The rise of clinical nutrition science in North-East Asia
Author:Mark L Wahlqvist MD (Adelaide), MD (Uppsala), FRAC
Keywords:workforce, Evidence-based Nutrition (EBN), Clinical Nutrition Practice Guidelines (CNPG)
Abstract:Effective clinical nutrition practice depends on a sound knowledge of biomedical, societal and environmental science and the skills to diagnose, prevent and manage the health problems related to food patterns, energy equilibrium (mostly to do with physical activity) and nutrient metabolism. Its delivery needs to be accessible, equitable,
affordable and sustainable. Ordinarily, this will require both local and widely distributed health services. In
North-East (NE) Asia, these requisites are being met to an ever increasing extent. The roots of this progress are
steeped in cultures which acknowledge the food-health connections and support education which pays regard to
these connections. As elsewhere, however, the food and health systems, their safety and security are threatened
by exploitative operatives. In China, a concerted effort was made in the mid-1980s to foster clinical nutrition in
major hospitals throughout the country by programs directed at medical graduates, nursing and kitchen staff; dietetics has appeared much more recently. By contrast, Japan has had an extensive and well-trained dietetic workforce for much longer, alongside a vibrant basic nutrition science constituency in its universities and foodnutraceutical industry. South Korea and Taiwan have traversed a similar course to that in Japan. Now, all of these
NE Asian economies have gathered rapid momentum in the publication of innovative approaches to public health
and clinical nutrition which have the prospect of not only improving health outcomes, but also reducing the societal and financial burden of health care. This is particularly important in rapidly ageing societies, which they are. It
is also a growing challenge where climate change threatens to engulf the lives and destinies of hundreds of millions of Asians on account of natural disasters, water and food insecurity.
Asia Pac J Clin Nutr. 2016;25(3):437-443.doi: 10.6133/apjcn.072016.02
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Use of knee height for the estimation of body height inThai adult women
Author:Nopphanath Chumpathat MEd, Ram Rangsin MD, Suprane
Keywords:actual height, estimated height, knee height, Thai women, validation
Abstract:Knee height has been the most frequently used measure for height prediction where full height is difficult to
measure. The aim of this study was to develop and validate predictive equations using knee height to estimate the
height of Thai women. The female participants were 18-59 years of age and lived in Bangkok or three surrounding provinces. They were assigned to one of two groups; the equation development group (n=488) and the equation validation group (n=188). Standing height and knee height were measured in duplicate using a stadiometer
and a knee height calliper. Age and physical characteristics of the equation development group and the validate
group were comparable. The measured heights showed a significant strongly positive correlation with the mean
knee height (r=0.84, p<0.001). Mean knee height in a regression model exhibited the most accurate height prediction (adjusted R2=0.718, standard error of estimate=2.80), according to the equation “Height=38.1+2.45 (average
knee height) - 0.051(age)”. This study proposes a new height estimation equation for Thai adult women using
knee height. The equation shows more estimation power than the previous studies conducted in Thailand.
Asia Pac J Clin Nutr. 2016;25(3):444-451.doi: 10.6133/apjcn.092015.05
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Plasma glutamine and cystine are decreased and
negatively correlated with endomysial antibody in
children with celiac disease
Author:Eylem Sevinc MD, Nergiz Sevinc MD, Himmet Haluk Ak
Keywords:cystine, glutamine, celiac disease, endomysial antibody
Abstract:Background and Objectives: Glutamine is a nonessential amino acid which improves intestinal mucosal regeneration and absorption. Glutathione is a vital molecule for antioxidant reactions and is synthesized from cystine.
The first aim of the study is to measure the plasma glutamine and cystine in children with celiac disease (CD) and
compare them with controls. The second aim of this study is to investigate whether these amino acids are correlated with endomysial antibody (EMA) or not. Methods and Study Design: Fifty children with CD were compared to 50 healthy, age, and sex matched normal children as control. Plasma glutamine and cystine levels of the
children were measured by using tandem mass spectrometry. Results: Plasma glutamine (808 vs 870 µmol/L)
and cystine (19 vs 48.5 µmol/L) were significantly lower in the celiac group than the controls (p<0.05). The levels of plasma glutamine (797 vs 928 µmol/L, n=42) and cystine (18 vs 31.5 µmol/L, n=8) were lower (p<0.05) in
the EMA-positive than the EMA-negative celiac patients. We could not find any statistically significance between EMA-negative celiac patients and controls for the plasma glutamine (928 vs 870 µmol/L) and cystine (31.5
vs 48.5 µmol/L) (p>0.05). Serum EMA was negatively correlated with plasma cystine (r=-0,321, p=0.023), glutamine (r=-0.413, p=0.003). Conclusions: Our study indicated that plasma glutamine and cystine were significantly lower in the celiac children than the controls. Also, these amino acids were negatively correlated with
EMA.
Asia Pac J Clin Nutr. 2016;25(3):452-456.doi: 10.6133/apjcn.092015.09
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Laboratory nutritional parameters predict one-year
mortality in elderly patients with intertrochanteric
fracture
Author:Jun Lu MD, Yuan-yuan Chen LPN, Lin Zhang MD, Yong-
Keywords:nutritional status, intertrochanteric fractures, mortality, elderly people, albumin
Abstract:Background and Objectives: The purpose of this study was to investigate the contributing value of nutrition related blood parameters to one-year mortality following intertrochanteric fracture surgery in a Chinese population
over the age of 65. Methods and Study Design: Nutritional status was evaluated by using admission serum albumin and total lymphocyte count (TLC). One hundred and seventy-four intertrochanteric fracture patients were
entered into this study for nutritional status assessment. Gender differences were evaluated by univariate analysis.
The predictive value of the variables for one-year mortality was assessed by multiple logistic regression analysis.
Results: The mean albumin was 31.0 g/L with 73% of patients less than 35 g/L and the mean TLC was 1.19×109
cells/L with 81% less than 1.50×109 cells/L. There were no significant differences in albumin (p=0.674) or TLC
(p=0.804) between men and women. Survival information was obtained in 149 patients who received surgical
treatment. The general one-year mortality was 31% with 35% in men and 29% in women, respectively. The surviving patients were younger and had higher albumin, TLC and calcium than those who died. However, multivariate analysis identified only serum albumin and TLC as independent and significant risk factors associated with
one-year mortality; the optimal cut-off points were 29.5 g/L and 0.93×109 cells/L, respectively, based on the receiver operating characteristic (ROC) curve. Conclusions: Malnutrition is a common phenomenon in an aged
Chinese population suffering from intertrochanteric fractures. A lower serum albumin level and total lymphocyte
count at admission are significant risk factors to predict the one-year mortality.
Asia Pac J Clin Nutr. 2016;25(3):457-463.doi: 10.6133/apjcn.092015.04
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The effect of daily consumption of the small fish
Amblypharyngodon mola or added vitamin A on iron
status: a randomised controlled trial among Bangladeshi
children with marginal vitamin A status
Author:Anna B Andersen MSc, Lise KH Schmidt MSc, Daniel F
Keywords:iron status, vitamin A, serum retinol, small nutrient-rich fish, Bangladesh
Abstract:Background and Objectives: Mola (Amblypharyngodon mola) is a nutrient-rich, small fish found in ponds and
rice fields in Bangladesh. The aim of the present intervention was to assess the effect of mola consumption on
iron status in children with marginal vitamin A status. Methods and Study Design: Bangladeshi children
(n=196), aged 3-7 years, with marginal vitamin A status were randomly allocated to one of three intervention
groups served different fish curries: mola curry (experimental group); rui (Labeo rohita) curry with added retinyl
palmitate (positive control group); or rui curry (negative control group). The intervention meals were served 6
days/week for 9 weeks. The experimental and positive control meals were designed to contain similar amounts of
retinol activity equivalents per portion. The mola curry contained four times more iron compared to the rui curries
due to different iron content in the two fish species. Haemoglobin, ferritin, serum transferrin receptor and Creactive protein were measured at screening and endpoint. Results: In the experimental group receiving mola, serum transferrin receptor concentration declined 0.73 mg/L (95% CI 0.17, 1.28, p=0.01) compared to the positive
control group, while there were no differences between groups in ferritin or haemoglobin. Conclusions: Consumption of mola instead of rui has potentially an effect on iron status in children with marginal vitamin A status,
seen as a decrease in serum transferrin receptor concentration.
Asia Pac J Clin Nutr. 2016;25(3):464-471.doi: 10.6133/apjcn.092015.11
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Contribution of hypoalbuminemia and decreased renal
function to the increased mortality after newly
diagnosed vertebral fracture in Japanese subjects
Author:Tetsuo Nakano MD, Akiko Kuwabara RD, PhD, Hiroshi
Keywords:fresh vertebral fracture, MRI, mortality, hypoalbminemia, renal function
Abstract:Background and Objectives: Reports on the mortality and its contributing factors after vertebral fracture (VFx)
has been scarce, and limited to prevalent VFx. In this paper, we have studied the factors influencing mortality after freshly diagnosed VFx. Methods and Study Design: 759 subjects aged 78.8±8.5 years old with back or lumbar pain, and diagnosed as fresh VFx by MRI were studied for their age, gender, number of prevalent fracture (s),
survival or the date of death, circulating concentrations of Hb, albumin, C reactive protein, and estimated glomerular filtration rate (eGFR). Cox’s proportional hazard analysis was performed to assess the significant predictors
for mortality. The cut-off concentrations of the variables for mortality were analyzed using the receiver operator
characteristic (ROC) curve. Results: The median observation duration was 3.8 years, and 3-year survival rate was
78.8%. Cox’s proportional hazard analysis has shown that serum albumin concentration (hazard ratio (HR)
=0.355) and eGFR (HR=0.993) were significant predictors for mortality. The cut-off concentrations were 3.6
g/dL and 60 mL/min/1.73m2, respectively. Kaplan-Meier curves revealed that survival rates were significantly
decreased in patients with both serum albumin concentration and eGFR below these cut-off concentrations. Conclusions: The present study has revealed that malnutrition and impaired renal function were significant predictors
for mortality after VFx.
Asia Pac J Clin Nutr. 2016;25(3):472-477.doi: 10.6133/apjcn.092015.17
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Single vegetable meal content equivalence as an
alternative to fat for satiety: a randomised trial in
Japanese women
Author:Chisaki Adachi MS, Hisami Yamanaka-Okumura PhD, Ta
Keywords:energy density, vegetable volume, Visual Analog Scale, satiety, dietary guidelines
Abstract:Background and Objectives: Although high energy density foods are highly palatable, their overconsumption
leads to obesity because of high fat content. Low energy density foods are more effective for preventing individuals from becoming overweight. We investigated how different amounts of a single vegetable affect the sensory
properties of meals with different energy densities. Methods and Study Design: In a randomized crossover design, 40 young Japanese women consumed control and high-fat (HF) lunches. Control meals contained the same
amount of rice and hamburger and 80 g (C80), 120 g (C120), 160 g (C160), 200 g (C200), 240 g (C240), or 280 g
(C280) of broccoli. HF meals were control meals to which 38.1 g of oil was added (HF80, HF120, HF160, HF200,
HF240, and HF280). Sensory properties before intake and 0.5, 1, 2, 3, 4, and 5 h after meals were assessed using
a visual analog scale. Results: Fullness was significantly lower with C80 than with C200 and C280 at 0.5 h and
all time points, respectively, after consumption. In contrast, satisfaction with all HF meals was similar at all time
points. Fullness and satisfaction were higher with almost all HF meals than with control meals; however, fullness
and satisfaction were similar between HF200 and all control meals 1-4 h after consumption. Conclusions: Fat
increases satiety when a single vegetable is included in the meal; however, at least of 200 g of vegetable in a 500-
kcal meal with low fat content provides fullness and satisfaction similar to those provided by an HF meal.
Asia Pac J Clin Nutr. 2016;25(3):478-486.doi: 10.6133/apjcn.092015.25
>>Abstract
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Randomized, double-blind, placebo-controlled trial of
Ficus carica paste for the management of functional
constipation
Author:Hyang-Im Baek MS, Ki-Chan Ha PhD, Hye-Mi Kim MS, E
Keywords:Ficus carica, constipation, defecation, colonic transit time, clinical trials
Abstract:Background and Objectives: Constipation affects up to 20% of the world’s population. The aim of this study
was to investigate whether supplementation with Ficus carica paste could be used to treat constipation in Korean
subjects with functional constipation. Methods and Study Design: We conducted a randomized, double-blind,
placebo-controlled trial. Subjects with functional constipation were orally supplemented with either F. carica
paste (n=40) or placebo (n=40) for 8 weeks. We measured the efficacy and safety of F. carica paste. Primary outcomes (colon transit time) and secondary outcomes (questionnaire related to defecation) were compared before
and after the 8-week intervention period. Results: F. carica paste supplementation was associated with a significant reduction in colon transit time and a significant improvement in stool type and abdominal discomfort compared with the placebo. Blood parameters and clinical findings for organ toxicity remained within normal ranges.
Conclusion: These results suggest that F. carica paste may have beneficial effects in subjects suffering from
constipation.
Asia Pac J Clin Nutr. 2016;25(3):487-496.doi: 10.6133/apjcn.092015.06
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Nutritional status and feeding practices in
gastrointestinal surgery patients at Bach Mai Hospital,
Hanoi, Vietnam
Author:Lorraine S Young RD, MS, Pham Thi Thu Huong MD, Ph
Keywords:enteral nutrition, malnutrition, subjective global assessment, parenteral nutrition, Vietnam
Abstract:Background and Objectives: The nutritional status and hospital feeding practices of surgical patients in Vietnam are not well documented. Based on a cross-sectional study at Bach Mai Hospital (BMH), the prevalence of
malnutrition was found to be 33% in the surgical ward using a body mass index (BMI<18.5 kg/m2. We conducted
an observational study over a three month period to evaluate the feeding practices in the gastrointestinal (GI) surgery ward at Bach Mai Hospital (BMH) in Hanoi, Vietnam. Methods and Study Design: Investigators from the
U.S. and the Vietnamese National Institute of Nutrition (NIN) enrolled 72 subjects admitted for elective GI surgery in an observational study at BMH. Baseline anthropometrics and changes over time, body mass index (BMI),
Subjective Global Assessment (SGA) and daily kcal and protein intake from oral diet, tube feeding, and parenteral nutrition (PN) from admission until discharge were documented. Results: A total of 50% of subjects scored a
B or C on the SGA; 48% of subjects had a BMI<18.5, while mean mid upper arm circumference was in the lownormal range (24±4 cm). Nearly all patients (98%) were given PN postoperatively, with oral feeding starting on
an average of postoperative day 4. Only one patient was tube fed. Mean daily total calorie intake was 15
kcal/kg/day and protein intake was 0.61 g/kg/day during hospitalization. Micronutrient supplementation was minimal in subjects receiving PN. Conclusions: Hospital malnutrition in surgical patients in Vietnam is a significant
problem, peri-operative feeding appears suboptimal and use of early postoperative PN was routine.
Asia Pac J Clin Nutr. 2016;25(3):513-520.doi: 10.6133/apjcn.092015.15
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A survey of the enteral nutrition practices in patients
with neurological disorders in the tertiary hospitals of
China
Author:Ying-Ying Su MS, Dai-Quan Gao MS, Xiao-Yan Zeng MS
Keywords:neurological disorders, enteral nutrition, practices, tertiary hospitals, survey
Abstract:Background and Objectives: With the development of enteral nutrition in patients with neurological disorders
in China, related guidelines were published in 2011. The Chinese Society for Parenteral and Enteral Nutrition
conducted a survey to evaluate the status quo of enteral nutrition practices in these patients. Methods and Study
Design: This multicenter prospective investigation was conducted from April 2012 to April 2013 and involved 18
tertiary hospitals in China. The survey using standardized questionnaires sought information about the basic protocols for enteral nutrition (devices and staffing) and specific information about patients with neurological conditions who received nutrition by way of enteral feeding. Results: In the 18 hospitals from 13 provinces, 83.3% patients were configured with an enteral nutrition infusion pump, 77.8% had a percutaneous endoscopic gastrostomy (PEG) device, and 88.9% had a clinical nutrition support group. Four hundred four patients participated in
this survey (259 men, 145 women; mean age 61.3±14.7 years), 85.7% had suffered a stroke, 83.9% had impaired
consciousness, and 98.0% had dysphagia. Of the 10 guidelines for enteral nutrition practices, setting the energy
target, choosing the enteral nutrition tube, and monitoring the patient received unsatisfactory ratings were in poor
compliance (56.2%, 30.0% and 38.9%, respectively); the remaining seven guidelines were in good compliance
(each >75%). Conclusion: The survey suggested that configuration of the enteral nutritional devices and staffing
was adequate in China’s tertiary hospitals. However, some associated practices had not yet reached the desired
levels of competency, indicating a need for this to be understood and for improved training.
Asia Pac J Clin Nutr. 2016;25(3):521-528.doi: 10.6133/apjcn.092015.20
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Food intolerance prevalence in active ulcerative colitis in
southwest China
Author:Xinling Ma RN, Yuke Chen RN, Fangyan Huang RN, Qia
Keywords:food intolerance, ulcerative colitis, seropositive, dietary patterns
Abstract:Background and Objectives: Food intolerance is believed to be a source of frequent medical problems in ulcerative colitis (UC), which closely correlate with patients’ dietary pattern. Living in an underdeveloped area of China, residents in southwestern region have diverse dietary habits. The objective of this study is to determine the
prevalence of food intolerance in the UC patients in this area and to discuss some of the possible risk factors leading to the condition. Methods and Study Design: Food antibodies in serum of 80 patients with active UC were
determined by standard enzyme-linked immuno sorbent assay (ELISA). This study examined the risk factors contributing to high titers of food antibodies and the dietary patterns correlating with food intolerance in these demographics. Results: 83.8% of patients (67/80) were found to be seropositive for food intolerance. Patients of
female, aged between 20 to 40 and the one who tended to have a high fat diet were tested to be highly seropositive (p<0.05). Neither spicy food intake nor the course the disease manifested any relationship with the presence
of food intolerance (p>0.05). Conclusion: Active UC patients in southwestern region of China have showed to be
high seropositive in food intolerance, particularly in female and young patients. Dietary patterns with high in fat
intake seem to have caused high prevalence of seropositivity in food intolerance. Although rice has been taken as
staple food and the spicy food has been popular among citizen in this region, these foods have indicated to no effect on food intolerance in this study.
Asia Pac J Clin Nutr. 2016;25(3):529-533.doi: 10.6133/apjcn.102015.04
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Lower body mass index is associated with hospital
mortality in critically ill Japanese patients
Author:Tomoaki Yatabe MD, PhD, Koichi Yamashita MD, PhD,
Keywords:body mass index, outcome, mortality, intensive care unit, Japanese
Abstract:Background and Objectives: A recent observational study conducted in European intensive care units (ICU)
showed that body mass index (BMI) is associated with mortality. We hypothesized that a lower BMI amongst
critically ill Japanese patients was associated with increased hospital mortality, similar to findings noted among
critically ill European patients. Therefore, we retrospectively investigated the relationship between BMI and patient outcomes in an ICU. Methods and Study Design: We included consecutive patients who were admitted to
our ICU between January 2012 and December 2013. Patients were divided into 3 groups based on their BMI at
ICU admission. The underweight (“lower”) group (group L) included patients with a BMI below 18.5 kg/m2, the
normal weight group (group N) included patients with a BMI between 18.5 and 24.9 kg/m2, and the overweight/obese (“higher”) group (group H) included patients with a BMI above 25.0 kg/m2. Patient data were retrospectively obtained from electronic patient records. Results: A total of 1,616 patients were admitted to our ICU.
Of these patients, 346 patients were ineligible, and therefore, 1,270 were included in the analysis. There were 169
patients in group L, 779 patients in group N and 322 patients in group H. Overall, the mortality rate was 8.1% and
the median hospital stay was 21 days. The mortality rate in group L was significantly higher than that in both
group N and group H (13.6% vs 7.8% vs 5.9%, p=0.01). Conclusions: Our retrospective study suggests that lower body mass index may be associated with increased hospital mortality in critically ill Japanese patients.
Asia Pac J Clin Nutr. 2016;25(3):534-537.doi: 10.6133/apjcn.092015.21
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25-hydroxy-vitamin D demography and the risk of
vitamin D insufficiency in the South East Asian
Nutrition Surveys (SEANUTS)
Author:Bee Koon Poh PhD, Nipa Rojroongwasinkul PhD, Bao K
Keywords:vitamin D, 25(OH)D, children, SEANUTS, aetiology
Abstract:The South East Asian Nutrition Surveys (SEANUTS) were conducted in 2010/2011 in Indonesia, Malaysia, Thailand and Vietnam in country representative samples totalling 16,744 children aged 0.5 to 12 years. Information
on socio-demographic and behavioural variables was collected using questionnaires and anthropometric variables
were measured. In a sub-sample of 2016 children, serum 25-hydroxy-vitamin D (25(OH)D) was determined. Data
were analysed using SPSS complex sample with weight factors to report population representative data. Children
were categorized as deficient (<25 nmol/L), insufficient (<50 nmol/L), inadequate (<75 nmol/L) or desirable (≥75
nmol/L). In Malaysia and Thailand, urban children had lower 25(OH)D than rural children. In all countries, except Vietnam, boys had higher 25(OH)D levels and older children had lower 25(OH)D. Regional differences after
correcting for age, sex and area of residence were seen in all countries. In Thailand and Malaysia, 25(OH)D status
was associated with religion. The percentage of children with adequate 25(OH)D (≥75 nmol/L) ranged from as
low as 5% (Indonesia) to 20% (Vietnam). Vitamin D insufficiency (<50 nmol/L) was noted in 40 to 50% of children in all countries. Logistic regression showed that girls, urban area, region within the country and religion significantly increased the odds for being vitamin D insufficient. The high prevalence of vitamin D insufficiency in
the (sub) tropical SEANUTS countries suggests a need for tailored approach to successfully combat this problem.
Promoting active outdoor livestyle with safe sunlight exposure along with food-based strategies to improve vitamin D intake can be feasible options.
Asia Pac J Clin Nutr. 2016;25(3):538-548.doi: 10.6133/apjcn.092015.02
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Fibroblast growth factor-23 and phosphorus related
factors in young Japanese women: a cross-sectional
study
Author:Sanae Ito PhD, Hiromi Ishida PhD, Kazuhiro Uenishi
Keywords:fibroblast growth factor-23, phosphorus, calcium, bone mineral density, young Japanese women
Abstract:Phosphorus homeostasis is determined by dietary intake, intestinal absorption, and renal tubular reabsorption of
phosphorus. Serum fibroblast growth factor-23 (FGF-23) is considered to be a sensitive early biomarker of disordered phosphorus metabolism in both patients with chronic kidney diseases and healthy subjects. However, the
number of studies evaluating serum FGF-23 concentrations in healthy subjects is limited. The objective of this
cross-sectional study was to examine the relationship between serum FGF-23 concentrations and phosphorus related factors in 182 young Japanese women (mean age, 19.5±0.4 years). We found that higher serum concentrations of inorganic phosphorus and lower serum concentrations of 1,25-dihydroxy vitamin D as well as lower fat
but higher phosphorus and calcium intake were weakly but significantly associated with high serum concentrations of FGF-23, adjusted for postmenarcheal age and body weight. These results suggested that in young Japanese women, serum FGF-23 might be indicative of phosphorus nutrition status. However, it is worthy of note that
maturity factors, including postmenarcheal age and physical attributes, such as body weight, might be related to
serum FGF-23 concentrations.
Asia Pac J Clin Nutr. 2016;25(3):549-555.doi: 10.6133/apjcn.092015.22
>>Abstract
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Changes in body composition of Indian lactating
women: a longitudinal study
Author:Neha A Kajale MSc, Vaman V Khadilkar MRCP, Zulf Mu
Keywords:body composition, bone mineral density, lactation, android fat percentage, urban Indian women
Abstract:Background and Objectives: Lactation places enormous demands on maternal bone mineral homeostasis. Indian middle class women (MSC) consume energy dense food supplements to meet these demands post-partum (PP)
along with restricted physical activity (PA). Effects of these changes on body composition (BC) of PP women
have not been studied. To examine longitudinal changes in: a) bone mineral density (BMD) at total body (TB),
AP-spine (APS) and dual femur neck regions (DF) b) BC by body weight, lean mass, fat mass using dual energy
X-ray absorptiometry (DXA) at baseline, 6-months and 1-year in urban MSC women. Methods and Study Design: 76-primi-parous (28±3.2 yrs) randomly selected PP women (<7-days) were studied; 70 reassessed at 6-
months and 42 1-yr PP. Data on anthropometry, BC, BMD at TB, APS & DF by DXA collected (baseline, 6-
months, 1-yr PP). Results: Weight, waist and body mass index (BMI) decreased both at 6-month & 1-yr PP with
respect to baseline (p<0.05). BC changes showed increase in android fat % at 1-yr by 10% over baseline (p<0.05). BMD with initial decline at 6-months (-2.8%, -2.3% and -2.3% respectively) recovered partially by
1-yr (+2.5% +1.2% and +4.8% respectively) at DF and TB with complete recovery at APS (p<0.05). Conclusion: These urban relatively sedentary MSC women consumed fat rich food PP with higher android fat retention
and partial recovery of BMD at DF and TB at 1-year. Modifications in activity and dietary nutrient intakes may
be necessary to prevent cardiovascular and bone health related risks.
Asia Pac J Clin Nutr. 2016;25(3):556-562.doi: 10.6133/apjcn.092015.16
>>Abstract
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Serum vitamin A status is associated with obesity and
the metabolic syndrome among school-age children in
Chongqing, China
Author:Xiaoping Wei MD, Rong Peng MD, Jiaoyang Cao MD, Yu
Keywords:vitamin A, metabolic syndrome, obesity, school-age children, body mass index
Abstract:The aim of our study was to examine the association of vitamin A status with obesity and the metabolic syndrome
(MS) in school-age children in Chongqing, China. A cross-sectional study was conducted of 1,928 children aged
7~11 years from 5 schools in Chongqing, China. Body height, weight, waist circumference (WC) and blood pressure were measured. Blood glucose, lipids and vitamin A were determined. Overall prevalences for overweight,
obesity and MS were 10.1%, 6.7% and 3.5%, respectively. There were 274 (14.2%) marginally vitamin A deficient (MVAD) children and 53 (2.8%) vitamin A deficient (VAD) children, respectively. Serum vitamin A in the
obese group was significantly lower than in the overweight and normal weight groups (p<0.001). Body mass index (BMI), WC, high density lipoprotein cholesterol (HDL-C) and glucose were strongly associated with vitamin
A status (p<0.05). In a separate model adjusted for age and sex, compared with normal children, participants with
obesity had a significantly higher risk of having vitamin A insufficiency (≤1.05 μmol/L) (OR: 2.37; 95% CI: 1.59,
3.55) (p<0.001), and participants with MS had a 1.99-fold (95% CI: 1.14, 3.47) greater risk of having vitamin A
insufficiency (p=0.016), while participants with VAD had significantly higher risk of having MS (OR: 3.82; 95%
CI: 1.44, 10.2) (p=0.007). Vitamin A insufficiency among Chongqing urban school-age children was found to be
a severe health problem, significantly associated with obesity, hypertriglyceridemia and MS.
Asia Pac J Clin Nutr. 2016;25(3):563-570.doi: 10.6133/apjcn.092015.03
>>Abstract
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Predictive factors for accuracy of perception of parents
regarding their overweight or obese children in Taiwan
Author:Cheng-Jung Chung PhD, Yueh-Guey Huang PhD
Keywords:childhood obesity, health status, perception, weight management, Taiwan
Abstract:Background and Objectives: Predictive factors for parental accuracy in perception of their children’s weight
and state of health have been unknown in Taiwan. Methods and Study Design: Data were obtained on children
aged 3-12 years from the 2005 Taiwan National Health Interview Survey (NHIS). The comparison of measured
BMI and parents’ perception of their children’s weight operationalized “weight perception”. A structured questionnaire ascertained demographic characteristics, and logistic regression determined demographic variables associated with a weight misperception. Results: The prevalence of parental misperception of children who were
overweight or obese was 50%; the ratio was higher in younger parents, parents with younger children, and those
with overweight or obese children. In fact, only 1.7% of children whose parents misperceived overweight or obesity were engaged in weight management. Conclusions: Most parents viewed excessive weight in their children
as better health than normal weight. Parental age, children’s age, and weight loss management may be predictive
factors in parents’ perceptive accuracy regarding children who are overweight or obese.
Asia Pac J Clin Nutr. 2016;25(3):571-577.doi: 10.6133/apjcn.092015.18
>>Abstract
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Coffee consumption and risk of gastric cancer: an
updated meta-analysis
Author:Yan Xie MD, Shifeng Huang PhD, MD, Tongchuan He Ph
Keywords:coffee, gastric cancer, meta-analysis, epidemiologic study, risk factor
Abstract:Background and Objectives: Coffee is one of the most widely consumed beverages worldwide, and many studies have investigated the association between coffee consumption and gastric cancer. However, the results are inconsistent. We conducted a systematic analysis of relevant population studies to derive a more precise estimation.
Methods and Study Design: Cochrane library, PubMed and Embase databases were searched to identify studies
that met predetermined inclusion criterion through July 2014. All epidemiologic studies regarding coffee consumption and gastric cancer risk were selected, and relative risks (RRs) with 95% confidence intervals (CIs) were
calculated. Results: Twenty two studies (9 cohort and 13 case-control studies) involving 7,631 cases and
1,019,693 controls were included. The summary RR of gastric cancer was 0.94 (95% CI: 0.80-1.10) for the highest category of coffee consumption compared with the lowest category, and 0.93 (95% CI: 0.88-0.99) for coffee
drinkers compared with nondrinkers. We stratified the population by coffee consumption. The pooled RR for the
population with <1 cup/day, 1-2 cups/day and 3-4 cups/day coffee consumption compared with nondrinkers were
0.95 (95% CI: 0.84-1.08), 0.92 (95% CI: 0.82-1.03) and 0.88 (95% CI: 0.76-1.02), respectively, indicating that an
increase in coffee consumption was associated with a decreased risk of gastric cancer. Furthermore, we stratified
the studies by design, sex, population and time. A significant association between coffee intake and decreased
gastric cancer risk was shown in case-control studies (RR=0.85, 95% CI: 0.77-0.95) and among the studies published over the last ten years (RR=0.88, 95% CI: 0.77-1.00). Conclusions: Our meta-analysis suggested that coffee consumption might be associated with a decreased risk of gastric cancer.
Asia Pac J Clin Nutr. 2016;25(3):578-588.doi: 10.6133/apjcn.092015.07
>>Abstract
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Limitations of studies on school-based nutrition
education interventions for obesity in China: a
systematic review and meta-analysis
Author:Kaimeng Kong MD, Jie Liu MD, Yexuan Tao PhD, MD
Keywords:nutrition education, school children, obesity, systemic review, meta-analysis
Abstract:Background and Objectives: School-based nutrition education has been widely implemented in recent years to
fight the increasing prevalence of childhood obesity in China. Methods and Study Design: A comprehensive literature search was performed using six databases to identify studies of school-based nutrition education interventions in China. The methodological quality and the risk of bias of selected literature were evaluated. Stratified
analysis was performed to identify whether different methodologies influenced the estimated effect of the intervention. Results: Seventeen articles were included in the analysis. Several of the included studies had inadequate
intervention duration, inappropriate randomization methods, selection bias, unbalanced baseline characteristics
between control and intervention groups, and absent sample size calculation. Overall, the studies showed no significant impact of nutrition education on obesity (OR=0.76; 95% CI=0.55-1.05; p=0.09). This can be compared
with an OR of 0.68 for interventions aimed at preventing malnutrition and an OR of 0.49 for interventions aimed
at preventing iron-deficiency anemia. When studies with unbalanced baseline characteristics between groups and
selection bias in the study subjects were excluded, the impact of nutrition education on obesity was significant
(OR=0.73; 95% CI=0.55-0.98; p=0.003). An analysis stratified according to the duration of intervention revealed
that the intervention was effective only when it lasted for more than 2 years (OR=0.49, 95% CI=0.42-0.58;
p<0.001). Conclusion: Studies of school-based nutrition education programs in China have some important limitations that might affect the estimated effectiveness of the intervention.
Asia Pac J Clin Nutr. 2016;25(3):589-601.doi: 10.6133/apjcn.092015.19
>>Abstract
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Instant noodles, processed food intake, and dietary
pattern are associated with atopic dermatitis in an adult
population (KNHANES 2009-2011)
Author:Sunmin Park PhD, Hyun-Seok Choi PhD, Ji-Hyun Bae P
Keywords: atopic dermatitis, processed foods, coffee, instant noodles, meat consumption
Abstract:Background and Objectives: The incidence of atopic dermatitis (AD) is continuously increasing in industrialized countries, possibly due to dietary and lifestyle changes. However, the association between processed food intake and AD has not been studied in a large adult population. Methods and Study Design: We investigated the
association between dietary habits and AD in 17,497 adults in the 2009-2011 Korean National Health and Nutrition Examination Survey (KNHANES). Results: We identified 4 dietary patterns using principal components
analysis of a 63-item food frequency questionnaire: the “traditional dietary pattern”, rich in rice and kimchi; the
“processed food pattern”, with more meat, instant noodles, soda, and processed foods; the “healthy dietary pattern”, high in grains, vegetables, fruits, and seaweeds; and the “drinking dietary pattern”, mainly drinking coffee
and alcohol. Adjusted odds ratios (ORs) for AD were calculated according to dietary patterns after adjusting for
potential confounders with incorporation of sample weights for the complex sample design. The “meat and processed food” pattern was associated with a significant 1.57 fold higher OR for atopic dermatitis than the low consumption group. Further analysis revealed that the increased atopic dermatitis was most closely associated with
instant noodles. In contrast, the groups with high intake of rice and kimchi exhibited lower ORs, 0.38 and 0.43
folds, compared to the low intake group. Conclusion: Consuming instant noodles, meat and processed foods was
associated with increased prevalence of atopic dermatitis, whereas consuming rice and kimchi, and coffee was associated with decreased prevalence of atopic dermatitis.
Asia Pac J Clin Nutr. 2016;25(3):602-613.doi: 10.6133/apjcn.092015.23
>>Abstract
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The genetic polymorphisms in vitamin D receptor and
the risk of type 2 diabetes mellitus: an updated
meta-analysis
Author:Fei Yu MD, LingLing Cui PhD, Xing Li MD, ChongJian
Keywords:vitamin D receptor, type 2 diabetes mellitus, genetic polymorphism, association, meta-analysis
Abstract:Background and Objectives: Vitamin D receptor (VDR) genetic polymorphisms are considered to be associated
with type 2 diabetes mellitus (T2DM), but this is inconclusive. The aim of this study is to quantify the association
between polymorphisms of BsmI and FokI in the VDR gene and T2DM risk through literature review. Methods
and Study Design: Original articles published from 1999 to June 2014 were discovered through PubMed, ISI
Web of Science, China National Knowledge Infrastructure, Chinese Wanfang Database, and the Chinese Biomedical Literature Database. The pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated with
software STATA version 12.0. Results: Twenty-three articles containing 30 case-control studies were included.
The association between the BsmI polymorphism and T2DM was weak in two genetic models (Bb vs bb and
BB+Bb vs bb). The subgroup analysis showed that this association was only found in the studies with a small
sample size (<200). A strong association between FokI polymorphism and T2DM indicated that this gene polymorphism was possibly a risk factor for T2DM (ff vs FF: OR=1.57, 95% CI: 1.28-1.93, p<0.001; Ff vs FF:
OR=1.54, 95% CI: 1.31-1.81, p<0.001; ff+Ff vs FF: OR=1.57, 95% CI: 1.35-1.83, p<0.001), especially in Chinese populations. Conclusion: More reliable conclusions about associations between VDR genetic polymorphisms and T2DM will depend on studies with larger sample size and by ethnicity.
Asia Pac J Clin Nutr. 2016;25(3):614-624.doi: 10.6133/apjcn.092015.12
>>Abstract
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Infant feeding concerns in times of natural disaster:
lessons learned from the 2014 flood in Kelantan,
Malaysia
Author:Zaharah Sulaiman PhD, Noraini Mohamad, MMed Fam Me
Keywords:concerns, disaster, flood, infant feeding, Kelantan
Abstract:The flood that hit Kelantan in December 2014 was the worst in Malaysian history. Women and their infants accounted for a large proportion of the people at risk who were badly affected, as almost half of the population in
Kelantan was in the reproductive age group. This report serves to raise awareness that breastfeeding mothers and
infants are a special population with unique needs during a disaster. Four of their concerns were identified during
this massive flood: first, the negative impact of flood on infant nutritional status and their health; second, open
space and lack of privacy for the mothers to breastfeed their babies comfortably at temporary shelters for flood
victims; third, uncontrolled donations of infant formula, teats, and feeding bottles that are often received from
many sources to promote formula feeding; and lastly, misconceptions related to breastfeeding production and
quality that may be affected by the disaster. The susceptibility of women and their infant in a natural disaster enhances the benefits of promoting the breastfeeding rights of women. Women have the right to be supported which
enables them to breastfeed. These can be achieved through monitoring the distribution of formula feeding,
providing water, electricity and medical care for breastfeeding mothers and their infants. A multifaceted rescue
mission team involving various agencies comprising of local government, including the health and nutrition departments, private or non-governmental organizations and individual volunteers have the potential to improve a
satisfactory condition of women and infants affected by floods and other potential natural disasters.
Asia Pac J Clin Nutr. 2016;25(3):625-630.doi: 10.6133/apjcn.092015.08
>>Abstract
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Parenteral nutrition combined with rice soup can be a
safe and effective intervention for congenital chylous
ascites
Author:Yi Cao MD, Weihui Yan MD, PhD, Lina Lu MD, Yijing
Keywords:congenital chylous ascites, neonate, optimal treatment, rice soup, parenteral nutrition
Abstract:Congenital chylous ascites in the neonatal period is a rare entity. Total parenteral nutrition (TPN), medium chain
triglyceride (MCT)-based diet, octreotide and repeated paracentesis are regarded as appropriate medical treatment
for congenital chylous ascites, and surgery is recommended when conservative therapy has failed. We present
two cases in which ascites were confirmed via an abdominal sonogram and diagnostic paracentesis. In our clinical experience, rice soup combined with PN can be a safe and effective intervention.
Asia Pac J Clin Nutr. 2016;25(3):631-635.doi: 10.6133/apjcn.092015.10
>>Abstract
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Australasian society for parenteral and enteral nutrition
(AuSPEN) adult vitamin guidelines for parenteral
nutrition
Author:Emma J Osland AdvAPD MPhil, Azmat Ali AdvAPD, Truc
Keywords:vitamins, guidelines, parenteral nutrition, vitamin D, micronutrients
Abstract:Background and Objectives: This work represents the second part of a progressive review of AuSPEN’s 1999
Guidelines for Provision of Micronutrient Supplementation in adult patients receiving parenteral nutrition. Methods and Study Design: A systematic literature review was undertaken and recommendations made based on the
available evidence and with consideration to specific elements of the Australian and New Zealand (NZ) practice
environment. The strength of evidence underpinning each recommendation was assessed. A multidisciplinary
steering committee and external reviewers provided feedback on the guidelines. Results: On review of the available literature it appears that the parenteral multivitamin preparations presently available in Australia and NZ are
to sufficient avoid deficiency without causing toxicity in most clinical situations for adults receiving PN when
provided regularly as part of the PN prescription. Vitamin D is the most vulnerable vitamin for the Australian and
NZ PN population. Conclusions: Vitamins are an essential component of PN and should be provided from commencement for all patients receiving PN. With the exception of vitamin D, which is recommended to be monitored annually, routine monitoring of vitamin levels is unlikely to be necessary in patients receiving regular parenteral multivitamin preparations. Clinical judgement is an important element when assessing, prescribing and
monitoring patients receiving PN. Areas requiring further research have been identified.
Asia Pac J Clin Nutr. 2016;25(3):636-650.doi: 10.6133/apjcn.022016.05
>>Abstract
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