An original discovery: selenium deficiency and Keshan
disease (an endemic heart disease)
This is a review article telling a 50-years old story about the studies on selenium deficiency and Keshan disease
in China, an endemic heart disease with high case-fatality, as an example of translational research. Extensive
cross-sectional epidemiological studies showed that low selenium concentrations in cereal grains and low selenium
status of local residents were associated with the occurrence of Keshan disease. Several large populationbased
intervention trials using oral administration of sodium selenite tablets showed significant reduction of Keshan
disease incidence. Based on the above evidence, it was concluded that selenium deficiency is the major
cause of Keshan disease, although other etiological factors could not be ruled out. The implications of the findings
include: provided critical scientific evidence for selenium being an essential trace element for humans; as
scientific basis for identifying minimum requirement and RDA/RNI for selenium; and as solid reference for the
formulation of effective preventive measures for Keshan disease in China.
Key Words: selenium, Keshan disease, translational research, essential trace element
Sasang types may differ in eating rate, meal size, and regular appetite: a systematic literature review
DUONG DUC PHAM, JAE CHUL LEE, MYEONG SOO LEE AND JONG YEOL KIM
Eating behaviours may be implicated in the increasing prevalence of obesity and metabolic disorders. The Sasang typology, a unique form of traditional Korean medicine, classifies individuals into four constitutional types that differ in a distinctive complex of external manifestations and innate natures, including eating behaviours. Our aim is to portray a picture of the distinguishing characteristics of eating behaviours across Sasang types and to provide suggestions for future studies. Six Korean and one English database were searched to acquire relevant articles. Ten peer-reviewed relevant research articles were found. The extracted data were categorised into the domains of i) food preferences; ii) eating rate; iii) eating initiation and termination; iv) meal size; v) regularity of eating; vi) regular appetite; vii) eating disorders; and viii) psychological factors. Eating rate and meal size were the issues of most concern that more frequently were different among Sasang types. The TaeEum type seemed to have obesitylinked eating behaviours, including a rapid eating rate, large meal sizes, and a strong appetite, whereas those attitudes seemed to be in contrast with those of the SoEum type. The SoYang type shared similarities with both the TaeEum and SoEum types. Future studies should be conducted with more reliable, objective, and quantitative assessment tools such as the Three Eating Factor Questionnaire or the Dutch Eating Behaviour Questionnaire.
Key Words: Sasang constitutional medicine, Sasang typology, eating behaviour, appetite, review
飲食行為或許和肥胖與代謝失調的盛行率漸增有關連。四象醫學是韓國的一種傳統醫學，根據外在表徵和先天本質(包括飲食行為)將人的體質分成四類型。篇研究目的為廓清四象不同型的人之飲食行為，並對未來相關研究提出建 議。從六個韓國和一個英國數據庫中檢索相關文獻。最後找到十篇相關研究文。將檢索出的資料歸類為：食物的喜好、食用速度、食用開始和結束、用餐 量、飲食規律、日常食慾、飲食失調及心理因素。食用速度和用餐分量是最 被關注且在四象類型中最有差異的特點。太陰型的人之飲食行為似乎與肥胖攸關，包括吃得快、吃得多和食慾好，此特點與少陰人正好相反。少陽人與太陰人或少陰人各有部分相似。未來的研究應使用更可靠、客觀和可量化的評估工 具，例如：三因子飲食行為量表或荷蘭飲食行為問卷。
Comparison between measured and predicted resting energy expenditure in mechanically ventilated
patients with COPD
ZHI-YONG RAO, XIAO-TING WU, MAO-YUN WANG AND WEN HU
The aim of this study was to compare resting energy expenditure (REE) obtained by indirect calorimetry (IC) and Harris-Benedict (H-B) equations, and to examine whether hypocaloric nutrition support could improve protein nutritional status in mechanically ventilated patients with chronic obstructive pulmonary disease (COPD). Thirtythree COPD patients (20 males, 13 females) were recruited and REE was measured by IC. Measured REE (REEm) was compared to predictive REE by H-B equations (REEH-B) and its corrected values. Correlation between REEm and APACHE II score was also analyzed. Patients were randomly divided into hypocaloric energy group (50%-90% of REEm, En-low) and general energy group (90%-130% of REEm, En-gen) for nutrition support. The differences of albumin, prealbumin, transferrin, hemoglobin, and lymphocyte count before and after 7 days nutrition support were observed. Results show that REEH-B and REEH-B×1.2 were significantly lower than REEm (p<0.01). REEm positively correlated with APACHE II score (p<0.05 or p<0.01). After nutrition support, hemoglobin decreased significantly in En-gen group (p<0.05); lymphocyte count in both groups, and transferrin and prealbumin in the En-low group increased significantly (p<0.05 or p<0.01). Our data suggest that 1) these patients’ REE were increased; 2) since IC is the best method to determine REE, in the absence of IC, H-B equations (with standard body weight) can be used to calculate REE, but the value should be adjusted by correction coefficients derived from APACHE II; 3) low energy nutrition support during mechanical ventilation in COPD patients might have better effects on improving protein nutritional status than high energy support.
Key Words: resting energy expenditure, indirect calorimetry, mechanical ventilation, APACHE II score, predictive equation for energy expenditure
为了研究机械通气的慢性阻塞性肺病(COPD)患者的能量代谢特点，比较间接测热法测定与Harris-Benedict公式预测的静息能量消耗(REE)的差异。并以此为依据，分析低能量的营养支持是否能改善患者蛋白质营养状况。纳入了33例(男20例，女13例)COPD患者，并测定其REE。比较测定的REE(REEm)和HB公式计算的REE(REEH-B)及其校正值之间的差异，同时还分析了REEm与APACHEⅡ评分之间的关系。33例患者被随机分成低能量组(REEm的50%-90%)和常规能量组(REEm的90%-130%)，按照以上标准进行营养支持。比较营养支持前和支持后7天的白蛋白、前白蛋白、转铁蛋白、血红蛋白和淋巴细胞计数。REEH-B 和用1.2 校正的值均明显低于REEm(p ＜ 0.01) ； REEm与APACHEⅡ评分之间存在正相关(p＜0.05或p＜0.01)。营养支持后，常规能量组的血红蛋白明显降低(p＜0.05)，两组患者的淋巴细胞计数，以及常规能量组的转铁蛋白和前白蛋白均明显升高(p＜0.05或p＜0.01)。结果提示：1)机械通气的COPD患者的REE升高；2)间接测热法是确定REE的最好方法，在不能作间接测热法時，Harris-Benedict公式可用于计算患者的REE，但要参照APACHEⅡ评分予以校正；3)低能量的营养支持在改善机械通气COPD患者的蛋白质营养状况优于常规能量的营养支持。
Height prediction from anthropometric length parameters in Thai people
KAWEESAK CHITTAWATANARAT, SAKDA PRUENGLAMPOO, VIBUL TRAKULHOON, WINAI UNGPINITPONG AND
Height is an important clinical parameter. However, there were no specific measurements available for particular clinical situations. Although many anthropometric measurements were suggested, no formula was recommended in Thailand. The objective of this study was to develop a formula for height prediction with acceptable validity. Two thousand volunteers were included and were divided consecutively according to both age and gender. Model and validation groups were further separated independently. Linear regression was analyzed to create a predictive formula. Ten parameters were included and analyzed. Of these, demispan, sitting height and knee height were selected with a correlation coefficient of more than 0.5 and significant F test in all age groups and genders. All single parameters and the highest predictive value of double (sitting and knee height) and triple regression models (demispan, sitting and knee height) were proposed and these were modified into a simple formula. After validation of both formulas the correlation, quantitative error and relative error were comparable. The simple formula had more than 90% precision with an error of up to 10 cm in the validation group (89.7 to 99.0% in range). Of these, knee height had the least predictive error in all subgroups. The double and triple models had decreased error only in the younger group. In summary, anthropometric parameters with demispan, sitting height, knee height and combination could be applied to height prediction in the adult Thai with acceptable error. These formulas should be applied only in people who could not be directly measured.
Key Words: anthropometry, body measure, body height, linear models, Thai
身高為一個重要的臨床參數。然而對於特定的臨床狀態，卻沒有一個專一的測量方法。雖然有許多體位測量方法被建議用來估量泰國人民的身高，但尚未有一個公式用於計算身高。這篇研究之目的在於發展出一個有效且能用以預測身高的公式。將2000位自願者根據年齡及性別加以區分。模式組及效度組再進一步獨立區分。用線性迴歸分析產生預測模式。共測量10 個參數並放入分析。在這10 個參數當中，中指尖到胸骨中心的距離、坐高及膝高與身高的相關係數，無論在男性或女性，及在各年齡層均大於0.5，且皆具有顯著相關。接著提出這3 個參數單獨、具有高預測值的雙變項(坐高與膝高)及三變項
Development and evaluation of a semi-quantitative food frequency questionnaire for use in urban and
LIZA BOWEN, ANKALMADAGU VENKATSUBBAREDDY BHARATHI, SANJAY KINRA, BIANCA DESTAVOLA, ANDY
NESS AND SHAH EBRAHIM
The objective of this study was to develop and evaluate a semi-quantitative food frequency questionnaire (FFQ) for use in urban and rural India. A single FFQ was developed for use in cities and rural areas of four regions of India. To assess validity, the FFQ was administered to 530 factory workers and rural dwellers, and subsequently three 24 hour recalls were administered on different days. Nutrient and food group intake calculated from these two methods were compared using medians, kappa statistics, Spearman’s correlation coefficients and Bland- Altman plots. Dietary intake was overestimated by the FFQ compared to the 24 hour recalls (mean difference in energy intake = 1743 kJ), with kappa statistics ranging from 0.07 (egg) to 0.51 (carbohydrate). The results showed acceptable validity for measuring intakes of groups, and demonstrated that it is feasible to measure dietary intake in diverse regions of India with a single FFQ.
Key Words: dietary assessment, food frequency questionnaire, validity, India, dietary intake
本篇研究目的為發展一份半定量飲食頻率問卷，並評估此問卷是否能有效測量 印度都市及鄉村地區研究對象的飲食情形。以一份簡單的飲食頻率問卷在印度 四個區域的城鎮及鄉村測試。為評估問卷效度，首先以飲食頻率問卷面訪530 位工廠工人及鄉村居民，相隔至少一周後，接續進行三次的24 小時飲食回憶 記錄。將營養素及食物類別攝取量以中位數、一致性檢定(kappa statistics)、相 關性檢定(Spearman’s correlation coefficients)及Bland-Altman plots 等方法，比較 兩種飲食測量方法之相關性。與24 小時飲食回憶記錄相比，飲食頻率問卷有 高估的現象(平均能量攝取差異為1743 kJ)；kappa 統計量之範圍為0.07(雞蛋)至 0.51(醣類)。結果顯示，此半定量飲食頻率問卷可用來評估印度不同地區的膳 食攝取，並且有足夠效度以量測食物類別的攝取。
Combined intensive nutrition education and micronutrient powder supplementation improved
nutritional status of mildly wasted children on Nias Island, Indonesia
DYAH A INAYATI, VERONIKA SCHERBAUM, RATNA C PURWESTRI, NIA N WIRAWAN, JULIA SURYANTAN, SUSAN
HARTONO,MAURICE A BLOEM, ROSNANI V PANGARIBUAN, HANS K BIESALSKI, VOLKER HOFFMANN AND
ANNE C BELLOWS
To assess the impact of intensive nutrition education (INE) with or without the provision of micronutrient powder (MNP) on the nutritional status of mildly wasted children in Nias, Indonesia, two groups of mildly wasted (≥-1.5 to <-1.0 WHZ) children aged ≥6 to <60 months in the Church World Service (CWS) project areas were assigned by village randomization to receive INE (n=64) or INE+MNP (n=51) in a weekly program. Another two groups of mildly wasted children who were living at a clear distance from INE and INE+MNP villages were selected to receive a monthly non-intensive nutrition education program (NNE) with or without MNP (n=50 both respectively). WHZ, weight, height, haemoglobin (Hb) level, and morbidity data were assessed at admission, during the study, and at individual discharge. Children’s weight gain (g/kg body weight/day) was highest in INE+MNP group (2.2±2.1), followed by INE (1.1±0.9), NNE+MNP (0.3±0.5) and NNE (0.3±0.4) group. In both MNP intervention groups (INE+MNP, NNE+MNP), supplements significantly increased Hb value (g/L) of respective children (10.0±10.0; p<0.001 and 3.0±8.0; p<0.05 respectively). Proportion of children who reached discharge criterion was highest among the INE+MNP (70.6%; n=36), followed by INE (64.1%; n=41), NNE+MNP (26.0%; n=13), and NNE (20.0%; n=10) groups (p<0.001). Shortest length of stay until recovery was observed among children in the INE+MNP group (29.9 days), followed by INE (40.0 days), NNE+MNP (80.6 days), and NNE (86.2 days) respectively (p<0.001). Weekly intensive nutrition education supported by MNP supplementation produced the best results regarding weight gain and haemoglobin status of mildly wasted children.
Key Words: educational activities, micronutrients, fortified, weight gain, mildly wasted children
本研究評估密集營養教育(INE)與是否補充微量營養素粉(MNP)對於印尼Nias島輕度消瘦兒童營養狀況之影響。在世界教會服務計劃區域，年齡在≥6 到<60 個月輕度消瘦(體重-身高比Z 分數，WHZ ≥-1.5 至<-1.0)的兒童以村落隨機分派成兩組，INE 組(64 位)或是INE+MNP 組(51 位)，照顧者每週接受一次營養教育，另給予INE+MNP 兒童微量營養素粉。另外選取兩組居住相當遠的輕度消瘦兒童，實施每個月一次的非密集營養教育(NNE)及有或無補充MNP (兩組各有50 位)。在納入、研究期間及釋出時，各評估WHZ、體重、
天) 最多， 再來是INE 組(1.1±0.9) 、NNE+MNP 組(0.3±0.5) 和NNE 組
(0.3±0.4)。在MNP 介入組(INE+MNP 及NNE+MNP)，兒童的血紅素(g/L)顯著
提高(分別是10.0±10.0，p<0.001 及3.0±8.0，p<0.05)。INE+MNP 組的兒童達到釋出標準的比例最高(70.6%；36 位)，再來是INE 組(64.1%；41 位)、
NNE+MNP 組(26.0%；13 位)和NNE 組(20.0%；10 位) (p<0.001)。INE+MNP組被留置到復原為止的天數最短(29.9 天)，再來分別是INE 組(40.0 天)、
NNE+MNP 組(80.6 天)和NNE 組(86.2 天) (p<0.001)。每週密集營養教育佐以
Supplementary feeding with locally-produced Ready-to-Use Food (RUF) for mildly wasted children on
Nias Island, Indonesia: comparison of daily and weekly program outcomes
RATNA C PURWESTRI, VERONIKA SCHERBAUM, DYAH A INAYATI, NIA N WIRAWAN, JULIA SURYANTAN,
MAURICE A BLOEM, ROSNANI V PANGARIBUAN, WOLFGANG STUETZ, VOLKER HOFFMANN, MATIN QAIM,
HANS K BIESALSKI AND ANNE C BELLOWS
Ready-to-Use Foods (RUFs) in the form of fortified cereal/nut/legume-based biscuits (±500 kcal and 8-10% protein per 100 g) were tested among mildly wasted children from October 2007 to June 2008, and were labelled as RUF-Nias biscuits. This study reports on a comparison of supplementary feeding program outcomes of mildly wasted children with weight-for-height z-score (WHZ) ≥-2 to <-1.5 SD aged ≥6 to <60 months old given locally produced RUF-Nias biscuits within daily (in semi-urban areas) and weekly (in rural remote regions) distribution and supervision program settings. In the Church World Service project area, all eligible children were recruited continuously from monthly community-based screening programs and admitted into existing nutrition centers managed by the community on Nias Island, Indonesia. Individual discharge criterion of the programs was WHZ ≥-1.5 SD. Of the index children admitted in daily programs (n=51), 80.4% reached target WHZ, which was higher than in weekly programs (72.9%; n=48) by a similar length of stay of about 6 weeks. Weight gain of the children in daily programs was higher (3.1±3.6 g/kg body weight/day) than in weekly programs (2.0±2.1 g/kg body weight/day), and they achieved significantly higher WHZ at discharge. However, the majority of caretakers preferred weekly programs due to lower time constraints. Locally produced RUF in the form of biscuits for treatment of mild wasting among children demonstrated promising results both in daily and weekly communitybased intervention programs.
Key Words: ready-to-use foods, fortified, supplementary feeding, mildly wasted children, weight gain
以強化穀類/堅果類/豆類為主製成的餅乾(每100 公克含±500 大卡及8-10%蛋白
質)做為即食補充品(RUFs)，並標示為RUF-Nias 餅乾。從2007 年10 月至2008年6 月，以當地輕度消瘦兒童作為測試。這個研究針對體重-身高比Z 分數
(WHZ)為-2 至<-1.5 標準差，年齡介於6 至<60 個月的輕度消瘦兒童，給予在地產的RUF-Nias 餅乾，比較以每日(半都會區)或每週(鄉村偏遠地區)發給及監督食
計劃的準則是WHZ-1.5 標準差。在相似的約6 週餵食補充期間，每日方案的兒童(51 位)顯示有80.4%達到WHZ 目標，高於每週方案的兒童(48 位中的
72.9%)。每日方案的兒童體重增加(平均每天3.1±3.6 g/kg 體重)也較每週方案(每天2.0±2.1 g/kg 體重)高，且在離開時達到顯著性較高的WHZ。然而，大多數的
Glutamine for chemotherapy induced diarrhea: a meta-analysis
JUXIAN SUN, HUI WANG AND HEPING HU
The clinical efficacy of glutamine in the control of chemotherapy-induced diarrhea remains controversial. We conducted a meta-analysis, including as many randomized control trails (RCTs) as possible, to clarify the effectiveness of prophylactic glutamine in patients requiring chemotherapy. Methods: the Embase, MEDLINE, Cochrane Library, and BIOSIS databases were searched, and the included studies were RCTs that compared the use of prophylactic glutamine versus placebo in patients receiving chemotherapy. The main outcomes were diarrhea severity and duration. Results: a total of 298 patients in eight RCTs were reviewed (147 patients who received glutamine, and 151 patients who received placebo). There was a statistically significant difference in the duration of diarrhea (weighted mean difference (WMD), -1; 95% confidence interval (CI), -1.73, -0.26) between the two groups, but there was no significant difference in the severity of diarrhea (WMD, -0.49; 95% CI, -1.36, 0.39) between the groups. Conclusion: we concluded that glutamine could reduce the duration of diarrhea but could not improve its severity.
Key Words: glutamine, diarrhea, chemotherapy, meta-analysis, prophylactic
腹泻中的疗效。方法: 搜索EMBASE 数据库、Medline 数据库、Cochrane 图书
馆和BIOSIS 数据库，所有比较谷氨酰胺与安慰剂对预防化疗相关性腹泻作用的随机对照研究均纳入本次荟萃分析。主要分析结果为腹泻评分和腹泻天数。结果: 8 个随机对照研究，共298 名患者纳入了本次研究，其中谷氨酰胺
组147 名，安慰剂对照组151 名。两组腹泻天数有很大差别(WMD, -1; 95%可信区间: -1.73, -0.26)，但是腹泻评分无明显差别(WMD, -0.49; 95%可信区间: -
1.73, 0.39)。结论: 谷氨酰胺可以减少化疗相关性腹泻的天数，但可能无法减轻腹泻程度。
The complexity of treating wasting in ambulatory rehabilitation: is it starvation, sarcopenia, cachexia
or a combination of these conditions?
ALISON YAXLEY, MICHELLE D MILLER, ROBERT J FRASER, LYNNE COBIAC AND MARIA CROTTY
Nutritional status is often impaired in ambulatory rehabilitation patients. Wasting conditions can be classified as starvation, sarcopenia or cachexia but differences between these are not well defined, and misdiagnosis may lead to inappropriate intervention. A secondary analysis of data from 187 ambulatory rehabilitation patients aged ≥60 years aimed to identify patients with one or more wasting condition, and investigate the impact on common rehabilitation outcomes. Starvation was defined by fat-free mass index and the Council on Nutrition Appetite Questionnaire score; sarcopenia by fat-free mass index and quadriceps strength; and cachexia by fat-free mass index and serum C-reactive protein. Selected rehabilitation outcomes were compared for those who were, and those who were not, identified as having one or more wasting condition. Of those identified with starvation (n=30), all were also identified as sarcopenic and 20 as cachectic; of those identified as sarcopenic (n=75), 30 had starvation and 37 were cachectic; and of those identified as cachectic (n=37), 20 had starvation and all were sarcopenic. Twenty participants were identified as having all three conditions. Those with starvation had higher level of depression (p=0.003), lower self-rated health (p=0.032), and lower levels of physical function (motor p=0.006; process p=0.004) than those with no evidence of a wasting condition. Those who had sarcopenia had lower physical function (motor p=0.012; process p=0.003) as did those with cachexia (motor p=0.025; process p=0.042). Results suggest problems in operationalising definitions in an ambulatory clinical setting. The overlap identified in this analysis suggests that up to 40% (75/187) of patients could be misidentified and prescribed inappropriate nutritional support.
Key Words: wasting, starvation, sarcopenia, cachexia, aged
肉衰減症或惡病質。然而此等分類之區別不甚明確，錯誤診斷下可導致不恰當的調理。本文就187 名年齡為60 歲或以上的非卧床復康中病人的之數據作進一步分析，旨在識別其中患有一種或多種消瘦情況的病人，並探討其對於一般復康指標之影響。用於界定飢餓的標準為無脂肪體重指數及食慾評估量表(Council on Nutrition Appetite Questionnaire)的得分；老年肌肉衰減症以無脂肪體重指數及四頭肌力量來評定；惡病質則根據無脂肪體重指數及血清C-反
應蛋白。本硏究根據幾項擬定的復康指標，就患有一種或多種消瘦狀況與沒有消瘦狀況的病人作出比較。被判斷為飢餓的消瘦病人(n=30)，全數均患有老年肌肉衰減症，而其中有20 名病人亦同時有惡病質的情況。被判斷為患老年肌肉衰減症的消瘦病人(n=75)當中，30 名有飢餓的情況，37 名有惡病質的情況。被判斷為惡病質的消瘦病人中(n=37)，有20 名有飢餓的情況，並全數患有老年肌肉衰減症。同時存在三種狀況的病人則有20 名。與沒有消瘦徵狀的病人相比，飢餓病人的抑鬱程度較高(p=0.003)，病者自我健康評估較差
Plasma phospholipid polyunsaturated fatty acids and homocysteine in Chinese type 2 diabetes patients
TAO HUANG, SAILIMUHAN ASIMI, DAJUN LOU AND DUO LI
The main aim of the present study was to investigate the plasma phospholipids (PL) fatty acids status and its association with plasma Hcy in patients with type 2 diabetes mellitus (T2DM). One hundred and four T2DM (aged 57.3±13.4 y) and 150 healthy subjects (aged 48.4±8.7 y) were recruited. Plasma Hcy and PL fatty acids were determined by standard methods. Plasma Hcy concentration in T2DM was significantly higher than that in healthy subjects (p<0.001). The prevalence of hyperhomocysteinemia was significantly higher in T2DM (36.54%) than that in healthy subjects (17.32%) (p=0.012). Plasma PL 20:4n-6 (r=0.303, p=0.012), 22:5n-3 (r=0.312, p=0.01), total PUFA (r=0.303, p=0.012), n-6 PUFA (r=0.261, p=0.032) were significantly positively associated with plasma Hcy concentration in T2DM. While, plasma PL n-3:n-6 PUFA (r=-0.400, p=0.046) was negatively associated with plasma Hcy in T2DM. In healthy subjects, plasma PL 22:6n-3 (r=-0.201, p=0.042) was negatively associated with plasma Hcy. In addition, plasma PL 22:6n-3 (r=0.193, p=0.044) and 22:5n-6 (r=0.234, p=0.038) were significantly negatively associated with plasma vitamin B-12 in healthy subjects. Our results suggested that increased plasma Hcy levels in T2DM associated with low n-3:n-6 ratio intake. We suggest that T2DM increase their long chain n-3 PUFA intake from fish or fish oil while decrease n-6 PUFA intake.
Key Words: n-3 polyunsaturated fatty acid, homocysteine, type 2 diabetes, phospholipids, monounsaturated fatty acids
本研究的主要目的是探究中国二型糖尿病人血浆磷脂多元不饱和脂肪酸与血浆同型半胱氨酸的关系。我们收集了104 份二型糖尿病病例(年龄：57.3±13.4 岁)和150 个健康样本(年龄：48.4±8.7 岁)。应用标准方法检测血浆的磷脂脂肪酸和同型半胱氨酸浓度。二型糖尿病人血浆同型半胱氨酸浓度显著高于健康人的浓度(p<0.001)。高同型半胱氨酸血症的发病率(36.54%)也显著高于健康人群(17.32%)(p=0.012) 。二型糖尿病人的血浆磷脂所含的20:4n-6(r=0.303 ，p=0.012)、22:5n-3(r=0.312，p=0.01)、总多元不饱和脂肪酸(PUFA)(r=0.303，p=0.012)、n-6 PUFA(r=0.261，p=0.032)与血浆同型半胱氨酸呈显著正相关；而血浆磷脂中的n-3:n-6 PUFA(r=-0.400，p=0.046)与同型半胱氨酸呈显著负相关。健康人群血浆磷脂之22:6n-3(r=-0.201，p=0.042)与血浆同型半胱氨酸亦呈
显著负相关。另外，血浆磷脂所含的22:6n-3(r=0.193，p=0.044)和22:5n-6(r=0.234，p=0.038)与血浆维生素B-12 呈显著负相关。我们的研究表明，二型糖尿病人高同型半胱氨酸浓度与较低的血浆磷脂n-3:n-6 相关。我们建议二型糖尿病人应该通过食用鱼和鱼油来增加饮食中的n-3 PUFA 的摄入，而降低n-6
Assessing current nutritional status of patients with HCV-related liver cirrhosis in the compensated
KENICHIRO YASUTAKE, MACHIKO BEKKI, MASAKO ICHINOSE, MICHIKO IKEMOTO, TATSUYA FUJINO, TOMOKI
RYU, YOSHIYUKI WADA, YUKO TAKAMI, HIDEKI SAITSU, MOTOYUKI KOHJIMA, KUNITAKA FUKUIZUMI,
MANABU NAKASHIMA, MAKOTO NAKAMUTA AND MUNECHIKA ENJOJI
Background/Aim: Nutritional states of Japanese patients with liver cirrhosis have recently shown great diversity, some show protein energy malnutrition and others excessive nutrition and obesity. For there to be adequate guidance regarding dietary treatment, it is important that a patient’s current nutritional state be clarified. Methods: We assessed nutritive intake in Japanese cirrhotic patients and determined their nutritional problems. Subjects were non-hospitalized patients with hepatitis C virus (HCV)-related cirrhosis in the compensated stage (n=47), chronic hepatitis C (n=46) or healthy volunteers (n=32). A brief self-administered diet history questionnaire was conducted with assistance from a registered dietitian. Results: We categorized patients with cirrhosis according to daily intake of energy and protein; 10.6% had an energy and protein intake within a normal range, 72.4% showed excessive intake, and 17.0% showed insufficient intake of energy or protein. In cirrhotic patients with diabetic complications, the intake levels of energy, proteins, fat and carbohydrates were significantly higher than in patients without diabetes. Moreover, cirrhotic patients had significantly higher intake levels of energy, protein and fat than did chronic hepatitis C patients and healthy individuals. In patients with HCV-related liver cirrhosis, insufficient intake of energy and protein was shown in some, while many, especially those with diabetes, showed excessive intake. Conclusion: For nutritive management of cirrhotic patients, the intake of various nutrients should be appropriately assessed and effective nutritional education systems established.
Key Words: liver cirrhosis, HCV, nutrition, obesity, chronic hepatitis C
型肝炎相關的肝硬化且處於代償期的患者47 人、慢性C 型肝炎46 人、健康自願者32 人。由註冊營養師協助受試者自行填寫一份簡短的飲食史問卷。結果：肝硬化病人根據其每天攝取的熱量及蛋白質分組，熱量及蛋白質攝取量在正常範圍內者占10.6%，攝取過多者占72.4%，不足者占17%。併發有糖尿病的肝硬化病人，其熱量、蛋白質、脂肪、醣類的攝取量顯著高於沒有糖尿病的病人。另外，肝硬化病人的熱量、蛋白質及脂肪的攝取量顯著高於慢性C 型肝炎患者及健康受試者。在C 型肝炎相關的肝硬化病人中，雖然有些人的熱量和蛋白質攝取有不足的情形，但大部分，尤其是同時患有糖尿病者，其攝取量是過多的。結論：對於肝硬化病人的營養管理，需適切地評估其各種營養素攝取情形及建立有效的營養教育系統。
關鍵字：肝硬化、C 型肝炎病毒、營養、肥胖、慢性C 型肝炎
Evaluation of taste acuity by the filter-paper disc in Japanese young women: The relationship with
AYAKO NAGAI, MASARU KUBOTA, YURIKO KATAYAMA AND CHIAKI KOJIMA
The aim of the present study is to investigate the taste acuity in Japanese young women in relation to their micronutrient status. Thirty-eight healthy young women (mean age; 21.3, range; 19-27 years) were enrolled. Gustatory thresholds were estimated for four basic tastes: sweet (sucrose), salty (sodium chloride), sour (tartaric acid), and bitter (quinine hydrochloride) by a filter-paper disk method. Various concentrations at each taste were serially scored from disc number 1 (lowest) to number 5 (highest). The lowest concentration at which the quality of the taste was correctly identified was defined as the recognition threshold. The mean of three measurements for each test on three different days was calculated. We divided our participants into normal taste and hypogeusia groups based on the mean threshold disc numbers, ≤3.5 and >3.5, respectively, according to previous literature using the same method. We also measured serum concentrations and dietary intakes of micronutrients including zinc, iron, copper, and selenium. The numbers of participants belonging to the hypogeusia group were 24 (63.2%) for sweet, 19 (50.0%) for sour, 17 (44.7%) for bitter, and 16 (42.1%) for salty taste. Although the hypogeusia group exhibited significantly lower serum iron concentrations, except for the salty taste, the other three micronutrients concentrations did not show any association with the four taste acuities. Dietary micronutrient intake did not show any association with the four taste acuities. This study indicates that in addition to zinc status, iron status should be considered in the study of taste acuity.
Key Words: Japanese young women, taste acuity, filter-paper disc method, micronutrient, dietary record
本研究目的為探討日本年輕女性的味覺敏銳度與微量營養素狀況之相關。總共有38 名健康年輕女性(平均年齡21.3 歲，範圍為19-27 歲)參與此研究。味覺閾值是以圓盤濾紙法測試4 種基本味道：甜(蔗糖)、鹹(氯化鈉)、酸(酒石酸)及苦(鹽酸奎寧)。每種味道以圓盤編號1(最低)到5(最高)的不同濃度，按順序測試
記分。可正確辨識的最低濃度，定義為該味道的認知閾值。以3 天測試的3 次測量計算平均閾值。依據之前的文獻使用的相同方法，將參與者按照平均閾值≤3.5 及>3.5 分別歸為正常味覺組及味覺遲鈍組。另外也測量參與者微量營養素的血清濃度及飲食攝取，包含鋅、鐵、銅及硒。被歸類在味覺遲鈍組的參與者在甜味有24 人(63.2%)、酸味有19 人(50.0%)、苦味有17 人(44.7%)及鹹味有16人(42.1%)。除了鹹味外，味覺遲鈍組顯示有較低的血清鐵濃度，而其它3 種微
量營養素血清濃度對4 種味覺敏銳度則沒有顯示任何相關性。飲食微量營養素4 種味覺敏銳度沒有任何相關。此研究指出，除了鋅之外，鐵營養狀況應該在味覺敏銳度研究中一併被考量。
Microcytic anaemia predominates in adolescent school girls in the delta region of Myanmar
MIN KYAW HTET, DRUPADI DILLON, ARWIN AKIB, BUDI UTOMO, UMI FAHMIDA AND DAVID I THURNHAM
Objective: Anaemia is one of major nutritional problems in Myanmar affecting all age groups. However, there is lack of recent information and a study was conducted to acquire information on the current status of anaemia among adolescent schoolgirls in Nyaung Done township, Ayeyarwady division where an intervention study was planned. Subjects and Methods: A cross-sectional survey was conducted on 1269 subjects to obtain complete blood count, anthropometry and socioeconomic characteristics were obtained by questionnaire. Using red cell indices, we applied Bessman’s, and Green and King’s index classification to differentiate the types of anaemia. Electrophoresis was also done on a subsample (n=228). Results: Stunting was 21.2% and wasting was 10.7% respectively. Prevalence of anaemia was 59.1% and was mainly microcytic. Green and King’s index showed 35.8% were iron deficient. Electrophoresis revealed 36 cases of Hb E haemoglobinopathy in the subsample. Conclusion: Anaemia is still a major nutrition problem in Myanmar. The reasons for this high prevalence should be explored and properly addressed. The study highlights the need for a comprehensive and large scale survey for the anaemia control programme in Myanmar.
Key Words: anaemia, haemoglobinopathy, Myanmar, adolescent, schoolgirls
目的：貧血是緬甸所有年齡層群眾的一個主要營養問題，然而缺少近期的相關資料。有一個介入型研究計劃將在伊洛瓦底省的央東鄉進行，因此先做一橫斷性研究，以得到緬甸青春期女學生貧血現況的資料。受試者與方法：針對1269 名受試者做橫斷面調查，進行完整血液檢查與體位測量，社會經濟特性則由問卷而得。使用Bessman’s 和Green and King’s 紅血球指數分類法來區分不同類型的貧血，其中228 個血液樣本有進行電泳分析。結果：發育遲緩和過度消瘦者分別占21.2%與10.7%。貧血的盛行率是59.1%，其中以小球性為主；從Green and
King’s 指數來看，有35.8%是由於鐵缺乏。電泳分析的樣本中顯示有36 名是屬於
High prevalence of anemia with lack of iron deficiency among women in rural Bangladesh: a role for
thalassemia and iron in groundwater
REBECCA D MERRILL, ABU AHMED SHAMIM, HASMOT ALI, ALAIN B LABRIQUE, KERRY SCHULZE, PARUL
CHRISTIAN AND KEITH P WEST, JR
Iron deficiency was absent in a recent population assessment of rural Bangladeshi women exhibiting anemia (57%), suggesting other causes of low hemoglobin. We assessed the relative influence on anemia of thalassemia, groundwater arsenic and iron, and diet among women of reproductive age living in rural Bangladesh. Women (n=207) sampled from a previous antenatal nutrient intervention trial in rural Bangladesh were visited during two seasons in 2008. Collected data included 7-day dietary and 24-hour drinking water intake recalls, 7-day morbidity recall, anthropometry, and drinking water arsenic and iron concentrations. Capillary blood was analyzed for iron (plasma ferritin, soluble transferrin receptor), inflammation (C-reactive protein) and thalassemia (β thalassemia and Hb E) status. In stratified, adjusted analyses, only parity was associated with anemia (odds ratio, OR (95% CI): 11.34 (1.94, 66.15)) for those with thalassemia (28% prevalent). In contrast, groundwater iron intake (>30 mg/d, 0.48 (0.24, 0.96)) and wasting (2.32 (1.17, 4.62)) were associated with anemia among those without thalassemia. Elevated groundwater arsenic (>50 μg/L, 12% of tubewells) and a diverse diet were unrelated to anemia regardless of thalassemia diagnosis (p>0.70 and >0.47, respectively). Among women in this typical rural Bangladeshi area, the prevalence of thalassemia was high and, unlike iron deficiency which was absent most likely due to high iron intake from groundwater, contributed to the risk of anemia. In such settings, the influence of environmental sources of iron and the role of thalassemias in contributing to anemia at the population level may be underappreciated.
Key Words: Bangladesh, anemia, iron-deficiency, thalassemia, women
近期調查顯示孟加拉部分鄉村地區的婦女中非鐵缺乏的貧血盛行率達57%，推測有其他因素造成低濃度的血色素值。本研究評估地中海貧血症、地下水中的砷及鐵、以及飲食對於孟加拉鄉村地區的育齡婦女貧血的相關影響。個案來自於先前的產前營養介入試驗的孟加拉鄉村婦女，計207 位的參與者於2008 年接受2 次面訪。資料收集包括7 天的飲食頻率問卷、24 小時飲用水攝取回憶記錄、7 天的疾病史、體位測量以及飲用水中的砷及鐵濃度。血液分析項目包括鐵(血漿儲鐵蛋白、水溶性運鐵蛋白受體)、發炎反應(C-反應蛋白)及地中海貧血症(β 地中海型貧血及血色素E)的狀態。在分層、校正分析結果顯示只有生產次數與地中海貧血患者(盛行率28%)的貧血有顯著相關(OR:
11.34，95% CI: 1.94, 66.15)。相反地，地下水的鐵攝取量每天高於30 毫克(OR: 0.48，95% CI: 0.24, 0.96)及消瘦(OR: 2.32，95% CI: 1.17, 4.62)與無地中海貧血症者的貧血具有顯著相關。高的地下水砷濃度(12%的管井含量高於50μg/L)或多樣化的飲食與無論是否有地中海貧血診斷的貧血都不具相關。在孟加拉典型鄉村地區的婦女，由於地下水中含有高量的鐵，故缺鐵性貧血較少見；然而偏高的地中海貧血症盛行率，卻是貧血的高風險因子。在這樣的情境下，環境來源鐵的影響及地中海貧血症導致貧血的重要角色，在族群的層次上有可能是被忽視的。
Sugary beverage intakes and obesity prevalence among junior high school students in Beijing – a
cross-sectional research on SSBs intake
MENG JIA, CHAO WANG, YUMEI ZHANG, YINGDONG ZHENG, LONG ZHANG, YANJIE HUANG AND PEIYU WANG
Background: Excessive consumption of sugar-sweetened beverages (SSBs) may increase the risk of obesity. Data in regards to the consumption of SSBs is insufficient in the Chinese population, especially in middle school students experiencing rapid nutritional transition. We aimed to describe the consumption of SSBs among junior high school students and explore the relationship between SSB intake and adolescents’ overweight/obesity in Beijing. Methods: This was a cross-sectional study under which 322 (46%) male and 380 (54%) female (age 11-15 y, median 13 y) were recruited from two middle schools of Xicheng District in Beijing. All subjects completed a questionnaire and 24-hour dietary recall for 3 consecutive days. Results: Prevalence of overweight was 21.1% in males and 11.6% in females. Prevalence of obesity was 22.7% in males and 10.3% in females. Of the students, 7.7% consumed SSBs at least once per day. Students whose storage of SSBs at home is more than 1 type are more likely to consume higher quantities of SSBs everyday (p<0.001). After adjusting for confounding factors, OR of high SSBs intake group versus low SSBs intake group was 2.6. Students whose parents had a higher BMI had a higher risk of overweight/obesity (OR=1.13, p=0.007). Conclusions: Among middle school students in Beijing, prevalence of obesity is more severe than that of overweight. Sugar-sweetened beverages have been the most popular drinks, and consumption of SSBs has a positive association with levels of overweight/obesity among male students.
Key Words: beverages; energy; overweight; obesity; dietary
目的：过量摄入含糖软饮料(SSBs)会增加肥胖的风险，中国目前针对中学生人群的相关研究很少。本次调查目的在于了解目前北京市中学生SSBs 的消费现况，并研究SSBs 摄入与中学生超重/肥胖流行之间的关系，为建立健全青少年超重肥胖预防体系提供理论支持。方法：本次调查为横断面研究，对北京市某区两所中学11-15 岁初中生(男生322 位，女生380 位)进行自填式问卷调查和连续3 天的24 小时膳食回顾调查。结果：肥胖率男生为22.7%，女生为10.3%；超重率男生为21.1%，女生为11.6%。家中储备SSBs 的种类在2 种以上的人平均每日SSBs 摄入量较高(p＜0.001)。在校正了混杂因素后，SSBs 摄入高水平的学生与摄入低水平的学生相比，发生超重/肥胖的相对危险度为OR=2.6；父母的BMI 与子女超重/肥胖的发生存在关联(OR=1.130，p=0.007)。结论：在北京11-15 岁中学生人群当中，肥胖的流行趋势与超重相比更加严峻，而SSBs已成为最经常消费的饮料品种；在男生当中，高摄入量的含糖软饮料与超重/肥胖的发生显著相关。
Lack of folate improvement in high risk indigenous Australian adults over an average of 6.5 years: a
KATINA D’ONISE, ROBYN ANNE MCDERMOTT, DYMPNA LEONARD AND SANDRA KAYE CAMPBELL
Socioeconomically vulnerable groups in developed countries suffer excess chronic disease due in large part to an energy dense but nutrient poor diet. Low folate can be a marker of poor dietary quality and is also affected by smoking and chronic alcohol intake, all of which cluster in groups with a low socioeconomic position. A 4.5 to 9 year follow-up study of 567 indigenous adults from remote communities in far north Queensland, Australia, from 1998 to 2007 was conducted. Analysis of the effects of demographic factors, smoking, risky alcohol drinking, fruit and vegetable intake and waist circumference on changes in red cell folate (RCF) status was conducted. Prevalence of low red cell folate doubled in the cohort from a high baseline over this seven year period: 36.9% deficient in 2007, 15.9% at baseline (p<0.001). Smoking was associated with lower folate levels. People with a normal RCF were less likely to be smokers, and were more likely to have a greater number of serves of vegetables (RR 1.06, 95% CI 1.02-1.10) than those who were deficient at follow-up. The introduction of voluntary folate fortification since 1995 does not appear to have impacted on the already poor folate status of this cohort of adults. The increased prevalence of low folate has occurred despite improvements in the food supply, indicating the need for nutrition promotion, and subsidies for healthy food in remote communities. The impact of mandatory folate fortification of flour since 2009 should be assessed in this high risk population.
Key Words: folic acid, indigenous population, policy, nutrition policy, cohort studies
攝取高能量密度且營養素含量低的飲食，使得已開發國家中社經狀況較差的弱勢族群面臨過多的慢性疾病。低葉酸可視為低飲食品質的標記，它也受到抽菸及長期飲酒影響，這些因子與較低的社經地位成聚集風險。一個4.5-9 年的追蹤研究，自1998 至2007 年共追蹤567 名在澳洲北昆士蘭偏遠社區的原住民成
人。分析人口學變項、抽菸、酗酒、蔬果攝取及腰圍，對於紅血球葉酸狀況的改變影響。經過7 年，這個世代的低紅血球葉酸盛行率增加為基線的兩倍：2007 年葉酸缺乏者有36.9%，基線為15.9% (p<0.001)。抽菸與較低葉酸量有相關。比起追蹤時為葉酸缺乏者，有正常紅血球葉酸的人較少抽菸，並攝取較多份數的蔬菜(RR: 1.06，95%CI: 1.02-1.10)。自1995 年引進的自主葉酸強化對世代中那些葉酸狀況原本就差的成人，並沒有顯現任何的效果。儘管食物供應有改善，低葉酸盛行率反倒增加，顯示有必要在偏遠地區施行營養推廣及健康的食物補助。自2009 年麵粉強制葉酸強化對高風險族群的影響應該被評估。
Folate knowledge and consumer behaviour among pregnant New Zealand women prior to the
potential introduction of mandatory fortification
SIMONETTE R MALLARD AND LISA A HOUGHTON
To reduce the risk of neural tube defects, the New Zealand Ministry of Health recommends women take supplemental folic acid from at least one month preconception until the end of the twelfth week of pregnancy, as well as consume folate-rich foods. A postpartum survey was conducted to describe folate knowledge and consumer behaviour among pregnant New Zealand women prior to the potential implementation of mandatory folic acid fortification of bread in May 2012. Increasing knowledge of folic acid recommendations was associated with higher supplement uptake among women who planned their pregnancies (p=0.001 for linear trend). Folic acid information failed to adequately reach some socio-demographic subgroups before conception, even when pregnancy was planned, including: indigenous Māori, Pacific and Asian women, younger women, women with large families, and women with lower educational attainment and income. Only half of all women surveyed knew some bread contained added folic acid, and among these women, less than 2% consistently chose voluntarily fortified bread during the periconceptional period by inspecting labels. Sixty-one percent of women indicated they were either in favour of mandatory fortification, or held no opinion on the matter, while 4% were opposed to the addition of folic acid to bread. Approximately one-third (35%) of women agreed with voluntary fortification. Future health promotion initiatives should be tailored toward women who are younger, less educated, with lower income, multiparous or of minority ethnicity status. Nonetheless, mandatory folic acid fortification may be required to attain the desired degree of equity.
Key Words: folic acid, neural tube defects, fortification, health behaviour, nutrition policy
為了降低胎兒神經管缺陷的風險，紐西蘭衛生部建議婦女補充葉酸，至少從懷孕前的一個月直到懷孕12 週，並多攝取富含葉酸的食物。可能在2012 年5
Food group intake among adolescents in Guangzhou city compared with the Chinese dietary
CAI-XIA ZHANG, YU-MING CHEN, WEI-QING CHEN, YI-XIANG SU, CUI-LING WANG AND JIANG-NAN WU
Food group intake in adolescents has many health implications. However, no study has been conducted to assess food group intake among Chinese adolescents. Objective: The purpose of this study was to evaluate food group intakes among Chinese adolescents living in Guangzhou city and the proportion of adolescents surveyed meeting the Chinese dietary guidelines, and the Chinese food pagoda for a balanced diet 2007. Methods: A school-based cross-sectional survey was conducted in Guangzhou city between October 2006 and April 2007. A random sample of 2977 adolescents, aged 12 to 17 years, was interviewed. A self-administered semi-quantitative food frequency questionnaire was used to estimate food group intakes of adolescents. Results: A high percentage of adolescents consumed too little plant foods including vegetables, fruit, and soybean products. Only 9%, 14% and 6% of adolescents surveyed reached the minimum daily recommended intake levels for vegetables, fruit, and soybean products and nuts. Nearly 70% of the studied adolescents consumed dairy less than the recommended daily intake and more than 20% adolescents reached the recommended amounts for cereals and eggs. More than one-third (35.6%) of adolescents did not meet any food group recommendations. And no adolescents reached all eight food group recommendations. An inadequate consumption of calcium and iron among adolescents was also found. Conclusions: The results of this study indicate that most adolescents living in Guangzhou city are not meeting the current recommendations for intakes of the various food groups.
Key Words: adolescents, China, Chinese dietary guidelines, food group intake, nutrients
食物類別攝入情况與青少年健康密切相關，目前爲止，尚無研究評估中國青少年的食物類別攝入情况。目的：瞭解居住在廣州市的青少年食物類別攝入情况，幷評價其是否達到中國居民膳食指南和中國居民平衡膳食寶塔(2007)推薦的攝入量。方法：2006 年10 月到2007 年4 月期間，在廣州市開展了一項以學校爲基礎的橫斷面研究。隨機調查了2977 名年齡在12-17 歲的青少年，采用自填式的半定量食物頻數問卷來估計青少年的食物攝入情况，幷根據中國居民平衡膳食寶塔(2007)推薦的食物種類，將食物分爲糧穀類、蔬菜、水果、畜禽肉
Association between insulin receptor gene polymorphism and the metabolic syndrome in Han and Yi
CHUNXIU WANG, BIN WANG, HUIJING HE, XIAOTONG LI, DAYING WEI, JIANHUA ZHANG, MINGJU MA, LI PAN,
TAO YU, FANG XUE, LIN LI AND GUANGLIANG SHAN
Insulin resistance has been a possible underlying pathophysiologic defect inducing the metabolic syndrome (MS). However association studies regarding Insulin receptor gene in different ethnic groups are scarce in literature. Here we conduct an association study between MS and genetic polymorphism of the INSR gene in Yi and Han Chinese. In a cross-sectional study, 3,436 Yi and Han people were investigated. Ethnicity-specific case-control studies were designed, with MS patients diagnosed as cases and non-MS people as controls matched on gender and age. Polymerase chain reaction-restriction fragment length polymorphism was used to detect the genotypes of the exon 8 of the INSR gene. Data were analyzed using one-way analysis of variance, chi-square test, and logistic regression where appropriate. Systolic blood pressure (SBP) was significantly higher in MS patients with the N1N2/N2N2 genotypes than that in those with the N1N1 genotype of both ethnic population (p<0.05). Frequency of the N2 allele was significantly higher in MS patients than that in controls of ethnic Han (p=0.020). Multivariable logistic regression analysis showed that the NsiI polymorphism of the exon 8 of the INSR was an independent predictor for MS in Han people adjusted for total cholesterol, sex, physical activity, educational level, family income, alcohol intake and smoking (OR=2.55, 95% CI: 1.31-4.94, p=0.006). The results indicated that NsiI polymorphism of the INSR gene is associated with SBP in these two different ethnic groups, and significantly associate with MS in Han Chinese. These findings contribute to our better understanding on the genetic basis of MS.
Key Words: metabolic syndrome (MS), insulin receptor (INSR) gene, NsiI Polymorphism, ethnic Yi, China
胰岛素阻抗是可能引起代谢综合征(MS)的病理生理基础之一。然而，有关不同种族胰岛素受体(INSR)基因与代谢综合征的关联研究并不多见。本文探讨了中国彝族和汉族INSR 基因多态性与MS 的关联性。本研究共调查彝族和汉族3,436人。按照种族的不同，分别设计两组病例对照研究。分别选取汉族和彝族的MS
病例，根据两组病例数随机选择汉族和彝族非MS 对照者，且与病例在年龄和性别上进行匹配。应用聚合酶链式反应–限制性片段长度多态性(PCR–RFLP)检测INSR 基因第8 外显子的基因型。采用单因素方差分析，卡方检验和邏輯斯回归对数据进行分析。研究结果显示，无论彝族或汉族，MS 患者N1N2/N2N2 基因型
携带者收缩压比N1N1 基因型携带者高(p<0.05)。汉族人群INSR 基因第8 外显子NsiI 的基因型和等位基因在病例组和对照组中的频数分布差异有显著性，MS 病例组N2 等位基因频率显著高于对照组(p=0.020)。多因素邏輯斯回归分析结果显示，调整总胆固醇，性别，体力活动，教育程度，家庭收入，吸烟情况和饮酒情况后，INSR 基因第8 外显子NsiI 多态性是汉族人群MS 的独立预测因子
(OR=2.55，95％CI: 1.31-4.94，p=0.006)。研究结果表明，INSR 基因第8 外显子NsiI 多态性与彝族和汉族人群的收缩压相关联，且与汉族人群的MS 相关联。本研究对于理解MS 发生和发展的遗传基础提供了一定的科学依据。
High output enterocutaneous fistula: a literature review and a case study
CHUNG YAN TONG, LI LIN LIM AND REBECCA A BRODY
An enterocutaneous (EC) fistula is referred to as a channel between the gut and the skin. Effluent of an EC fistula of more than 500 ml per day is considered as high output. Patients with high output EC fistulae have a high morbidity and mortality rate. No evidence-based guidelines are available for this condition and more research is required to evaluate the effectiveness of treatment. Nevertheless, patients with fistulae should be managed based on the available evidence, detailed clinical and nutrition assessment, and close monitoring. Management of high output EC fistula is complex and challenging. It involves nutrition, medical, skin care and psychological treatment, which is best managed by a multidisciplinary team. It requires an individualized nutrition and clinical treatment plan to maximize patient outcomes. Up to 70% of patients with fistulae have malnutrition and it is a significant prognostic factor of spontaneous fistula closure. Nutrition therapies including macronutrient and micronutrient delivery, enteral nutrition and parenteral nutrition are discussed in this review. A case study of a patient with multiple EC fistulae is presented to illustrate the management of high output EC fistulae.
Key Words: intestinal fistula, cutaneous fistula, parenteral nutrition, enteral nutrition, intestinal secretions