24(3):456-463.doi: 10.6133/apjcn.2015.24.3.04
>>Abstract
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New data for vitamin D in Australian foods of animal
origin: impact on estimates of national adult vitamin D
intakes in 1995 and 2011-13
Author:Jerry Liu PhD, Jayashree Arcot PhD, Judy Cunningha
Keywords:vitamin D, animal origin foods, Australia, adult diets, dietary survey
Abstract:Objectives: To assess the potential dietary supply of vitamin D to Australian adults by application of new data
for Australian primary foods of animal origin. Methods: New published analytical data on the vitamin D contents
of Australian primary foods from animal products were obtained and assessed for reliability. Using food consumption data from Australian population dietary surveys for 1995 and 2011-2013, estimates were made of the
likely average daily intakes of vitamin D equivalents from these sources by Australian adults. Results: Meats,
chicken, fish, eggs and dairy produce may alone have contributed about 4.2 µg vitamin D equivalents per day to
average Australian diets of adults >18 years in 1995 and 4.3 µg in 2011-2013. Conclusions: Dietary vitamin D
intake in Australia is likely to be higher than previously estimated because new data from improved analytical
methods reveal the contributions to vitamin D supply from foods of animal origin. Absence of reliable vitamin D
data for milk and milk products, and the gaps in vitamin D data for many commonl y consumed seafood, poultry,
eggs and processed animal products greatly limit estimation of dietary vitamin D intakes by Australians.
Asia Pac J Clin Nutr. 2015;24(3):464-471.doi: 10.6133/apjcn.2015.24.4.04
>>Abstract
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BMI and all-cause mortality among Chinese and
Caucasians: the People’s Republic of China and the
Atherosclerosis Risk in Communities Studies
Author:Eva Erber Oakkar PhD, June Stevens MS, PhD, Kimber
Keywords: body mass index, all-cause mortality, Chinese, Caucasians, BMI cutpoint
Abstract:Background: Lower ethnic-specific body mass index (BMI ) cutpoints have been proposed for Asians and
adapted in some countries. However, to our knowledge, no study has directly compared Asians to other ethnic
groups to test differences in associations between BMI and all-cause mortality using common methods. Objectives: We estimated the association between BMI and all-cause mortality in Chinese Asians and Caucasian Americans to determine if lower Asian-specific BMI cutpoints are warranted. Methods: Extant data of the People’s
Republic of China Study (1983-1997) including 5546 Chinese and the Atherosclerosis Risk in Communities
Study (1987-2002) including 9932 Caucasians aged 45-64 years at baseline were used. All analyses were performed using Cox proportional regression models. Results: Standardized mortality rates were 6.88 (95% confidence interval (CI ): 5.75-8.24) and 5.50 (95% CI: 4.74-6.39) per 1000 person-years for Chinese and Caucasians,
respectively. Standardized mortality probabilities by age 70 were similar across all BMI categories among Chinese. Furthermore, the probabilities were similar to those among Caucasians with BMI of 27.5-<32.5 kg/m
2
. The
BMI associated with lowest mortality risk was almost identical between Chinese (25.1 kg/m
2
) and Caucasians
(25.2 kg/m
2
). The analysis of categorical BMI did not reveal an increased mortality risk at any BMI categor y
among Chinese. I n contrast, compared to those with a BMI of 23.0-<25.0 kg/m
2
, risk was elevated by 35%
among Caucasians with a BMI of 30.0-<32.5 kg/m
2
. Conclusions: These findings do not support different BMI
cutpoints for Chinese than Caucasians on the basis of mortality rates.
Asia Pac J Clin Nutr. 2015;24(3):472-479.doi: 10.6133/apjcn.2015.24.3.12
>>Abstract
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The correlation between high body mass index and
survival in patients with esophageal cancer after
curative esophagectomy: evidence from retrospective
studies
Author:Wenbiao Pan MD, Zhiyong Sun MD, Yangwei Xiang MD,
Keywords:high body mass index, survival, esophageal cancer, esophagectomy, pooled quantitative analysis
Abstract:Objective: To investigate the predictive value of high body mass index (H-BMI ) on the survival of patients with
esophageal cancer (EC) after curative esophagectomy. Methods: Studies were systematically identified to investigate the relationship between overweight and obese (H-BMI ) and clinical outcomes in EC patients treated with
curative esophagectomy. Measured clinical outcomes were disease-free survival (DFS) and overall survival (OS).
The pooled hazard ratio (HR) with 95% confidence interval (CI ) was estimated. Subgroup analyses were performed according to tumour type and body mass index (BMI ). Results: Fourteen studies with 4823 cases were
included in the final pooled quantitative analysis. I n EC patients overall, H-BMI was associated with improved
DFS (HR, 0.83; 95% CI: 0.75-0.90) and OS (HR, 0.79; 95 % CI: 0.73-0.85), as compared with normal BMI . The
results were consistent with those who were overweight. Among patients with esophageal adenocarcinoma (EAC),
a better prognosis, as reflected by OS, was observed with H-BMI (HR, 0.81; 95% CI: 0.73-0.89). The same results were also observed in EAC patients who were obese and overweight. I n contrast, among patients with
esophageal squamous cell carcinoma (ESCC), H-BMI was associated with a worse prognosis, as reflected by
DFS (HR, 2.26; 95% CI: 1.29-3.24). Conclusions: H-BMI has distinctly different impacts on the postoperative
survival of EAC and ESCC patients. H-BMI is a potential predictor for better prognosis in EC patients overall,
and particularly in EAC patients, treated with curative esophagectomy. However, in ESCC patients, H-BMI is a
potential predictor for a worse prognosis of postoperative survival.
Asia Pac J Clin Nutr. 2015;24(3):480-488.doi: 10.6133/apjcn.2015.24.3.05
>>Abstract
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Interrelationship between glucose metabolism and
undercarboxylated osteocalcin: a cross-sectional study in
a community-dwelling population
Author:Shozo Yano MD, Toru Nabika PhD, Atsushi Nagai MD,
Keywords:undercarboxylated osteocalcin, glucose metabolism, diabetes mellitus, bone metabolism, TRACP5
Abstract:Objective: Undercarboxylated osteocalcin (ucOC) produced from the bone was recently found to play a regulatory role in the insulin and adiponectin secretion. We performed a cross-sectional study to investigate the relationship between ucOC and diabetes mellitus (DM). Methods: We included 1,870 subjects aged over 50 from participants of a health examination. According to the current medication and past history, 605 subjects had hypertension (HT), 316 had dyslipidemia (DL), and 182 had type 2 DM. Fasting blood samples were collected to measure
concentrations of ucOC and the bone turnover marker, tartrate-resistant acid phosphatase 5b (TRACP5b) by ELISA. Results: The serum ucOC level was significantly lower in DM(+) than DM(-) in both men and women. I n a
logistic regression analysis, a low level of ucOC was significantly associated with the presence of DM in both
men and women after adjusting for age, BMI , serum creatinine, trigl yceride, and TRACP5b. Multiple regression
analysis showed a negative association of ucOC with HbA1c and fasting plasma glucose, and a positive association with the insulin level. I n contrast, no association was found between TRACP5b and the indices above, suggesting that the effect of ucOC on the insulin secretion and the glycemic status was independent of bone turnover.
Conclusions: The present cross-sectional study showed a significant association between ucOC and glucose metabolism after correction with bone turnover in a community-dwelling population both in men and women, indicating that ucOC may play an important role in the pathogenesis of DM through the pathways independent of
bone metabolism.
Asia Pac J Clin Nutr. 2015;24(3):489-495.doi: 10.6133/apjcn.2015.24.4.02
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A meta-analysis combining parallel and cross-over
randomized controlled trials to assess impact of iodine
fortified foods on urinary iodine concentration among
children
Author:Ramesh Athe MSc, MPhil, PhD, Vishnu Vardhana Rao M
Keywords:iodine fortification, meta-analysis, carry-over effect, meta-regression, covariate meta-analysis
Abstract:The purpose of this analysis was to combine evidence from parallel and cross-over randomized controlled trials to
assess the impact of iodine fortified foods on urinary iodine concentration (UIC) in children. A structured search
for studies on iodine intervention studies on MEDLINE, Pro Quest, and the Cochrane Library from Jan, 1990 to
Dec, 2012 was carried out. Carry-over effect was estimated by general linear model. We explored two methods to
pool continuous outcomes in a meta-analysis by combining parallel and cross-over trial designs. The standard
mean difference was calculated for net change in UIC. Fixed or random-effects models were used to summaries
fortified food response data. Meta-regression and covariate meta-analysis were performed to explore the influence of confounders on the net pooled effect on UIC. The overall pooled estimate, which combined parallel with
cross-over trials in the absence of carry-over effect of UIC from 9 studies, showed a significant increase in the
fortified group compared with the control group (n=3448; standard mean difference=2.02 μg/L; 95% CI : 1.30,
2.73; I
2
=99%, τ
2
=1.81, p<0.01). Meta-regression analysis indicated that dose of the feeding was positively related
to the effect size (regression coefficient=0.014; 95% CI: 0.003, 0.026; p<0.019). The net pooled effect size after
removing the confounders was 1.59 (95% CI: 0.953, 2.23) μg/L. There was an association between intakes of iodine fortified foods and UIC in children. These results suggest that we can combine parallel with cross-over trials
for meta-analysis for nutrients such as iodine when absorption is high.
Asia Pac J Clin Nutr. 2015;24(3):496-503.doi: 10.6133/apjcn.2015.24.3.10
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Standard values of rapid turnover proteins and zinc in
Japanese children
Author:Kei Yamamoto MD, Norihiko Kitagawa MD, PhD, Tetsuy
Keywords:children, retinol binding protein, transthyretin, zinc, Japanese
Abstract:Measurement of rapid-turnover proteins has an established place in nutrition assessment and is partly dependent
on the zinc metallo-enzymes involved. We investigated the reference values of rapid turnover proteins and zinc
in Japanese children. This cross-sectional study was conducted at a single center. We collected data from children aged 0 to 12 years with inguinal hernia, umbilical hernia, or hydrocele of the spermatic cord, who had body
mass index z scores of -2 to 2. The standard references (mean±2 SD) of transthyretin were 11.5-21.5 mg/dL in
infants (≤1.5 years), 13.6-21.5 mg/dL in preschool children (1.6-6 years), and 12.3-23.4 mg/dL in preadolescent
children (6.1-12 years). The standard references of retinol binding protein were 1.27-2.55 mg/dL, 1.28-2.54
mg/dL, and 1.27-2.44 mg/dL in each age group, respectively. Rapid turnover proteins did not differ significantl y
in each group. The transthyretin level was weakly correlated with aging (r=0.284, p=0.003) and estimated lean
body mass (r=0.274, p=0.004). Retinol-binding protein was not correlated with aging and anthropometric parameters. We established reference values for rapid turnover proteins with known zinc status in Japanese children. These values were not, or only weakly, correlated with anthropometric parameters for assessing protein energy malnutrition.
Asia Pac J Clin Nutr. 2015;24(3):504-508.doi: 10.6133/apjcn.2015.24.4.01
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Is parental body weight related with their children’s
overweight and obesity in Gao Hang Town, Shanghai?
Author:Yanping Wan MD, Renying Xu MD, PhD, Haixia Feng MD
Keywords:overweight, children, parents, body mass index, waist circumference
Abstract:Objectives: This study aimed to evaluate the relationship between parental body weight and their children’s
overweight and obesity in school students in Gao Hang Town, Shanghai. Methods: A cross-sectional study was
performed in five primary schools in Gao Hang Town, Shanghai. Overall, 2,025 sets of parents and their children
(7-13 years, 981 boys/1044 girls) were enrolled. Body mass index (BMI) and waist circumference for each child
were measured. Age, gender, birth weight, and breastfeeding history was recorded for each child and the BMI of
their parents was obtained by a self-completion questionnaire. Overweight (including obesity) was defined as a
BMI of ≥24.0 kg/m
2
in parents and a BMI ≥P
85 in children according to age- and gender-specific percentiles. Results: The total prevalence of overweight was higher in boys than in girls (35.5% vs 19.5%), while it was the
same in fathers compared with mothers (50.6% vs 18.9%). The prevalence of overweight in boys showed a trend
with increasing age, but remained stable versus age in girls. Parents were further divided into four subgroups as
follows: I) both father and mother had a normal BMI; II) father overweight, mother normal weight; III) father
normal weight, mother overweight; IV) both father and mother are overweight. The odds ratio of overweight was
2.26 for group II, 2.71 for group III, and 4.36 for group IV, respectively, compared with group I. Gender, paternal
BMI, and maternal BMI were chosen as risk factors for children overweight. Conclusions: Parental BMI affects
their offspring overweight and obesity in Chinese school students.
Asia Pac J Clin Nutr. 2015;24(3):509-514.doi: 10.6133/apjcn.2015.24.3.09
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Polychlorinated biphenyl and heavy metal exposures
among fishermen in the Straits of Malacca:
neurobehavioural performance
Author:Alina Mohamad MSc, Azrina Azlan PhD, Mohd Yusoff A
Keywords:fish, fishermen, heavy metal, neurobehavioural, polychlorinated biphenyl
Abstract:The aim of this study was to determine the level of exposure to pol ychlorinated biphenyls (PCBs) and selected
heavy metals among fishermen via dietary intake of fish and other seafood from the eastern coast along the Straits
of Malacca. This study determined the neurobehavioural performances (based on neurobehavioural core test battery scores) of the fishermen and evaluated the correlations between scores of neurobehavioural core test battery
and exposure factors. Ninety fishermen participated in the study. The total fish intakes of the fishermen were
measured using a set of food frequency questionnaires. The PCBs contents in the seafood samples ranged between 0.2 and 0.6 pg/g f resh sample. The concentrations of mercury (Hg), arsenic (As), cadmium (Cd), and lead
(Pb) in the seafood samples were 1.1-5.4, 0.3-4.4, 0.6-36.1, and 0.02-0.3 µg/g fresh sample, respectively. The
PCBs, Hg, As, Cd, and Pb exposures of the f ishermen was estimated to be 2.8, 0.02, 4.5, 0.09, and 0.5 pg/kg body
weight/day, respectively. PCB and heavy metal exposures through dietary intake of fish and seafood were within
the tolerable daily limits. The results of neurobehavioural core test battery revealed that the neurobehavioural performances of the fishermen were not affected due to PCB and heavy metal intoxication. No correlations were
found between the exposure and neurobehavioural performance among the fishermen. These data are useful for
policy makers to assure the safety and quality of seafood in relation to sea pollution. Although the levels of exposure were low, periodic assessment of the quality of fish and fish products is required due to the polluted seawater.
Asia Pac J Clin Nutr. 2015;24(3):515-524.doi: 10.6133/apjcn.2015.24.3.06
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Effectiveness of a public dietitian-led diabetes nutrition
intervention on glycemic control in a community setting
in China
Author:Huaqing Liu MS, Min Zhang MS, Xuesen Wu PhD, Chunh
Keywords: diabetes, public dietitian, diet, nutrition, community
Abstract:Objective: Diabetes mellitus requires lifelong treatment, most of which is accomplished in family and community settings. The present study was designed to identify the effectiveness of nutrition intervention provided by public dietitian on glycemic control in a community setting in China. Methods: Two communities were selected and
randomly assigned to a routine care group (59 subjects) and a public dietitian-led intervention group (58 subjects)
who received diabetic nutrition management for one year. The main measures included fasting plasma glucose,
HbA1c, weight, body mass index (BMI ), lipid profile, and blood pressure. Results: I n the intervention group,
there was significant improvement in fasting plasma glucose, HbA1c, cholesterol, and triglyceride levels relative
to the control subjects (p<0.05). Over the 12-month period, there was a decrease in energy intake, including reductions in absolute amounts (grams) of protein and fat in the intervention group. The energy percent values of
carbohydrate, protein, and fat were 50.7%, 17.0%, and 32.3%, respectively, at baseline and 53.0%, 17.1%, and
29.9% (within the recommended range) after the intervention. There were significant improvements in total energy, absolute amounts of fat and protein, and the energy percent values of carbohydrates and fat. I n the control
group, however, these values were similar before and after the intervention, and the energy percent values of fat
were still above the recommended range. Conclusions: I n a community setting, a diabetes nutrition intervention
led by a public dietitian significantly improved the glycemic control of type 2 diabetic patients
Asia Pac J Clin Nutr. 2015;24(3):525-532.doi: 10.6133/apjcn.2015.24.3.07
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Identifying barriers to the implementation of nutrition
education in South Korea
Author:Jounghee Lee PhD,Youngsun Hong MS
Keywords:barriers, nutrition education, nutrition teacher, school dietitian, South Korea
Abstract:To improve the nutritional status of children and adolescents, it is critical to identify the barriers to the implementation of nutrition education in schools. We carried out a cross-sectional study by analyzing data from 121 subjects (45 nutrition teachers and 76 school dietitians). Among the personal, environmental and systematic barriers,
the top four barriers to the implementation of nutrition education were heavy workload (4.28 points), lack of a
systematic curriculum (4.12 points), lack of perception of nutrition education by school administrators and teachers (4.07 points), and lack of continuing education for nutrition teachers and school dietitians (4.05 points). Additionally, poor working conditions, such as low pay, were identified as significant barriers to nutrition education
for school dietitians compared with nutrition teachers (4.33 vs 3.47 points, p<0.001). This research provides useful information for nutrition policy makers to promote nutrition education in schools in South Korea.
Asia Pac J Clin Nutr. 2015;24(3):533-539.doi: 10.6133/apjcn.2015.24.3.21
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The adherence of packaged food products in Hyderabad,
India with nutritional labelling guidelines
Author:Elizabeth K Dunford PhD, Rama K Guggilla MMed, Ane
Keywords:nutritional labelling, processed foods, Codex Alimentarius, India, labelling regulation
Abstract:Background: I ndia is experiencing a nutrition transition with the consumption of processed foods rapidly increasing. Nutrition labels are essential if consumers are to understand the healthiness of these products. The Food
Safety and Standards Authority of I ndia have recently introduced regulation def ining national nutrition labelling
requirements and Codex Alimentarius recommends a global standard. Objectives: To quantify the adherence of
the declared nutrients on I ndian packaged foods with national and global requirements. Methods: The presence
or absence of data for seven required nutrients was recorded for all food products available for sale. Branches of
three major retail chains and three smaller stores in Hyderabad, I ndia between October and November, 2010 were
surveyed. Results: Data were collected for 4166 packaged products that fell into 14 different food groups. 52% of
products displayed nutrient information on energy, protein, carbohydrate, sugar and total fat, meeting the minimum requirements of the Food Safety and Standards Authority of India. Only 27% met the minimum criteria defined by Codex which also requires the reporting of saturated fat and sodium. There was significant variation in
compliance for leading brands, country of manufacture and food group (p<0.01 for all). Conclusions: The majority of I ndian packaged foods do not meet national and international nutrient labelling guidelines. With the I ndian population likely to consume much more packaged food over coming years full and effective food labelling
will be essential. The failure of I ndian legislation to require labelling of sodium and saturated fat may warrant review.
Asia Pac J Clin Nutr. 2015;24(3):540-545.doi: 10.6133/apjcn.2015.24.3.08
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Diets high in carbohydrate may not be appropriate for
rs328 G carriers with the metabolic syndrome
Author:Shixiu Zhang PhD, Yiyi Ma PhD, MD, Hongwei Guo MD,
Keywords:gene-by-diet interaction, carbohydrate, lipoprotein lipase, metabolic syndrome, insulin resistance
Abstract:The objective of this study was to test how the genetic pol ymorphisms located within the lipoprotein lipase (LPL)
locus would modulate the relationship between a diet high in carbohydrate and insulin resistance related traits in
metabolic syndrome adults. A one year nutritional intervention study focusing on education to increase dietary intake of whole grain, vegetable and fruit, and to reduce the intake of sodium, simple sugar and dietary fat (especially cooking oil and pork lard) was conducted. Two districts in Shanghai, China were randomly selected to be
the intervention and control group, and patients (n=235) with metabolic syndrome within these two districts were
selected based on a multistage sampling method. Fasting glucose was reduced in rs328 CC homozygotes
(p=0.028) but not G carriers (p=0.686) within the intervention group. Also an ancillary study with greater statistical power by combining the baseline measurements across both the intervention and control groups was conducted to test the cross-sectional statistical interactions between carbohydrate/fat and lipoprotein lipase genot ypes for
homeostasis model assessment of insulin resistance/insulin/fasting glucose. I ncreased carbohydrate intakes were
positively associated with homeostasis model assessment of insulin resistance and insulin in rs328 G carriers but
not CC homozygotes (p for interaction was 0.025). These results indicate that diet high in carbohydrate may not
be suitable for metabolic syndrome rs328 G carriers, calling for the development of personalized dietary intervention for metabolic syndrome subjects.
Asia Pac J Clin Nutr. 2015;24(3):546-554.doi: 10.6133/apjcn.2015.24.3.17
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