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1 Asia Pacific Journal of Clinical Nutrition
       Volume 21, 4

         (December 2012)


Abstracts

Contents

Abstract PDF

Mini Review

Paradoxes for health systems with weight disorders
MARK L WAHLQVIST AND SHAO-YUAN CHUANG
Asia Pac J Clin Nutr. 2012;21(4):471-475.

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Reviews

Micronutrient interventions on cognitive performance of children aged 5-15 years in developing countries
GEOK LIN KHOR AND SNIGDHA MISRA
Asia Pac J Clin Nutr. 2012;21(4):476-486.

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Fish advisories in the USA and Japan: risk communication and public awareness of a common idea with different backgrounds
PING HAN SER AND CHIHO WATANABE
Asia Pac J Clin Nutr. 2012;21(4):487-494.

 

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Original Research Communications

 

Nutritional Measurement & Methodology

 

Chest circumference in infancy predicts obesity in 3-year-old children
IZUMI AKABOSHI, AKITO KITANO, HIROAKI KAN, YOUGO HARAGUCHI, YUUJI MIZUMOTO, FOR THE KUMAMOTO INFANT RAPID GROWTH STUDY GROUP
Asia Pac J Clin Nutr. 2012;21(4):495-501.

 

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Clinical Nutrition or Feeding Studies

 

Fish oil supplementation is beneficial on caloric intake, appetite and mid upper arm muscle circumference in children with leukaemia
ZALINA ABU ZAID, SUZANA SHAHAR, A RAHMAN A JAMAL AND NOOR AINI MOHD YUSOF
Asia Pac J Clin Nutr. 2012;21(4):502-510.

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Effects of omega−3 fatty acids supplementation on se-rum adiponectin levels and some metabolic risk factors in women with polycystic ovary syndrome
ELAHE MOHAMMADI, MARYAM RAFRAF, LAYA FARZADI, MOHAMMAD ASGHARI-JAFARABADI AND SIAMAK
SABOUR
Asia Pac J Clin Nutr. 2012;21(4):511-518.

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Plasma ω-3 fatty acid levels negatively and ω-6 fatty acid levels positively associated with other cardiovascular risk factors including homocysteine in severe obese subjects
IDRIS MEHMETOGLU, F HÜMEYRA YERLIKAYA, SEVIL KURBAN AND HAKKI POLAT
Asia Pac J Clin Nutr. 2012;21(4):519-525

 

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Nutritional Status, Dietary Intake, and Body Composition

 

25(OH)D status and demographic and lifestyle determinants of 25(OH)D among Korean adults
EUN YOUNG CHOI
Asia Pac J Clin Nutr. 2012;21(4):526-535

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Age- and gender-specific associations between low serum 25-hydroxyvitamin D level and type 2 diabetes in the Korean general population: analysis of 2008-2009 Korean National Health and
Nutrition Examination Survey data

BYUNG-KOOK LEE, SUNMIN PARK AND YANGHO KIM
Asia Pac J Clin Nutr. 2012;21(4):536-546.

 

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Choline and betaine food sources and intakes in Taiwanese
DA-MING CHU, MARK L WAHLQVIST, HSING-YI CHANG, NAI-HUA YEH AND MEEI-SHYUAN LEE
Asia Pac J Clin Nutr. 2012;21(4):547-557.

 

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Maternal and Child Nutrition

Snack foods consumption contributes to poor nutrition of rural children in West Java, Indonesia
MAKIKO SEKIYAMA, KATRIN ROOSITA AND RYUTARO OHTSUKA
Asia Pac J Clin Nutr. 2012;21(4):558-567.

 

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Trends in the prevalence of undernutrition, nutrient & food intake and predictors of undernutrition among under five year tribal children in India
INDRAPAL ISHWARJI MESHRAM, NIMMATHOTA ARLAPPA, NAGALLA BALAKRISHNA, KODAVANTI MALLIKHARJUNA RAO, AVULA LAXMAIAH AND GINNELA NAG VEERA BRAHMAM
Asia Pac J Clin Nutr. 2012;21(4):568-576.

 

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Nutritional Epidemiology and Public Health

 

The U-shaped relationship between BMI and all-cause mortality contrasts with a progressive increase in medical expenditure: a prospective cohort study
WEN-HARN PAN, WEN-TING YEH, HSIN-JEN CHEN, SHAO-YUAN CHUANG, HSING-YI CHANG, LIKWANG CHEN AND MARK L WAHLQVIST
Asia Pac J Clin Nutr. 2012;21(4):577-587.

 

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Alcohol consumption and the risk of type 2 diabetes mellitus: effect modification by hypercholesterolemia: The Third Korea National Health and Nutrition Examination Survey (2005)
HYEONGAP JANG, WON-MO JANG, JONG-HEON PARK, JUHWAN OH, MU-KYUNG OH, SOO-HEE HWANG, YONG-IK KIM AND JIN-SEOK LEE
Asia Pac J Clin Nutr. 2012;21(4):588-593.

 

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Prevalence of functional gastrointestinal disorders in Taiwan: questionnaire-based survey for adults based on the Rome III criteria
FANG-YUAN CHANG, PO-HON CHEN, TZEE-CHUNG WU, WEN-HARN PAN, HSING-YI CHANG, SHIN-JIUAN WU, NAI-HUA YEH, REN-BIN TANG, LITE WU AND FRANK E JAMES
Asia Pac J Clin Nutr. 2012;21(4):594-600.

 

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Effects of healthy dietary pattern and other lifestyle factors on incidence of diabetes in a rural Japanese population
AKIKO MORIMOTO, YUKO OHNO, YUKAKO TATSUMI, SHOICHI MIZUNO AND SHAW WATANABE
Asia Pac J Clin Nutr. 2012;21(4):601-608.

 

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Public support for restrictions on fast food company sponsorship of community events
SIMONE PETTIGREW, MELANIE PESCUD, MICHAEL ROSENBERG, RENEE FERGUSON AND STEPHEN HOUGHTON
Asia Pac J Clin Nutr. 2012;21(4):609-617.

 

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South Korea’s entry to the global food economy: shifts in consumption of food between1998 and 2009
HAENG-SHIN LEE, KIYAH J DUFFEY AND BARRY M POPKIN

Asia Pac J Clin Nutr. 2012;21(4):618-629.

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Do registered dietitians search for evidence-based information? A nationwide survey of regional hospitals in Taiwan
YA-WEN CHIU, YI-HAO WENG, MARK L WAHLQVIST, CHUN-YUH YANG AND KEN N KUO
Asia Pac J Clin Nutr. 2012;21(4):630-637.

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Case Study

Repeated lung lavage with extracorporeal membrane oxygenation treating severe acute respiratory distress syndrome due to nasogastric tube malposition for enteral nutrition: a case report
XIAOMING KAO, WENKUI YU, WEIMING ZHU, NING LI AND JIESHOU LI
Asia Pac J Clin Nutr. 2012;21(4):638-641.

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Bleeding tendency in an adolescent with chronic small bowel obstruction
CHONNIKANT VISUTHRANUKUL, VORANUSH CHONGSRISAWAT, PAISARN VEJCHAPIPAT AND SIRINUCH CHOMTHO
Asia Pac J Clin Nutr. 2012;21(4):642-647.

 

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Future Events

 

Asia Pac J Clin Nutr. 2012;21(4):648.

 

 

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Paradoxes with weight disorders for health systems
MARK L WAHLQVIST AND SHAO-YUAN CHUANG
The body mass index (BMI) has served public health and clinical medicine well in the recognition of obesity. However, its use has generated some instructive paradoxes and misunderstandings which argue for the appreciation of body compositional disorders (BCD) as such and, in particular, for the parallel evaluation of muscle mass with a definition of ‘orthosarcal’ conditions to enable the early detection of sarcopenia. Across the life-span, and with gender and ethnic differentials, BCD is basic to the full spectrum of nutritionally-related disorders and diseases. In the case of metabolic diseases like diabetes, muscle, fatness and its distribution, and even bone seem to play pathogenetic roles. Optimal body fat and distribution are relevant to child development, maternal health and healthy ageing, with much more to learn about the mechanisms. The economic and societal costs of obesity tend to increase progressively with the BMI, but the health outcomes, at least for mortality, are J-or U-shaped. With some established chronic diseases, like diabetes, renal failure or cardiac failure, overfatness may be protective; sometimes this may be because contaminant fat-soluble endocrine disrupters are segregated in fat tissue. This means that some of the relatively favourable survival in the elderly who have more body fat is at the expense of the health care system. Younger children with chronic energy deficiency, on the other hand, may succumb before expenditure saves them. In these respects, our species is more vulnerable than we have thought. Fortunately, a better understanding of BMI and health is emerging.
Key Words: nutritional economics, obesity paradox, endocrine disrupters, sarcopenic obesity, orthosarcal
 

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體重失調矛盾
身體質量指數(BMI)為公共衛生與臨床醫學中肥胖判定的常用依據。然而它的使用卻也造成一些矛盾及誤解,例如體組成失調(BCD)的判定爭論,特別是用在以肌肉質量為評估指標之肌少症的早期偵測並不適當。在生命週期中,身體組成會隨著性別、年齡與種族而有所差異,而身體組成異常疾病通常是導因於個人相關營養需求失調及慢性疾病。譬如在代謝異常的糖尿病患中,肌肉、脂肪甚至骨質的分布可能是影響其代謝異常發展的重要機轉之一。因此,理想的體脂肪量及分布與孩童的發展、母親健康及健康老化的機制密切相關。整體而言,肥胖所導致的經濟及社會成本是伴隨BMI的增加而提高,但BMI亡率卻是呈現J或是U型的關係。在慢性病患中,例如糖尿病、腎衰竭或是心衰竭,較多體脂肪的人可能有較低的死亡風險;可能是因為較肥胖者有較多的心肌維持生命或者是因為脂肪細胞阻絕環境汙染因子對肌肉細胞的傷害。這些因素可能解釋健康照護系統中,體脂肪較高的老人,其存活率相對較高。因此,因果相關倒置的現象不應該被忽略。另一方面,熱量缺乏的幼童,可能在未獲得足夠能量前即死亡。在這樣的觀點中,人類比我們自己想像的還要脆弱。所幸,我們逐漸了解BMI 及健康關係。
關鍵字:營養經濟、肥胖矛盾、內分泌干擾物、肌少症肥胖、orthosarcal (健康的肌肉)

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Micronutrient interventions on cognitive performance of children aged 5-15 years in developing countries
GEOK LIN KHOR AND SNIGDHA MISRA

It is estimated that more than 200 million young children worldwide fail to reach their potential in cognitive development owing to undernutrition. Numerous studies have assessed the effects of micronutrient supplementation on growth and cognitive development in infants, toddlers and preschoolers. However, micronutrient interventions on the cognitive performance of older children are limited. This article seeks to provide an update on micronutrient interventions and cognitive outcomes among children aged 5-15 years in developing countries. A total of 13 randomized controlled trials published since 2000 were identified. Majority of these studies assessed the effects of micronutrient-fortified foods on various domains of cognitive function. Among key micronutrients assessed were iron, zinc, iodine and vitamin A. This review found a lack of consistency in the impact of micronutrient supplementation on intelligence, long term mental functions and school examination grades of the children. A beneficial effect of micronutrient supplementation on short term memory was more consistently reported. Overall, the evidence from this review for the impact of micronutrients on cognitive performance in older children remains equivocal. In light of the growing interest on the influence of nutrition on cognition, it is important that culturally-appropriate and sufficiently sensitive assessment tools be used for measuring the desired cognitive outcomes that are most likely to be affected by the nutrients under study.

Key Words: micronutrients, cognitive performance, children aged 5-15 years
 

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開發中國家5-15 歲孩童在微量營養素介入後的認知功能表現
據估計,全球有超過2億的幼童由於營養不足導致認知功能發育遲緩。目前已有許多研究,致力於評估微量營養素的補充,對於嬰兒、幼童及學齡前兒童成長及認知發展的影響。然而,微量營養素對於較大兒童認知表現的研究則有限。本文旨在提供關於微量營養素介入對於開發中國家5-15歲孩童認知影響的最新研究結果訊息。自2000年開始,共有13篇隨機對照試驗結果發表。大多數研究評估微量營養素強化食品對於不同認知功能領域的影響。被評估的主要微量營養素包括鐵、鋅、碘及維生素A。此次回顧發現,微量營養素補充的介入研究,在兒童的智力、長期心智功能及在校成績的影響結果並不一致。只有在短期記憶的部分,具有正向且較一致性的研究結果。整體而言,微量營養素對於較大兒童認知表現的影響,仍不明確。有鑑於,營養 對於認知發育的效應越來越受重視,因此有必要建立適合各族群以及具足夠敏感度的分析工具,以測量最有可能受到欲研究的營養素影響之認知表現。
關鍵字:微量營養素、認知表現、5-15 歲孩童

 

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Fish advisories in the USA and Japan: risk communication and public awareness of a common idea with different backgrounds
PING HAN SER AND CHIHO WATANABE

Some countries have established fish advisories to manage fish consumption to minimize methylmercury exposure. Our objective was to compare the fish advisories and the resultant consumer behavior in the United States of America (USA) and Japan. Both countries have national consumption guidelines, but American states enjoy greater independence in issuing guidelines for local water bodies and vary in the information that is provided for the public. The proportion of the American public that has heard of state fish advisories is thought to be close to 30%. There is a concern that this low level of awareness extends to pregnant women. In Japan, the current problem is the lack of comprehensive studies on the public awareness of fish advisories. Nonetheless, there is evidence that fish consumption has decreased in both countries. In USA, there is a possibility that the strong emphasis on mercury toxicity drives the general population towards a trend of lower fish consumption. In Japan, the fish advisory encourages seafood consumption for nutritional benefits. Consequently, the decrease may be due to the shift towards a “Western diet”. Also, the Japanese fish advisory seems to be less active in advocating the issue of fish consumption and mercury exposure, which may be partly responsible for the possible lesser attention of the consumers. Cultural factors may explain for the baseline difference in consumption and account partly for the change in Japanese consumer behavior. However, the dissimilarities in fish advisories may also be responsible for the variations in consumer behavior.

Key Words: fish advisory, fish consumption, mercury, public awareness, risk communication
 

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美國及日本的魚類公告:不同背景下對共通理念的風險溝通及公眾意識
有些國家已經建立魚類公告以管理魚類攝取,進而減少甲基汞的曝露。本文的目標為,比較美國及日本的魚類公告及其導致的消費者行為。兩個國家都有國民消費指南,但是美國各州有較高的獨立性,可針對當地水域發布指南,且能提供給民眾特異的資訊。美國民眾有聽過各州魚類公告者大約接近30%。值得注的是這樣低度的認知意識還包括懷孕婦女。在日本,目前的問題是缺乏完整的針對魚類公告的公眾意識之相關研究。在美國,有可能由於非常強調汞毒性而使得大眾傾向減少魚類攝取。在日本,魚類公告鼓勵為了營養益處而攝取海鮮食物。因此,魚類消費降低或可歸因於飲食型態轉趨“西方飲食”所致。而日本的魚類公告似乎較少宣導魚類攝取與汞暴露的主題,這或許可解釋為什麼消費者較少去注意的部分原因。文化因素可解釋兩國在魚類攝取的基本差異及日本消費者行為改變的部分原因。然而,魚類公告內容的差異或許也是造成消費者行為不同的緣由。
關鍵字:魚類公告、魚類攝取、汞、公眾意識、風險溝通

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Chest circumference in infancy predicts obesity in 3-year-old children
IZUMI AKABOSHI, AKITO KITANO, HIROAKI KAN, YOUGO HARAGUCHI, YUUJI MIZUMOTO, FOR THE KUMAMOTO INFANT RAPID GROWTH STUDY GROUP
The purpose of this study was to investigate the associations between chest circumference in infancy and rapid growth or obesity at 3 years of age. We conducted a retrospective observational study of 1353 children in Kumamoto, Japan. Data collected included chest circumference, head circumference, weight, and body mass index. The area under the receiver operating characteristic curves for chest circumference were analyzed to determine the ability of this index to identify obesity at 3 years of age. Chest circumference at 3-4 months of age and increases in chest circumference during the first 3-4 months of life had higher mean standard deviation scores for rapid growth than for slow or no change in growth (p<0.05). Chest circumference and the increase in chest circumference were also positively correlated with rapid weight gain, and were associated with obesity at 3 years of age. The area under the curve for chest circumference was significantly different from the area under the curve for weight z-score at 6-9 months but not for weight z-score at 3-4 months. In conclusion, we found that chest circumference is associated with obesity in young children, and is positively correlated with rapid growth. Therefore, chest circumference may be a useful marker for rapid growth, and may help clinicians to identify obese children at 3 years of age.

Key Words: area under the curve, chest circumference, obesity, rapid growth, receiver operating characteristic curve
 

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嬰兒期的胸圍預測兒童3 歲時的肥胖
此研究的目的為探討嬰兒期的胸圍與快速成長或3 歲時肥胖的相關性。此回溯性觀察研究對象包含1353 位日本熊本市的兒童。資料收集包含胸圍、頭圍、體重及身體質量指數。分析接受器操作特徵曲線(ROC)下面積用以決定預測3 歲兒童肥胖的指標。生長速度較快的幼童在3-4 個月時的胸圍和3-4 個月時的胸圍增加,比起生長速度較慢或體重沒有改變者,具有較高的平均標準差分數(p<0.05)。胸圍以及胸圍增加數值與快速體重增加及3 歲時的肥胖具有正相關。胸圍的曲線下面積與6-9 個月時體重Z 分數的曲線下面積具有顯著差異,但與3-4 個月的數值則無顯著差異。結論是,胸圍與幼童的肥胖以及成長速度具有正相關性。因此,嬰兒期的胸圍可能是有用的成長速度指標,而有助於臨床評估3 歲幼童是否肥胖。
關鍵字:曲線下面積、胸圍、肥胖、快速成長、接受器操作特徵曲線
 

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Fish oil supplementation is beneficial on caloric intake, appetite and mid upper arm muscle circumference in children with leukaemia
ZALINA ABU ZAID, SUZANA SHAHAR, A RAHMAN A JAMAL AND NOOR AINI MOHD YUSOF
A randomised trial was carried out to determine the effect of supplementation of fish oil among 51 children with leukaemia aged 4 to 12 years on appetite level, caloric intake, body weight and lean body mass. They were randomly allocated into the trial group (TG) and the control group (CG). At baseline, 30.8% of TG subjects and 44.0% of CG subjects were malnourished and 7.7% of subject from TG and 28.0% from CG were classified as stunted. The majority of subjects from TG and CG were in the mild malnutrition category for mid upper arm muscle circumference (MUAMC)-for-age. The TG group showed significant increment in MUAMC (0.13 cm vs -0.09 cm) compared with CG at 8 weeks (p<0.001). There was a significant higher increase for appetite level (0.12±0.33) (p<0.05) and an increasing trend on energy and protein intake in the TG group (213±554 kcal; 3.64±26.8 g) than in the CG group. In conclusion, supplementation of fish oil has a positive effect on appetite level, caloric intake and MUAMC among children with leukaemia.

Key Words: fish oil, MUAMC, appetite, caloric intake, leukaemia
 

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白血病兒童補充魚油有助增加熱量攝取、食慾及上臂肌 肉環圍
以隨機試驗評估51 名4 至12 歲患有白血病的兒童,補充魚油對於食慾、熱量 攝取、體重及淨體重(去脂體重)的影響。他們被隨機分派為試驗組及對照組。在基線,30.8%的試驗組病童及44.0%的對照組為營養不良;有7.7%的試驗組及28.0%的對照組研究對象被歸類為發育不足。兩組大部份病童在上臂肌肉環圍(MUAMC)年齡比項目被歸為輕度營養不良。在魚油補充至第8 週時,試驗組的上臂肌肉環圍增加(0.13 公分) 比起對照組(-0.09 公分) , 顯著較高 (p<0.001)。試驗組比起對照組有顯著較高的食慾量增加(0.12±0.33;p<0.05)以及增加熱量及蛋白質攝取(213±554 卡;3.64±26.8 克) 的趨勢。 本研究之結論是, 白血病兒童補充魚油對於食慾量、熱量攝取及上臂肌肉環圍有正向影響。
關鍵字:魚油、上臂肌肉環圍、食慾、熱量攝取、白血病

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Effects of omega−3 fatty acids supplementation on serum adiponectin levels and some metabolic risk factors in women with polycystic ovary syndrome
ELAHE MOHAMMADI, MARYAM RAFRAF, LAYA FARZADI, MOHAMMAD ASGHARI-JAFARABADI AND SIAMAK SABOUR
Objective: Polycystic ovary syndrome (PCOS) is a common female endocrine disorder associated with several risk factors of type 2 diabetes and cardiovascular diseases. The objectives of this study were to investigate the effects of omega−3 fatty acids on serum adiponectin levels and some metabolic risk factors in PCOS patients. Methods: This double-blind randomized controlled clinical trial was conducted on 64 overweight or obese PCOS patients; aged 20-35 years. Subjects in omega−3 fatty acids (n=32) and placebo (n=32) groups were given 4 omega− 3 fatty acids capsules (each one contained 180 mg eicosapentaenoic acid and 120 mg docosahexanoic acid) or placebo daily for 8 weeks. Fasting blood samples, anthropometric measurements and 3-day, 24-hour dietary recalls were collected at the baseline and at the end of the trial. Results: The study was completed by 61 subjects. Omega−3 fatty acids significantly increased serum levels of adiponectin (p=0.003) and decreased glucose (p<0.001), insulin (p=0.002), homeostatic model assessment for insulin resistance (p<0.001), total cholesterol (p=0.002) and low-density lipoprotein cholesterol (p=0.003) compared with placebo. Serum levels of triglyceride significantly decreased (p=0.024) and high-density lipoprotein cholesterol increased (p=0.018) in the omega−3 fatty acids group, in comparison with baseline values. No significant changes were shown in serum high sensitive C-reactive protein (hs-CRP) levels in both groups. Conclusion: Omega−3 fatty acids had some beneficial effects on serum adiponectin levels, insulin resistance and lipid profile in PCOS patients and may contribute to the improvement of metabolic complications in these patients.

Key Words: omega−3 fatty acids, polycystic ovary syndrome, adiponectin, insulin resistance, lipid profile

 

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Omega-3 脂肪酸的補充對於多囊性卵巢症婦女血清中 脂聯素與其他代謝危險因子的影響
多囊性卵巢症是常見的女性內分泌失調疾病,且與第2 型糖尿病及心血管疾病之某些危險因子相關。此研究的目的在探討omega-3 脂肪酸,對於多囊性卵巢患者血清中脂聯素和數項代謝危險因子的影響。研究方法採雙盲隨機臨床試驗,研究對象為64 位過重或肥胖,年齡介於20-35 歲的多囊性卵巢患者。8 週試驗期內,試驗組(32 位)每天接受4 顆各含180 毫克的EPA 與120 毫克DHA 的膠囊;而對照組(32 位)則每天給予4 顆安慰劑。在試驗前及結束時,皆收集空腹血液樣本、體位測量及3 天的24 小時飲食回憶記錄。最後共61 位參與者完成試驗。研究結果顯示,與對照組相比,omega-3 脂肪酸顯著地增加試驗組的血清脂聯素濃度(p=0.003),並降低血糖(p<0.001)、胰島素(p=0.002)、胰島素阻抗(p<0.001)、總膽固醇(p=0.002)以及低密度脂蛋白膽固 醇(p=0.003)。與試驗前的數值相比,omega-3 脂肪酸的補充顯著地減低血清中三酸甘油酯,且增加高密度脂蛋白膽固醇的濃度。兩組試驗前後的血清高敏感性C 反應蛋白,皆不具顯著的改變。結論:omega-3 脂肪酸有助於多囊性卵巢症患者,維持較佳的血清脂聯素濃度、胰島素抗性及血脂狀態,而這可能改善患者的代謝性併發症。
關鍵字:omega-3 脂肪酸、多囊性卵巢症、脂聯素、胰島素阻抗、血脂全套指數


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Plasma ω-3 fatty acid levels negatively and ω-6 fatty acid levels positively associated with other cardiovascular risk factors including homocysteine in severe obese subjects
IDRIS MEHMETOGLU, F HÜMEYRA YERLIKAYA, SEVIL KURBAN AND HAKKI POLAT
Obesity and homocysteine (tHcy) are important risk factors for cardiovascular diseases (CVD). Plasma omega-3 fatty acids (ω-3 FAs) and omega-6 fatty acids (ω-6 FAs) are essential fatty acids with diverse biological effects in human health and disease. We have investigated the relation of plasma ω-3 FAs and ω-6 FAs levels with other cardiovascular risk factors including tHcy in severe obese subjects. This study was performed on 96 severe obese and 65 normal weight subjects. Plasma fatty acid composition was measured by GC/MS and serum tHcy level was measured by HPLC methods. There were no differences between groups in terms of concentrations of serum tHcy, plasma ω-3 FAs, ω-6 FAs and ω-3/ω-6 ratio, whereas serum vitamin B-12 (p<0.01) and folic acid (p<0.05) levels were lower than those of the normal weight subjects. Homocysteine positively correlated with ω-6 FAs and negatively correlated with ω-3 FAs in severe obese and normal weight subjects. Serum vitamin B-12 positively correlated with ω-3 FAs (p<0.01) and ω-3/ω-6 ratio (p<0.01) and negatively correlated with ω-6 FAs (p<0.05) in severe obese subjects. Serum folic acid positively correlated with ω-3 FAs (p<0.01) in severe obese subjects. Our results suggest an association between the plasma ω-3 FAs and ω-6 FAs and serum tHcy concentrations in severe obese and normal weight subjects. Low levels vitamin B-12 and folic acid may have been responsible for the elevated tHcy levels in severe obese subjects, increasing the risk for future development of cardiovascular diseases.

Key Words: ω-3 fatty acids, ω-6 fatty acids, homocysteine, obesity, vitamin B-12
 

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重度肥胖者其血漿ω-3 和ω-6 脂肪酸與其他心血管危險因子包括同半胱胺酸成負向和正向相關
肥胖與同半胱胺酸皆是心血管疾病重要危險因子。血漿中ω-3 和ω-6 脂肪酸皆為必需脂肪酸,對人類健康和疾病卻有不同的生物學作用。本篇研究探討重度肥胖者其血漿ω-3 和ω-6 脂肪酸濃度與其他心血管危險因子包括同半胱胺酸之關聯。研究對象為96 位重度肥胖及65 位正常體重者,利用氣相層析質譜儀來測量血漿中脂肪酸組成;利用高壓液相層析儀來測定血清同半胱胺酸濃度。兩組之間的血清同半胱胺酸、血漿ω-3 和ω-6 脂肪酸濃度及其比值皆無顯著差異;然而,重度肥胖者的血清維生素B-12(p<0.01)和葉酸(p<0.05)濃度較正常體重者低。兩組研究對象之同半胱胺酸皆與ω-6 脂肪酸成正相關,與ω-3 脂肪酸成負相關。重度肥胖者的血清維生素B-12 與ω-3 脂肪酸(p<0.01)、ω-3/ω-6 比值(p<0.01)成正相關,但與ω-6 脂肪酸(p<0.05)成負相關。此外,重度肥胖者的血清葉酸亦與ω-3 脂肪酸(p<0.01)成正相關。本研究結果顯示,重度肥胖與正常體重者,其血漿ω-3 及ω-6 脂肪酸皆與血清同半胱胺酸濃度具有相關性。低維生素B-12 和葉酸濃度可能是使得重度肥胖者有較高同半胱胺酸濃度的原因,並提高未來罹患心血管疾病之風險。
關鍵字:ω-3 脂肪酸、ω-6 脂肪酸、同半胱胺酸、肥胖、維生素B-12


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25(OH)D status and demographic and lifestyle determinants of 25(OH)D among Korean adults
EUN YOUNG CHOI
Purpose: Vitamin D deficiency is a global health problem that is associated with increased risks of major diseases. This study investigated the status of 25-hydroxyvitamin D [25(OH)D] and its demographic and lifestyle determinants among Korean adults. Methods: A total of 5,847 adults who had participated in the Korean National Health and Nutrition Examination Survey of 2008 (KNHANES) were included in the present study. Stepwise linear regression analysis was performed to determine the demographic and lifestyle determinants of 25(OH)D concentration. Results: The weighted prevalence (standard error) of 25(OH)D deficiency (<20 ng/mL) was 49.9 (2.1)% among the males and 67.4 (1.7)% among the females. Severe 25(OH)D deficiencies (<10 ng/mL) were found in 5.7 (0.8)% of the males and 11.1 (1.0)% of the females. These peaked in spring and winter. Only 12.2 (1.1)% of the males and 6.4 (0.6)% of the females exhibited 25(OH)D sufficiency (≥30 ng/mL). The correlates with higher 25(OH)D concentration for both genders included summer, fall (vs spring), the 60s age group (vs 20s), rural residence (vs urban), moderate and vigorous physical activity (vs sedentary), alcohol consumption, and multivitamin supplementation. Higher education and unmarried status were inversely associated with 25(OH)D concentration for both genders. The strongest predictors of 25(OH)D concentration were season and residential area. Conclusions: 25(OH)D deficiency is a prevalent condition in Korea. Understanding the determinants of 25(OH)D can facilitate identification of persons at risk of 25(OH)D deficiency.

Key Words: 25(OH)D, prevalence, determinants, lifestyle, Korean
 

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韓國成人25-羥基維生素D 狀態與其人口學及生活型態決定因子
目的:維生素D 缺乏是一個全面性健康問題,它與主要疾病危險性的增加有關。這個研究探討韓國成年人25-羥基維生素D[25(OHD]狀況,和它的人口 學及生活型態決定因子。方法:總共5847 名成人參與2008 年韓國國民健康營養評估調查被納入這個研究。以逐步直線迴歸分析評估25(OH)D 濃度的人口學及生活型態的決定因子。結果:25(OH)D 缺乏(<20 ng/mL)的加權盛行率(標準誤)男性為49.9(2.1)%、女性為67.4(1.7)%。嚴重缺乏25(OH)D(<10 ng/mL) 的男性有5.7(0.8)%、女性有11.1(1.0)%。這個比率在春天及冬天達到巔峰。只有12.1(1.1)% 的男性及6.4(0.6)% 女性顯示25(OH)D 足夠(≥30 ng/mL) 。男女性都顯示,較高的25(OH)D 與夏天及秋天(對比春天)、60 歲年齡層(與20 歲相比)、鄉下居民(比上都市)、中度或強度體能活動(相較久坐者)、酒精攝取和綜合維他命的補充有關。較高的教育程度和未婚者,在男女性都與25(OH)D 濃度有負相關。25(OH)D 濃度的最強預測因子為季節及居住區域。結論:25(OH)D 缺乏在韓國是普遍的情形。了解25(OH)D 的預測因子,有助於確認處於25(OH)D 缺乏危險性的人群。
關鍵字:25(OH)D、盛行率、決定因子、生活型態、韓國人

 

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Age- and gender-specific associations between low serum 25-hydroxyvitamin D level and type 2 diabetes in the Korean general population: analysis of 2008-2009 Korean National Health and Nutrition Examination Survey data
BYUNG-KOOK LEE, SUNMIN PARK AND YANGHO KIM
Introduction: We present data from the Korean National Health and Nutritional Examination Survey (KNHANES) 2008-2009 on the association between 25-hydroxyvitamin D[25(OH)D] status and type 2 diabetes in a representative sample of the adult Korean population. Methods: This study was based on data obtained from the KNHANES 2008–2009, which was conducted for 3 years (2007-2009) using a rolling sampling design that involved a complex, stratified, multistage, probability-cluster survey of a representative sample of the noninstitutionalized civilian population of South Korea. Results: We showed that serum 25(OH)D concentration is inversely associated with type 2 diabetes in the Korean general population. In particular, low serum 25(OH)D concentration was associated with an increased prevalence of type 2 diabetes in young women and old men. The present study showed that 25(OH)D has a significant negative association with fasting insulin and insulin resistance. Conclusion: The age- and gender-specific association between low 25(OH)D level and type 2 diabetes may be related to interactions between vitamin D, sex hormone concentrations, and type 2 diabetes. In conclusion, we showed that low 25(OH)D concentration is associated with type 2 diabetes in the Korean general population in an age- and gender-specific pattern.

Key Words: vitamin D, diabetes, age, gender, 25-hydroxyvitamin D
 

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韓國人民之低血清25-羥基維生素D 濃度和第2 型糖尿 病在不同年齡及性別之相關性: 2008-2009 韓國國民健 康營養調查資料之分析
前言:我們呈現的資料是來自2008-2009 韓國國民健康營養調查,針對韓國成年人中一群具代表性樣本,探討25-羥基維生素D(25(OH)D)狀況和第2 型糖尿病之相關性。方法:本篇研究是根據2008-2009 韓國國民健康營養調查的資料,調查之執行於2007 至2009 共3 年的時間,利用滾動式抽樣設計,為一個 複雜、分層、多步驟、集束的調查,所得到的樣本是一個南韓具代表性非機構住民之群體。結果:由分析資料顯示,韓國人民之血清25(OH)D 濃度與第2 型糖尿病呈負相關。尤其在年輕女性和老年男性,其低血清25(OH)D 與第2 型糖尿病發生率的增加有相關。本研究亦顯示,25(OH)D 與禁食胰島素濃度和胰島素抗性有顯著負相關。結論:低25(OH)D 濃度與第2 型糖尿病在不同年齡、性別之相關性,可能受維生素D、性荷爾蒙濃度和第2 型糖尿病之間的交互作用影響。總之,韓國人民之低25(OH)D 濃度與第2 型糖尿病之相關性在不同性別、年齡呈現不一樣的模式。
關鍵字:維生素D、糖尿病、年齡、性別、25-羥基維生素D


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Choline and betaine food sources and intakes in Taiwanese
DA-MING CHU, MARK L WAHLQVIST, HSING-YI CHANG, NAI-HUA YEH AND MEEI-SHYUAN LEE
Choline and betaine are involved in several similar health-relevant metabolic pathways, but the foods sources are different. We have assessed their intakes (individual, sums and ratios) from a dominantly Chinese food cultural point of view. A representative free-living Taiwanese population aged 13-64 years was drawn from the Nutrition and Health Survey in Taiwan (NAHSIT) 1993-1996. Food intake was derived from interviews as 24-hour recalls. The USDA database, with adaptations for Taiwan, provided choline and betaine food compositions. Major food contributors of these nutrients were identified and compared with data from the US Framingham offspring study. Mean and variance reduced median nutrient intakes were calculated. Top ten major food contributors of choline in Taiwan were eggs, pork, chicken, fish, soybean and its products, dark leafy vegetables, dairy, fruit, wheat products and light leafy vegetables in sequence. For betaine, the top ten were dark leafy vegetables, wheat products, fish, pork, bread, chicken, cake/cookies, grain-based alcoholic beverages, rice and its products and sauces. The main contributors of choline in Taiwan and the USA were, respectively, eggs and red meat; and for betaine, greens were similarly best contributor. The rankings of the main food contributors of choline and betaine differed substantially between Taiwan and the USA. The total daily intakes (mean±SE, mg) in Taiwan for choline were 372±19 (median=348) in men and 265±9 (median 261) for women; for betaine, values were 101±3 (median 93) in men and 78±8 (median 76) for women. These allow for health outcome considerations.

Key Words: USDA food composition, gender, eggs, pork, soy, green leafy vegetables, wheat, choline, betaine
 

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臺灣民眾膽鹼與甜菜鹼的食物來源及攝取情形
膽鹼與甜菜鹼皆參與數個與健康有關的代謝路徑,但它們的食物來源卻不同。我們以中華食物文化的角度來評估兩者攝取情形(個別的、兩者總和、兩者比例)。從具代表性的1993-1996 國民營養健康調查中選取13-64 歲台灣民眾作為研究對象。食物攝取量以面訪方式獲得的24 小時回憶記錄來計算;食物中膽鹼與甜菜鹼含量之估算,是以美國農業部(USDA)食物成分資料庫為根據,再調整成適用於台灣的食物。這兩個營養素的主要來源被確認後,與美國佛來明罕子代研究的結果比較。並且計算營養素攝取量的平均值與降低變異中位數。在臺灣,提供膽鹼的前十項主要食物依序為蛋類、豬肉、雞肉、肉、黄豆及其製品、深色葉菜、奶類、水果、小麥製品、淡色葉菜。提供甜菜鹼的前十項主要食物依序為深色葉菜、小麥製品、魚肉、豬肉、麵包、雞肉、蛋糕/餅乾、酒(以穀類為原料)、米及其製品、醬汁。膽鹼的主要提供者,在臺灣與美國,分別是蛋類與紅肉。但在兩地,青菜都是甜菜鹼的主要供應者。臺灣與美國的膽鹼與甜菜鹼主要食物來源順序大不相同。臺灣男性膽鹼每日平均攝取量為372±19 毫克(中位數為348),女性為265±9 毫克(中位數為261);臺灣男性甜菜鹼每日平均攝取量為101±3 毫克(中位數為93),女性為78±8 毫克(中位數為76)。這些資料可作為影響健康結果的參考因素。
關鍵字:美國農業部食物成分表、性別、蛋類、豬肉、黃豆、綠葉蔬菜、小 麥、膽鹼、甜菜鹼
 

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Snack foods consumption contributes to poor nutrition of rural children in West Java, Indonesia
MAKIKO SEKIYAMA, KATRIN ROOSITA AND RYUTARO OHTSUKA
Dietary habits of children, including snack foods consumption, in developing countries have seldom been investigated in relation to their nutrition and health. To assess the effects of snack foods consumption of 154 children aged 1-12 years in a rural village of West Java, Indonesia, a 3-hour-interval food recall survey for all meals and snack foods consumed in seven consecutive days for each subject, anthropometry, and interviews for sociodemographic indicators were conducted. Their overall prevalence of stunting and underweight was 69.5% and 35.7%. There were 221 foods consumed by the subjects, among which 68 foods were categorized as snack foods. Though the children of both <7 year and ≥7 year age groups consumed snack foods similarly throughout the day, the latter group only consumed larger amounts of energy from snack foods at school recess-times. The mean percent contribution of snack foods was 59.6% for fat, 40.0% for energy, 20.6% for calcium, and <10% for vitamins A and C. Half number of the subjects who snacked more than the median amount consumed less carbohydrate and vitamin C than the remaining half. Furthermore, the more snack-consuming group the lower z score for height-for-age (HAZ) among schoolchildren. To improve this nutritionally vulnerable situation, consumption of snack foods should be replaced by the non-snack foods which contain much higher nutrient density, i.e., 15 times for calcium and 32 times for vitamin A. Moreover, considering high snack foods consumption of ≥7 y age group at school, appropriate school nutrition programs should be promoted.

Key Words: child nutrition, developing country, Indonesia, schoolchild

 

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印尼西爪哇的鄉村兒童零食攝取與較差營養有關
在發展中國家較少研究兒童的飲食習慣,包括零食攝取與他們的營養與健康之相關。本研究評估印尼西爪哇鄉村的154 位年齡1-12 歲兒童的零食攝取之影響。連續7 天以3 小時間隔之飲食回憶記錄,調查他們所有餐點及零食攝取;也進行體位測量和社經人口學指標的面談。這些兒童矮小及體重過輕的整體盛行率為69.5%及35.7%。有221 種食物被研究對象攝取,其中有68 種食物被歸類為零食。一天之中,兒童<7 歲或≥7 歲零食攝取的熱量類似,但≥7 歲的學童在學校休息時間攝取較多零食。零食平均貢獻百分比為脂肪59.6%、熱量40.0%、鈣質20.6%及<10%的維生素A 與C。零食攝取熱量超過中位數的研究對象比起另一半兒童有較少的醣類和維生素C 攝取量。而且在學童中,零食攝取越多,身高年齡比Z 分數越低。為了改善這個營養缺陷狀況,零食的攝取應該以非零食食物取代,後者含較高營養密度,即15 倍的鈣與32 倍的維生素A。此外,對攝取較多零食的≥7 歲學童,應進行適當的學校營養計劃。
關鍵字:兒童營養、發展中國家、印尼、學童

 

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Trends in the prevalence of undernutrition, nutrient & food intake and predictors of undernutrition among under five year tribal children in India
INDRAPAL ISHWARJI MESHRAM, NIMMATHOTA ARLAPPA, NAGALLA BALAKRISHNA, KODAVANTI MALLIKHARJUNA RAO, AVULA LAXMAIAH AND GINNELA NAG VEERA BRAHMAM
Undernutrition among children under five year is a significant public health problem in India. The present study was carried out to assess trends in nutritional status, nutrient and food intake among children under five year over two time periods. It was a community-based cross-sectional study, carried out in tribal areas of India. A total of 14,587 children, 0-5 years old were covered for nutritional assessment in terms of underweight, stunting and wasting. A 24 hour diet survey was carried out in a sub-sample of households surveyed. Wealth index was constructed using principle component analysis. The prevalence of underweight and stunting had declined significantly over the periods (49% vs 57%, 51% vs 58%, respectively), while the prevalence of wasting remained similar (22% vs 23%). There was marginal decrease in the intake of foods and nutrients over the periods, and was below recommended levels. Stepwise regression showed that the risk of underweight and stunting was significantly (p<0.01) higher among children of illiterate mothers and children from lowest and middle households wealth index. Morbidities during preceding fortnight had 1.3 times higher risk of underweight and wasting. In conclusion, undernutrition is a significant health problem among tribal children and is associated with literacy status of mothers, household wealth index and morbidities. Therefore implementation of appropriate nutritional intervention strategies and improvement in households food security through public distribution systems, food intakes, socioeconomic condition, literacy of parents and personal hygiene may help in improving the nutritional status of tribal children.

Key Words: underweight, stunting, wasting, Households wealth index, nutrient intakes
 

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印度部落5 歲以下孩童之營養缺乏盛行率和營養素及食物攝取趨勢以及營養不良預測因子
在印度,五歲以下孩童營養缺乏,是非常重要的公共健康問題。本研究目的為評估五歲以下幼童之營養狀態、營養素和食物攝取,在兩個不同時期之趨勢。此為印度部落地區之社區橫斷面研究。共涵蓋14,587 位0-5 歲孩童,評估其營養狀態是否有過輕、矮小及消瘦的情況。從調查家戶中抽取次樣本來做24 小時膳食評估。使用主成分分析法建立財富指標。隨著年代的改變,體重過輕及矮小的盛行率有顯著下降(過輕比例49%對照57%;矮小51%比上 58%),然而消瘦的盛行率並無明顯差別(22%對比23%)。食物及營養素的攝取,則有些微減少且低於建議攝取量。逐步回歸顯示,孩童母親未受教育以及家戶財富指標為中或低之孩童,具有顯著較高的過輕及矮小風險(p<0.01)。受訪前兩個禮拜有發燒、腹瀉或急性呼吸道感染等疾病者,其為過輕及消瘦的風險增為1.3 倍。總之,部落孩童之營養缺乏為重要的健康問題,且這與母親是否受教育、家戶財富指標以及罹病相關。因此,實施適當的營養介入策略,及透過公共分配體系提高家戶糧食可獲度,改善食物攝取、社經狀況、雙親教育以及個人衛生,可能有助於改善部落孩童的營養狀況。
關鍵字: 體重過輕、矮小、消瘦、家戶財富指標、營養素攝取
 

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The U-shaped relationship between BMI and all-cause mortality contrasts with a progressive increase in medical expenditure: a prospective cohort study

WEN-HARN PAN, WEN-TING YEH, HSIN-JEN CHEN, SHAO-YUAN CHUANG, HSING-YI CHANG, LIKWANG CHEN AND MARK L WAHLQVIST
The U-shaped relationship between body mass index (BMI) and all-cause mortality has generated uncertainty about optimal BMI. For clarification, we have related BMI to both mortality and medical expenditure. The MJ Health examination cohort of 111,949 examinees established during 1994-1996 was followed with endpoint information derived from death certificates and National Health Insurance records from 1996 to 2007. Age- and gender-specific relative risks between BMI groups were estimated by Cox and logistic regressions. The BMI and all-cause mortality relationship is U-shaped with the concave regions sitting in the region of BMI 22-26, butshifted rightward for the elderly. After excluding smokers and cancer patients at baseline, the low mortality region moved leftward to BMI 20-22. Cause-specific mortalities from respiratory disease, injury, and senility increased in the underweight group (BMI <18.5). Above 18.5, BMI was negatively associated with mortality from respiratory diseases and senility, but not with others. In contrast, irrespective of age and gender, the overall median and mean medical expenditures progressively increased with BMI, particularly beyond 22. Expenditures for injury, respiratory, circulatory diseases and senility all increased with BMI. The U-shaped BMI-mortality relation was a result of elevated death rate at both ends of the BMI scale. Increased mortality at the low end did not contribute to higher medical expenditure, maybe because the lean and frail deceased tend to die abruptly before large amount of medical expenditure was consumed. Our findings suggest that current recommendations to maintain BMI at the lower end of the desirable range remain tenable for the apparently healthy general public.

Key Words: cohort studies, body mass index, mortality, expenditure, Asians
 

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前瞻性世代研究顯示:身體質量指數與總死亡率的U 型關係有異於其與醫療支出的持續上升關係
身體質量指數(BMI)與死亡率呈現U 型關係,因而很難訂定最適BMI 範圍。為了釐清這個問題,我們同時探討比較BMI 和死亡率,以及醫療支出的 關係。我們以美兆多中心診所在1994 到1996 年的111,949 名健檢個案的資料,連結死亡及1996 到2007 年的健保資料作分析。各性別、年齡、BMI 層別的相對危險率以Cox 及邏輯式回歸分析來估算。BMI 和總死亡率的關係確實是U 型的,死亡率的最低點座落在BMI 22 到26 之間,而老年人的死亡率最低點有右移的現象。在去除了基線時的抽菸及癌症個案後,死亡率最低點往左移到了BMI 20 到22 之間。死於呼吸疾病、意外受傷、以及老化的比率在體重過輕(BMI<18.5)組別有增高的情形,但其他死因則都無此現象。相對的,在各性別年齡層的總體醫療支出平均值及中位數都隨著BMI 的升高而增多,特別在BMI 大於22 時,尤為甚之。有關意外受傷、呼吸疾病、心血管疾病以及老化的醫療花費也都隨著BMI 的升高而增加。BMI 與死亡率的U 型關係源於曲線兩端的死亡率較高,而在BMI 低的曲線前端,並沒有醫療支出較高的情形,有可能是因為大部分極瘦的個案,因為體弱可能在很短的時間內就死亡,所以並不會使醫療支出提高。對於一般的健康民眾而言,建議其BMI 維持在最適範圍內的較低點仍是合理的。
關鍵字:世代研究、身體質量指數、死亡率、支出、亞洲人

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Alcohol consumption and the risk of type 2 diabetes mellitus: effect modification by hypercholesterolemia: The Third Korea National Health and Nutrition Examination Survey (2005)
HYEONGAP JANG, WON-MO JANG, JONG-HEON PARK, JUHWAN OH, MU-KYUNG OH, SOO-HEE HWANG, YONG-IK KIM AND JIN-SEOK LEE
OBJECTIVE: While the protective nature of moderate alcohol consumption against diabetes mellitus is well known, inconsistent findings continue to be reported. The possibility of different mixes of effect modifiers has been raised as a reason for those inconsistent findings. Our study aim was to examine potential effect modifiers that can change the effect of alcohol consumption on type 2 diabetes. METHODS: From data in the third Korea National Health and Nutrition Examination Survey, 3,982 individuals over the age of 30 years who had not been diagnosed with diabetes were selected for inclusion in the study population. Breslow and Day's test and the Wald test between hypercholesterolemia and alcohol consumption in a multiple logistic regression model were used to assess effect modification. RESULTS: Odds ratios for diabetes stratified by alcohol consumption strata and assessed using Breslow and Day's tests for homogeneity indicated that hypercholesterolemia was not a significant confounding factor (p=0.01). However, the Wald test for interaction terms, which is a conservative method of effect modification, was significant (p=0.03). CONCLUSIONS: The results indicate that moderate alcohol consumption is not necessarily protective for type 2 diabetes mellitus, if a person has hypercholesterolemia. People who have hypercholesterolemia should be aware of the risk associated with alcohol consumption, a risk that contrasts with the reported protective effect of moderate alcohol consumption on diabetes.

Key Words: diabetes, alcohol consumption, hypercholesterolemia, dyslipidemia, effect modification, interaction
 

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酒精攝取與第2 型糖尿病罹患風險:高膽固醇血症之效應修飾:第三次韓國國民健康與營養調查(2005)
目的:已知適量飲酒對於糖尿病具有保護作用,但仍有報告指出不一致的結果,造成此差異的原因可能來自於效應修飾因子之間互相影響。本研究目的為檢視酒精攝取對第2 型糖尿病影響之潛在效應修飾因子。方法:本研究資料來自第三次韓國國民健康與營養調查,納入之研究對象共有3982 位,條件為30歲以上未被診斷為糖尿病者。在多元邏輯斯迴歸模式下,以Breslow -Day 檢定和Wald 檢定來分析高膽固醇血症與飲酒之間的效應修飾作用。結果:利用 Breslow-Day 檢定來檢測同質性,在不同飲酒狀況之糖尿病勝算比(OR)指出,高膽固醇血症並不是一項顯著干擾因子(p=0.01)。然而,由較保守之效應修飾分析方法-Wald 檢定的結果顯示,兩者之間具有顯著之交互作用(p=0.03)。結論:由結果指出,對於有高膽固醇血症者,適量飲酒對第2 型糖尿病風險不一定具有保護作用。因此高膽固醇血症患者應對飲酒相關風險有所警覺,此風險與適量飲酒對糖尿病之保護作用卻是相對立的。
關鍵字:糖尿病、酒精攝取、高膽固醇血症、血脂異常、效應修飾、交互作用
 

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Prevalence of functional gastrointestinal disorders in Taiwan: questionnaire-based survey for adults based on the Rome III criteria
FANG-YUAN CHANG, PO-HON CHEN, TZEE-CHUNG WU, WEN-HARN PAN, HSING-YI CHANG, SHIN-JIUAN WU, NAI-HUA YEH, REN-BIN TANG, LITE WU AND FRANK E JAMES
Functional gastrointestinal disorders (FGID) are a group of disorders of the digestive system in which the chronic or recurrent symptoms cannot be explained by the presence of structural or tissue abnormality. This survey used a modified Rome III questionnaire on the health and nutrition status of a general population in Taiwan during 2005-2008. A total of 4,275 responders completed the questionnaire. The sample was evenly distributed for men (n=2,137) and women (n=2,138). The prevalence of FGID was 26.2%. Unspecified functional bowel disorder was the most prevalent (8.9%). The second was functional dyspepsia (5.3%), and the third were irritable bowel syndrome (4.4%) and functional constipation (4.4%). Women had a greater prevalence than males (33.2% compared to 22.4%, p<0.05) with regards to total FGID. Most categories of FGID were significantly prominent in women, except functional diarrhea. The FGID groups took fewer servings of vegetables and fruits than the non-FGID group each day (vegetables 2.51 vs 2.70, p<0.001; fruits 0.82 vs 0.91, p<0.001). Smoking, alcohol consumption, and betel nut chewing had no significant impaction on prevalence of FGID. The mean BSRS (briefsymptom rating scale) for screening depression and suicide ideation was higher in the FGID group (2.86 vs 1.63, p<0.001). In conclusion, FGID diagnosed with Rome III criteria are not uncommon in Taiwan’s general population. Subjects who met the Rome III criteria for FGID in Taiwan were younger, had less vegetables and fruits intake, higher BSRS scores and were of greater female predominance.

Key Words: Rome criteria, functional gastrointestinal disorders, irritable bowel syndrome, functional constipation, prevalence
 

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臺灣功能性腸胃道障礙的盛行率:以羅馬III 準則為基礎的成人問卷調查
功能性腸胃道障礙(FGID)是一群無法檢查到構造上異常或病變,而必須藉由臨床上慢性或重覆出現的症狀做為診斷依據的腸胃道疾病。本研究以臺灣2005- 2008 年國民營養健康調查中19 歲以上的受訪族群,藉由Rome III 準則設計的問卷,對其做功能性腸胃道障礙的調查。共有4275 個受訪者完成問卷,男女比例相當(男性2137 人;女性2138 人),FGID 的盛行率約為26.2%。以未特定功能性腸道疾病為最多(8.9%),其次為功能性消化不良(5.3%)、腸躁症(4.4%)及功能性便秘(4.4%)。女性患有FGID 的總比例較男性高(女性33.2%/男性22.4%);除了功能性腹瀉,大多種類的FGID 仍以女性患者較多。功能性腸胃 道障礙患者每日平均攝取的蔬菜水果份數較少( 蔬菜2.51/2.70 ; 水果0.82/0.91),用以評估憂鬱傾向的BSRS 分數較高,但在抽煙、喝酒或是嚼食檳 榔上則並無差異性。由此研究可知,用Rome III 準則診斷的功能性腸胃道障礙在臺灣並非少見,而患者通常較年輕、蔬果攝取較少、有較高的心理壓力分數,且以女性居多。
關鍵字:羅馬準則、功能性腸胃道障礙、腸躁症、功能性便秘、盛行率


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Effects of healthy dietary pattern and other lifestyle factors on incidence of diabetes in a rural Japanese population
AKIKO MORIMOTO, YUKO OHNO, YUKAKO TATSUMI, SHOICHI MIZUNO AND SHAW WATANABE
This study assessed the effects of dietary habits and other lifestyle factors on the incidence of diabetes in a rural Japanese population. This 10.3-year study investigated a cohort of 1,995 men and 3,670 women aged 40-69 years without diabetes at baseline who underwent health check-ups between April 1990 and March 1992. Participants were followed up until diabetes was confirmed or until the end of 2006. The incidence of diabetes was determined from fasting and random levels of plasma glucose, HbA1c levels or being under medical treatment for diabetes. Principal component analysis identified a major dietary pattern characterized by more frequent consumption of vegetables, potatoes, seaweeds, fruits and soybean products that we labeled “healthy”. Diabetes developed in 446 of the participants during 58,151 person-years of follow-up. Consuming a healthy diet was associated with a lower risk of diabetes (multivariable-adjusted hazard ratio for highest vs lowest quartiles, 0.78 [95% CI, 0.61- 0.95]. In addition, scores for a healthy diet were associated with a lower risk for diabetes among persons who consumed regular meals (0.76 [0.58-0.96]), persons with an exercise habit (0.65 [0.44-0.96]) and non- and exsmokers (0.72 [0.53-0.96]). Our findings suggest that consuming a healthy diet is associated with a lower risk for diabetes among the Japanese, particularly among those who eat regularly, those who habitually exercise and nonand ex-smokers.

Key Words: diabetes mellitus, prospective study, dietary habits, lifestyle, Japanese
 

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鄉居的日本人健康的飲食模式及其它生活型態對糖尿病發生率的影響
這個研究評估飲食習慣及其它生活型態因子,對鄉居的日本人族群糖尿病盛行率的影響。歷時10.3 年的世代研究,探討對象包括1995 名男性及3670 名女性,年齡介於40-69 歲。在1990 年4 月至1992 年3 月進行研究對象的健康檢查,確認在基線時未患糖尿病。追蹤參與者至罹患糖尿病或直到2006 年底。糖尿病發生率的評估是依據禁食及隨機的血漿葡萄糖量、HbA1c 量或是已接受糖尿病治療。經由主成分分析,確認一個特性為較頻繁攝取蔬菜、馬鈴薯、海菜、水果及大豆製品的飲食模式,將之標示為”健康的”。經過58151 人年的追蹤,共有446 名參與者罹患糖尿病。健康的飲食模式與較低的罹患糖尿病風險呈現相關(最高與最低四分位的多變項校正危險比為0.78[95%信賴區間為0.61- 0.95])。此外,在那些有規律用餐(0.75[0.53-0.96])、運動習慣(0.65[0.44-0.96])及非抽菸或已戒菸的人, 其健康飲食的分數與較低的糖尿病風險有相關 (0.72[0.53-0.96])。研究結果顯示日本人攝取健康飲食與較低的糖尿病風險有 關,尤其是那些用餐規律、習慣地運動及非抽菸或是戒菸者。
關鍵字:糖尿病、前瞻性研究、飲食習慣、生活型態、日本人

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Public support for restrictions on fast food company sponsorship of community events
SIMONE PETTIGREW, MELANIE PESCUD, MICHAEL ROSENBERG, RENEE FERGUSON AND STEPHEN HOUGHTON
This study investigated community attitudes to fast food companies’ sponsorship of community events. The aim was to inform future efforts to introduce greater restrictions on these marketing activities to reduce child obesity. While previous research has focused on the sponsorship of sporting events, the present study included all community events and gauged public support for fast food company sponsorships in general as well as specific sponsorship activities such as securing event naming rights, advertising on event premises, and distributing free items to children in the form of food and redeemable vouchers. A large and diverse sample of Western Australian adults (n=2,005) responded to a community attitudes telephone survey that included questions relating to event sponsorship. Almost half of the respondents reported that the promotion of fast foods is inappropriate at community events, and only a third considered it appropriate at events where children are likely to be present. Around twothirds agreed that promoting fast foods at such events sends contradictory messages to children and just a quarter of respondents considered it acceptable for free fast food to be distributed at events or for children to be rewarded for participation with fast food vouchers. The results suggest that efforts to reduce child obesity that involve restrictions on the sponsorship of community events by organisations promoting unhealthy foods may be supported by a substantial proportion of the population.

Key Words: attitudes, community, children, food companies, sponsorship
 

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限制速食公司贊助公眾活動之公共支持
本研究調查民眾對速食公司贊助公眾活動之態度。目的是為了降低兒童肥胖,告知未來應盡力對這些商業活動給予更大限制。儘管過去的研究多著重在體育活動贊助方面,本篇研究則包含所有公眾活動,並評量對速食公司的一般贊助及特定贊助面向之公共支持,例如取得活動命名權、在活動場所廣告及以食物或兌換劵免費分送給兒童。研究對象來自一個大型且多樣化的西澳成人樣本,共2005 位。利用電訪調查對於贊助活動之公眾態度。幾乎一半以上的回應者認為在公眾活動中促銷速食食品是不合適的;只有三分之一的人認為有兒童在場的活動,這樣的促銷是恰當的。大約三分之二的人同意在這類活動中促銷速食食品會帶給兒童負面的訊息;且只有四分之一的回應者可以接受,在活動中分送免費的速食食品或給兒童兌換劵做為參與活動的獎勵。結果顯示,限制促銷不健康食物之團體對公眾活動的贊助,藉以減少兒童肥胖的用心,可被大部分的群眾所支持。
關鍵字:態度、社區、兒童、食品公司、贊助
 

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South Korea’s entry to the global food economy: shifts in consumption of food between1998 and 2009
HAENG-SHIN LEE, KIYAH J DUFFEY AND BARRY M POPKIN
Korea has undergone a major opening of its food markets and economy in the past decade. Little is understood about the impact of these shifts on the diet of Koreans. This analysis studies the shifts in consumption of foods between 1998 and 2009 to provide a thorough understanding of the transition and insights into directions in the next decades in Korea. Data are from the Korea National Health and Nutrition Examination Survey (KNHANES). The sample used was a nationally representative sample of individuals age ≥2 in 1998 and 2009 (n=10,267 and 9,264, respectively). The data was corrected for seasonality, and the original raw food data was regrouped into 53 food groups. SAS was used to adjust for design effects and weight. Despite a decade of efforts to increase whole grains intake, and fruit and vegetable intake, the mean intake of whole grains increased only a small amount (16 kcal/person/day); however, the proportion consuming any whole grains doubled from 24% to 46.3%. Rice declined significantly, and several important less healthful food trends emerged: total alcohol intake increased from 39 kcal/person/day to 82 kcal/person/day. Also, energy from sugar-sweetened beverages increased among teens and energy from tea and coffee increased among adults. Remarkably, compared to other Asian countries and a general worldwide trend, vegetable intake remained relative high in South Korea during this last decade while fat energy increased modestly from relative low levels. Dynamic causes of these trends and the government’s response are discussed.

Key Words: nutrition transition, South Korea, diet, National Health and Nutrition Examination Survey, energy intake

 

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南韓進入全球食物經濟體:1998 年及2009 年間食物攝取的轉變
韓國在過去十年經歷食物市場及經濟的大幅開放。然而這些轉變對於韓國人飲食的影響卻鮮少被了解。經由分析1998 年至2009 年食物攝取的變遷,本研究可提供對未來十年韓國的趨勢轉變有較深刻的理解。資料是來自韓國國民健康營養調查(KNHNES)。樣本取自具有全國代表性的1998 及2009 年年齡2 歲的研究對象(分別為10,267 及9,264 位)。將資料依季節校正,並將原始的生食資料歸類為53 個食物類別。以SAS 校正設計誤差及加權。儘管當局十年的努力,意圖增加全穀類及蔬果攝取,但全穀類的平均攝取量只有少量增加(16 大卡/人/天);然而,有攝取任一全穀類的人數比例增倍,從24%到46.3%。米攝取顯著降低,而顯現幾個較不健康食物攝取升高的趨勢:總酒精攝取從39 大卡/人/天增加至82 大卡/人/天。青少年攝取來自含糖飲料的熱量增加,成人則攝取來自茶及咖啡的熱量增加。值得注意的是,雖然過去十年脂肪熱量從相對低點緩步增加,但比起其他亞洲國家及全世界的趨勢,南韓的蔬菜攝取仍然相對較高。造成這些趨勢的原因及政府的因應措施都在文中加以討論。
關鍵字:營養過渡期、南韓、飲食、國民健康營養調查、熱量攝取
 

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Do registered dietitians search for evidence-based information? A nationwide survey of regional hospitals in Taiwan
YA-WEN CHIU, YI-HAO WENG, MARK L WAHLQVIST, CHUN-YUH YANG AND KEN N KUO

Dietitians can obtain nutrition-related information from a variety of sources. The current study was to investigate how registered dietitians look for nutritional information and perceive evidence-based nutrition (EBN). A postal questionnaire survey was conducted, with 67 valid returns collected. The most common informational sources were Web portals, followed by continuing education, colleague consultation, textbooks, online databases, electronic journals, printed journals, and electronic textbooks. Among the 11 commonly used online databases, dietitians preferred to access MEDLINE and three databases in Chinese. Sixty-two dietitians (92.5%) were aware of EBN. Although they had a favorable impression of EBN, their knowledge of and skills in EBN were relatively lacking. The most common barrier to the implementation of EBN was a lack of library resources in Chinese (58.1%), followed by deficient skill in critical appraisal (54.8%), insufficient convenient kits (53.2%), and time constraints (50.0%). In conclusion, most registered dietitians search for information through non-EBN resources. Language is an important element relevant to the implementation of EBN. These findings may help the refining of strategies to promote the accessing of evidence-based information.

Key Words: evidence-based nutrition, registered dietitian, information, online, database
 

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營養師是否經由實證營養之管道來搜尋訊息﹖台灣區域醫院之全國性調查
營養師可以從許多不同的管道來獲取營養相關之訊息。本研究評估營養師如何取得營養方面之訊息及其對於實證營養之看法。採用郵寄問卷進行調查,共回收67份有效問卷。營養師最常從入口網站以搜尋營養相關之資訊,其次為繼續教育,再依次為詢問同事、教科書、網路資料庫、電子期刊、纸本期刊,最後為電子教科書。在11 個經常使用的網路資料庫當中, 營養師較常使用 MEDLINE 及三個中文的網路資料庫。有62 位營養師(92.5%)知曉何謂實證營 養。雖然營養師一致認同且支持實證營養,但是他們對應用實證營養的知識及技巧是相對不足的。在進行實證營養之應用時,最常見的障礙為缺乏中文化之 圖書來源(58.1%),其次為對文獻評讀之技巧不足(54.8%)、缺乏便利之相關工具(53.2%)及沒有時間(50.0%)。總結為,多數有執照的營養師經由非實證營養之管道以搜尋訊息,其中語言為應用實證營養時一個很重要的相關因素。本研究之發現將有助於規劃策略來推廣實證資訊之使用。
關鍵字:實證營養、營養師、資訊、網路、資料庫
 

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Repeated lung lavage with extracorporeal membrane oxygenation treating severe acute respiratory distress syndrome due to nasogastric tube malposition for enteral nutrition: a case report
XIAOMING KAO, WENKUI YU, WEIMING ZHU, NING LI AND JIESHOU LI
Enteral nutritional support, a frequently applied technique for providing nutrition and energy, played a pivotal role in the treatment of high risk patients. However, severe complications induced by malposition of nasogastric tube caused great danger and even death to the patients. In this case report, we present a patient with severe acute respiratory distress syndrome (ARDS) induced by bronchopleural fistula (BPF) due to malposition of nasogastric tube. Repeated lung lavage combined with extracorporeal membrane oxygenation (ECMO) was performed after transferring to the ICU of our hospital. Finally, the patient recovered and discharged 7 days after admission.

Key Words: enteral nutritional support, acute respiratory distress syndrome, extracorporeal membrane oxygenation, nasogastric tube malposition, bronchopleural fistula
 

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肺灌洗联合体外膜氧合治疗置管错位引发的急性呼吸窘迫综合征:病例研究
肠内营养支持可为重症患者提供营养与能量支持,在临床领域广泛应用。但因置管错位导致的并发症常危及患者生命安全。本文报道一例因置管错位导致胸膜瘘,并最终引发急性呼吸窘迫综合征的病例。患者入院后,行肺灌洗与体外 膜(葉克膜)氧合进行治疗。治疗7 天后患者康复出院。
關鍵字:肠内营养支持、急性呼吸窘迫综合征、体外膜氧合、置管错位、胸膜瘘

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Bleeding tendency in an adolescent with chronic small bowel obstruction
CHONNIKANT VISUTHRANUKUL, VORANUSH CHONGSRISAWAT, PAISARN VEJCHAPIPAT AND SIRINUCH CHOMTHO
We report a case of fat-soluble vitamin deficiency in a 14-year old boy who had chronic duodenal obstruction. He presented with periodic unexplained bleeding tendency. The laboratory results showed positive fat globules in stool and prolonged prothrombin time. His further investigation revealed low plasma vitamin A and undetectable plasma vitamin E. After parenteral vitamin K and oral vitamin A and E supplement, these abnormalities resolved although he still had absent knee jerk. We propose that fat malabsorption and fat-soluble vitamin deficiency can occur after prolonged duodenal obstruction that induce bacterial overgrowth following by bile acid deconjugation. Despite very few case reports, screening for fat malabsorption and fat-soluble vitamin deficiency might be warranted in patients with chronic small bowel obstruction.

Key Words: bleeding tendency, fat-soluble vitamin deficiency, vitamin K deficiency, small bowel obstruction, blind loop syndrome
 

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慢性小腸阻塞的青少年其出血傾向
本文報告一位慢性十二指腸阻塞的14 歲男孩,顯現脂溶性維生素缺乏的病例。病患有周期性不明原因的出血傾向。檢驗結果顯示糞便中有脂肪球及特別長的凝血酶原時間。進一步檢查發現低血漿維生素A 及偵測不到維生素E。在 靜脈維生素K 及口服維生素A 及E 補充後,這些異常症狀消失,但他仍然缺乏膝反射。可能長時間的十二指腸阻塞進而誘導細菌過度生長以致膽酸早期解離,使得脂肪吸收不良及脂溶性維生素缺乏。儘管此類病例報告很少,患有慢性小腸阻塞的病人,有必要做脂肪吸收不良及脂溶性維生素缺乏的檢測。
關鍵字:出血傾向、脂溶性維生素缺乏、維生素K 缺乏、小腸阻塞、盲環症候群

 

 

Last Updated: October 2012