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Asia Pacific Journal of Clinical Nutrition
Volume 15, issue 3

(September 2006)



Full papers

Contents

Abstract

Papers

Review Articles
Central obesity and risk of cardiovascular disease in the Asia Pacific Region
ASIA PACIFIC COHORT STUDIES COLLABORATION

Asia Pac J Clin Nutr. 2006;15(3):287-292.


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Original Articles

   

Defining obesity by body mass index in the Thai population: an epidemiologic study
CHATLERT PONGCHAIYAKUL, TUAN V NGUYEN, VONGSVAT KOSULWAT, NIPA ROJROONGWASINKUL, SOMSRI CHAROENKIATKUL, CHOOWONG PONGCHAIYAKUL, PATARA SANCHAISURIYA AND RAJATA RAJATANAVIN

Asia Pac J Clin Nutr. 2006;15(3):293-299.

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Relation of anthropometric parameters to the functional assessment of HDL particle size in three ethnic cohorts
HAMIDREZA ZAKERI, JIRI J FROHLICH AND SCOTT A LEAR

Asia Pac J Clin Nutr. 2006;15(3):300-306.

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Use Of [14C]-sodium bicarbonate/urea to measure total energy expenditure in overweight men and women before and after low calorie diet induced weight loss
NATALIE D LUSCOMBE, CHRISTOPHER TSOPELAS, MAX BELLON, PETER M CLIFTON, IAN KIRKWOOD AND GARY A WITTERT
Asia Pac J Clin Nutr. 2006;15(3):307-316.

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Validity and reliability of BodyGem for measuring resting metabolic rate on Taiwanese women
TSAN-HON LIOU, CHING-MIN CHEN, WAN-YU CHUNG AND NAIN-FENG CHU

Asia Pac J Clin Nutr. 2006;15(3):317-322.

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Nutrition education in medical schools in Japan: results from a questionnaire survey
HIDEO ORIMO, TOSHIRO SHIMURA AND TAKASHI SHIMADA

Asia Pac J Clin Nutr. 2006;15(3):323-328.

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Nutritional status of pregnant women in Northeast Thailand
CHRISTOPH U ANDERT, PATTARA SANCHAISURIYA, KANOKWAN SANCHAISURIYA, FRANK P SCHELP AND FLORIAN J SCHWEIGERT

Asia Pac J Clin Nutr. 2006;15(3):329-334.

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Which mothers take folic acid and folate containing foods?
COLIN BINNS, JANE SCOTT, NKEONYELU NWAFOR, KATHLEEN GRAHAM, WENDY ODDY AND ANDY LEE
Asia Pac J Clin Nutr. 2006;15(3):335-340.

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Dietary and blood folate status of Malaysian women of childbearing age
GEOK LIN KHOR, G DURAISAMY, SU PENG LOH, TIMOTHY J GREEN AND C MURRAY SKEAFF

Asia Pac J Clin Nutr. 2006;15(3):341-349.

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Anaemia and iron deficiency anaemia among young adolescent girls from the peri urban coastal area of Indonesia
YUSTINA ANIE INDRIASTUTI KURNIAWAN, SITI MUSLIMATUN, ENDANG L ACHADI AND
SOEMILAH SASTROAMIDJOJO
Asia Pac J Clin Nutr. 2006;15(3):350-356.

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Goitre prevalence and the state of iodine nutrition in the sundarban delta of north 24-parganas in West Benegal
AMAR K CHANDRA, SMRITIRATAN TRIPATHY, DISHARI GHOSH, ARIJIT DEBNATH AND
SANJUKTA MUKHOPADHYAY

Asia Pac J Clin Nutr. 2006;15(3):357-361.

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Determination of discretionary salt intake in an iodine deficient area of East Java-Indonesia using three different methods ANNASARI MUSTAFA, SITI MUSLIMATUN IR, JULIAWATI UNTORO IR, MARIA CPJ LAN IR AND YOHANES KRISTIANTO

Asia Pac J Clin Nutr. 2006;15(3):362-367.

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Effects of probiotic or prebiotic supplemented milk formulas on fecal microbiota composition of infants
OSCAR BRUNSER, GUILLERMO FIGUEROA, MARTIN GOTTELAND, ELIZABETH HASCHKE-BECHER, CORINE MAGLIOLA, FLORENCE ROCHAT, SYLVIA CRUCHET, RICHARD PALFRAMAN, GLENN GIBSON, FRANÇOISE CHAUFFARD AND FERDINAND HASCHKE

Asia Pac J Clin Nutr. 2006;15(3):368-376.

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A population-based survey on infant feeding practice (0-2 years) in Hong Kong: breastfeeding rate and patterns among 3,161 infants below 6 months old WARREN TK LEE, SUSAN SH LUI, VERONICA CHAN, ERIC WONG AND JOSEPH LAU
Asia Pac J Clin Nutr. 2006;15(3):377-387.

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Diet, nutritional knowledge and health status of urban middle-aged Malaysian women LW PON, MY NOOR-AINI, FB ONG, N ADEEB, SS SERI, K SHAMSUDDIN, AL MOHAMED, N HAPIZAH, A MOKHTAR AND HWH WAN

Asia Pac J Clin Nutr. 2006;15(3):388-399.

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Good oral health, adequate nutrient consumption and family support are associated with a reduced risk of being underweight amongst older Malaysian residents of publicly funded shelter homes
RENUKA VISVANATHAN AND ZAITON AHMAD

Asia Pac J Clin Nutr. 2006;15(3):400-405.

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Structured triglyceride for parenteral nutrition: meta-analysis of randomized controlled trials YONG ZHOU, XIAO-TING WU, NI LI, WEN ZHUANG, GUANJIAN LIU, TAIXIANG WU AND MAO-LING WEI

Asia Pac J Clin Nutr. 2006;15(3):406-411.

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The Glycemic Index of standard and diabetes-specific enteral formulas
ZANDRIE HOFMAN, JENNEKE DE VAN DRUNEN AND HARM KUIPERS
Asia Pac J Clin Nutr. 2006;15(3):412-417.

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Low dose supplementation with two different marine oils does not reduce pro-inflammatory eicosanoids and cytokines in vivo
KAREN J MURPHY, KAREN GALVIN, MAIREAD KIELY, PATRICK A MORRISSEY, NEIL J MANN AND ANDREW J SINCLAIR

Asia Pac J Clin Nutr. 2006;15(3):418-424.

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Evaluation of Rhodiola crenulata and Rhodiola Rosea for management of Type II diabetes and hypertension
YOUNG-IN KWON, HAE-DONG JANG AND KALIDAS SHETTY

Asia Pac J Clin Nutr. 2006;15(3):425-432.

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Potential of cranberry-based herbal synergies for diabetes and hypertension management
EMANOUIL APOSTOLIDIS, YOUNG-IN KWON AND KALIDAS SHETTY

Asia Pac J Clin Nutr. 2006;15(3):433-441.

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Central obesity and risk of cardiovascular disease in the Asia Pacific Region
ASIA PACIFIC COHORT STUDIES COLLABORATION

This paper compares body mass index, waist circumference, hip circumference, and waist-hip ratio as risk factors for ischaemic heart disease and stroke in Asia Pacific populations. We undertook a pooled analysis involving six cohort studies (45 988 participants) and used Cox proportional hazards regression to assess the associations of the four anthropometric indices with stroke and ischaemic heart disease by age, sex and region. During a mean follow-up of six years, 346 stroke and 601 ischaemic heart disease events (fatal and non-fatal) were documented. Overall, a one-standard deviation increase in index was associated with an increase in risk of ischaemic heart disease of 17% (95% CI 7-27%) for body mass index, 27% (95% CI 14-40%) for waist circumference, 10% (95% CI 1-20%) for hip circumference, and 36% (95% CI 21-52%) for waist-hip ratio. There were no significant differences between age groups, sex, and region. None of the four anthropometric indices had a strong association with risk of stroke. These data indicate that measures of central obesity such as waist circumference and waist-hip ratio are strongly associated with risk of ischaemic heart disease in this region. Therefore, we suggest that, along with calculation of body mass index, measures of central obesity such as waist circumference and waist-hip ratio should be undertaken routinely.
Key Words: abdominal obesity, waist circumference, waist hip ratio, cardiovascular diseases, cohort studies, Asia

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Defining obesity by body mass index in the Thai population: an epidemiologic study
CHATLERT PONGCHAIYAKUL, TUAN V NGUYEN, VONGSVAT KOSULWAT, NIPA ROJROONGWASINKUL,
SOMSRI CHAROENKIATKUL, CHOOWONG PONGCHAIYAKUL, PATARA SANCHAISURIYA AND RAJATA RAJATANAVIN

The objective of this study was to develop cut-off values and evaluate the accuracy of body mass index (BMI) in the definition of obesity in the Thai population. A cross-sectional, epidemiologic study in 340 men and 507 women aged 50 ± 16 yr (mean ± SD; range: 20-84 yr), were sampled by stratified clustering sampling method. Body composition, including percentage body fat (%BF), was measured by dual energy X-ray absorptiometry (GE Lunar Corp, Madison, WI). BMI was obtained by dividing weight (in kg) by height (in m2). The "golden standard" for defining obesity was %BF 25% in men and %BF 35% in women. The %BF-based prevalence of obesity in men and women was 18.8% and 39.5%, respectively. However, using the BMI cut-off of 30, only 2.9% of men and 8.9% of women were classified as obese. In the cubic regression model, BMI was a significant predictor of %BF, such that in men a BMI of 27 kg/m2 would predict a %BF of 25%, and in women a BMI of 25 kg/m2 would correspond to a %BF of 35%. The area under the receiver operating characteristic curve for BMI was approximately 0.87 (95% CI: 0.82-0.92) and 0.86 (95% CI: 0.83-0.90) in men and women, respectively. In conclusion, for the Thai population, BMI is a reasonably useful indicator of obesity; however, the cut-off values of BMI for diagnosing obesity should be lowered to 27 kg/m2 in men and 25 kg/m2 in women.
Key Words: BMI, percentage body fat, epidemiology, Thailand, Asian

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Relation of anthropometric parameters to the functional assessment of HDL particle size in three ethnic cohorts HAMIDREZA ZAKERI, JIRI J FROHLICH AND SCOTT A LEAR
The purpose of this study was to characterize the association between HDL particle size (assessed by fractional esterification rate in apo B depleted plasma (FERHDL)), and anthropometric measures in men and women of Chinese, European and South Asian origin and to determine if ethnic background is a modifier of this relationship. A convenience sample of apparently healthy men and women of Chinese (n=56), European (n=66) or South Asian (n=76) descent were recruited and assessed for body mass index, waist circumference, blood pressure, lipids, insulin, glucose and FERHDL. Univariate correlations with FERHDL were determined within each ethnic -gender group. Regression analysis was used to determine if ethnicity was a significant modifier of the relationship between FERHDL and waist circumference. FERHDL was significantly correlated with various anthropometric measures within the ethnic and gender groups. The relationship between waist circumference and FERHDL was significantly different between the European, and Chinese and South Asian groups combined in women but not in men. After adjustment for age, body mass index and insulin, ethnicity was no longer a significant predictor. However, ethnic background (European vs. Chinese/South Asian) was a significant predictor (P=0.034) of the relationship between FERHDL and waist circumference adjusted for age, gender, body mass index and insulin in the entire cohort. Increasing adiposity in Chinese and South Asian men and women is associated with a less protective HDL particle profile. Ethnic background (Asian compared to European) is a significant modifier of the relationship between FERHDL and waist circumference.
Key Words: anthropometry, lipoproteins, HDL, Asians.
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Use Of [14C]-sodium bicarbonate/urea to measure total energy expenditure in overweight men and women before and after low calorie diet induced weight loss NATALIE D LUSCOMBE, CHRISTOPHER TSOPELAS, MAX BELLON, PETER M CLIFTON, IAN KIRKWOOD AND GARY A WITTERT
The aim of this study was to evaluate the use of the [14C]-sodium bicarbonate/urea technique to measure the change in total energy expenditure after weight loss and a period of weight maintenance. Eleven healthy subjects (6 men and 5 women aged 50 ± 3 yrs, BMI 34.1 ± 2.1 kg/m2, body fat 38.7 ± 3%) underwent 8 weeks of energy restriction using a combination of 'Modifast™' formula and one small meal per day (˜3.3 MJ/day). For an additional 2-weeks, subjects resumed a solid food diet that contained enough energy to stabilize body weight at the newly reduced level. Body composition, total energy expenditure (TEE), resting energy expenditure (REE) and the thermic effect of a 2.7 MJ test meal (TEF) were measured at both weeks 0 and 10. At week 10 as compared to week 0, body weight decreased by 12.2 1.6 kg (12.5%) (P < 0.001). Total fat and lean mass decreased by 8.4 1.0 kg (20.4%) and 3.8 0.7 kg (6.7%), respectively (P < 0.001). REE decreased by 500 128 kJ/day (5.6 1.3%) (P < 0.002). Decreases in the TEE (0.18 3.7%) and TEF (1.4 0.9%) were not significant. In conclusion, although [14C]-sodium bicarbonate/urea was well tolerated and did not interfere with normal daily activities, it did not have sufficient sensitivity to accurately measure weight loss induced changes in TEE in the range of 0.1-10%.
Key Words:
energy expenditure, thermic effect of feeding, weight loss, low calorie diet, clinical intervention.
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Validity and reliability of BodyGem for measuring resting metabolic rate on Taiwanese women
TSAN-HON LIOU, CHING-MIN CHEN, WAN-YU CHUNG AND NAIN-FENG CHU
Resting metabolic rate (RMR) accounts for about two thirds of total energy expenditure. The widely used Harris-Benedict equations systematically overestimate RMR. This study assessed overall reliability and validity of a handheld indirect calorimeter, BodyGem, on a sample of women. Thirty healthy nurses participated in this study with an age of 41.9 ± 9.0 years old and a body mass index of 24.0 ± 2.8 kg/m2. The Deltatrac Metabolic Monitor was used as the criterion method to validate BodyGem. Reliability was estimated by repeated measures of BodyGem to test internal consistency and stability. Analysis indicated that measurements of Deltatrac and BodyGem are well correlated (r = 0.76, P < 0.001). The correlation coefficients of two BodyGem RMR measurements were of large statistical significance (r = 0.96, P <0.001, mean difference = 15.8±55.8 Kcal/d). A significant difference (F = 3.81, P = 0.04) in repeated measures ANOVA and post hoc revealed a difference between BodyGem and Deltatrac. There was a systematic difference between both methods (mean difference between BodyGem and Deltatrac = 36.4~52.2 Kcal/d). After adjustment of additional energy demand by holding BodyGem in position, the difference became non-significant (F = 1.62, P = 0.22). Bland-Altman plots revealed that there was no significant trend in both methods, and repeated measurements of Bodygem. In conclusion, RMR obtained using the BodyGem has a high degree of reproducibility and an acceptable validity compared to the Deltatrac. Further validity research is needed in Taiwanese women..
Key Words: women, reliability, validity, resting metabolic rate, indirect calorimeter, Harris-Benedict equations, Taiwan


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Nutrition education in medical schools in Japan: results from a questionnaire survey
HIDEO ORIMO, TOSHIRO SHIMURA AND TAKASHI SHIMADA

Diet is known to play a critical role in the pathogenesis of major age-related chronic diseases, which are rapidly becoming more common in Japan and other industrialized countries. However, traditional medical education has not provided adequate knowledge of nutrition. To understand the current status of nutrition education in Japan, we sent a questionnaire to all Japanese medical schools to survey their nutrition curricula. The questionnaire was sent to 79 medical schools in Japan, which includes all medical schools except for that of the authors. We also used a questionnaire to survey second year medical students just after they received a short nutrition course at Nippon Medical School. Fifty-seven medical schools (72.2%) responded to the questionnaire: 12 (21.1% of the responding schools) offered a "nutrition" course and 3 (5.4%) offered a "clinical nutrition" course. Including "nutrition" and "clinical nutrition" courses, 14 of the responding medical schools (24. 6 %) offered stand-alone nutrition courses in their undergraduate education. Although a total of 48 of the responding medical schools (84.2%) offered some nutrition topics, only 8 of the responding schools (14.0%) may have offered substantial nutrition education. No special postgraduate course in medical or clinical nutrition was offered by any of the schools. Despite this, more than 80% of the students that appeared to be interested in a nutrition course recognized the importance of nutrition education in medical school. This survey showed that nutrition education in Japanese medical schools remains inadequate and changes are necessary.
Key Words: nutrition education, medical schools, Japan, questionnaire, curriculum

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Nutritional status of pregnant women in Northeast Thailand
CHRISTOPH U ANDERT, PATTARA SANCHAISURIYA, KANOKWAN SANCHAISURIYA, FRANK P SCHELP AND
FLORIAN J SCHWEIGERT
A comparative study on the nutritional status of primiparous and multiparous women in the first trimester of pregnancy was conducted in the northeastern province of Thailand, Khon Kaen, to investigate differences in protein-energy-malnutrition, iron deficiency anaemia, vitamin A deficiency and carotenoid status between both parity groups. 94 subjects were recruited at first attendance of antenatal clinic. Data about weight, height, haemoglobin and haematocrit were obtained from hospital records. Anthropometric measurements of mid-upper arm circumference and triceps skinfold were done on a sub sample. Retinol, carotenoids and a-tocopherol were analysed using a reversed-phase high-performance liquid chromatography method. Ferritin, transthyretin and retinol-binding protein were determined by enzyme-linked immunosorbent assay. Primi-parous women showed lower body mass index, mid-upper arm circumference, corrected arm muscle area (P <0.001) as well as lower retinol, cholesterol and triceps skinfold (P <0.05). After adjusting for age and socio-economical status the significant difference persisted for all parameters but triceps skinfold. No significant differences of a-tocopherol, serum proteins, carotenoids and iron indices could be observed, even though a tendency to higher values for ferritin, haemoglobin and haematocrit was shown in multiparous women. Prevalence of protein-energy-malnutrition (body mass index <18.5 kg/m2) in the primiparous group was significantly higher compared to the multiparous group (P<0.05). Prevalence of protein-energy-malnutrition, iron deficiency anaemia and vitamin A deficiency were 15.1%, 6.3 % and 3.3%, respectively, in the total study population. No differences between parity groups could be observed for prevalence of iron deficiency anaemia and vitamin A deficiency.
Key Words: nutritional status, pregnancy, vitamin A, iron, carotenoids.
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Which mothers take folic acid and folate containing foods?
COLIN BINNS, JANE SCOTT, NKEONYELU NWAFOR, KATHLEEN GRAHAM, WENDY ODDY AND ANDY LEE
This study documented the prevalence (proportion) of mothers taking folic as supplements or as fortified foods and explored the factors that determined whether folic acid was taken. A cross sectional analysis of the baseline data of mothers who participated in the Perth Infant Feeding Study was performed. A total of 587 mothers who delivered at the two hospitals in the study completed baseline questionnaires. The factors associated with the decision to take folic acid supplements or fortified foods were investigated using multivariate logistic regression. Main outcome measures were the percentage of mothers taking folic acid or folic acid fortified foods. A total of 455 (78%) mothers stated that they took folic acid supplements before or during the first three months of their pregnancy. Of the 132 who did not take folate supplements only 35 (6% of all participating mothers) claimed to have taken folate fortified food or beverages. In the highest income group, 87% of mothers took folic acid supplements compared to 64% in the poorest group. The significant factors independently associated with not taking folic acid supplements or fortified food were "years of education" (OR '10 years or less' 0.45 (0.23-0.88)), "family income" (OR <$25000 0.40(0.20-0.80)), and for taking folic acid "the timing of the pregnancy." (OR 'actively trying' 2.01 (0.1.04-0.3.87)). There was a significant proportion of mothers who did not take folic acid periconceptually. The mothers who were not taking folic were less educated, from lower socio-economic groups and were not actively trying to fall pregnant at the time they became pregnant. The results suggest that in order to reach all Australian mothers, mandatory fortification of foods with folic acid should be required.
Key Words: folic acid, folate, pregnancy, Australia, socio-economic group.

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Dietary and blood folate status of Malaysian women of childbearing age
GEOK LIN KHOR, G DURAISAMY, SU PENG LOH, TIMOTHY J GREEN
AND C MURRAY SKEAFF
The protective role of folic acid taken during the periconceptual period in reducing the occurrence of neural tube defects (NTD) has been well documented by epidemiological evidence, randomized controlled trials and intervention studies. Much of the evidence is derived from western populations while similar data on Asian subjects is relatively nascent. Baseline data on folate status of Malaysian women is lacking, while NTD prevalence is estimated as 10 per 10,000 births. This study was conducted with the objective of determining the dietary and blood folate status of Malaysian women of childbearing age. A total of 399 women comprising 140 Malay, 131 Chinese and 128 Indian subjects were recruited from universities and worksites in the suburbs of Kuala Lumpur. Inclusion criteria were that the subjects were not pregnant or breastfeeding, not taking folic acid supplements, not habitual drinkers or smokers. Based on a 24-hour recall, the median intake level for folate was 202.4 g (59.4-491.8 g), which amounts to 50.6% of the Malaysian Recommended Nutrient Intakes level. The median (5-95th percentiles) values for plasma and red cell folate (RBC) concentrations were 11
(4-33) nmol/L and 633 (303-1209) nmol/L respectively. Overall, nearly 15.1% showed plasma folate deficiency (< 6.8 nmol/L), with Indian subjects having the highest prevalence (21.5%). Overall prevalence of RBC folate deficiency (< 363 nmol/L) was 9.3%, and an almost similar level prevailed for each ethnic group. Only 15.2% had RBC concentration exceeding 906 nmol/L, which is associated with a very low risk of NTD. The result of this study point to the need for intervention strategies to improve the blood folate status of women of childbearing age, so that they have adequate protection against the occurrence of NTD at birth.

Key Words: blood folate, dietary intake, women, Malaysia.

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Anaemia and iron deficiency anaemia among young adolescent girls from the peri urban coastal area of Indonesia
YUSTINA ANIE INDRIASTUTI KURNIAWAN, SITI MUSLIMATUN, ENDANG L ACHADI AND SOEMILAH SASTROAMIDJOJO

Anaemia due to iron deficiency is still a widespread problem. Among adolescent girls, it will bring negative consequences on growth, school performance, morbidity and reproductive performance. This cross sectional study aimed to identify the different nutritional and iron status characteristics of young adolescent girls 10 - 12 years old with iron deficiency anaemia and anaemia without iron deficiency in the rural coastal area of Indonesia. Anaemic girls (N = 133) were recruited out of 1358 girls from 34 elementary schools. Haemo-globin, serum ferritin, serum transferrin receptor and zinc protophorphyrin were determined for iron status, whilst weight and height were measured for their nutritional status. General characteristics and dietary intake were assessed through interview. Out of 133 anaemic subjects, 29 (21.8%) suffered from iron deficiency anaemia, which was not significantly related to age and menarche. About 50% were underweight and stunted indicating the presence of acute and chronic malnutrition. The proportion of thinness was significantly higher (P <0.05) among subjects who suffered from iron deficiency anaemia (51.7% vs. 29.8%). Furthermore, thin subjects had a 5 fold higher risk of suffering from iron deficiency anaemia (P < 0.05) than non-thin subjects (OR: 5.1; 95%CI 1.34 -19.00). Further study was recommended to explore other factors associated with anaemia and iron deficiency anaemia, such as the thalassemia trait and vitamin A deficiency. The current iron-folate supplementation program for pregnant women should be expanded to adolescent girls.
Key words: iron, deficiency, anaemia, adolescent, girls, urban, Indonesia.

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Goitre prevalence and the state of iodine nutrition in the sundarban delta of north 24-parganas in West Benegal
AMAR K CHANDRA, SMRITIRATAN TRIPATHY, DISHARI GHOSH, ARIJIT DEBNATH AND
SANJUKTA MUKHOPADHYAY

The main objective of this study was to assess the iodine nutritional status among school children (6-12 yrs) of Sundarban delta in North 24- Parganas district of West Bengal in eastern India. A total of 2050 children were clinically examined for goiter and 240 urine samples were analyzed for iodine and thiocyanate respectively; iodine content in 48 water samples and 210 salt samples were also measured. Results indicate that the studied region is clinically severely goiter endemic having goiter prevalence 33.1 % (grade 1: 30.4 %; grade 2: 2.7%), median urinary iodine level 200 µg/l indicating no biochemical iodine deficiency, 65.2 % salt samples contain recommended level of iodine and the iodine content in drinking water is sufficient while mean urinary thiocyanate level was 0.708 0.38 mg/dl. In spite of the consumption of adequate iodine, the existing goiter prevalence may be for the consumption of dietary goitrogens/antithyroid substances that possibly come through food and water.
Key Words:
endemic goiter, goitrogens, school children, urinary iodine, urinary thiocyanate, West Bengal

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Determination of discretionary salt intake in an iodine deficient area of East Java-Indonesia using three different methods
ANNASARI MUSTAFA, SITI MUSLIMATUN IR, JULIAWATI UNTORO IR, MARIA CPJ LAN IR AND YOHANES KRISTIANTO
As salt is a potential vehicle for delivering iodine to a population, study on salt intake is important. Many methods have been used to measure iodised-salt intake, but the methods were suspected to be inaccurate. A new method, called a lithium-marker technique, has been considered as suitable and safe; hence it has been proposed as a gold standard for measuring the actual salt intake of an individual. We conducted a study to determine discretionary salt intake using the lithium marker technique. The study shows that the total salt intake for children (N =15) and mothers (N =15) were 5.4 2.1 g/d and 5.8 1.7 g/d respectively in which 48.5 17.1% and 50.5 17.3% were discretionary salt. The discretionary salt intake measured using lithium marker (2.53 ± 1.2 g/d for children and 2.99 ± 1.5 g/d for mother) were significantly lower than using 24-hour salt recall (7.01 2.44 g/cap/d) and salt weighing (6.00 1.8 g/cap/d) (P<0.001). In conclusion, the discretionary salt intake by 24-hour salt recall and salt weighing were over estimated as compared to the lithium-labelled salt measurement. It is recommended that the level of iodine fortification in salt be increased up to 80-100 ppm of KIO3 to provide iodine intake of 150µg/d.
Key Words: lithium marker technique, 24-hour salt recall, salt weighing, discretionary salt intake.
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Effects of probiotic or prebiotic supplemented milk formulas on fecal microbiota composition of infants
OSCAR BRUNSER, GUILLERMO FIGUEROA, MARTIN GOTTELAND, ELIZABETH HASCHKE-BECHER,
CORINE MAGLIOLA, FLORENCE ROCHAT, SYLVIA CRUCHET, RICHARD PALFRAMAN, GLENN GIBSON,
FRANÇOISE CHAUFFARD AND FERDINAND HASCHKE

The aim of the study was to evaluate whether supplementation of milk-formulas with prebiotic fructo-oligosaccharides or a probiotic, Lactobacillus johnsonii La1 (La1), could modulate the composition of the fecal microbiota of formula-fed infants, compared to breastfed (BF) infants. Ninety infants close to 4 months of age were randomized into one of three groups to be blindly assigned to receive for 13 weeks: a) an infant formula (Control), b) the same formula with fructo-oligosaccharides (Prebio), or c) with La1 (Probio). At the end of this period, all infants received the control formula for 2 additional weeks. Twenty-six infants, breastfed throughout the study, were recruited to form group BF. Fecal samples were obtained upon enrolment and after 7 and 15 weeks. Bacterial populations were assessed with classical culture techniques and fluorescent in situ hybridisation (FISH). Seventy-six infants completed the study. On enrolment, higher counts of Bifidobacterium and Lactobacillus and lower counts of enterobacteria were observed in BF compared to the formula-fed infants; these differences tended to disappear at weeks 7 and 15. No major differences for Clostridium, Bacteroides or Enterococcus were observed between the groups or along the follow up. Probio increased fecal Lactobacillus counts (P<0.001); 88% of the infants in this group excreted live La1 in their stools at week 7 but only 17% at week 15. Increased Bifidobacterium counts were observed at week 7 in the 3 formula groups, similar to BF infants. These results confirm the presence of higher counts of bifidobacteria and lactobacilli in the microbiota of BF infants compared to formula-fed infants before dietary diversification, and that La1 survives in the infant digestive tract.
Key Words: breastfeeding, milk formula, fructooligosaccharides, infants, intestinal microbiota, Lactobacillus johnsonii La1, prebiotic, probiotic.
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A population-based survey on infant feeding practice (0-2 years) in Hong Kong: breastfeeding rate and patterns among 3,161 infants below 6 months old
WARREN TK LEE, SUSAN SH LUI, VERONICA CHAN, ERIC WONG AND JOSEPH LAU

The prevalence of breastfeeding for the first 6 months in infants has been low in Hong Kong since the 1970s. In order to develop effective breastfeeding policies and promotion programs, an appraisal of feeding practices and factors related to initiation and early cessation of breastfeeding is necessary. A survey with a population-based representative sample was conducted to determine social-demographic, personal and cultural factors that influenced decision, duration and practice of infant feeding among infants 0-24 months old. This paper focuses on infants below 6 months old to study factors related to decision, duration and practice of breastfeeding. In 1993, 7,298 healthy infants were recruited from 46 Maternal-and-Child-Health-Clinics (MCHC) throughout Hong Kong, of whom 3161 were below 6 months old. The mother reported her feeding decision, duration and practice in a questionnaire. Breastfeeding rate was found to be very low (8.4%) for infants below 6 months old. Only 50.9% infants were breastfed. Infant formulae were widely given among partially breastfed infants. 45% mothers were full-time employed. Most mothers were aware of the benefits of breastfeeding to the infants and themselves. Husbands (43.3%) were regarded the most influential on initiation and duration on breastfeeding. Restricted food varieties (54%), sore nipple and breast engorgement (67%), perceived home confinement (41.5%) and perceived inadequate milk supply (31.7%) were major concerns upon breastfeeding. Furthermore, 76.9% mothers turned to MCHC staff for advice when they encountered difficulties during breastfeeding. In conclusion, the survey collected population-based representative data on factors determining initiation and early cessation of breastfeeding in Hong Kong in 1993. The findings will serve as a cornerstone in understanding the evolution of breastfeeding practice in Hong Kong. It merits further study to investigate how the confounders interplay to modulate initiation, duration and patterns of breastfeeding.
Key Words: : breastfeeding, breastmilk, infant formulae, infants, Hong Kong.
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Diet, nutritional knowledge and health status of urban middle-aged Malaysian women LW PON, MY NOOR-AINI, FB ONG, N ADEEB, SS SERI, K SHAMSUDDIN, AL MOHAMED, N HAPIZAH,
A MOKHTAR AND HWH WAN
GARY TC KO AND JOYCE SF TANG
The objective of the study was to assess nutritional and health status as well as nutritional knowledge in urban middle-aged Malaysian women. The impact of menopause on diet and health indices was also studied. The study included 360 disease free women, non users of HRT, aged =45 years with an intact uterus recruited from November 1999 to October 2001. Personal characteristics, anthropometric measurements and blood sample were acquired followed by clinical examination. Nutrient intake and nutritional knowledge was determined by a quantitative FFQ and KAP. The findings showed that urban middle-aged women, aged 51.65±5.40 years had energy intakes (EI) 11% below RDA, consisting of 53% carbohydrates, 15% protein and a 32% fat which declined with age. The sample which comprised of 42.5% postmenopausal women had a satisfactory diet and healthy lifestyle practices. Premenopausal women consumed more dietary fat (6%) with other aspects of diet comparable to the postmenopausal women. Iron intake was deficient in premenopausal women, amounting to 56% RDA contributing to a 26% prevalence of anaemia. Overall, calcium intake reached 440mg daily but dairy products were not the main source. The postmenopaused had a more artherogenic lipid profile with significantly higher total cholesterol (TC) and LDL-C, but more premenopausal women were overweight/obese (49% versus 35%). EI was the strongest predictor for BMI and waist circumference (WC), with WC itself an independent predictor of fasting blood sugar and TC with BMI strongly affecting glucose tolerance. High nutritional knowledge was seen in 39% whereas 20% had poor knowledge. Newspapers and magazines, followed by the subject's social circle, were the main sources of nutritional information. Nutritional knowledge was positively associated with education, household income, vitamin/mineral supplementation and regular physical activity but inversely related to TC. In conclusion, middle-aged urban women had an adequate diet with low iron and calcium intakes. Nutritional knowledge was positively associated to healthier lifestyle practices and lower TC. A comparable nutrient intake and lifestyle between pre and postmenopausal women suggested that health changes associated with menopause was largely independent of diet.
Key Words: food frequency, perimenopause, knowledge, health, middle-aged, women, urban, Malaysia

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Good oral health, adequate nutrient consumption and family support are associated with a reduced risk of being underweight amongst older Malaysian residents of publicly funded shelter homes
RENUKA VISVANATHAN AND ZAITON AHMAD

A low body mass index in older people has been associated with increased mortality. The main objective of this study was to identify factors associated with low body mass indices [BMIs] (< 18.5 kg/m2) in older residents of shelter care facilities in Peninsular Malaysia. 1081 elderly people (59%M) over the age of 60 years were surveyed using questionnaires determining baseline demographics, nutritional and cognitive status, physical function and psychological well being. Body mass index was also determined. Subjects were recruited from publicly funded shelter homes in Peninsular Malaysia. 14.3% of residents had BMIs < 18.5 kg/m2. Multivariate analyses (adjusted for age and sex) revealed that having no family (RR 1.98 [95%CI 1.40-2.82], P<0.001) and negative responses to statement 3 [I eat few fruits or vegetables or milk products] (RR 0.62 [95% CI 0.42-0.90]; P=0.013) and statement 5 [I have tooth or mouth problems that make it hard for me to eat] (RR 0.69 [95%CI 0.50-0.96]; P=0.023) of the 'Determine Your Nutritional Health Checklist' were independently associated with low BMIs (<18.5 kg/m2). Older people with no family support were at risk of becoming underweight. Older people who consumed fruits, vegetables or milk or had good oral health were less likely to be underweight. Nutrient intake, oral health and social support were important in ensuring healthy body weight in older Malaysians.
Key Words: Body mass index, oral health, nutrition, social support, poverty, homeless, elderly, shelter homes, Malaysia.


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Structured triglyceride for parenteral nutrition: meta-analysis of randomized controlled trials
YONG ZHOU, XIAO-TING WU, NI LI, WEN ZHUANG, GUANJIAN LIU, TAIXIANG WU AND MAO-LING WEI


This study assessed the safety and efficacy of structured triglyceride (ST) for parenteral nutrition. A meta-analysis of all the relevant randomized controlled trials (RCTs) was performed. Clinical trials were identified from the following electronic databases: MEDLINE, EMBASE, the Cochrane Controlled Trials Register, Chinese Bio-medicine Database. The search was undertaken in March 2005. Language was restricted to Chinese and English. Literature references were checked at the same time. Only RCTs were extracted and evaluated by two reviewers independently of each other. The statistical analysis was performed by RevMan4.2 software which was provided by the Cochrane Collaboration. A P value of <0.05 was considered statistically significant. Ten RCTs involving 236 patients were included. Eight of them compared ST with the long-chain triglyceride (LCT), and the combined results showed that the ST had significant effect on resting energy expenditure (weighted mean difference [WMD] = 1.54, 95%CI [1.26, 1.82], P<0.00001), plasma glycerol (WMD = 0.14, 95%CI [0.06, 0.22], P=0.0007), free fatty acids (WMD = 0.24, 95%CI [0.10, 0.37], P=0.0006), and ß-hydroxybutyric acid (WMD = 0.14, 95%CI [0.06, 0.22], P=0.0007), but no differences was found regarding nitrogen balance (standardized mean difference [SMD] = 0.64, 95%CI [-0.30, 1.59], P= 0.18), respiratory quotient (WMD = -0.02, 95%CI [-0.04, 0.01], P=0.18), and plasma triglycerides (WMD = -0.10, 95%CI [-0.30, 0.10], P=0.32). Only two RCTs compared ST with the physical mixture of medium- and long-chain triglyceride (MCT/LCT), data from trials were not combined due to clinical differences between trials, and conclusions can not be drew from the present data. ST appeared to be safe and well tolerated. Further trials are required, especially compared with the MCT/LCT, with sufficient size and rigorous design.
Key Words: structured triglyceride, parenteral nutrition, meta-analysis, randomized controlled trials.


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The Glycemic Index of standard and diabetes-specific enteral formulas
ZANDRIE HOFMAN, JENNEKE DE VAN DRUNEN AND HARM KUIPERS
A recent meta-analysis showed that foods with a low Glycemic Index (GI) have a clinically useful effect on glycemic control in patients with diabetes. Although diabetes-specific enteral formulas are commonly used for diabetic patients with insufficient oral intake, not much is known about the GI of these formulas. Therefore the purpose of this study was to assess the GI of several diabetes-specific formulas and to compare them with standard formulas. The randomised, double blinded, crossover study included twelve products which were tested in 7 - 10 individuals from a pool of 14 healthy volunteers. After an overnight fast, volunteers were given a portion of a product containing 25 grams of carbohydrate or the reference feed (200 ml containing 25 gram glucose) on different occasions in random order. Postprandial blood glucose levels were measured in venous whole blood for two hours after intake of the products and positive incremental area under the curve (AUC) was calculated for both the products and the reference feed. The GI of the test products was determined by dividing AUC (test products) by the AUC (reference feed). Enteral formulas varied widely in their GI values with the diabetes-specific enteral formulas being characterized by a significant (P=0.004) lower GI (average ±SEM: 19.4 ± 1.8) than standard formulas (42.1 ± 5.9). However, there was an overlap between the two types of formulas. Three of the diabetes-specific formulas had significantly lower GI than 3 of the standard products. Although there is some overlap with the GI of diabetes-specific and standard formulas, certain diabetes-specific formulas had very low GI values, which may be clinically beneficial due to better glycemic control. Therefore the use of diabetes-specific formulas with a low GI should be the preferred option for the nutritional management of diabetic patients in need of nutritional support.
Key Words: diabetes, hyperglycemia, clinical nutrition, glycemic index, nutritional treatment.


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Low dose supplementation with two different marine oils does not reduce pro-inflammatory eicosanoids and cytokines in vivo
KAREN J MURPHY, KAREN GALVIN, MAIREAD KIELY, PATRICK A MORRISSEY, NEIL J MANN AND
ANDREW J SINCLAIR
In view of the reported potential anti-inflammatory activity of the New Zealand green lipped mussel (NZGLM), we aimed to compare the effect of low dose marine oil supplementation, from mussels and fish, in reducing blood markers of inflammation. Thirty apparently healthy males and females were recruited from the general public in Melbourne, Australia to participate in a double blind, randomised, parallel intervention study. Subjects were consuming approximately 73 mg of omega-3 long chain polyunsaturated fatty acids (n-3 LCPUFA) daily in their background diet prior to the commencement of the intervention. Subjects were randomly assigned to consume either 2 mL/day of the NZGLM oil preparation (mixed with olive oil and dl- -tocopherol) or fish oil preparation (also mixed with olive oil and dl- -tocopherol) for six weeks. Two mL of the oils contained 241 mg and 181 mg of n-3 LCPUFA, respectively. Neutrophil phospholipid fatty acids, serum thromboxane B2 (TXB2), stimulated monocyte production of prostaglandin E2 (PGE2), interleukin-1 (IL-1 ) and tumor necrosis factor a (TNFa) were measured. During the intervention, the total intakes of n-3 LCPUFA from the background diet and the supplements were 199 mg/d and 173mg/day for the NZGLM and FO groups, respectively. Following six weeks of supplementation, both groups showed a small, but significant increase in neutrophil phospholipid proportion of eicosapentaenoic acid. The NZGLM group also showed a significant increase in docosahexaenoic acid levels. There were no significant changes with time or treatment for TXB2, PGE2, IL-1 or TNFa. This study showed that low dose supplementation with n-3 LCPUFA from two different marine oil preparations showed no difference in inflammatory markers in this group of healthy individuals. Further studies are warranted including dose response trials and studies in populations with inflammatory conditions.
Key Words: NZGLM; fatty acids; n-3 LCPUFA; eicosanoid; cytokine, gas chromatography.


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Evaluation of Rhodiola crenulata and Rhodiola Rosea for management of Type II diabetes and hypertension YOUNG-IN KWON, HAE-DONG JANG AND KALIDAS SHETTY
In the current study, we investigated 2 species of the genus Rhodiola for the inhibition of a-amylase,
a-glucosidase and angiotensin converting enzyme (ACE) inhibitory activity. Water extracts of Rhodiola crenulata had the highest a-amylase inhibitory activity (IC50, 98.1 µg total phenolic/ml) followed by ethanol extract of R.crenulata (IC50, 120.9 µg total phenolic/ml) and ethanol extract of R.rosea (IC50, 173.4 µg total phenolic/ml). Ethanol R.rosea (IC50, 44.7 µg total phenolic/ml), water extract of R.rosea (IC50, 52.3 µg total phenolic/ml), water extract of R.crenulata (IC50, 60.3 µg total phenolic/ml) and ethanol extract of R.crenulata (IC50, 60.2 µg total phenolic/ml) also showed significant a-glucosidase inhibitory activity. The a-glucosidase inhibitory activity of the extracts was compared to standard tyrosol, which was significantly detected in the extracts using HPLC. Tyrosol had strong a-glucosidase inhibitory activity (IC50, 70.8 µg total phenolic/ml) but did not have any inhibitory effect on the a-amylase activity. Results suggested that a-glucosidase inhibitory activities of both Rhodiola extracts correlated to the phenolic content, antioxidant activity and phenolic profile of the extracts. The ability of the above Rhodiola extracts to inhibit rabbit lung angiotensin I-converting enzyme (ACE) was investigated. The ethanol extracts of R.rosea had the highest ACE inhibitory activity (38.5 %) followed by water extract of R.rosea (36.2 %) and R.crenulata (15.4 %).
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Key Words: Rhodiola, tyrosol, salidroside, antioxidants, amylase, glucosidase, angiotensin converting enzyme, enzyme inhibitors, type 2 diabetes, hypertension


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Potential of cranberry-based herbal synergies for diabetes and hypertension management
EMANOUIL APOSTOLIDIS, YOUNG-IN KWON AND KALIDAS SHETTY
Water soluble cranberry-based phytochemical combinations with oregano, rosemary, and Rhodiola rosea were evaluated for total phenolic content, related antioxidant activity and inhibition of diabetes management- related a-glucosidase, pancreatic a-amylase inhibition, and hypertension - related ACE - I inhibitory activities. Water extracts of oregano had 114.9 mg/g DW of phenolics which was highest among all the extracts tested, whereas the 75% cranberry with 25% oregano combinations had the highest phenolics (38.9 mg/g DW) among all the combinations tested. The water extracts of oregano had the highest DPPH radical inhibition activity (73.6 %), whereas among combinations the 75% cranberry and 25% oregano had the highest DPPH radical inhibition activity (50.8 %). These results indicated a correlation between total phenolic content and antioxidant activity. The water extracts of pure Rhodiola rosea had the highest a-glucosidase inhibition, whereas the 75% cranberry and 25% Rhodiola rosea combination had the highest inhibition among the combinations. In the case
of?? a-amylase inhibition the water extracts of Rhodiola rosea had the highest inhibition, whereas the 75% cranberry with 25% Rhodiola rosea combination had the highest inhibition among the combinations. All the water extracts tested indicated that they had anti-ACE-I inhibitory activity. More specifically, among the water extracts 100% cranberry had the highest ACE-I inhibitory activity and among the combination the 75% cranberry with 25% rosemary had the highest ACE-I inhibitory activity. The analysis of a-glucosidase, a - ?amylase, and ACE-I inhibitory activities suggested that inhibition depend on the phenolic profile of each unique extract and by bringing together synergistic combinations to cranberry, health beneficial functionality was enhanced. This enhanced functionality in terms of high a-glucosidase and a-amylase inhibitory activities indicate the potential for diabetes management, and high ACE - I inhibitory activity indicates the potential for hypertension management.
Key Words: water soluble phenolics, antioxidants, a-amylase, a-glucosidase, angiotensin converting- I enzyme, inhibitor, type 2 diabetes, hypertension, synergies, cranberry, rosemary, Rhodiola rosea, oregano


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Last Updated: May 2006