Self-monitoring networks for personal and societal health:
Dietary patterns, activities, blood pressure and Covid-19
Author:Mark L Wahlqvist, FRACP, FAFPHM
Keywords:POC (point-of-care), socioecological beings, food security, ecosystem health disorders (EHD), telehealth,
spike protein rapid test
Abstract:The contributors to and consequences of disordered health are increasingly complex with sociodemographic, ecological, economic and food system change. But there are opportunities for any adversity to be mitigated by advances in the understanding of human, especially nutritional, ecobiology and in its more accessible and affordable evaluation and monitoring. Viral pandemics are on the rise with climate change and loss of ecosystems. They
threaten human civilisation and planetary habitability. Human security is dependent on sustainable livelihoods of which food and water systems are a vital part. We are socioecological beings and depend for our health on biodiversity and the food diversity that ensures; and on connectedness and communication, made more difficult in pandemics. Rapid and accessible point-of-care (POC) tools are now becoming available to compliment other selfmonitoring network approaches, whether checklist or questionnaire, physical, chemical, or biological, for healthcare and nutritional health. They can provide information as several complimentary and interdependent
health indices to facilitate personal, group and community action and management plans. This applies to indices of both communicable and non-communicable disease which problems separately and together are compromising health prospects. These indices include ones of physical and mental activities, dietary patterns, metabolites, blood pressure and now the presence and severity of viruses like Covid-19.Of imminent relevance and promise are optically-readable biosensor based strips for nasal, pharyngeal or salivary samples to check viral presence or finger
prick blood for immunoglobulins and interleukins. These should allow less socially prohibitive measures to curb viral transmission and promote personal and societal wellbeing.
Asia Pac J Clin Nutr. 2020;29(3):446-449.doi: 10.6133/apjcn.202009_29(3).0001
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Dietary patterns and anemia morphology in young men
and women in Shandong province, China
Author:Qingxue Deng, Ting Zhao, Chunxiao Liu, Xiaotong Kuang, Jusheng Zheng, Mark L Wahlqvist, Duo Li
Keywords:dietary pattern, anemia, nutrition, alcohol, menstruation
Abstract:Background and Objectives: The association between diet and macrocytic and hypochromic anemia in young Chinese men and women remains unclear. The present study aimed to investigate the relationship between dietary
pattern and macrocytic and hypochromic microcytic anemia in young Chinese men and women. Methods and Study Design: Some 4,840 first-year students (2,385 men and 2,455 women) were recruited for this study from
Qingdao University, China. Biochemical and hematological parameters, and food frequency questionnaires were obtained from the subjects. Based on dietary intake, participants were divided into three dietary patterns: seafood dietary pattern (SDP), vegan dietary pattern (VDP) and omnivorous dietary pattern (ODP). The risks for macrocytic and microcytic hypochromic anemia in three dietary patterns were assessed. Results: Macrocytic and hypochromic anemia were less common in participants who adhered to the omnivorous dietary pattern than to the vegan or seafood dietary patterns (p<0.05). Adhering to an omnivorous dietary pattern was negatively associated with macrocytic anemia in men [odds ratio (95% CI): 0.74 (0.62, 0.89), p<0.001] and microcytic, hypochromic anemia in both genders [men: odds ratio (95% CI): 0.64 (0.45, 0.92), p=0.01; women: odds ratio (95% CI): 0.71 (0.51, 0.99), p=0.04]. Conclusions: Adhering to an omnivorous dietary pattern was associated with less common macrocytic anemia in young men and microcytic, hypochromic anemia. Dietary diversity is important in preventing macrocytic anemia in men and also microcytic, hypochromic anemia in young men and women. Excessive alcohol intake is the most plausible explanation for macrocytosis in the young men.
Asia Pac J Clin Nutr. 2020;29(3):513-522.doi: 10.6133/apjcn.202009_29(3).0010
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The effects of palm oil on serum lipid profiles:
A systematic review and meta-analysis
Author:Muhammad Danish Badrul Hisham, Zoriah Aziz BPharm, MApp. Stats,
Weng Kit Huin, Chi Haur Teoh, Amira Hajirah Abd Jamil
Keywords:palm oil, saturated fatty acid, unsaturated fatty acid, lipid levels, meta-analysis
Abstract:Background and Objectives: Current guidelines recommend reducing intake of diets rich in saturated fats and replacing it with diets rich in unsaturated fats. Palm oil contains a high amount of saturated fatty acids, but its effect on serum lipid levels is unclear. The study aimed to compare the effects of palm oil consumption with other edible oils rich in monounsaturated fatty acids (MUFAs) and polyunsaturated fatty acids (PUFAs) on serum lipid profiles. Methods and Study Design: We searched Medline, Embase, Cochrane Central Registry of Controlled Trials and CINAHL. Clinical trials were eligible if they compared palm oil-rich diets with diets rich in MUFAs or PUFAs. We pooled results of included studies using a random effects model and assessed the quality of the evidence and certainty of conclusions using the GRADE approach. Results: Intake of palm oil intake compared to oils rich in MUFA was associated with increased levels of total cholesterol (TC) [mean difference (MD)=0.27
mmol/L; 95% CI 0.08 to 0.45], LDL-C (MD=0.20 mmol/L; 95% CI 0.02 to 0.37) and HDL-C (MD=0.06 mmol/L; 95% CI 0.02 to 0.10). Similarly, for comparison with oils rich in PUFAs, palm oil showed increased in TC
(MD=0.38 mmol/L; 95% CI 0.14 to 0.62), LDL-C (MD= 0.44 mmol/L; 95% CI 0.01 to 0.88) and HDL-C (MD=0.08 mmol/L; 95% CI 0.03 to 0.13). For both comparisons, there were no significant effects on triglycerides. Conclusions: Even though palm oil increases marginally the level of serum lipids, the evidence is mostly of low to moderate quality.
Asia Pac J Clin Nutr. 2020;29(3):523-536.doi: 10.6133/apjcn.202009_29(3).0011
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Dietary saturated fats and apolipoprotein B48 levels are
similarly associated with cognitive decline in healthy
older aged Australians
Author:Mason Hill, Ryusuke Takechi, Devahuti Rai Chaliha,
Keywords:Alzheimer’s disease, apolipoprotein B, cognitive performance, dementia, saturated fatty acids
Abstract:Background and Objectives: As the incidence and prevalence of Alzheimer’s disease increases, so does the body of epidemiological and clinical research that suggests a relationship between dietary fatty acids, in particular saturates, and cognitive decline. In this study, we investigated the association between serum apolipoprotein B48 (apoB48), saturated fatty acid intake and consumption behaviour, and cognitive performance, in healthy, older aged Australians. Methods and Study Design: We retrospectively analysed fasted serum apoB48 concentrations,
food frequency questionnaire, and cognitive performance data collected from 147 participants (98F|49M) over the age of 50. We used Spearman’s correlations and a nested domain model to evaluate the relationship between serum apoB48, dietary behaviour and measures of cognitive performance. Results: Overall, we found that higher fasted apoB48 concentrations, and/or dietary behaviours which led to increased dietary consumption of diets high
in saturated fatty acids, were inversely associated with cognition. Interestingly however, dietary behaviour patterns of saturated fatty acid consumption and serum apoB48 were linked with better secondary memory and perceptual speed, respectively. Conclusions: This is the first time that fasted apoB48 has been implicated as a biomarker for cognitive decline and Alzheimer’s disease risk.
Asia Pac J Clin Nutr. 2020;29(3):537-544.doi: 10.6133/apjcn.202009_29(3).0012
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Interpersonal communication campaign promoting
knowledge, attitude, intention, and consumption of iron
folic acid tablets and iron rich foods among pregnant
Indonesian women
Author:Emily Gamboa , Eliza Broadbent, Noyra Quintana, Sarah Callaway , Paola Donoso, Mary Linehan, Lindawati Wibowo, Otte Santika, Josh H West, P. Cougar Hall, Benjamin T Crookston
Keywords:stunting, maternal, iron, IFA, Indonesia
Abstract:Background and Objectives: Indonesia’s community health delivery system offers services such as prenatal care and supplementation. Despite accessibility to these services, compliance with supplementation is low, and childhood stunting rates remain high. To address undernutrition, a National Nutrition Communication Campaign (NNCC) – using interpersonal communication (IPC) strategies – was implemented to promote consumption of
iron-folic acid (IFA) supplements and iron-rich foods (ATIKA). The purpose of this study was to understand how participation in IPC activities influenced knowledge, attitude/intention, and consumption of IFA supplements and ATIKA among pregnant Indonesian women. Methods and Study Design: Cross-sectional data came from 766 pregnant women that participated in a survey that was based on the constructs from the Theory of Planned Behavior and Health Belief Model. Adjusted linear and logistic regression models were conducted to analyze the differences between self-reported IPC participants and non-IPC participants. Approximately 20% of women were exposed to the IFA portion of the IPC campaign, and 18% were exposed to the ATIKA portion. Results: Women that were exposed to the campaign reported significantly higher knowledge of IFA tablets and ATIKA, and improved attitudes/intentions towards IFA, compared to non-exposed women. Exposure was not associated with actual consumption behaviors. Conclusions: These findings suggest that exposure to a low-intensity intervention can increase knowledge but may not be sufficient to impact behavior. As such, future efforts to reduce stunting through improved maternal nutrition should seek to increase exposure, address barriers, understand perceived susceptibility, and improve self-efficacy in order to expand intervention reach in Indonesia.
Asia Pac J Clin Nutr. 2020;29(3):545-551.doi: 10.6133/apjcn.202009_29(3).0013
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Very low birth weight preterm infant complications
where parenteral nutrition is soy or fish oil-based: A
retrospective study in Shanghai
Author:Tian Qian, Rong Zhang, Li Zhu, Chao Chen,Yun Cao, Jin Wang
Keywords:very low birth weight infants, fish oil, cholestasis, retinopathy of prematurity, bronchopulmonary
dysplasia
Abstract:Background and Objectives: To examine whether a parenteral mixed lipid emulsion containing fish oil reduces the incidence of cholestasis, retinopathy of prematurity (ROP) and bronchopulmonary dysplasia (BPD) in very low birth weight (VLBW, birth weight <1500 g) infants. Methods and Study Design: This retrospective study was conducted in the neonatal intensive care unit of the Children’s Hospital of Fudan University. Patients received either a soybean and medium-chain oil (MCT)-based lipid emulsion (Lipofundin) or a mixed lipid emulsion consisting of soybean oil, medium-chain triglycerides, olive oil, and fish oil (SMOF) as parenteral nutrition.
The primary outcomes were cholestasis, ROP and BPD, and the secondary outcomes were necrotizing enterocolitis (NEC) and sepsis. Results: A total of 149 premature infants (78 in the soybean oil group and 71 in the fish oil group) were included in this study. Multivariate logistic regression analysis showed that gestational age was associated with the incidence of ROP [odds ratio: 0.446, 95% confidence interval (CI): 0.332-0.576, p<0.001] and BPD [odds ratio: 0.428, 95% CI: 0.316-0.555, p<0.001]. The type of lipid emulsion had no statistically significant effect on any other neonatal morbidity. Conclusions: Both fish oil-containing and soybean oil-based parenteral lipid emulsions are safe and well-tolerated by preterm infants. However, the use of the SMOF lipid emulsion did not significantly reduce the incidence of cholestasis, ROP and BPD in VLBW infants.
Asia Pac J Clin Nutr. 2020;29(3):552-557.doi: 10.6133/apjcn.202009_29(3).0014
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Effects of rapid growth in early childhood on metabolic
and cardiovascular diseases among preschool-aged
children
Author:Nan Li, Shuang Zhang, Jun-Hong Leng, Wei-Qin Li, Lei-Shen, Wang, Wei Li, Hui-Kun Liu, Yue-Xin Du, Rong-Xiu Zheng
Keywords:rapid growth, obesity, blood pressure, children
Abstract:Background and Objectives: To investigate whether the tempo of weight gain of children during infancy (from birth up to two years of age) or childhood (between two and five years old) is associated with metabolic and cardiovascular disease. Methods and Study Design: Cluster sampling was employed to obtain a random sample of preschool children. In total, 1450 children aged five to six years participated in this survey. We obtained data on body weight, height, blood pressure (BP), and serum levels of total cholesterol, triglycerides, glucose, and uric acid, as well as anthropometry at birth and at age 2. Results: The prevalence of obesity at five years old was 14.5%. At five years of age, children with rapid growth (change in body mass index, BMI z-score >0.67) during infancy had a higher odds ratio (OR) of childhood obesity (OR: 2.97 [95% CI: 2.15–4.11]) compared to children with non-rapid growth (change in BMI z-score ≤0.67). Also, children with rapid growth during childhood had a higher OR of childhood obesity (OR: 17.90 [95% CI: 12.31–26.04]), higher systolic BP (OR: 2.38 [95% CI: 1.68–3.39]), higher diastolic BP (OR: 2.42 [95% CI: 1.53–3.83]), and higher triglycerides (OR: 4.09 [95% CI: 1.47–11.33]) or hyperuricemia (OR: 2.23 [95% CI: 1.51–3.29]). Conclusions: Rapid growth in early childhood is associated with risk factors for both cardiovascular outcomes and metabolic outcomes among preschool children.
Developing effective prevention and intervention programs for pre-school children might be important to reduce incidence of long-term metabolic and cardiovascular disease as adults.
Asia Pac J Clin Nutr. 2020;29(3):558-565.doi: 10.6133/apjcn.202009_29(3).0015
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Vitamin A status and recurrent respiratory infection among Chinese children: a nationally representative survey
Author:Yixin Zhang, Zifang Du, Wenbo Ma, Keliang Chang, Chunmei Zheng
Keywords:vitamin A, distribution, deficiency, children, China
Abstract:Background and Objectives: Vitamin A is involved in immune function, vision, reproduction, and cell differentiation and is essential for child growth. Vitamin A deficiency (VAD) contributes significantly to mortality and morbidity in developing countries. This study assessed the current vitamin A status in Chinese children. Methods and Study Design: A cross-sectional survey was conducted in 26 provinces in China between 2015 and 2018, and 277,064 children aged 0–14 years were enrolled. Data on sociodemographic factors and dietary supplements were obtained through interviews with their parents. Serum vitamin A concentrations were measured using HPLC. To reduce the sampling error, a weighted distribution was produced to estimate the distribution of serum vitamin A concentration in Chinese children. A new method was used calculate the CI. Results: The results revealed that 10.4% (23.9 million) (95% CI: 10.1%–10.8%) of Chinese children aged 0–14 years were at risk of suffering from
subclinical VAD (SVAD) (<0.2 mg/L). Sick children, especially those with recurrent respiratory infections (21.3%, 95% CI: 20.5%–22.2%), were vulnerable to SVAD. A high prevalence of SVAD was observed in western and
northeastern areas in China. Serum vitamin A concentrations in ethnic minority groups were significantly lower than those in Han Chinese children (p<0.01). Conclusions: VAD is still a moderate public health problem in Chinese children, especially in those with respiratory symptoms. Regular consumption of vitamin A–rich foods should be promoted through nutrition education for parents.
Asia Pac J Clin Nutr. 2020;29(3):566-576.doi: 10.6133/apjcn.202009_29(3).0016
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Improving the iron status of school children through a
school noon meal programme with meals prepared using
a multiple micronutrient–fortified salt in Tamil Nadu,
India
Author:Malavika Vinod Kumar and Juergen Erhardt
Keywords:multiple micronutrient–fortified salt, school meals, transferrin receptor, total body iron stores, iron deficiency
Abstract:Background and Objectives: To improve the iron status of school children through noon meals prepared using a multiple micronutrient–fortified salt. Methods and Study Design: Children from a randomly selected school
who consumed (intervention) and did not consume (reference) a noon meal prepared using a multiple micronutrient–fortified salt were studied over 1 year. A pre–post-test design for children aged 5–17years in reference
(n=100) and intervention (n=128) groups was used. Levels of serum ferritin, soluble transferrin receptor (sTfR), alpha glycoprotein (AGP), and C-reactive protein (CRP) were assessed at baseline and at 1 year. In a subsample, urinary iodine was assessed. Results: sTfR decreased in the intervention group (−0.80 mg/L) but increased in the reference group (0.47 mg/L) at 1 year (p=0.0001).Body iron stores (BIS) increased in the intervention group (0.09 mg/kg body weight) and decreased (−0.58 mg/kg body weight) in the reference group at 1 year (p=0.028).These findings indicate an increase in iron deficiency in the reference group and a decrease in the intervention group.
However, no changes in serum ferritin and urinary iodine were observed in either group or between groups. Conclusions: Iron status can be improved in schoolchildren in Tamil Nadu by increasing the amount of micronutrients in the fortified salt used for preparing noon-time school meals.
Asia Pac J Clin Nutr. 2020;29(3):577-583.doi: 10.6133/apjcn.202009_29(3).0017
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Toddler neurodevelopment is associated with
ganglioside intake but not serum ganglioside
Author:Shengjie Tan, Ai Zhao, Jian Zhang, Pin Li, Chang Chen,Yumei Zhang
Keywords:dietary gangliosides, neurodevelopment, serum gangliosides, food intake, HPLC-MS
Abstract:Background and Objectives: Gangliosides (GAs) are important components of neural tissue and cell membrane.
This study aims to investigate the association between toddlers’ neurodevelopment, dietary GA intake, and serum
GA concentration. Methods and Study Design: A cross-sectional study was conducted in Beijing and Xuchang, Henan Province in China. 110 eligible healthy toddlers aged 24–48 months were recruited. Food frequency questionnaire (FFQ) and 24-h dietary recall were used to collect dietary information. Blood serum samples obtained from participants were used to perform GA composition analysis with high-performance liquid chromatographymass spectrometry (HPLC–MS). The neurodevelopment level was assessed with the Gesell Developmental Scale (GDS). Results: Dietary ganglioside GD3, total GA, and seafood intake were identified to be associated with the gross motor developmental quotient (DQ). An inverse association was revealed between the fine motor DQ and fruit intake. No correlation was detected between serum GA concentration and DQ. Conclusions: Dietary GA intake but not serum GA concentration is associated with neurodevelopment. Further prospective studies are needed to probe the relationships between the recommended dietary GA intake and toddlers.
Asia Pac J Clin Nutr. 2020;29(3):584-592.doi: 10.6133/apjcn.202009_29(3).0018
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Iron status is linked to disease severity after avian
influenza virus H7N9 infection
Author:Hailong Wang, Xiaopeng Wu, Xiaoxin Wu, Juan Liu, Yan Yan, Fudi Wang , Lanjuan Li, Jiyong Zhou, Min Liao
Keywords:H7N9, influenza, iron, ferritin, outcomes
Abstract:Background and Objectives: The high mortality rate of H7N9 strain of avian influenza virus (AIV) infected patients has been a major clinical concern. Iron overload increases the susceptibility of host for several kinds of microbial infection. However, the study on patients’ iron and ferritin status associated with clinical outcome of AIVH7N9 virus infection is poorly understood, and in order to explain the linkage we carried out this study. Methods and Study Design: We retrospectively collected serum from 46 patients infected with H7N9 virus from the hospital in Hangzhou city, Zhejiang province of China in 2013. We measured the level of serum iron and ferritin by Enzyme-Linked Immunosorbent Assay (ELISA). The correlation analysis of iron and ferritin with disease severity was done by SPSS 16.0 and MedCalc Software. Results: After H7N9 infection, there is a reduction in iron level and an increase in ferritin, hepcidin and C-reactive protein (CRP) level in patient’s serum compared to those of the control (p<0.001), and there’s little correlation between procalcitonin (PCT) level and H7N9 infection. At week 1 and week 2 post-infection, serum iron level is much lower and ferritin level is much higher in the patients who died later than those in the patients who survived. The sensitivity, specificity, and Area Under the Curve (AUC) of the assay was calculated with MedCalc software and they were 85.5%, 65.9% and 0.803 for iron and 84.9%, 80.7% and 0.900 for ferritin, 95.2%, 51.1% and 0.684 for PCT and 100%, 94.6% and 0.988 for CRP, respectively. Conclusions: Our study found that low serum iron and high serum ferritin levels are correlated with the disease severity of H7N9-infected patients and can predict fatal outcomes.
Asia Pac J Clin Nutr. 2020;29(3):593-602.doi: 10.6133/apjcn.202009_29(3).0019
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Implications of protein malnutrition and inflammatory
disorders in the pathophysiology of Alzheimer’s disease
Author:Yves Ingenbleek
Keywords:lean body mass, malnutrition, inflammation, transthyretin, homocysteine
Abstract:Lean body mass (LBM) agglomerates the bulk of nitrogen (N)-containing molecules following well-identified age and sex evolutionary patterns best appraised in clinical practice using the serial measurement of plasma transthyretin (TTR). Methionine (Met), the sole essential amino acid bearing a sulfur (S) atom, presides at the initiation of protein synthesis while maintaining stable body tissue S:N molar ratios of approximately 1:14.5. In protein-depleted states, N- and Met-deficiencies operate as limiting factors for LBM protein synthesis and accretion,
causing growth retardation and subnormal TTR plasma values. In inflammatory disorders, LBM is subjected to cytokine-induced tissue breakdown reflecting the S:N ratio found in healthy tissues whereas the liver secretion of
TTR declines in proportion. Both malnutrition and inflammation are characterized by stepwise LBM downsizing and reduced bioavailability of Met body stores setting in motion molecular mechanisms safeguarding Met homeostasis at the expense of augmented homocysteine (Hcy) values in biological fluids. Divergent TTR and Hcy alterations indicate that rising Hcy values measured in plasma and cerebrospinal fluid should be regarded as the dark side of efficient compensatory processes. As a result, the neuroprotective activities normally exerted by TTR are weakened, whereas the oxidative burden generated by supranormal Hcy concentrations are strengthened. The combination of protein malnutrition and inflammatory disorders of any cause maximizes the risk of incurable neurodegenerative effects.
Asia Pac J Clin Nutr. 2020;29(3):450-461.doi: 110.6133/apjcn.202009_29(3).0002
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Potential role of iodine excess in papillary thyroid
cancer and benign thyroid tumor: A case–control study
Author:Dawei Hou, Haie Xu, Pan Li, Jianhui Liu, Zhuyin Qian
Keywords:thyroid cancer, papillary thyroid cancer, urinary iodine concentrations, Nanjing, thyroglobulin antibody
Abstract:Background and Objectives: The relationship between nutritional status of iodine and thyroid tumor is unclear.
We investigated the association between urinary iodine concentration and thyroid function in patients with papillary thyroid cancer, benign thyroid tumor and healthy individuals. Methods and Study Design: We compared
the biomarkers of thyroid function and urinary iodine concentration within and between each group. A regression analysis was used to identify risk factors for papillary thyroid cancer. Correlation analysis was performed to determine whether any significant correlation exists between urinary iodine concentration and thyroid function biomarkers. Results: The iodine nutrition statuses of these three groups were adequate (median urinary iodine concentration=100–199 μg/L). However, the median urinary iodine concentration of papillary thyroid cancer (174.7 μg/L) and benign thyroid tumor (165.04 μg/L) groups was significantly higher than that of the healthy control group (135.8 μg/L) (p<0.05). The regression analysis showed that thyroglobulin antibody was an independent risk factor for papillary thyroid cancer. After adjusting for age and gender, the association between thyroglobulin antibody and urinary iodine concentration was significant (β: 0.002; p<0.05). In subgroup analyses, significant correlations was noted only in the papillary thyroid cancer group (adjusted β: 0.002; 95% confidence interval: 0.000–0.003). Conclusions: Excessive iodine in patients with thyroid tumors may affect thyroglobulin antibody, which may be an independent risk factor for papillary thyroid cancer.
Asia Pac J Clin Nutr. 2020;29(3):603-608.doi: 10.6133/apjcn.202009_29(3).0020
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Dietary and nutritional factors associated with
hyperuricemia: The seventh Korean National Health
and Nutrition Examination Survey
Author:Min Wook So, Doo-Ho Lim, Seong-Ho Kim and Sunggun
Keywords:hyperuricemia, gout, dietary fiber, vitamin C, alcohol, hypertension
Abstract:Background and Objectives: The association of dietary and nutritional factors with hyperuricemia and gout is well-known in Western populations. The present study aimed to examine the association of dietary and nutritional factors with hyperuricemia among Korean adults. Methods and Study Design: This cross-sectional study included 10,175 participants from the seventh Korean National Health and Nutrition Examination Survey 2016-2017. Dietary information was collected using a single 24-hour recall method, and nutritional information was derived from the 9th Korean Food Composition Table. The associations between serum uric acid and intake of meat, seafoods, nuts, and legumes, sugar-sweetened products, dairy products, alcohol, sodium, vitamin A, vitamin B1, vitamin C, and dietary fiber were analyzed using linear regression analysis adjusting for confounding variables. The association with hyperuricemia was analyzed using logistic regression analysis. All analyses were weighted by the sampling design. Results: Alcohol intake was associated with serum uric acid in both men and women. In men, the highest quartile of alcohol intake was associated with a 1.5-times higher prevalence of hyperuricemia (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.16–1.95), while vitamin C and dietary fiber intakes were found to be inversely associated with hyperuricemia. For vitamin C and dietary fiber intake, the ORs for a quartile increase were 0.93 (95% CI 0.86–0.99) and 0.92 (95% CI 0.85–0.99), respectively. Conclusions: The associations between vitamin C, dietary fiber and alcohol intakes and hyperuricemia in men support the Dietary Approach to Stop Hypertension (DASH)-based approach and attention to alcohol intake for managing hyperuricemia in Korean men.
Asia Pac J Clin Nutr. 2020;29(3):609-617.doi: 10.6133/apjcn.202009_29(3).0021
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Urine iodine level and multiple risks are associated with
thyroid structural abnormalities among adults in
Heilongjiang Province, China
Author:Jinlai Yao, Min Guo, Huaiqiu Cai, Xiaohui Shao, Xiaoqiu Dong
Keywords:thyroid ultrasound, epidemiology, independent risk factor, urine iodine, universal salt iodization
Abstract:Background and Objectives: The prevalence of adult thyroid structural abnormalities has increased significantly worldwide. However, no study has examined the thyroid structure and urine iodine levels of adults in Heilongjiang Province in the last decade. Therefore, this study aims to investigate the rate and risk factors of thyroid structural abnormalities among the residents of this province. Methods and Study Design: A probability proportional sampling method was used, and a total of 3,645 individuals in Heilongjiang Province were included. The subjects was asked to complete a thyroid ultrasound and fill out a questionnaire. Furthermore, urine iodine levels and salt iodine content were determined, and multivariate logistic regression was used to identify the independent
risk factors for thyroid diseases. Results: The prevalence of thyroid structural abnormalities in Heilongjiang Province was 56.0%. Univariate analysis showed that there were significant differences between the structural abnormalities group and the normal thyroid group in terms of sex, age, body mass index, hypertension, diabetes, smoking, alcohol consumption, frequency of seafood consumption and pickled food consumption, employment status, and urine iodine level (p<0.05). Multivariate analysis showed that the following were independent risk factors of thyroid disease: female, increased age, hypertension, diabetes, cigarette smoking frequent seafood consumption, employment, and urine iodine levels. Conclusions: The prevalence of thyroid structural abnormalities in adults in Heilongjiang Province was relatively high. Therefore, to help prevent the occurrence of thyroid disease in adults in Heilongjiang Province, the risk factors of thyroid structural abnormalities should be better understood.
Asia Pac J Clin Nutr. 2020;29(3):618-627.doi: 10.6133/apjcn.202009_29(3).0022
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Dietary diversity and physical activity associations with
lipid indices among Beijingese: A cross-sectional study
Author:Qiao Guo, Zuchang Ma, Changan Zhu, Qiang Zeng
Keywords:dietary diversity, physical activity level, lipid-related indices, Beijingers, cross-sectional study
Abstract:Background and Objectives: To examine the association of dietary diversity and physical activity with lipidrelated indices in a Beijing population. Methods and Study Design: This cross-sectional study included 21,472
participants (72.3% men) aged 16 to 78 years. Data were obtained through a physical examination that included anthropometric measurements, biochemical tests, and questionnaires. The dietary diversity score (0-8) was calculated according to the baseline consumption frequencies of eight food groups (cereals, fruits, vegetables, meat, eggs, fish, dairy, and legumes). Physical activity level was classified as low, moderate, or high according to International Physical Activity Questionnaire scoring protocol. Abnormalities in lipid-related indices were assessed using the criteria of the National Cholesterol Education Program Adult Treatment Panel III guidelines. Results:
Compared with individuals with poor dietary diversity (score 0–5), higher dietary diversity was associated with
lower risk of abnormal levels of triglycerides and high-density lipoprotein cholesterol. Dairy intake was associated with a lower risk of having a high triglyceride–to–high-density lipoprotein cholesterol ratio after adjusting for potential covariates. Participants with the lowest risk of abnormal lipid profiles were those who had high levels of physical activity. Conclusions: Dietary diversity and physical activity level were associated with lipid-related indices. Therefore, to maintain healthy lipid profiles in the general population, improving dietary diversity and physical activity is essential.
Asia Pac J Clin Nutr. 2020;29(3):628-637.doi: 10.6133/apjcn.202009_29(3).0023
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Iron deficiency and risk factors in pre-menopausal
females living in Auckland, New Zealand
Author:Kimberley Lim, Kathryn Louise Beck, Pamela Ruth Von Hurst, Kay Jenice Rutherfurd-Markwick, Claire Evelyn Badenhorst
Keywords:iron insufficiency, hepcidin, inflammation, diet, ethnicity
Abstract:Background and Objectives: Iron deficiency is prevalent in New Zealand, with low dietary haem intake and blood loss previously identified as risk factors. However, the influence of the hormone hepcidin on iron status has
not been investigated. Methods and Study Design: Females (n=170) aged 18-45 residing in Auckland participated in a cross-sectional study. Iron status and inflammation were assessed with serum biomarkers including; serum ferritin, haemoglobin, soluble transferrin receptor, hepcidin, C-reactive protein and interleukin-6. Lifestyle factors were assessed using a series of validated questionnaires, including an iron food frequency questionnaire.
Potential determinants of serum ferritin were identified using multiple linear regression analysis. Results: Iron
insufficiency was confirmed in 55.8% of participants (Serum ferritin <30 µg·L-1). Hepcidin levels were higher in those who were iron sufficient (Serum ferritin ≥30 µg·L-1) (6.62 nM vs 1.17 nM, p<0.001). South Asian females had higher hepcidin (8.78 nM) levels, compared to New Zealand Europeans (6.28 nM) (p=0.018), a result likely due to South Asians presenting with higher interleukin-6 (1.66 vs 0.63 pg·mL-1, p<0.001). Hepcidin (β=0.082, p<0.001) and frequency of meat intake (β=0.058, p=0.001) were identified as significant predictors of serum ferritin in New Zealand Europeans, while hepcidin was the only identified predictor in South Asians (β=0.138, p<0.001) and those of other ethnicities (β=0.117, p<0.002). Conclusions: This is the first study in New Zealand to show that hepcidin levels strongly predict serum ferritin in premenopausal females. Additionally, frequency of meat intake appears to be an important determinant of iron status in New Zealand Europeans.
Asia Pac J Clin Nutr. 2020;29(3):638-647.doi: 10.6133/apjcn.202009_29(3).0024
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Does vitamin D affect sarcopenia with insulin resistance
in aging?
Author:Yang Du, Chorong Oh, Jaekyung No
Keywords:vitamin D, insulin resistance, sarcopenia, meta-analysis, muscle
Abstract:There are many studies investigating nutritional factors that affect both sarcopenia and muscle formation. According to extensive research, protein has an essential role in muscle formation. More recently, vitamin D has
emerged as an important factor that regulates muscle metabolism. However, studies and research of association between 25-Hydroxyvitamin D (25(OH)D) status and components of homeostasis model assessment of insulin
resistance (HOMA-IR) in older are limited. Nineteen studies were found through a search of electronic databases and were subjected to a meta-analysis to investigate the differences in serum levels of 25(OH)D and HOMA-IR between patients with controls and sarcopenia. The random-effects standardized mean difference (SD) and 95% confidence interval (CI) were calculated as the effect size. Nineteen studies with 19,528 participants (5,081 with sarcopenia and 14,447 without) were analyzed. Sarcopenic participants had significantly lower serum levels of 25(OH)D (SD =1.163; 95% CI 0.514, 1.812; p<0.001; I2=99.652%) and HOMA-IR (SD=-2.040; 95% CI -3.376, -0.705; p<0.005; I2=99.837%) than controls. It has been reiterated that sarcopenia may be related serum levels of 25(OH)D and HOMA-IR. This relationship needs to be clarified by future longitudinal studies.
Asia Pac J Clin Nutr. 2020;29(3):648-656.doi: 10.6133/apjcn.202009_29(3).0025
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Vitamin D binding protein gene polymorphisms in
ulcerative colitis among those of Han Chinese ancestry:
Pathogenetic, diagnostic and management implications
Author:Fubin Qiu, Lijuan Zhang, Jing Wang, Rui Li, Linxue Yang
Keywords:ulcerative colitis, vitamin D, vitamin D binding protein, gene polymorphisms, Han Chinese
Abstract:Background and Objectives: Vitamin D deficiency has been reported in patients with ulcerative colitis, and polymorphism in the gene encoding the vitamin D binding protein can affect the characteristics of vitamin D
binding protein, thus affecting the level and function of vitamin D in vivo. Previous studies have rarely reported on the potential relationship between vitamin D binding protein polymorphisms and ulcerative colitis. The objective of this study is to investigate the associations between genetic variants in vitamin D binding protein genes and ulcerative colitis susceptibility in the Han Chinese population. Methods and Study Design: In this casecontrol study, the genotyping of vitamin D binding protein rs4588 and rs7041 polymorphisms was conducted using polymerase chain reaction-ligase detection reactions, genotypes were detected by polymerase chain reactionligase fragment length polymorphism. We also measured inflammatory factors, oxidation and antioxidant indicators. Results: There was no significant difference in the distribution of two loci genotypes, alleles and haplotypes between the two groups (p>0.05). However, the differences in the distribution of serum MDA in different haplotypes in the case group were statistically significant (p=0.014): CG>, CT>AT. Conclusions: Our results suggest that polymorphism of these two sites (rs4588 and rs7401) in the vitamin D binding protein gene may have no correlation with susceptibility to ulcerative colitis in the Han Chinese population. But, interestingly, haplotype GC may affect the level of oxidative stress in ulcerative colitis patients, especially the level of malondialdehyde.
Asia Pac J Clin Nutr. 2020;29(3):657-666.doi: 10.6133/apjcn.202009_29(3).0026
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Improved nutritional support with immune-modulating
formula in patients with head and neck and esophageal
cancer undergoing radiochemotherapy: A retrospective
clinical study
Author:Pei-Chun Chao, Frank Cheau-Feng Lin
Keywords:immune-modulating enteral nutrition, standard enteral nutrition, radiochemotherapy, nutritional risk index, head and neck and esophageal cancer
Abstract:Background and Objectives: Malnutrition is frequent in patients with head and neck (HN) and esophageal cancer, aggravated by radiochemotherapy (RCT), and increases morbidity and mortality and treatment toxicity. Recent studies suggest that the immune, nutritional, or inflammatory status can be modulated by the use of pharmaconutrients in RCT-treated patients. In this study, the effect of immunonutrition, including arginine, ω-3 fatty acid,
and nucleotide enriched diet, on nutritional status in patients with HN or esophageal cancer undergoing RCT was investigated. Methods and Study Design: A retrospective review of 88 patients undergoing RCT was conducted.
Either an immune-modulating enteral nutrition (IEN) (Impact formula) or a standard enteral nutrition (SEN) (isonitrogenous and isoenergetic formula) was administered. Anthropometric parameters, nutritional risk index
(NRI), serum albumin, and functional capacity were recorded at the beginning and end of the RCT. Results: Approximately 45% of patients were moderate to severely malnourished (NRI <97.5) at the beginning of the RCT in the SEN (n=19) and IEN (n=21) groups alike. Significant improvement was observed in the NRI of malnourished patients of the IEN group (97.3±11.9 vs 98.0±12.0, p=0.021). Additionally, a significant difference in the body
weight (BW) between the two groups was observed, and BW increased (65.4±14.8 kg vs 66.3±14.3 kg, p=0.03) in the IEM group but decreased (62.3±12.3 kg vs 61.7±12.0 kg, p=0.023) in the SEM group. Conclusions: Pharmaconutrient-enriched IEN had a more potent effect than SEN in preventing deterioration of nutritional status during RCT.
Asia Pac J Clin Nutr. 2020;29(3):462-468.doi: 10.6133/apjcn.202009_29(3).0003
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Does early postoperative enteral ecoimmunonutrition
enhance intestinal function in gastric cancer?
Author:Rui Xu, Shuomeng Xiao, Zhi Ding , Ping Zhao
Keywords:gastric cancer, ecoimmunonutrition, enteral nutrition, early nutrition support, surgery
Abstract:Background and Objectives: We assessed the effect of enteral ecoimmunonutrition (enteral nutrition involving probiotics and immune nutrients) on gastric cancer in the postoperative period. Methods and Study Design: In total, 60 patients with gastric cancer were randomized into an enteral ecoimmunonutrition group or an enteral nutrition group. Information on postoperative complications; hospitalization length; time to first bowel movement and first flatus; and differences between preoperative and postoperative nutritional status, inflammatory reactions, and immune function was collected. Results: No significant between-group differences in nutritional status and complications were observed. C-reactive protein concentrations were lower in the enteral ecoimmunonutrition group than in the enteral nutrition group on postoperative day 7 (p<0.001) and CD4+
concentrations were significantly higher (p=0.01). The enteral ecoimmunonutrition group had a significantly shorter time to first flatus than the enteral nutrition group (p=0.03). Conclusions: Early postoperative enteral ecoimmunonutrition significantly improved immune function, reduced inflammatory responses, and promoted intestinal function recovery in patients with gastric cancer undergoing gastrectomy.
Asia Pac J Clin Nutr. 2020;29(3):469-475.doi: 10.6133/apjcn.202009_29(3).0004
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Association of ABC (HbA1c, blood pressure and
LDL-cholesterol) goal achievement with visit-to-visit
ABC variability and postprandial dysmetabolism in type
2 diabetic patients
Author:Kaori Kitaoka, Akiko Takenouchi, Satomi Minato-Inokawa, Mika Takeuchi,Ayaka Tsuboi, Miki Kurata , Keisuke Fukuo , Tsutomu Kazumi
Keywords:visit-to-visit variability, HbA1c, blood pressure, LDL cholesterol, postprandial glycemia, postprandial triglyceridemia
Abstract:Background and Objectives: Although roles of ABC (HbA1c, blood pressure [BP] and LDL-cholesterol) goal attainment on CVD risk outcomes have been well established, it is less studied whether ABC goal attainment associates with ABC variability, non-traditional risk factors. Methods and Study Design: : Intrapersonal mean levels and standard deviation (SD) of HbA1c, BP and LDL-cholesterol, fasting and post-breakfast plasma glucose
(PG) and serum triglyceride (TG) during 12 months were calculated in 168 type 2 diabetes patients (aged 62.3 years, 53.6% men). Associations of ABC goal attainment with non-traditional glycemic, BP and lipid risk factors
were analyzed. Results: Among 168 patients, 92 (54.8%), 91 (54.2%) and 111 (66.1%) patients achieved HbA1C, BP and cholesterol goal, respectively, and 47 (28.0 %), 45 (26.8 %), 63 (37.5 %) and 13 (7.7 %) achieved triplegoal, dual-goal, single-goal and no-goal, respectively. Achieving more ABC goals was associated with stepwise decreases in mean levels and SD of fasting and post-breakfast PG, and HbA1c. It was also associated with stepwise decreases in mean levels and SD of fasting and post-breakfast TG, and LDL-cholesterol. Further, achieving more ABC goals was associated with stepwise decreases in brachial pulse pressure and mean levels and SD of
systolic BP. Conclusions: ABC goal achievement was associated with a broad range of non-traditional glycemic, BP and lipid risk factors in type 2 diabetic patients. Reaching more ABC treatment targets may be important for
reductions in long-term ABC variability and postprandial dysmetabolism.
Asia Pac J Clin Nutr. 2020;29(3):476-482.doi: 10.6133/apjcn.202009_29(3).0005
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Impact of a low-carbohydrate and high-fiber diet on nonalcoholic fatty liver disease
Author:Jie Chen, Yiqin Huang, Hua Xie, Huijing Bai, Guang
Keywords:NAFLD, low-carbohydrate diet, metabolism, inflammation, hepatic fatty infiltration
Abstract:Background and Objectives: To study the effects of a low-carbohydrate and high-fiber diet and education on patients with nonalcoholic fatty liver disease. Methods and Study Design: We randomly divided 44 patients with nonalcoholic fatty liver disease into two groups: low-carbohydrate and high-fiber diet and education (in-tervention group), and education alone (control group). Liver and kidney function, fasting plasma glucose, insulin resistance index, body composition, and controlled attenuation
Asia Pac J Clin Nutr. 2020;29(3):483-490.doi: 10.6133/apjcn.202009_29(3).0006
>>Abstract
Tomato juice preload has a significant impact on
postprandial glucose concentration in healthy women:
A randomized cross-over trial
Author:Yuuki Saito, Ayasa Nitta, Saeko Imai, Shizuo Kajiyama, Takashi Miyawaki, Neiko Ozasa, Shintaro Kajiyama, Yoshitaka Hashimoto, Michiaki Fukui
Keywords:diet, tomato juice, vegetable, postprandial glucose, carbohydrate, diabetes
Abstract:Background and Objectives: Our aim was to evaluate the effect of consuming tomato juice before carbohydrate on postprandial glucose concentrations in healthy women. Methods and Study Design: In this randomized controlled cross-over study, 25 healthy women (age 21.6±3.8 years, HbA1c 5.3±0.2 %, mean±SD) consumed either 200 g of tomato juice, tomato, or water (control) at 30 min before consuming 200 g of boiled white rice at 9:00
and consumed identical lunch at 13:00 for 3 days. The blood glucose concentrations were measured by selfmonitoring blood glucose at 0, 30, 45, 60, 90, 150, and 210 min pre- and post-breakfast, and at 0, 30, 60, 120, 150, and 180 min pre- and post-lunch. The concentration of postprandial glucose, incremental glucose peak (IGP), and incremental area under the curve for glucose after the test meals were compared among 3 days. Results: Incremental blood glucose concentrations at 60 min (2.32±0.16 vs 2.97±0.19 mmol/L, p<0.05, mean±SEM), 90 min (2.36±0.23 vs 3.23±0.24 mmol/L, p<0.01), and IGP (2.77±0.19 vs 3.68±0.22 mmol/L, p<0.001) in consuming tomato juice 30 min before carbohydrate were all significantly lower than those of water, while IGP of consuming tomato was tended to be lower than that of water (2.82±0.19 mmolL, p=0.023). No significant difference was observed in glycaemic parameters after consuming lunch among 3 days. Conclusions: Consuming tomato juice half hour before carbohydrate ameliorates the postprandial blood glucose concentrations, although total amounts of energy and carbohydrate of tomato juice are higher than those of water.
Asia Pac J Clin Nutr. 2020;29(3):491-497.doi: 10.6133/apjcn.202009_29(3).0007
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The effects of eel biscuits on nutritional intake of
hospitalized children
Author:Dewi Marhaeni Diah Herawati, Pratiwi Indraswari, Deni Kurniadi Sunjaya
Keywords:effects, eel biscuits, nutritional intake, hospitalized, children
Abstract:Background and Objectives: Support from fortified food during hospitalization is an important factor to increase nutritional intakes of patients to meet nutritional needs and nutritional status. The objective of the study
was to analyze the effects of eel biscuits on the nutritional intake of sick children. Methods and Study Design:
The study had an experimental post-test design, and included 40 hospitalized children at Dr. Hasan Sadikin Hospital, Bandung, who were selected by consecutive sampling. The inclusion criteria were children aged from 1 to
18 years old who received standard hospital food. The exclusion criteria were patients with fish allergies and
those undergoing special diet therapy. The intervention was conducted for 5 days, in which the intervention group
was given eel biscuits while the control group was given standard hospital snacks. The food intake was assessed
using the food record and 24-hour recall methods. Unpaired t-test and Mann-Whitney test were used in data analysis. Results: There was an increase in nutritional intake from snacks in the intervention group, namely energy
(p<0.001), protein (p<0.001), fat (p<0.001), carbohydrate (p=0.005), zinc (p=0.012), and vitamin A (p=0.046) intake. There was also a positive impact on the main meal intake, especially in protein (p=0.037), fat (p=0.032), and
zinc (p=0.037) intake. Conclusions: Consumption of eel biscuits to hospitalized children could increase their nutrient intake. Eel biscuits could be given as a snack to fulfill the nutritional requirements for sick children.
Asia Pac J Clin Nutr. 2020;29(3):498-504.doi: 10.6133/apjcn.202009_29(3).0008
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Beneficial effects of konjac powder on lipid profile in
schizophrenia with dyslipidemia: A randomized
controlled trial
Author:Lei Zhang, Yong Han, Zhijun Zhao, Xiangqun Liu, Yahui Xu,Guimei Cui,Xiangyang Zhang,Ruiling Zhang
Keywords:konjac powder, schizophrenia, inpatient, dyslipidemia, randomized controlled trial
Abstract:Background and Objectives: Konjac powder has the effect of improving blood lipids in the general population, but there is no research on schizophrenic patients who are susceptible to dyslipidemia. The aim of our study is to
evaluate the effects of konjac powder on blood lipid, glucose levels, body weight, and blood pressure in schizophrenia inpatients with dyslipidemia. Methods and Study Design: After a two-week adaptation period, 76 people with schizophrenia were enrolled in a 30-day double-blind randomized controlled trial. The subjects in the experimental group were given a beverage containing konjac powder 30 minutes before each meal, whereas those in the control group were given a beverage containing resistant maltodextrin. Results: The lipid profile, plasma glucose, blood pressure, and body weight were measured at baseline and at the end of 30-day treatment. Fiftynine subjects completed the study. There was a substantial decrease in total serum cholesterol in the experimental group, but an increase in the control group. Likewise, apolipoprotein B decreased in the experimental group but increased in the control group. Conclusions: We concluded that a diet supplemented with konjac powder may prevent the deterioration of dyslipidemia in people with schizophrenia, demonstrating its potential value in the treatment of metabolic disorders in schizophrenia as a new therapeutic method.
Asia Pac J Clin Nutr. 2020;29(3):505-512.doi: 10.6133/apjcn.202009_29(3).0009
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