Preferred ecosystem characteristics: their food and
health relevance to China’s rapid urbanisation
Author:Valerie Gibson BSc, Yong-Guan Zhu PhD, Rubing Ge M
Keywords: ecosystem health disorders, urbanisation, rural, natural environment, food systems
Abstract:For most of its history, China has supported a growing population through food systems which have been mutually inclusive of people and their locality. This trajectory has required adequate ecosystem maintenance or humanised reformulation and a high degree of recyclable nutrient flow. The ‘tipping point’ in habitat sustainability has
come with the size and demographic structure of China’s population to one that is ageing, with modernisation of
its infrastructure and increased expectations of better livelihoods, standards of living and health. I n order to meet
these expectations, China has embarked on rapid urbanisation for upwards of 300 million people over the next
15-20 years and to do so taking account of the environmental limitations. The process will radically change rural
as well as urban China and the systems which connect them. Chief among these will be ecosystems in number
and type along with the food and health systems integral to them. To minimise ecological damage and optimise
the benefits to people and place, describing, monitoring and managing the process will be paramount. The present
paper is a situational analysis of health as it may be ecologically favoured or disordered (Ecosystem Health Disorders) and of the food systems on which the environment and health depend. An effort is made to enumerate the
current situation in China in a way that might enable the optimisation of humanised ecosystems.
Asia Pac J Clin Nutr. 2015;24(4):556-574.doi: 10.6133/apjcn.2015.24.4.29
>>Abstract
>> Download PDF
Garlic intake lowers fasting blood glucose: meta-analysis
of randomized controlled trials
Author:Li-qiong Hou MSc, Yun-hui Liu MSc, Yi-yi Zhang MSc
Keywords:garlic, meta-analysis, glucose, randomized controlled trial, type 2 diabetes
Abstract:Garlic is a common spicy flavouring agent also used for certain therapeutic purposes. Garlic’s effects on blood
glucose have been the subject of many clinical and animal studies, however, studies reporting hypogl ycemic effects of garlic in humans are conflicting. A comprehensive literature search was conducted to identify relevant
trials of garlic or garlic extracts on markers of gl ycemic control [fasting blood glucose (FBG), postprandial glucose (PPG), glycosylated haemoglobin (HbA1c)]. A meta-analysis of the effect of garlic intake on human was
done to assess garlic’s effectiveness in lowering glucose levels. Two reviewers extracted data from each of the
identified studies. Seven eligible randomized controlled trials with 513 subjects were identified. Pooled analyses
showed that garlic intake results in a statistically significant lowering in FBG [SMD=-1.67; 95% CI (-2.80, -0.55),
p=0.004]. Our pooled analyses did not include PPG control and HbA1c outcomes. Because only 1 study included
in the meta-analysis reported PPG variables and only 2 studies reported HbA1c variables. I n conclusion, the current meta-analysis showed that the administration of garlic resulted in a significant reduction in FBG concentrations. More trials are needed to investigate the effectiveness of garlic on HbA1c and PPG.
Asia Pac J Clin Nutr. 2015;24(4):575-582.doi: 10.6133/apjcn.2015.24.4.15
>>Abstract
>> Download PDF
Peri-operative immunonutrition in patients undergoing
liver transplantation: a meta-analysis of randomized
controlled trials
Author:Qiucheng Lei BS, Xinying Wang MD, Huazhen Zheng B
Keywords:immunonutrition, ω-3 polyunsaturated fatty acids, glutamine, liver transplantation, meta-analysis
Abstract:Background and Objectives: No consensus has been reached concerning the effects of peri-operative immunonutrition in patients undergoing liver transplantation. We conducted a meta-analysis to evaluate the effects
of peri-operative immunonutrition on clinical outcomes and liver f unction in patients undergoing liver transplantation. Methods and Study Design: The Pubmed, Embase, Cochrane Central Register of Controlled Trials, Web
of Science, and google scholar were searched to identify all available randomized controlled studies which compared peri-operative immunonutrition support (glutamine, ω-3 polyunsaturated fatty acids, arginine and ribonucleic acids) with standard nutrition. The data analysis was performed using Revman 5.2 software. Results: A total of 7 randomized controlled trials (RCTs) involving 501 patients were included. Peri-operative immunonutrition signif icantly reduced the risk of infectious complications (RR: 0.51; 95% CI: 0.27 to 0.98, p=0.04) and
shortened the postoperative hospital stay [weighted mean difference (WMD): -3.89; 95% CI: -7.42 to -0.36;
p=0.03] . Furthermore, peri-operative immunonutrition improved liver function by decreasing the levels of aspartate aminotransferase (AST) in the blood (WMD: -25.4; 95% CI: -39.9 to -10.9, p=0.0006). However, we did not
find statistically significant differences in serum alanine aminotransferase (ALT), total bilirubin (TB) and direct
bilirubin (DB) levels. There were no statistically significant differences in mortality and rejection reaction. Conclusions: Peri-operative nutrition support adding immunonutrients like glutamine, ω-3 polyunsaturated fatty acids,
arginine and ribonucleic acids may improve outcomes in patients undergoing liver transplantation. Due to the
limited sample size of the included trials, further large-scale and rigorously designed RCTs are needed.
Asia Pac J Clin Nutr. 2015;24(4):583-590.doi: 10.6133/apjcn.2015.24.4.20
>>Abstract
>> Download PDF
Preoperative Nutritional Risk Index to predict
postoperative survival time in primary liver cancer
patients
Author:Yacong Bo MD, Mingjie Yao MD, Ling Zhang MD, Wolde
Keywords:Nutritional Risk Index, postoperative survival time, weight loss, primary liver cancer, hepatectomy
Abstract:Background and Objectives: We designed this study to determine the predictive value of Nutritional Risk Index
(NRI) for postoperative survival time of patients who had undergone hepatectomy for primary liver cancer.
Methods and Study Design: The 620 patients who underwent hepatectomy for primary liver cancer (PLC) in the
Department of Hepatobiliary Surgery, Cancer Hospital of Henan Province, Zhengzhou, China from December 1,
2008 to December 1, 2012 were followed up. A nutritional risk index (NRI) was used to screen the patients with
malnutrition (NRI 100). At the same time, the prognosis and survival of the patients were recorded. KaplanMeier curve with log-rank test was used to analyze the relationship between malnutrition and prognosis of the
subjects. Also the postoperative survival time and its influencing factors were analyzed by Cox proportional hazards model. Results: The cumulative survival probability at 1, 3, and 5 years of the 620 subjects was 49%, 33%
and 29% respectively. Kaplan-Meier analysis with log-rank test showed that non-malnourished (NRI values >100)
patients had longer postoperative survival time compared with malnourished patients. NRI values >100 was significantly associated with longer postoperative survival time. Cox proportional hazards model showed that NRI
was an independent predictor of postoperative survival time and that NRI varied inversely with the risk of deat h.
Conclusion: The patients with NRI values >100 survived longer than those with NRI values 100.
Asia Pac J Clin Nutr. 2015;24(4):591-597.doi: 10.6133/apjcn.2015.24.4.26
>>Abstract
>> Download PDF
Relationship between pre-treatment nutritional status,serum glutamine, arginine levels and clinicopathologicalfeatures in Taiwan colorectal cancer patients
Author:Yi-Ping Pan BA, Pei-Hung Chang MD, Chung-Wei Fan
Keywords:body weight loss, low BMI, hypoalbuminemia, glutamine, arginine
Abstract:Background and Objectives: To examine the relationship between malnutrition criteria, serum glutamine and
arginine concentrations, and clinicopathological features in T aiwan colorectal cancer patients. Methods and
Study Design: Three malnutrition criteria (body weight loss >5% over past 6 months, body mass index (BMI )
<18.5 kg/m
2
, and hypoalbuminemia) and serum levels of glutamine and arginine were measured in 164 colorectal
patients. Malnutrition status and serum glutamine and arginine concentrations were tested for their association
with each other , as well as with the clinicopathological variables. Results: Of the 164 patients, 38 (23.5%) had
body weight loss, 19 (11.9%) had low BMI , and 57 (35.8%) had hypoalbuminemia. The univariate analysis
showed hypoalbuminemia was correlated with advanced tumour stage, lower concentrations of glutamine, higher
C-reactive protein level, and progression-free survival rate. Univariate analysis also showed glutamine levels
were lower in advanced tumour stage, but arginine levels were not associated with any clinicopathologic variables. Neither the nutrition criteria used in this study nor glutamine and arginine levels were correlated with hospi tal stay or progression-free survival rate in multivariate analysis. Conclusions: Dif ferent nutrition assessment criteria produced dif ferent malnutrition rates in colorectal cancer patients; however , pre- treatment malnourished status and low serum glutamine and arginine concentrations were not correlated with hospital stay and progressionfree survival rate
Asia Pac J Clin Nutr. 2015;24(4):598-604.doi: 10.6133/apjcn.2015.24.4.23
>>Abstract
>> Download PDF
The adductor pollicis muscle: a poor predictor of clinical
outcome in ICU patients
Author:Claudia Leong Shu-Fen BSc, Venetia Ong BN, Yanika
Keywords:adductor pollicis, anthropometry, nutritional status, intensive care, clinical outcome
Abstract:No nutrition assessment tools specifically tailored for intensive care unit (I CU) patients have been developed and
validated in Singapore. Studies conducted in Brazilian populations suggest that the thickness of the adductor pollicis muscle (TAPM) may be used to assess nutritional status and predict mortality of critically ill patients. The
aim of this study was to determine if TAPM can be used as a predictive indicator of mortality in Singapore I CU
patients. TAPM values were obtained using skinfold calipers in 229 patients admitted to the medical I CU. TAPM
measured in both hands showed no significant correlation with either the primary outcome (28-day mortality) or
secondary outcomes (hospital outcome and hospital length of stay). This study demonstrated that TAPM does not
predict 28-day mortality and hospital outcome, and is not correlated to length of stay in Singapore I CU patients.
More studies are necessary to validate the use of TAPM as an anthropometric indicator of I CU outcome in other
regions of the world.
Asia Pac J Clin Nutr. 2015;24(4):605-609.doi: 10.6133/apjcn.2015.24.4.22
>>Abstract
>> Download PDF
Association between nutrient adequacy and psychosocial
factors with overall rate of weight loss after bariatric
surgery
Author:Divya Vanoh Msc, Suzana Shahar PhD, Nik Ritza Kosa
Keywords:obesity, bariatric surgery, binge eating disorder, depression, rate of weight loss
Abstract:This was a cross-sectional study that investigated the relationship between nutrient intake and psychosocial factors with the overall rate of weight loss after bariatric surgery among patients who had undergone sleeve gastrectomy in University Kebangsaan Malaysia Medical Centre (UKMMC). Forty-three subjects (15 men and 28 women) were recruited for this study. Subjects completed assessment questionnaires including the Binge Eating Scale
(BES), Beck Depression I nventory (BECK), Family Support Questionnaires, and the I ndex of Peer Relation
(I PR). Results showed that the median overall rate of weight loss was 4.3±5.5 kg/month, which was lower when
compared to the rate of weight loss at three months which was 5.0±5.6 kg/month. Pre-operative weight was the
predictor of overall rate of weight loss (p<0.05, R²=0.52). Binge eating disorder (BED) and depression were also
closely associated with each other after bariatric surgery (p<0.001, R²=0.46). Subjects with good compliance to
dietary advice had lower scores on the binge eating scale. The mean caloric and protein intake was very low, onl y
562±310 kcal/day and 29.6±16.1 g/day. The intake of vitamin A, B-1, B-2, B-3, B-12, C, folate, and iron met the
Malaysian Recommended Nutrient I ntake (RNI ). However, the RNI for calcium, zinc, selenium, vitamin D, and
vitamin E was not met. I n conclusion, although bariatric surgery had many health benef its, several factors hindered weight loss after bariatric surgery. Health care professionals should closely monitor patients after bariatric
surgery.
Asia Pac J Clin Nutr. 2015;24(4):610-619.doi: 10.6133/apjcn.2015.24.4.11
>>Abstract
>> Download PDF
Effect of cooling of cooked white rice on resistant starch
content and glycemic response
Author:Steffi Sonia MD, Fiastuti Witjaksono PhD, Rahmawa
Keywords:cooling, rice, resistant starch, glycemic response, retrogradation
Abstract:Cooling of cooked starch is known to cause starch retrogradation which increases resistant starch content. This
study aimed to determine the effect of cooling of cooked white rice on resistant starch content and glycemic response in healthy subjects. Resistant starch contents were analyzed on freshly cooked white rice (control rice),
cooked white rice cooled for 10 hours at room temperature (test rice I ), and cooked white rice cooled for 24 hours
at 4°C then reheated (test rice II ). The results showed that resistant starch contents in control rice, test rice I , and
test rice II were 0.64 g/100 g, 1.30 g/100 g, and 1.65 g/100 g, respectively. Test rice II had higher resistant starch
content than test rice I , hence used in the clinical study along with control rice to characterize glycemic response
in 15 healthy adults. The clinical study was a randomized, single-blind crossover study. I n the clinical study, test
rice II significantly lowered glycemic response compared with control rice (125±50.1 vs 152±48.3 mmol.min/L,
respectively; p=0.047). I n conclusion, cooling of cooked white rice increased resistant starch content. Cooked
white rice cooled for 24 hours at 4°C then reheated lowered glycemic response compared with freshly cooked
white rice.
Asia Pac J Clin Nutr. 2015;24(4):620-625.doi: 10.6133/apjcn.2015.24.4.13
>>Abstract
>> Download PDF
Association of cystatin C with leptin and TNF-α in
elderly Japanese women
Author:Ayaka Tsuboi NRD, Mika Takeuchi PhD, NRD, Mayu Ter
Keywords: cystatin C, leptin, TNF-α, kidney function, elderly
Abstract:Background and Objectives: Determinants of cystatin C, a novel marker of mortality in the elderly, have not
been extensively studied in Asian elderly population. Methods and Study Design: Associations of cystatin C
with anthropometric, cardiometabolic, hematological, nutritional variables and inflammatory markers were examined in 159 community-living elderly Japanese women whose BMI averaged 22.6±2.9 (SD) kg/m
2
. Results: Serum creatinine and cystatin C averaged 0.73±0.16 mg/dL and 0.85±0.20 mg/L, respectively. Creatinine-based estimated glomerular filtration rate (standardized β, -0.538, p<0.001), age (standardized β, 0.274, p<0.001), serum
leptin (standardized β, 0.218, p<0.001) and tumour necrosis factor-α (TNF-α, standardized β, 0.165, p=0.002)
emerged as significant predictors of serum cystatin C independent of percentage body fat, homeostasis model assessment of insulin resistance, high-sensitivity C-reactive protein, systolic blood pressure and HDL cholesterol
(cumulative R
2
=0.674). Conclusions: Elevated serum levels of leptin and TNF-α contributed to elevated cystatin
C independent of kidney function, fat mass, insulin resistance and inflammation in community-living elderl y
women and may represent confounders of associations between cystatin C and mortality in this population
Asia Pac J Clin Nutr. 2015;24(4):626-632.doi: 10.6133/apjcn.2015.24.4.18
>>Abstract
>> Download PDF
Cohort study examining the association between
vegetable consumption and weight gain in a single
year among Japanese employees at a manufacturing
company
Author:Kimi Sawada MSc, Nobuko Murayama PhD, Yukari Take
Keywords:vegetable consumption, weight gain, Japanese employees, one-year cohort study
Abstract:Background and Objectives: Overweight and obesity increase the risk of hypertension, type 2 diabetes, and
other metabolic disorders and are increasing in Japan, particularly among men. Several prospective studies have
suggested that high vegetable intake is inversely associated with weight gain. Here, the association between vegetable consumption and weight gain in a group of food manufacturing workers over the course of one year was investigated. Methods and Study Design: The study was a one-year cohort study of the nutrition and lifestyle survey. The study population consisted of 900 and 910 Japanese employees (aged 19-60 years) from a manufacturing company located in Musashino City, Tokyo, Japan, that were administered the same validated brief selfadministered diet history and dietary lifestyle questionnaire in 2006 and 2007, respectively. Clinical examinations
of body weight were also performed to assess changes in weight. We analyzed participants who responded in
both 2006 and 2007 (n=478). Results: Risk of weight gain of more than 3 kg was significantly lower in the group
consuming the most vegetables than in the group consuming the least, and this difference remained significant after adjustment for baseline age, sex, and consumption of other foods (p for trend=0.028). Conclusions: Weight
gain was inversely associated with high consumption of vegetables. Encouraging Japanese employees to consume
more vegetables may be an important strategy in controlling weight gain and preventing metabolic syndrome.
Asia Pac J Clin Nutr. 2015;24(4):633-638.doi: 10.6133/apjcn.2015.24.4.08
>>Abstract
>> Download PDF
Comparison of the dietary intakes of individuals with
and without type 1 diabetes in China
Author:Lindsay M Jaacks PhD, Shufa Du PhD, Michelle A Men
Keywords:human nutrition, carbohydrate, epidemiology, type 1 diabetes, China
Abstract:Background and Objectives: The objective was to compare the dietary intakes of individuals with type 1 diabetes (T1D) to individuals without diabetes in China. Methods and Study Design: Data are from 1) the 3C Nutrition Ancillary Study, a cross-sectional study of individuals with T1D in China, and 2) the China Health and Nutrition Survey. Dietary intake in both samples was assessed using three 24-hour recalls. ANCOVA and multivariable logistic regression, adjusted for sex, age, and urban-rural residence, were used to assess differences in nutrient and food group intake between participants without diabetes (n=1059) and participants with T1D (n=97), who
were stratified by insulin regimen (basal-bolus, n=49, versus fixed, n=48). Results: Participants with T1D had a
lower percentage of energy from carbohydrates, higher vegetable intake, and were more likely to consume lowfat cakes and fungi/sea weed compared to participants without diabetes (all p<0.05). Distinguishing characteristics of insulin regimen groups also emerged. Participants on fixed regimens had higher intakes of wheat and were
less likely to consume fruit and more likely to consume high-fat cakes and dairy compared to participants without
diabetes (all p<0.05). Participants on basal-bolus regimens were less likely to consume fried foods and more likely to consume fish/shellfish compared to participants without diabetes (all p<0.05). Conclusions: Differences in
dietary intake between participants with and without T1D in China suggest that dietary modifications are common and reflect carbohydrate-conscious nutrition recommendations for individuals with T1D. Future research
should focus on the health effects of these modifications.
Asia Pac J Clin Nutr. 2015;24(4):639-649.doi: 10.6133/apjcn.2015.24.4.03
>>Abstract
>> Download PDF
Relationship between perinatal antioxidant vitamin and
heavy metal levels and the growth and cognitive
development of children at 5 years of age
Author:Yongfang Liu MD, Qian Chen MD, Xiaoping Wei MD, Li
Keywords:antioxidant vitamins, heavy metals, intelligence quotients, cord blood, children
Abstract:To evaluate how prenatal exposure to antioxidant vitamins and heavy metals affects subsequent development.
Maternal serum and cord serum levels of antioxidant vitamins (A, E, and C) were determined. Full-state, performance, and verbal intelligence quotients (FSI Q, PI Q, and VI Q, respectively) of 97 children were assessed at 5
years of age. The placental transport ratio (PTR: cord level relative to maternal serum level) of vitamin A (VA)
was associated positively with FSI Q score (p=0.041), vitamin E (VE)-PTR was associated positively with PIQ
(p=0.002) and FSI Q (p=0.025) scores, and cord serum cadmium (Cd) level was correlated negatively with VIQ
score (p=0.025) at 5 years of age. High VE-PTR protected against low PI Q (OR=0.025; p=0.021) and FSI Q
(OR<0.001; p=0.004). High maternal age was a protective factor against low VI Q (OR=0.661; 95% CI , 0.500-0.875; p=0.004) and FSI Q (OR=0.700; 95% CI , 0.512-0.957; p=0.025). A higher maternal education (OR=0.038;
95% CI , 0.003-0.458; p=0.010) and economic level (OR=0.047; 95% CI , 0.004-0.579; p=0.017) were protective
against a low FSI Q score. VA-PTR predicted physical growth. VA-PTR and VE-PTR predicted intelligence test
performance at 5 years old. High Cd in cord blood may negatively affect subsequent intelligence.
Asia Pac J Clin Nutr. 2015;24(4):650-658.doi: 10.6133/apjcn.2015.24.4.25
>>Abstract
>> Download PDF
Dietary survey of anaemic infants and young children in
urban areas of China: a cross-sectional study
Author:Ni Jia MD, Shuaiming Zhang MD, Tao Li MD, Zangwen
Keywords:anaemia, infant and young child, diet nutrients, continuing breastfeeding, urban areas
Abstract:Background and Objectives: To explore the diet characteristics of anaemic infants and young children of China,
blood tests and diets surveys were conducted in five cities. Methods and Study Design: About 150 children aged
6-36 mo were selected in a typical community health center of each city, and the total sample was 750. Nutritional status was measured through 24h dietary recall method and HEMO Cue was used for Haemoglobin concentration testing. Results: The average prevalence of anaemia was 17.2% in 6-12 mo children, which was higher than
in other age groups. Median intakes of 8 nutrients (protein, vitamin A, B-1 and C, calcium, iron, zinc and copper)
in anaemic children were less than non-anaemic children (p<0.05) in 6-12 mo olds; at age 12-24 mo the intake of
vitamin A in anaemic children was less than in non-anaemic children (p<0.05). Market complementary food was
the main source of iron in both anaemic and non-anaemic children (6-12 mo olds: 2.28 and 3.69 mg; 12-24 mo
olds: 2.06 and 2.09 mg, respectively). I ron intake from formula was lower in anaemic children than in nonanaemic children (6-12 mo olds: 0.88 vs 2.54 mg; 12-24 mo olds: 1.59 vs 2.87 mg). The proportion of children
obtaining continued breastfeeding in anaemic children was significantly higher than in non-anaemic children
aged 6-12 mo (65% vs 37%, p<0.05). Conclusions: Appropriate practices around continuing breastfeeding and
complementary feeding particularly targeted to breast fed older inf ants and young children are needed to reduce
anaemia in infants and young children.
Asia Pac J Clin Nutr. 2015;24(4):659-664.doi: 10.6133/apjcn.2015.24.4.05
>>Abstract
>> Download PDF
The relationship between socioeconomic development
and malnutrition in children younger than 5 years in
China during the period 1990 to 2010
Author:Lifang Wu PhD, Zhenyu Yang PhD, Shi-an Yin PhD, Me
Keywords:socioeconomic development, children, malnutrition, anaemia, China
Abstract:Background and Objectives：More than 30 years of socioeconomic development in China has improved living
conditions which contributed to a steep decline in malnutrition prevalence of children under 5 years. To elucidate
the role of socioeconomi c development in improving nutritional status and to identify appropriate policy priorities
for intervention in nutrition improvement for younger children. Methods and Study Design: We collected data
on socioeconomic development, education, cultural and recreational services, food consumption, average famil y
size and malnutrition prevalence from national surveys. Results: From 1990 to 2010, Gross Domestic Product
(GDP) per capita increased from 1644 Chinese Yuan (CNY) to 30,015 CNY; average disposable income and
food expenditure per capita significantly increased in urban and rural areas; per capita consumption for education
increased from 112 CNY to 1628 CNY and from 15.3 CNY to 367 CNY for other cultural services; illiteracy rate
decreased from 15.9% to 4.1%; average family size from 3.97 to 3.10; and prevalence of stunting and underweight decreased from 33.1% to 9.9% and 13.7% to 3.6%, respectively. However, anaemia prevalence did not
obviousl y decline between 1992 and 2000. After adjusting confounding effects of variables, negative relationships were observed between GDP per capita, average family size and stunting or underweight prevalence. However, no association was observed between illiteracy rate and prevalence of stunting and underweight, and there
was no correlation between GDP per capita, illiteracy rate, average family size and anaemia prevalence. Conclusions: Our results indicated that economic development cannot solve all nutritional problems and comprehensive
national developmental strategies should be considered to combat malnutrition.
Asia Pac J Clin Nutr. 2015;24(4):665-673.doi: 10.6133/apjcn.2015.24.4.24
>>Abstract
>> Download PDF
Whole grain intake, determined by dietary records and
plasma alkylresorcinol concentrations, is low among
pregnant women in Singapore
Author:Alastair B Ross PhD, Marjorelee T Colega BSc, Ai L
Keywords:whole grain, Singapore, pregnant women, alkylresorcinols, dietary intake
Abstract:Background and Objectives: To quantify whole grain intake in pregnant women in Singapore in order to provide the first detailed analysis of whole grain intake in an Asian country and in pregnant women. Methods and
Study Design: Analysis of 24-h diet recalls in a cross-sectional cohort study and analysis of a biomarker of
whole grain intake (plasma alkylresorcinols) in a subset of subjects. The Growing Up in Singapore Towards
healthy Outcomes-mother offspring cohort study based in Singapore. 998 pregnant mothers with complete 24-h
recalls taken during their 26-28
th
week of gestation. Plasma samples from a randomly select subset of 100 subjects were analysed for plasma alkylresorcinols. Results: Median (IQR) whole grain intake for the cohort and the
30% who reported eating whole grains were 0 (I QR 0, 9) and 23.6 (I QR 14.6, 44.2) g/day respectively. Plasma
alkylresorcinol concentrations were very low [median (I QR)=9 (3, 15) nmol/L], suggesting low intake of whole
grain wheat in this population. Plasma alkylresorcinols were correlated with whole grain wheat intake (Spearman’s r=0.35; p<0.01). Conclusions: Whole grain intake among pregnant mothers in Singapore was well below
the 2-3 (60-95 g) servings of whole grains per day recommended by the Singapore Health Promotion Board. Efforts to increase whole grain intake should be supported to encourage people to choose whole grains over refined
grains in their diet.
Asia Pac J Clin Nutr. 2015;24(4):674-682.doi: 10.6133/apjcn.2015.24.4.19
>>Abstract
>> Download PDF
Elevated total plasma homocysteine levels are associated
with type 2 diabetes in women with hypertension
Author:Changyi Wang PhD, Qunhong Wu PhD, Lina Zhang PhD,
Keywords: tHcy, type 2 diabetes, hypertension, interaction, population-based study
Abstract:Background and Objectives: There is only limited available evidence of a relationship between total plasma
homocysteine (tHcy) levels and type 2 diabetes in hypertensive subjects. Methods and Study Design: A total of
5,935 Chinese essentially hypertensive subjects were recruited by cluster sampling from 60 communities. The
cases had diabetes, whereas the controls did not. Anthropometric indices and biochemical parameters were assessed using standard procedures. A multivariable analysis was performed to analyze the association of tHcy and
type 2 diabetes susceptibility in hypertensive subjects. Results: The 5,241 controls (women/men: 2,716/2,625)
and 594 cases (women/men: 291/303) were recruited consecutively. The level of tHcy was dose- dependently associated with type 2 diabetes in the hypertensive women subjects. After controlling for corresponding confounding factors, a significant trend was only noted in the women subjects, with odds ratios per 5 μmol/L tHcy of 1.11
(95% confidence interval (CI ), 1.07-1.16) in the crude model, 1.05 (95% CI , 1.01-1.11) in model 1, and 1.07
(95% CI , 1.02-1.13) in model 2. However, no significant result was found for levels of tHcy ≥15 μmol/L vs <15
μmol/L in the men, women and all hypertensive subjects. Conclusions: When the level of tHcy was divided into
quartiles, tHcy was positively associated with type 2 diabetes in hypertensive women subjects. However, when
the level of tHcy was separated into hyperhomocysteinemic (≥15 μmol/L) and normal (<15 μmol/L), no significant results were observed.
Asia Pac J Clin Nutr. 2015;24(4):683-691.doi: 10.6133/apjcn.2015.24.4.09
>>Abstract
>> Download PDF
Why is there gender disparity in the body mass index
trends among adults in the 1997-2011 China health and
nutrition surveys?
Author:Yifei Ouyang PhD, Huijun Wang PhD, Chang Su PhD, W
Keywords:body mass index, obesity, overweight, gender disparity, China
Abstract:Background and Objective: Over the past three decades, the prevalence of overweight and obesity in China has
increased greatly. Chinese body mass index (BMI ) dynamics have shown much greater rates of changes among
men, aged 18-45 years, than among women. This study examined the gender difference in the BMI trends and related factors. Methods and Study Design: We used longitudinal data from the China Health and Nutrition Survey collected in 1997, 2000, 2004, 2006, 2009 and 2011. A total of 10,982 participants (N=5339 men and 5643
women) aged 18-45 years were included in the final analysis. Lambda mu sigma method (LMS) was used to describe changes of BMI distribution. Separate sex-stratified multilevel random intercept-slope growth models were
applied to examine effects of individual and community variables on BMI trends of Chinese adults. Results:
Male BMI increased by 0.21 kg/m
2
overtime, which was larger than female BMI at 0.16 kg/m
2
. Higher income,
drinking and away-from-home food consumption were associated with higher BMI , and these variables were only
significant among men. Physical activity (PA) had a negative association for both genders. Conclusions: Since
different variables resulted in gender disparity in BMI trends among Chinese adults, separate health policies
should be developed for men and for women.
Asia Pac J Clin Nutr. 2015;24(4):692-700.doi: 10.6133/apjcn.2015.24.4.06
>>Abstract
>> Download PDF
Longitudinal study of body mass index in Asian men
who immigrate to the US
Author:Eva Erber Oakkar PhD, June Stevens MS, PhD, Patric
Keywords:Asians, immigration, acculturation, body mass index, residence
Abstract:Background and Objectives: Cross-sectional studies indicate that adaptation to Western norms, especially at a
younger age, might explain the higher average body mass index (BMI ) among Asians living in the United States
(US) compared to Asians living in Asia. However, migrants differ f rom non-migrants in sociocultural factors that
are difficult to measure and, thus, longitudinal studies on the same individuals prior to and after immigration are
needed. The objective of this study was to determine differences in changes in BMI across age by residence (US
or Asia) and age at immigration using longitudinal data on BMI prior to and after immigration. Methods and
Study Design: The California Men’s Health Study includes 1,549 foreign-born Asian men who were aged 44-71
at baseline in 2002-03. BMI at ages 30, 40, 50 and 60 was calculated using self-reported weight history and current height. Residence at each age decade and age at immigration were determined. Data were analyzed using
generalized estimating equations. Results: Ten-year BMI increases were smaller among Asians who lived in Asia
prior to migrating to the US compared to those who already lived in the US. This effect was most evident between ages 30-40 when Asians in Asia had a 0.69 kg/m
2
(95% CI: -1.08, -0.30) smaller increase in BMI . Immigrants who moved to the US before age 40 experienced greater increases in BMI than immigrants who moved t o
the US at an older age. Conclusion: This study is the first to support the hypothesis that living in the US and
younger age at immigration results in larger BMI increases in Asian men.
Asia Pac J Clin Nutr. 2015;24(4):701-709.doi: 10.6133/apjcn.2015.24.4.10
>>Abstract
>> Download PDF
Dietary patterns and their association with hypertension
among Pakistani urban adults
Author:Nilofer F Safdar PhD, Elizabeth R Bertone-Johnson
Keywords:dietary patterns, factor analysis, Pakistan, hypertension, lifestyle behaviours
Abstract:Hypertension is one of the most common chronic diseases affecting more than 25% of adults worldwide. I n Pakistan, 33% of the adult population suffers from hypertension. Numerous epidemiological studies have demonstrated the critical role of dietary patterns in the causation, prevention and management of hypertension. There’s a
dearth of evidence from South Asia in this regard. The present study aimed to identify the association between
dietary patterns and hypertension among 4304 low income urban adults who participated in the Control of Blood
Pressure and Risk Attenuation (COBRA) study in Karachi, Pakistan. Dietary information was collected by a 33-item food frequency questionnaire and 3 unique dietary patterns namely; fat and sweet, fruit and vegetable, and
seafood and yogurt patterns were derived using principal component factor analyses. We used univariate and
multivariable logistic regression to examine the association between dietary patterns and hypertension. Men were
more likely to have hypertension, while increase in age, and body mass index were also associated with hypertension (p<0.001). After adjusting for age, gender, education, marital status, body mass index, and tobacco use; the
seafood and yogurt pattern was less likely (OR=0.78: 95% CI: 0.63, 0.98; p-value 0.03) to be associated with hypertension, whereas no significant associations were seen for other two dietary patterns. These f indings suggest
that certain dietary patterns may be associated with hypertension among Pakistani low income urban adults.
Asia Pac J Clin Nutr. 2015;24(4):710-719.doi: 10.6133/apjcn.2015.24.4.27
>>Abstract
>> Download PDF
Correlates of household food insecurity and low dietary
diversity in rural Cambodia
Author:Christine M McDonald ScD, Judy McLean PhD, Hou Kro
Keywords:household food security, dietary diversity, Cambodia
Abstract:The objective of this study was to identify correlates of household food insecurity and poor dietary diversity in
rural Cambodia. Trained interviewers administered a survey to 900 households in four rural districts of Prey
Veng Province, Cambodia. The Household Food I nsecurity Access Scale (HFI AS) and Household Dietary Diversity Score (HDDS) were used to assess household food insecurity and dietary diversity. Multivariate logistic regression models were constructed to identify independent correlates of household food insecurity and poor dietary diversity (HDDS 3). The meanSD HFIAS and HDDS scores were 5.33.9 and 4.71.6, respectively. The
respective prevalence of mild, moderate, and severe food insecurity were 33%, 37%, and 12%; and 23% of
households had an HDDS 3. I n multivariate analyses, several indicators of socioeconomic status, and ownership
of agricultural land were associated with household food security status, although the latter association lost its
significance in models that adjusted for household income. Similarly, although ownership of agricultural and
homestead land was initially associated with poorer dietary diversity, income mitigated these associations. The
presence of electricity and vegetable production were the only other variables that were significantly associated
with both outcomes. I n this rural area of Cambodia, the prevalence of any degree of household food insecurit y
was very high and dietary diversity was generally low. I nterventions to improve food security and dietary diversity should encompass income-generating activities and be targeted toward the poorest households.
Asia Pac J Clin Nutr. 2015;24(4):720-730.doi: 10.6133/apjcn.2015.24.4.14
>>Abstract
>> Download PDF
Food systems and life expectancy with rapid
urbanisation in provincial China
Author:Valerie Gibson BSc, Yong-Guan Zhu PhD, Rubing Ge M
Keywords:ecosystem health disorders, urbanisation, rural, food systems, life expectancy
Abstract:Background and Objectives: Health outcomes such as survival, minimal disability and well-being are presumptively dependent on food and ecosystems. An integral measure of the critical urban food system linkages to health
problems is needed. Much of the current health change in cities could be attributed to short-comings in food systems which can pose threats to food security and food safety. Health problems have needed a reconceptualisation
of present medical and nutritional constructs. Methods and Study Design: The present study is based on a situational analysis of food and the related ecosystems presumptively affected by rapid urbanisation in China. With an
ecological information matrix, an Urban Food System I ndex with ten indicators which could influence food system outcomes and promote health and well-being has been developed. I t uses sixteen data sets from the National
Bureau of Statistics for all 31 provinces in China. The indicators were Locality, Climate, Biodiversity, I nfrastructure, Transport, Population structure, Livelihood, Recreation and Socialisation, Personal security and Communication. The indicators for each province, scored between 1 (severe) and 5 (best), were used to predict life expectancy for China as a whole by multivariable regression analysis. Results: The best model explained 70% of the
variance and had significant beta coefficients for population structure (proportion of juveniles) (-0.52, p<0.0001)
and livelihood (food expenditure) (0.31, p<0.05). Conclusions: Population characteristics and livelihoods related
to food systems can account for much of life expectancy as a health outcome. An index which captured this information is provided and could evaluate concurrently as well as prospectively food system-related health with
urbanisation.
Asia Pac J Clin Nutr. 2015;24(4):731-743.doi: 10.6133/apjcn.2015.24.4.28
>>Abstract
>> Download PDF
Dietary health behaviour and beliefs among university
students from 26 low, middle and high income countries
Author:Supa Pengpid DrPH, Karl Peltzer PhD
Keywords:dietary behaviour, health beliefs, knowledge, university students, multi-country
Abstract:The aim of this study was to assess the prevalence of six healthy dietary behaviours and associated factors in uni
versity students from 26 low, middle and high income countries. I n a cross-sectional survey, we used a self
administered questionnaire (largely based on the European Health and Behaviour Survey) among 19503 under
graduate university students (mean age 20.8, Standard deviation=2.8, age range of 16-30 years) from 27 universi
ties in 26 countries. Results indicated that for a total of six healthy dietary behaviours, overall, students scored a
mean of 2.8 healthy dietary behaviours. More female than male students indicated healthy dietary behaviours. I n
multivariate linear regression among men and women, living in an upper middle income or high income country,
dieting to lose weight, the high importance of dietary health benefits, high non-organized religious activity, high
physical activity and currently a non-tobacco user were associated with the healthy dietary behaviour index. The
study found a high prevalence of relatively poor dietary healthy behaviours.
Asia Pac J Clin Nutr. 2015;24(4):744-752.doi: 10.6133/apjcn.2015.24.4.21
>>Abstract
>> Download PDF
Gaviscon and domperidon responsive apnea episodes
associated with gastro-esophageal reflux disease in twin
Author:Huseyin Bilgin MD, Abdulkadir Eren MD, Semra Kara
Keywords:apnea, gastro esophageal reflux disease, premature, newborn, treatment
Abstract:Background: The possible pathophysiology of the relationship between gastro-esophageal ref lux disease and apnea of prematurity has been widely investigated. Various physiological protective reflex responses provide a
plausible biological link between gastro-esophageal reflux and apnea of prematurity. I t is uncertain whether or
not there is a causal relationship between the two diseases. Patient’s Findings: Twins were admitted to the neonatal intensive care unit due to feeding problems. Physical examination was normal except for reticulated, blueviolet skin changes. Short apneic attacks occurred on the f irst day in twin 1 and on the second day in twin 2, and
these were initially treated by stimulation and increased ambient O
2
concentration. Then, we conducted
methylxanthine and continuous positive airway pressure treatment. Laboratory and radiological analysis were
normal. As gastro-esophageal reflux disease was thought to be the causes of the treatment-refractory apnea, therapy with gaviscon and domperidon was begun for both cases. Apneic attacks did not recur after gaviscon and
domperidon therapy. Conclusion: Pharmacological therapy for gastro-esophageal reflux disease has not definitively been shown to be effective in improving symptoms and hence, should be reserved especially for infants
with treatment refractory apnea episodes suspected as being gastro-esophageal reflux in premature infants.
Asia Pac J Clin Nutr. 2015;24(4):753-755.doi: 10.6133/apjcn.2015.24.4.12
>>Abstract
>> Download PDF
Feeding an infant with high arched palate by high flow
rate bottle nipple
Author:Abdulkadir Eren MD, Huseyin Bilgin MD, Semra Kara
Keywords:newborn, high arched palate, feeding, nipple, bottle
Abstract:For infants with high arched palate, feeding is one of the most immediate challenges faced by parents and caretakers. General suggestions for feeding in infants with cleft palate may be adapted to infants with high arched
palate. These include oral feeding facilitation techniques and special feeding tools. Here we present a newborn
with a high arched palate and serious feeding problems who was fed easily by a large size and a large hole nipple,
ordinarily used for infants older than 6 months, instead of specialized feeding equipment.
Asia Pac J Clin Nutr. 2015;24(4):756-758.doi: 10.6133/apjcn.2015.24.4.16
>>Abstract
>> Download PDF
Adolescent Pregnancy and the First 1000 Days (the
Philippine Situation)
Author:Mario V Capanzana PhD, Divorah V Aguila MSPH, Char
Keywords:adolescent females, maternal nutrition, adolescent pregnancy, pregnant and lactating women, Philippines
Abstract:The Seminar on Adolescent Pregnancy and the First 1000 Days (the Philippine Situation) was held in Metro Manila on September 2013. The objectives were to: 1) describe the current nutrition and health status of Filipino adolescent females, including those pregnant and lactating; 2) discuss existing programs that address their concerns;
and 3) identify gaps in existing knowledge and programs, and ways to address these gaps. Adolescent pregnancy
rates had increased from 8% in 2003 to 10% in 2008. I n 2008, more than 35 percent of pregnant women below 20
years old were considered nutritionally-at-risk. I odine deficiency and anaemia were major health problems in
both pregnant and lactating women of all ages. While government programs exist to address the needs of pregnant women, none were geared towards meeting the specific needs of pregnant adolescents. Conclusions: Studies
are needed to find ways to improve adolescent health and to effectivel y prevent and deal with unwanted pregnancies among adolescents. Recommendations include 1) developing adolescent-friendly health centers, information
and education materials to increase reproductive and health awareness among youth and health workers, 2) examining the psychosocial and nutritional factors that determine birth outcomes and nutritional status of pregnant/non-pregnant adolescents, 3) examining adolescent growth patterns following delivery, 4) evaluating the impact of current programs and interventions geared towards improving adolescent and maternal health, and more
importantly, 5) identifying the underlying reasons for the continued rise in adolescent pregnancy in the country.
Asia Pac J Clin Nutr. 2015;24(4):759-766.doi: 10.6133/apjcn.2015.24.4.07
>>Abstract
>> Download PDF
