The double burden of malnutrition in Association of South East Asian Nations (ASEAN) countries: a comprehensive review of the literature
Author:Cut Novianti Rachmi, Mu Li, Louise Alison Baur
Keywords:double burden malnutrition, ASEAN, undernutrition, overnutrition
Abstract:Background and Objectives: The double burden of malnutrition (DBM) – a combination of undernutrition and overnutrition – is a problem faced by many countries. This study aimed to comprehensively review the DBM in ASEAN (Association of South East Asian Nations) countries, including levels (population [including country, city, or any community], household, or individual), types (the type of undernutrition and overweight), and prevalence. Methods and Study Design: Data were sourced from four electronic databases, Medline via OvidSP, Scopus, Global Health via OvidSP and Web of Science, from January 1990 until May 2017. We only included studies that reported prevalence of DBM, were published in English language peer-reviewed journals and were available in full text. Studies were formally assessed against a published critical appraisal tool to produce a robust narrative review. Results: We included 48 studies in the review from eight countries. No study was found from Singapore or Brunei Darussalam. Most studies were from Indonesia and there was only one study from Lao PDR. There were a range of criteria for anthropometry used in these studies, hence comparison is impossible. DBM happened at community, household, and individual levels, with different types of undernutrition (stunting/ underweight/ wasting/ thinness) in combination with overweight/obesity. At the household level, DBM ranged from 5.0% in Vietnam to 30.6% in Indonesia. Conclusions: ASEAN countries may need to strengthen surveillance using WHO standards to improve the comparability of data, further develop strategies to address under- or overweight issues and investigate potential “double-duty actions” as suggested by the World Health Organization.
Asia Pac J Clin Nutr. 2018;27(4):736-755.doi: 10.6133/apjcn.062018.02
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Development of a screening tool to detect nutrition risk in patients with inflammatory bowel disease
Author:Natasha Haskey, Juan Nicolás Peña-Sánchez, Jennifer LJones, Sharyle AFowler
Keywords:nutrition screening tool, nutrition risk, inflammatory bowel disease,
Crohn’s disease, ulcerative colitis
Abstract:Background and Objectives: Malnutrition is a known complication of Inflammatory
Bowel Disease (IBD). We assessed a known screening tool, as well as developed and
validated a novel screening tool, to detect nutrition risk in outpatients with IBD. Methods
and Study Design: The Saskatchewan IBD–Nutrition Risk (SaskIBD-NR Tool) was
developed and administered alongside the Malnutrition Universal Screening Tool (MUST).
Nutrition risk was confirmed by the IBD dietitian (RD) and gastroenterologist (GI).
Agreement between screening tools and RD/GI assessment was computed using Cohen’s
kappa. Results: Of the 110 patients screened, 75 (68.2%) patients had Crohn’s Disease and
35 (31.8%) ulcerative colitis. Mean BMI was 26.4 kg/m2 (SD=5.8). RD/GI assessment
identified 23 patients (20.9%) at nutrition risk. The SaskIBD-NR tool classified 21 (19.1%)
at some nutrition risk, while MUST classified 17 (15.5%). The SaskIBD-NR tool had
significant agreement with the RD/GI assessment (k 0.83, p<0.001), while MUST showed
a lack of agreement (k 0.15, p=0.12). The SaskIBD-NR had better sensitivity (82.6% vs
26.1%), specificity (97.7% vs 87.4%), positive predictive value (90.5% vs 35.3%), and
negative predictive value (95.5% vs 81.7%) than the MUST. Conclusion: The
SaskIBD-NR, which assesses GI symptoms, food restriction, and weight loss, adequately
detects nutrition risk in IBD patients. Broader validation is required.
Asia Pac J Clin Nutr. 2018;27(4):756-762.doi: 10.6133/apjcn.112017.01
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Accuracy of basal metabolic rate estimated by predictive equations in Japanese with type 2 diabetes
Author:Shogo Tabata, Norimitsu Kinoshita, Satoru Yamada, Hideo Matsumoto
Keywords:basal metabolic rate (BMR), predictive equation, diabetes, portable gas
analyzer, Japanese
Abstract:Background and Objectives: Estimation of energy demand using basal metabolic rate
(BMR) is a rational approach for optimizing glycemic control and weight management in
patients with type 2 diabetes mellitus (T2DM). Here, we assessed the accuracy of
predictive equations in estimating BMR in Japanese patients with T2DM. Methods and
Study Design: BMR was measured indirectly (BMRm) with a portable gas analyzer in the
fasting state in 69 Japanese patients with T2DM. BMR was estimated using the
Harris-Benedict equation (BMRhb) and Ganpule equation (BMRg). An original predictive
equation (BMRdm) was formulated by stepwise multiple regression analysis using subject
age, lean soft tissue mass, fat mass and bone mineral content. Mean differences and 95%
limits of agreement between measured and three estimated BMRs were evaluated by
Bland-Altman plots. In addition, subjects were divided into three BMI groups (normal,
BMI <25; overweight, BMI ≥25; obese, BMI ≥30), and the influence of BMI on the error
size between measured and estimated BMRs was assessed. Results: Between BMRm and
the three estimated BMRs (BMRhb, BMRg, and BMRdm), there were small systematic
errors with large random errors (mean difference±2SD ; −32±365 kcal，26±405 kcal, and
−1.6±349 kcal, respectively) and significant proportional errors (r=0.42, 0.44, and 0.30,
respectively). BMI subgroup analysis revealed that the obese group showed larger random
errors and significant proportional errors compared to the overweight and normal weight
groups. Conclusion: Predictive equations provide unacceptably inaccurate estimates of
BMR in Japanese patients with T2DM, particularly in obese individuals.
Asia Pac J Clin Nutr. 2018;27(4):763-769.doi: 10.6133/apjcn.102017.05
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Risk factors for parenteral nutrition-dependence and mortality with the short bowel syndrome: a 10-year retrospective study in Thailand
Author:Narisorn Lakananura
Keywords:short bowel syndrome, parenteral nutrition-dependence, catheter-related bloodstream infection (CRBSI), residual colon, surviva
Abstract:Background and Objectives: Short bowel syndrome (SBS) is a rare and life-threatening disease. Few studies have investigated risk factors for parenteral nutrition (PN)-dependence and death in SBS. Accordingly, the aim of this study was to investigate the risk factors for PN-dependence and long-term mortality in SBS. Methods and Study Design: This retrospective study reviewed and evaluated children and adults who were diagnosed with SBS at King Chulalongkorn Memorial Hospital from October 2005 to January 2015. Age, causes of SBS, length of remnant bowel, type of anastomosis, types of nutrition support, SBSassociated complications, PN-dependence rate, duration of PN-dependence, mortality rate, and causes of death were evaluated. Results: Twenty-two adults and 19 children were reviewed. The median follow-up time was 48 months. At the end of follow-up, PNdependence rate was 51.2%. The residual colon ≥50% group had a significantly lower PNdependence rate, with a hazard ratio of 0.36 (95% CI: 0.14-0.93; p=0.03). The most frequent cause of death was infection, with the highest percentage of mortality occurring within the first 2 years after surgery. The mortality rate was 53.8% and the residual colon ≥50% group had a significantly lower mortality rate, with a hazard ratio of 0.36 (95% CI: 0.14-0.88; p=0.03). Conclusions: PN-dependence and death occurred in about half of all patients. Residual colon ≥50% was significantly associated with lower death rate and PN-dependence. The crucial role of colon in continuity as a protective factor should be investigated further in prospective studies.
Asia Pac J Clin Nutr. 2018;27(4):770-776.doi: 10.6133/apjcn.102017.03
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Determinants and nutritional assessment value of hand grip strength in patients hospitalized with cancer
Author:Chun-lei Hu, Miao Yu, Kai-tao Yuan, Hong-lan Yu, Ying-ying Shi, Jia-jun Yang, Wei Li, Hai-ping Jiang, Zeng-ning Li, Hong-xia Xu, Yi Ba, Kun-hua Wang, Su-yi Li, Han-ping Shi
Keywords: hand grip strength, PG-SGA, malnutrition, sarcopenia, cancer patients
Abstract:Background and Objectives: Hand grip strength (HGS) has emerged as a predictor of the nutritional status. However, many factors may modify the malnutrition–HGS association. This study explored the nutritional assessment value and determinants of HGS in patients hospitalized with cancer. Methods and Study Design: In this multicenter, retrospective, observational study (11,314 patients), the Receiver operator characteristic curve was used to observe HGS and nutritional status sensitivity/specificity. Sex; age; height; weight; mid-upper arm circumference (MAMC); Patient-Generated Subjective Global Assessment (PG-SGA) score; Karnofsky score; physical function (PF) domain; cognitive function (CF) domain; global health and quality of life (QL) domain of EORTC QLQ-C30 (a quality of life instrument designed by the European Organization for Research and Treatment of Cancer); and albumin, prealbumin, and hemoglobin levels were included in a Stepwise analysis model to identify the factors influencing HGS. Results: HGS showed a very low diagnostic value and accuracy for identifying severe malnourishment (area under the curve, 0.615–0.640; p˂0.01). HGS positively correlated with sex; height; weight; MAMC; Karnofsky score; QL, PF, and CF domains; and hemoglobin and prealbumin levels (Beta=0.02–0.42, p≤0.05), and negatively with age (Beta=−0.19, p˂0.01). However, the PG-SGA score was excluded because of its very limited contribution to HGS variability. Conclusions: HGS is a mutifactorial index. The use of HGS cutoff values to identify malnutrition is markedly challenging. Thus, HGS may be of limited use as a predictor of nutritional status
Asia Pac J Clin Nutr. 2018;27(4):777-784.doi: 10.6133/apjcn.072017.04
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The effects of Melissa officinalis (lemon balm) in chronic stable
angina on serum biomarkers of oxidative stress, inflammation
and lipid profile
Author:Ahmad Zare Javid, Habib Haybar, Parvin Dehghan, Mohammad Hosein
Haghighizadeh, SeyedeMarjan Mohaghegh, Maryam Ravanbakhsh, Assieh
Mohammadzadeh
Keywords: Melissa officinalis, coronary artery disease, oxidative stress, paraxonase
1, lipid profile
Abstract:Background and Objectives: Coronary artery disease (CAD) is a major cause of death
worldwide. Chronic stable angina (CSA) is the primary sign of CAD. Oxidative stress and
inflammation play a substantial role in pathogenesis and progression of CAD. The aim of
this study was to investigate the effects of oral administration of powdered Melissa
officinalis (MO) on biomarkers of oxidative stress, inflammation, and lipid profile in
patients with CSA. Methods and Study Design: A randomized, double-blind,
placebo-controlled clinical trial was performed in 80 patients with CSA. The subjects were
randomly assigned to obtain either oral MO 3 g/d (n=40) or placebo (n=40) for eight weeks.
Anthropometric indices, biomarkers of oxidative stress, inflammation, and lipid profile
were evaluated at baseline and post-intervention. Results: The mean serum concentrations
of triglycerides, total-cholesterol, LDL-cholesterol, and malondialdehyde (MDA), and high
sensitive C-Reactive Protein (hs-CRP) were lower in the intervention group compared with
placebo (p<0.01) post intervention. Moreover, the mean serum concentration of
paraxonase 1 (PNO1) and HDL-c were higher (p<0.001) in the intervention group
compared with the control group. Conclusion: Oral MO supplementation improves the
lipid profile, MDA, hs-CRP, and PNO1 in patients with CSA.
Asia Pac J Clin Nutr. 2018;27(4):785-791.doi: 10.6133/apjcn.022018.01
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Effect of ascorbic acid rich, micro-nutrient fortified supplement on the iron bioavailability of ferric pyrophosphate from a milk based beverage in Indian school children
Author:Maria Pauline, Sejil T Verghese, Bindu Y Srinivasu, Beena Bose, Tinku Thomas, Amit K Mandal, Prashanth Thankachan, Anura V Kurpad MBBS
Keywords:ferric pyrophosphate, micronutrient, milk, iron bioavailability, stable isotope
Abstract:Background and Objectives: Nutritional anemia is a significant public health issue with 5080% prevalence in Indian children. Fortification of food, specifically milk, with iron is a potential approach to increase dietary iron intake. Ferric pyrophosphate [Fe4(P2O7)3] is organoleptically neutral and is less soluble in acid medium and, further, has low bioavailability in milk. However, since ascorbic acid is a potent enhancer of iron absorption, the co-administration of ascorbic acid with Fe4(P2O7)3 might enhance the absorption of iron. We evaluated the effect of ascorbic acid on iron absorption from a Fe4(P2O7)3 and an ascorbic acid fortified milk beverage with respect to milk fortified with Fe4(P2O7)3 alone. Methods and Study Design: A double-blind, two-way crossover, randomized study was conducted in 25 mildly anemic children. The test group received milk fortified with beverage powder containing 7 mg isotopically labeled iron (57Fe/58Fe) as Fe4(P2O7)3 , equimolar proportions of ascorbic acid and 200 mg of calcium whereas control group received milk fortified with energy, calcium and iron equivalent beverage powder. Fractional iron absorption was measured by erythrocyte incorporation of stable isotopes of iron (57Fe/58Fe) in both the groups. Results: The fractional iron absorption from the control drink was 0.80% (95% CI: 0.57, 1.12). Fortifying the milk with an equimolar amount of ascorbic acid increased the fractional iron absorption almost 2-fold to 1.58% (95% CI: 1.13, 2.22). Conclusions: The presence of ascorbic acid in an equimolar ratio with that of iron from Fe4(P2O7)3 salt in milk as a fortificant enhanced iron absorption when compared to milk fortified with only Fe4(P2O7)3
Asia Pac J Clin Nutr. 2018;27(4):792-796.doi: 10.6133/apjcn.092017.07
>>Abstract
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Effect of a daily snack containing green leafy vegetables on
women’s fatty acid status: a randomized controlled trial in
Mumbai, India
Author:Harsha V Chopra, Sarah H Kehoe, Sirazul A Sahariah, Harshad N Sane,
Vanessa A, Dnyaneshwar V Tarwade, Barrie M Margetts, Ramesh D Potdar, Caroline HD, Sadhana R
Keywords:alpha-linolenic acid, erythrocyte, docosahexaenoic acid, green leafy
vegetables, intervention study
Abstract:Background and Objectives: There are few data on the fatty acid status of non-pregnant
Indian women. Our objective was to investigate the effect of a snack containing green
leafy vegetables (GLVs) on women’s erythrocyte long chain polyunsaturated fatty acid
status (LCPUFA). Methods and Study Design: Non-pregnant women (n=222) aged 14-35
years from Mumbaislums were randomized to consume a snack containing GLVs, fruit and
milk (treatment) or a control snack containing foods of low micronutrient content such as
potato and onion, daily under observation. One treatment snack contained a mean (SD) of
54.1 (33.7) mg alpha-linolenic acid (ALA) and one control snack contained 4.1 (3.4) mg
ALA. Blood was collected at baseline (0 weeks) and after 12 weeks of supplementation.
Erythrocyte fatty acids were analyzed using gas chromatography and expressed as g/100g
fatty acids. Plasma malondialdehyde, homocysteine, and erythrocyte superoxide dismutase
and glutathione peroxidase were measured. The effect of the treatment on 12 week
LCPUFA was assessed using ANCOVA models. Results: Median (IQR) erythrocyte DHA
in the treatment group increased from 1.50 (1.11, 2.03) at baseline to 1.86(1.50, 2.43)
(p<0.001) at 12 weeks, and fell in controlsfrom 1.78 (1.37, 2.32) to 1.60 (1.32, 2.04)
(p<0.001). The total n-3 fatty acids increased in the treatment group. There was no effect
on malondialdehyde and antioxidant enzyme levels. Plasma homocysteine at 0 and 12
weeks was inversely associated with erythrocyte DHA at 12 weeks. Conclusion:Daily
consumption of a snack containing GLV improved women’s erythrocyte DHA levels
without increasing oxidative stress
Asia Pac J Clin Nutr. 2018;27(4):804-817.doi: 10.6133/apjcn.122017.02
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Comparison of effectiveness, safety, and costs of standardized
and customized parenteral nutrition support among gastric
cancer patients after gastrectomy: a retrospective cohort study
Author:Bin Zhao, Yan Xia Wang, Xin Yue Liu, Hai Long Li, Dan Mei
Keywords:parenteral nutrition, multi-chamber bag, clinical outcome, cost analysis,
PNALD
Abstract:Background and Objectives: To compare the effectiveness, safety, and costs of
commercial standardized multi-chamber bag and customized compounded total parenteral
nutrition (TPN) among gastric cancer patients after gastrectomy. Methods and Study
Design: A retrospective cohort study was conducted among 64 gastric cancer patients who
underwent gastrectomy from 2014 to 2016 in a tertiary teaching hospital in Beijing, China.
Patients were categorized into standardized (s-TPN) and customized TPN (c-TPN) groups
based on their TPN order after gastrectomy. Patients were followed up until discharge. The
effectiveness measures (body mass index (BMI) and albumin) and safety measures (liver
and renal functions and electrolytes) were compared before TPN started and after TPN
finished within and between the two groups. The length of hospital stay and costs were
compared between the two groups. Results: There were no significant differences between
the two groups in BMI preservation, metabolic complications, the length of hospital stay
and costs, except that both total bilirubin (Tbil) and direct bilirubin (Dbil) were
significantly higher in the s-TPN group than c-TPN (p<0.05). Conclusions: There were no
significant differences in effectiveness and safety measures, the length of hospital stay and
costs between s-TPN and c-TPN groups, except that s-TPN group was more likely to lead
to parenteral nutrition-associated liver disease (PNALD). More studies are needed to
confirm the findings of this study in other healthcare settings and study populations.
Asia Pac J Clin Nutr. 2018;27(4):818-822.doi: 10.6133/apjcn.012018.03
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Adult serum 25(OH)D3 in Gansu province, northwest China: a cross-sectional study
Author:Jing Liu, Wenjuan Ma, Lianhua Wei, Yan Yang, Ruifei Yang, Feifei Shao, Yu Wang, Limin Tian
Keywords:vitamin D deficiency, gender, sun exposure, physical activity, Gansu, China
Abstract:Background and Objectives: This analytical cross-sectional study investigated the prevalence of vitamin D deficiency and its association with metabolic risk factors in the adult population of Gansu Province, China. Methods and Study Design: In total, 11,157 healthy participants (4,740 men and 6,417 women) were enrolled. A questionnaire was used to assess general characteristics and personal habits. We detected 25-hydroxyvitamin D and associated metabolic parameters through electrochemiluminescence immunoassays. Results: The prevalence of severe deficiency (<10 ng/mL), deficiency (10-20 ng/mL), insufficiency (20–30 ng/mL), and sufficiency (≥30 ng/mL) among the participants was 17.3%, 64.6%, 11.8%, and 6.3%, respectively. Vitamin D deficiency was more prevalent in women than in men (82.5% vs 81.1%, p<0.001). The significant predictors of vitamin D deficiency included younger age and female sex (p<0.05), whereas sun exposure, physical activity, and calcium (Ca) supplementation were associated with less vitamin D deficiency (p<0.05). Serum 25(OH)D3 was inversely associated with parathyroid hormone (r=−0.279, p<0.001) and positively associated with serum Ca (r=0.239, p<0.001), serum P (r=0.090, p=0.018), LDL cholesterol (r=0.100, p=0.008), and BMI (r=0.093, p=0.014). No significant association was observed between serum 25(OH)D3 and metabolic disorders. Conclusions: Vitamin D deficiency is highly prevalent among the adult population of Gansu Province, northwest China, especially young physically inactive and overweight women with limited sunlight exposure, whose biomarkers put them at greater risk of osteoporosis and cardiovascular disease.
Asia Pac J Clin Nutr. 2018;27(4):832-839.doi: 10.6133/apjcn.092017.06
>>Abstract
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Processed and ultraprocessed food consumption pattern
in the Jakarta Individual Food Consumption Survey
2014
Author:Dyah Setyowati, Nuri Andarwulan, Puspo Edi Giriwono
Keywords:Individual Food Consumption Survey, nutrient intake, processed foods, processed ingredients,
ultraprocessed foods
Abstract:Background and Objectives: Dietary patterns are undergoing a major shift worldwide. This study analysed the
consumption of processed and ultraprocessed foods in Jakarta and its contribution to the energy and nutrient intake based on the Individual Food Consumption Survey 2014. Methods and Study Design: Food consumption
data were based on 24-hour dietary recall. Foods were grouped into four food groups: nonprocessed foods, processed ingredients, processed foods, and ultraprocessed foods and subsequently categorised according to the Indonesian Food Category System. Energy and nutrient intake were calculated using Nutrisurvey 2007 software.
Results: Nonprocessed food, processed ingredient, processed food, and ultraprocessed food consumption contributed to 57.2%, 21.6%, 1.7%, and 19.5% of total weight consumption, respectively. Ultraprocessed foods contributed to 15.7%, 16.7%, 14.2%, 12.6%, 18.4%, and 31.3% of daily energy, carbohydrate, protein, fat, sodium,
and sucrose intake, respectively, and the respective contributions of nonprocessed foods were 52.2%, 58.7%,
65.8%, 32.6%, 7.9%, and 11.1%; of processed ingredients were 30.0%, 22.7%, 16.4%, 53.6%, 68.9%, and 57.6%;
and of processed foods were 2.1%, 2.0%, 3.6%, 1.2%, 4.8%, and 0%. Linear regression analysis between the
amount of food consumption and nutrient intake showed that at the same weight consumption, processed ingredients provided a higher intake of energy, fat, sodium, and sucrose than the other food groups. Conclusions: Processed and ultraprocessed foods still have a lower contribution to energy and nutrient intake in Jakarta than
nonprocessed foods and processed ingredients.
Asia Pac J Clin Nutr. 2018;27(4):840-847.doi: 10.6133/apjcn.062017.01
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Maternal Iodine dietary supplements and neonatal
thyroid stimulating hormone in Gippsland, Australia
Author:Eleanor Katherine Louise Mitchell, Julie Christine Martin, Angelo
D’Amore, Ivan Francis, Gayle S Savige
Keywords:nutritional supplements, pregnancy, iodine, neonatal screening, thyroid stimulating hormone
Abstract:Background and Objectives: Pregnant women are at particular risk of iodine deficiency due to their higher iodine requirements. Iodine is known to be essential for normal growth and brain development, therefore neonatal
outcomes in mildly iodine deficient areas, such as Gippsland, are a critical consideration. This study aimed to investigate whether iodine supplementation prevented iodine insufficiency as determined by neonatal thyroid
stimulating hormone (TSH) screening criteria. Methods and Study Design: Gippsland-based women aged 18
years, in their third trimester of pregnancy, provided self-reported information regarding their iodine supplement
use and consent to access their offspring’s neonatal TSH screening data. 126 women consented to participate,
with 111 women completing all components of this study. Results: Only 18.9% of participants followed the National Health and Medical Research Council (NHMRC) recommendation of 150 µg/day iodine supplement, with
42.3% of participants not taking any supplements, or taking supplements with no iodine or insufficient iodine.
The remaining women (38.7%) were taking supplements with doses of iodine much higher (200-300 µg) than the
NHMRC recommended dose or were taking multiple supplements containing iodine. When correlating iodine intake to their neonates’ TSH, no correlation was found. When iodine supplementation usage was categorised as
below, equal to, or above NHMRC recommendations there was no significant difference in neonatal TSH. Conclusion: This study found that iodine supplementation appeared to prevent maternal iodine insufficiently when
measured against neonatal TSH screening criteria.
Asia Pac J Clin Nutr. 2018;27(4):848-852.doi: 10.6133/apjcn.022018.02
>>Abstract
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Iodine deficiency in women of childbearing age: not bread alone?
Author:Kharis Burns, Constance Yap, Ashraf
Mina, Jenny E Gunton
Keywords:pregnancy-planning, iodine deficiency, women, public health, urine iodine
Abstract:Background and Objectives: Iodine deficiency remains a public health concern, particularly
in pregnant women and those planning pregnancy because of the risk of impaired fetal
neurological development. Following implementation of strategies to improve iodine intake
in Australia, there has been minimal investigation into current iodine status. We aimed to
characterise iodine status in a population of women of childbearing-age in Australia.
Methods and Study Design: A cross-sectional study was performed in 97 women of
childbearing-age attending outpatient clinics at a tertiary hospital in Sydney. Pregnant and
postmenopausal women were excluded. Iodine intake was surveyed via questionnaire. Spot
urinary iodine (UI) was concurrently measured. The relationships between UI, dietary intake
and use of iodine-containing multivitamins/medications were examined. Results: Median UI
was 117 ug/L. Forty women (41%) were iodine deficient (UI <100 ug/L). The most
commonly consumed source of dietary iodine was bread (29/97, 30% daily). Forty-three
women took iodine-containing multivitamins but 18/43 (41.2%) remained deficient. There
were no significant associations between UI and diet. There was a smaller proportion of
deficient people than in our previous study (125/180 non-pregnant subjects, 69%, vs 41% in
this study, p<0.001). Conclusion: The overall population median is now sufficient, however,
a significant proportion of this multicultural group are iodine deficient. There are similar
proportions of deficiency in those using iodine supplements versus not. Contributors may
include ethnicity-related dietary practices, limited awareness or poor adherence to iodine
supplements. Despite public health strategies, a significant proportion of women of
child-bearing age remained iodine deficient. Further research involving a larger population
and contributors to iodine deficiency is warranted.
Asia Pac J Clin Nutr. 2018;27(4):853-859.doi: 10.6133/apjcn.102017.01
>>Abstract
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The role of familial and sibling factors on abdominal adiposity:
a study of south Indian urban children
Author:Rebecca Kuriyan, Natasha Rodgers, Tinku Thomas, Jini Aravind, Subramanian
SV, Anura V Kurpad
Keywords:childhood obesity, anthropometric measurements, waist circumference,
lifestyle factors, sibling relationships
Abstract:Background and Objectives: Childhood obesity is increasing in urban India. This study
aimed to examine the associations of younger siblings abdominal adiposity with individual,
familial and environmental factors, in urban school aged siblings. Methods and Study
Design: Weight, height and waist circumference of 2906 siblings aged 3-16 years were
measured along with details on demographics, diet, lifestyle, behavior and reported
parental anthropometrics. Abdominal adiposity was classified as waist circumference
above the age and sex specific 75th percentile value. The associations of various factors
with abdominal adiposity in the younger siblings were examined through logistic
regression analyses. Results: Sibling, familial factors and environmental factors had
significant associations with abdominal adiposity. The odds of a younger sibling having
abdominal adiposity was greatest (OR=3.16, 95% confidence interval (95% CI): 2.27 to
4.42), when the older sibling had abdominal adiposity, followed by the odds ratio of both
parents being overweight (OR=1.63, 95% CI: 1.33 to 1.99) compared to neither being
overweight. The influence of abdominal adiposity of the older sibling was greater when the
siblings were of the same sex (OR=3.53, 95% CI: 2.22 to 5.60) than when they were of
different sex (OR=2.73, 95% CI: 1.67 to 4.46); the odds ratio being highest when both
siblings were males. Conclusions: The younger sibling’s abdominal obesity is associated
with that of his/her sibling and parental obesity, in addition to other known risk factors in
urban south Indian families. Interventions to prevent childhood obesity need to also
consider the sibling effect along with the other known factors.
Asia Pac J Clin Nutr. 2018;27(4):869-874.doi: 10.6133/apjcn.012018.02
>>Abstract
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The different effects of prenatal nutrient supplementation on neonatal birth weights between urban and rural areas of northwest China: a cross-sectional study
Author:Ruo Zhang, Chao Li, Baibing Mi, Shanshan Li, Pengfei Qu, Shaonong Dang, Danmeng Liu, Ruhai Bai, Hong Yan
Keywords:prenatal nutrient supplementation, neonatal birth weight, different effects, northwest China, cross-sectional study
Abstract:Background and Objectives: The results of prenatal nutrient supplementation on birth weight are inconsistent in different areas. This study aimed to investigate whether the effects of prenatal iron plus folic acid and folic acid supplementation on neonatal birth weights differed between urban and rural areas of Northwest China. Methods and Study Design: A stratified multistage random sampling method was used to recruit women between the ages of 15 and 49 and their offspring born between 2010 and 2013 from 10 urban areas and 20 rural areas of the Shaanxi Province of Northwest China. Information regarding socio-demographics and prenatal nutrient supplementation status was collected using a standardized questionnaire, and the neonatal birth weights were obtained from the birth certificates. Multilevel models were established separately for the urban and rural areas to assess the effects of prenatal nutrient supplementation on neonatal birth weights. Results: The association between prenatal nutrient supplementation and neonatal birth weight was not statistically significant in urban areas. However, in rural areas, prenatal iron plus folic acid and folic acid supplementation increased the mean birth weights by 45.3 g (9.4 to 81.1 g, p=0.014) and 30.9 g (15.6 to 46.1 g, p<0.001), respectively. Conclusions: The effects of prenatal nutrient supplementation on neonatal birth weights differ between urban and rural areas of Northwest China. The different effects may be due to the different nutritional status of the urban and rural pregnant women. Prenatal nutrient supplementation may be a helpful way for improving neonatal birth weight in rural areas.
Asia Pac J Clin Nutr. 2018;27(4):875-885.doi: 10.6133/apjcn.102017.01
>>Abstract
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Weight and height faltering in the indigenous children (Orang Asli) of Peninsular Malaysia during the first 2 years of life
Author:Wong Chee Yen, Zalilah Mohd Shariff, Siti Nur’Asyura Adznam, Norhasmah Sulaiman, Chin Yit Siew
Keywords:undernutrition, growth faltering, Orang Asli children, Peninsular Malaysia, prospective cohort study
Abstract:Background and Objectives: Information on the growth status of indigenous children is useful for developing intervention strategies, but the data are limited. This study determined the prevalence of undernutrition among under-five indigenous children (Orang Asli) and tracked the growth status of Orang Asli children aged 0–3 years. Methods and Study Design: This study had two phases: a cross-sectional growth study of under-five Orang Asli children (N=304; Phase 1) and a 2-year prospective cohort growth study of Orang Asli children aged 0–3 years (N=214; Phase 2) in the Temerloh district of Pahang, Malaysia. Weight-for-age, length/height-for-age, weight-for-length/height, and body mass index-for-age were determined. Results: The prevalence rates of stunting, underweight, wasting, and thinness in under-five Orang Asli children (Phase 1) were 64%, 49%, 14%, and 12%, respectively. In the cohort of 214 children (Phase 2), weight-for-age was initially documented and maintained closely at −1.50 standard deviations (SD) in the first 6 months, but it declined to approximately −2.00 SD at 15 months and remained close to −2.00 SD thereafter. Length/height-for-age declined rapidly to approximately −2.50 SD at 18 months and fluctuated between −2.30 and −2.50 SD thereafter. Weight-for-length/height increased sharply to −0.40 SD at 2–3 months, declined gradually to less than −1.00 SD at 12 months, and plateaued between −1.00 and −1.30 SD thereafter. Conclusions: Undernutrition is prevalent among Orang Asli children, with length rather than weight faltering being more pronounced in the first 2 years of life. Identifying the causes of early growth retardation in this population is required to inform future preventive strategies.
Asia Pac J Clin Nutr. 2018;27(4):886-892.doi: 10.6133/apjcn.072017.02
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Comparative validity of a Food Frequency Questionnaire
(MyUM Adolescent FFQ) to estimate the habitual dietary intake
of adolescents in Malaysia
Author:Khairunnisa Mohamed, Tin Su Tin, Muhammad Yazid Jalaludin, Nabilla
Al-Sadat, Hazreen Abdul Majid
Keywords:reproducibility, validity, food frequency questionnaire, adolescent,
Malaysia
Abstract:Background and Objectives: The food frequency questionnaire (FFQ) is a dietary tool
used to assess the habitual intake of the population. The goal of this study is to examine the
reproducibility and validity of the FFQ that was developed for a multi-ethnic population in
Malaysia. Methods and study design: Collective food data from MyHeARTs 2012
database were used to construct the MyUM Adolescent FFQ. Seventy-eight participants
between 13 and 15 years old in 2014 were selected through convenient sampling for test –
retest study. They completed the MyUM Adolescent FFQ twice, with an interval period of
one week. One hundred and fifty-six MyHeARTs study participants who were 15 years old
in 2014 were randomly selected for this comparative validity study. They completed a
7-day diet history (7DDH) and subsequently completed the self-administered MyUM
Adolescent FFQ. Results: Pearson’s correlations between the FFQ and 7DDH for all
macronutrients were statistically significant. Energy-adjusted correlations for protein,
carbohydrate, and fat were 0.54, 0.63 and 0.49 respectively. Most of the micronutrients and
minerals, were statistically correlated ranging from 0.31 to 0.49 after energy adjustment.
Cross-classification analyses revealed that more than 70 percent of adolescents were
classified into either the same or adjacent quartile of nutrient intake when comparing data
of 7DDH and FFQ. No serious systematic bias was evident in the Bland-Altman plots.
Conclusion: The 200-item FFQ developed for Malaysian adolescents has moderate to
good comparative validity for assessment of macronutrient and micronutrient intake.
Asia Pac J Clin Nutr. 2018;27(4):898-907.doi: 10.6133/apjcn.022018.03
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New Chinese dietary guidelines: healthy eating patterns
and food-based dietary recommendations
Author:YueXin Yang, XiaoLi Wang, PooiMun Leong, HuanMei Zhang, XiaoGuang Yang, LingZhi Kong, FengYing Zhai, YiYong Cheng, JunSheng Guo, YiXiang Su
Keywords:China, dietary guidelines, healthy eating patterns, evidence-based nutrition, Chinese Food Guide Pagoda
Abstract:Background and Objectives: The Chinese Dietary Guidelines (CDGs) were first released to the public in 1989
by the Chinese Nutrition Society (CNS). In 2016, the Ministry of Health commissioned the CNS to revise and
publish new CDGs. Methods and Study Design: The CNS convened an expert committee of leaders in the fields
of nutrition, epidemiology, public health, preventive medicine, and food science. The CDGs were revised according to the World Health Organization Handbook for Guideline Development procedures. The expert committee
recommended key inclusions for the CDGs on the basis of the current status of public health and priority health
challenges affecting the Chinese population, as well as the quality of scientific evidence. Results: The CDGs
(2016) provide six key dietary recommendations for the general Chinese population aged 2 years and above. In
addition to a newly revised Chinese Food Guide Pagoda, both the Chinese Food Guide Plate and Chinese Food
Guide Abacus are newly created pictorial models in the CDGs (2016); the Chinese Food Guide Abacus is specifically designed for children. Seven additional dietary guidelines targeting specific populations are included; these
guidelines emphasize the different physiological and nutritional requirements of particular populations, including
dietary guidelines for vegetarians for the first time. Conclusions: The CDGs (2016) is an official document published by the National Health Commission of China. Its content highlights the current status of public health and
offers advice to address health concerns faced by the Chinese population. The CDGs (2016) have been widely
disseminated and accepted in the Chinese population; the National Nutrition Week is a major national event in
which the CDG are used as its core to increase public awareness towards a healthy diet and lifestyle.
Asia Pac J Clin Nutr. 2018;27(4):908-913.doi: 10.6133/apjcn.072018.03
>>Abstract
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Is adherence to the Chinese Dietary Guidelines
associated with better self-reported health? The Chinese
Dietary Guidelines Adherence Score
Author:Jiajie Zang, Changyi Guo, Zhengyuan Wang, Yuejia Cheng, Wei Jin, Zhenni Zhu, Shurong Zou, Chunfang Wang, Ye Lu,Wenjing Wang, Xin He, Hongmei Tang, Hongmei Gao,
Xiaodong Jia, Fan Wu
Keywords:diet quality, self-reported health, China, Item Response Theory, Dietary-Guideline Adherence
Abstract:Background and Objectives: Poor adherence to dietary guidelines is related to physical and mental disorders, as
reflected in self-reported health statuses. This study evaluates the association between diet quality and selfreported health within the Shanghai Diet and Health Study. Methods and Study Design: We used Chinese Dietary Guidelines Adherence scores to assess diet quality in a cross-sectional study of 4487 subjects above 15 years
of age, who completed three-day 24h diet recalls and responded to self-reported health questionnaires. A composite health score was calculated based on Item Response Theory, using the Rasch model. Multiple linearregression models were evaluated to assess the relationship between self-reported health status and diet quality.
Results: Based on the various adherence scores, we divided our sample into fifths. Based on these divisions and
with the exception of a single instance, our results show a significant trend: self-reported health declines with declining adherence to official dietary guidelines. This trend was even significant when controlling for a large number of potential confounders. Conclusions: This study shows that consumption of a healthy and balanced diet, as
reflected in adherence to the Chinese Dietary Guidelines, is related to increased levels of overall health among
Shanghai residents.
Asia Pac J Clin Nutr. 2018;27(4):914-924.doi: 10.6133/apjcn.072018.02
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The quality of evidence on nutrition intervention published in Chinese journals: an assessment of meta-analyses on vitamin interventions
Author:Yanhua Ning, Juxia Zhang, Yun Li
Keywords:systematic review, meta-analyses, vitamin, methodological quality, reporting quality
Abstract:Background and Objectives: The quality of meta-analyses (MAs) on nutrition intervention in mainland China remains uninvestigated. To assess the quality of the evidence regarding nutrition intervention in mainland China, we used vitamin intervention as an example to assess the overall methodological and reporting qualities of MAs on nutrition interventions published in Chinese journals. Methods and Study Design: A cross-sectional study on MAs of vitamin interventions was performed. Four Chinese databases were searched from inception through September 2016 for all MAs of vitamin intervention. A Measurement Tool to Assess Systematic Reviews (AMSTAR) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements were used to assess methodological and reporting qualities, respectively. Results: A total of 43 MAs of vitamin interventions were included, but none of the studies had been updated. These reviews mainly focused on the effects of interventions involving vitamin D, B vitamins and vitamin E, and the most studied condition was “Endocrine, Nutritional and Metabolic diseases,” such as diabetes, obesity, and nutritional rickets. The median AMSTAR score was 6 (0-7), and median PRISMA score was 18 (3-24). No study provided an ‘a priori’ design, a list of excluded studies, or a statement on conflict of interest, and less than 50.0% of included MAs stated the publication status and performed an adequate structure summary. Conclusions: The quality of the included MAs was disappointing regarding some items, and some lower quality reviews should be updated. Future MAs should improve on reporting conflicts of interest, harm, and publication bias.
Asia Pac J Clin Nutr. 2018;27(4):825-934.doi: 10.6133/apjcn.052017.02
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Processed and ultraprocessed food consumption pattern in the Jakarta Individual Food Consumption Survey 2014
Author:Dyah Setyowati, Nuri Andarwulan, Puspo Edi Giriwono
Keywords: Individual Food Consumption Survey, nutrient intake, processed foods, processed ingredients, ultraprocessed foods
Abstract:Background and Objectives: Dietary patterns are undergoing a major shift worldwide. This study analysed the consumption of processed and ultraprocessed foods in Jakarta and its contribution to the energy and nutrient intake based on the Individual Food Consumption Survey 2014. Methods and Study Design: Food consumption data were based on 24-hour dietary recall. Foods were grouped into four food groups: nonprocessed foods, processed ingredients, processed foods, and ultraprocessed foods and subsequently categorised according to the Indonesian Food Category System. Energy and nutrient intake were calculated using Nutrisurvey 2007 software. Results: Nonprocessed food, processed ingredient, processed food, and ultraprocessed food consumption contributed to 57.2%, 21.6%, 1.7%, and 19.5% of total weight consumption, respectively. Ultraprocessed foods contributed to 15.7%, 16.7%, 14.2%, 12.6%, 18.4%, and 31.3% of daily energy, carbohydrate, protein, fat, sodium, and sucrose intake, respectively, and the respective contributions of nonprocessed foods were 52.2%, 58.7%, 65.8%, 32.6%, 7.9%, and 11.1%; of processed ingredients were 30.0%, 22.7%, 16.4%, 53.6%, 68.9%, and 57.6%; and of processed foods were 2.1%, 2.0%, 3.6%, 1.2%, 4.8%, and 0%. Linear regression analysis between the amount of food consumption and nutrient intake showed that at the same weight consumption, processed ingredients provided a higher intake of energy, fat, sodium, and sucrose than the other food groups. Conclusions: Processed and ultraprocessed foods still have a lower contribution to energy and nutrient intake in Jakarta than nonprocessed foods and processed ingredients.
Asia Pac J Clin Nutr. 2018;27(4):935-944.doi: 10.6133/apjcn.062017.01
>>Abstract
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Supplementation with trans fatty acid at 1% energy did not
increase serum cholesterol irrespective of the obesity-related
genotypes in healthy adult Japanese
Author:Hiroyuki Takeuchi, Chiaki Futatsuya, Akari Miki, Eiichi Tabuchi, Michihiro
Sugano
Keywords:partially hydrogenated oil¸ trans fatty acid, serum lipid, intervention
trial, single nucleotide polymorphisms
Abstract:Background and Objectives: The excessive intake of trans fatty acids increases serum
low-density lipoprotein-cholesterol and reduces high-density lipoprotein-cholesterol. We
studied the effects of 1% energy trans fatty acid supplementation on serum lipid
concentrations in healthy adult Japanese with different obesity-related gene
polymorphisms. Methods and Study Design: A randomized, double-blind, parallel trial
was conducted in 53 healthy adults. The volunteers consumed one cookie containing either
1% energy or <0.01% energy (control) of trans fatty acids every day for 4 weeks, and a
blood sample was then obtained after overnight fasting. The single nucleotide
polymorphisms of the fat mass- and obesity-associated gene rs9939609 and beta-3
adrenergic receptor rs4994 were genotyped. Results: The mean trans fatty acid intake of
the control and trans fatty acid groups corresponded to 0.28% and 1.31 % energy,
respectively. There were no significant differences in serum cholesterol (total, low-density
lipoprotein and high-density lipoprotein) or triacylglycerol between the control and trans
fatty acid groups. The responses of serum cholesterol, triacylglycerol, glucose, insulin and
hemoglobin A1c were also independent of the fat mass- and obesity-associated gene and
beta-3 adrenergic receptor gene variants. Conclusions: Our findings indicate that
supplementation with 1% energy trans fatty acids has little effect on serum cholesterol in
healthy adult Japanese, regardless of genotype of fat mass- and obesity-associated gene or
beta-3 adrenergic receptor. More systematic studies, with respect to dietary trans fatty acid
intakes above those used here, may be warranted to determine the tolerable upper level of
dietary trans fatty acid.
Asia Pac J Clin Nutr. 2017;27(4):797-803.doi: 10.6133/apjcn.112017.04
>>Abstract
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Diabetic diets in South Asia: recommendations, adherence, and
outcomes
Author:Shirin Kasturia, Mohammed K. Ali, KM Venkat Narayan, Nikhil Tandon, Shivashankar, Vandana Garg, Deksha
Kapoor, Anitha Mohanasundaram, Deepa Mohan, Muhammad M Kadir, Dorairaj Prabhakaran, Viswanathan Mohan, Lindsay
M. Jaacks
Keywords:type 2 diabetes mellitus, India, Pakistan, lifestyle modifications,
secondary prevention
Abstract:Background and Objectives: To determine how frequently diabetic diets are
recommended to individuals with diabetes in South Asia, whether they are followed, and if
they are associated with healthier dietary choices and clinical benefits. Methods and
Study Design: Data are from the Centre for cArdiometabolic Risk Reduction in
South-Asia Cohort Study. Participants with self-reported physician-diagnosed diabetes
(n=1849) were divided into four groups based on whether they reported being prescribed
and/or following a diabetic diet. Linear regression was used to estimate associations
between these groups and outcomes. Results: 53% of participants with self-reported
diabetes reported not being prescribed or following a diabetic diet. Among those
prescribed and following a diet, mean whole grain consumption was 1.18 times/day and
refined grain consumption was 0.75 times/day compared to 0.88 times/day and 1.74
times/day, respectively, among those neither prescribed nor following a diet (both
p<0.0001). Following a diet despite not being prescribed a diet was not associated with
glycemic control, blood pressure, or body mass index, but was associated with a -8.5
mg/dL (95% confidence interval: -15.5, -1.6) lower low-density lipoprotein cholesterol
compared to not following and not being prescribed a diet after adjustment for confounders.
Conclusion: Though participants who were prescribed diabetic diets and followed them
exhibited healthier dietary choices, the majority of participants with diabetes in urban
South Asia was neither prescribed nor followed such diets. Moreover, there was no
statistically significant clinical benefit, thus indicating that current dietary modifications
may not be large enough or consistent enough to produce meaningful changes in health
outcomes in this population.
Asia Pac J Clin Nutr. 2017;27(4):823-831.doi: 10.6133/apjcn.112017.03
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Combined dietary-exercise intervention for gestational weight gain and birthweight: a meta-analysis
Author:Paul N Morison, Montserrat Bacardi-Gascon, Manuel Lopez-Corrales, Arturo
Jimenez-Cruz
Keywords: gestational weight gain, RCT, diet and exercise interventions, large for
gestational age, birthweight
Abstract:Background and Objectives: Excessive gestational weight gain has been associated with
higher risk for large for gestational age newborns. This systematic review and
meta-analysis aims to assess whether an intensive diet and exercise intervention has an
effect in reducing gestational weight gain and large for gestational age newborns. Methods
and Study Design: The search was conducted on PubMed and Cochrane database.
Through PRISMA flow diagram, clinical trials which met the including criteria were
selected. Risk of bias, sensitivity analysis, and quality of evidence assessment were
conducted using adequate statistical tests, and the quality of evidence was performed by
GRADE method. A random-effect model was used to estimate the statistical significance
of the meta-analysis. Results: Ten clinical trials met the inclusion criteria. Using the
random-effect model and a sensitivity analysis, it was found that an intensive
patient-centered intervention reduced gestational weight gain when compared with
standard prenatal care (Z=6.21 (p<0.00001); Tau²=0.00; Chi²=3.90, df=4 (p=0.42); I²=0%),
and the quality of evidence was moderate. An intensive diet and exercise intervention
decreased the number of large for gestational age newborns (Z=2.20(p=0.03); Tau²=0.14;
Chi²=7.84, df=4 (p=0.10); I²=49%), and the quality of evidence using the GRADE
approach was moderate. Conclusion: The present review and meta-analysis indicates that
an intensive diet and exercise intervention reduced gestational weight gain and large for
gestational age newborns.
Asia Pac J Clin Nutr. 2017;27(4):860-868.doi: 10.6133/apjcn.112017.02
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Vitamin A nutrition among East Timor refugee children
Author:Marcelino Correia, V.Swetha E Jeganathan, Nitin Verma
Keywords:vitamin A deficiency, East Timor, children, refugee, nutrition
Abstract:Background and Objectives: Children age 6 to 72 months, living in refugee camps are at
increased risk of developing vitamin A deficiency (VAD), resulting in increased morbidity
and mortality. Due to poverty, often this population group has limited access to foods
containing vitamin A from animal-based food sources and do not commonly consume
available foods containing beta-carotene. To date, there is a paucity of data on vitamin A
intake in young refugee children. To determine vitamin A intake in children ages 6 to 72
months at refugee camps in East Timor. Methods and Study Design: A cross sectional
study was carried out among children ages 6 to 72 months at refugee camps near Dili, East
Timor. A detailed vitamin A intake questionnaire was ascertained from the primary
caretaker, and the criteria and indicator cut off values suggested by World Health
Organization (WHO) were used to classify the populations’ vitamin A risk. Results:
Although animal sources of vitamin A were limited due to costs, all 89 children commonly
consumed fruit containing vitamin A sources more than 3 times a week. Most children
(69.7%) had been breast fed regularly, while 30.3% combined with bottle milk. 80.9% of
children received vitamin A supplementation. Conclusion: Children in East Timor refugee
camps have adequate vitamin A intake.
Asia Pac J Clin Nutr. 2017;27(4):893-897.doi: 10.6133/apjcn.102017.04
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