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1 Asia Pacific Journal of Clinical Nutrition
       Volume 22, 3

         (August 2013)


Abstracts

Contents

Abstract PDF

Reviews

Poverty and the state of nutrition in India
KIRUBA S VARADHARAJAN, TINKU THOMAS AND ANURA V KURPAD
Asia Pac J Clin Nutr. 2013;22(3):326-339.

doi: 10.6133/apjcn.2013.22.3.19

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Iron status of the Pakistani population-current issues and strategies

SAEED AKHTAR, ANWAAR AHMED, ASIF AHMAD, ZULFIQAR ALI, MUHAMMAD RIAZ AND TARIQ ISMAILD
Asia Pac J Clin Nutr. 2013;22(3):340-347.

doi: 10.6133/apjcn.2013.22.3.17

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Original Research Communications

Nutritional Measurement & Methodology

Relationship between anthropometric and dual energy X-ray absorptiometry measures to assess total and regional adiposity in Malaysian adolescents
LENG HUAT FOO, PEY SZE TEO, NURUL FADHILAH ABDULLAH, MOHD EZANE AZIZ AND ANDREW P HILLS
Asia Pac J Clin Nutr. 2013;22(3):348-356.

doi: 10.6133/apjcn.2013.22.3.02

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Clinical Nutrition or Feeding Studies

Effect of soy isoflavone supplementation on vascular endothelial function and oxidative stress in postmenopausal women: a community randomized controlled trial
PUSPARINI, RAHAYUNINGSIH DHARMA, FRANSISCUS D SUYATNA, MUCHTARUDDIN MANSYUR AND ADI HIDAJAT
Asia Pac J Clin Nutr. 2013;22(3):357-364.

doi: 10.6133/apjcn.2013.22.3.13

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Effect of Korean red ginseng on insulin sensitivity in non-diabetic healthy overweight and obese adults
YOUNG HYE CHO, SOON CHEOL AHN, SANG YEOUP LEE, DONG WOOK JEONG, EUN JUNG CHOI, YUN JIN KIM, JEONG GYU LEE, YU-HYUN LEE AND BYUNG-CHEUL SHIN
Asia Pac J Clin Nutr. 2013;22(3):365-371.

doi: 10.6133/apjcn.2013.22.3.04

 

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Effect of variety and cooking method on resistant starch content of white rice and subsequent postprandial glucose response and appetite in humans
YU-TING CHIU AND MARIA L STEWART
Asia Pac J Clin Nutr. 2013;22(3):372-379.

doi: 10.6133/apjcn.2013.22.3.08

 

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Acute effects of oral preloads with increasing energy density on gastric emptying, gut hormone release, thermogenesis and energy intake, in overweight and obese men
NATALIE D LUSCOMBE-MARSH, RADHIKA V SEIMON, ERIN BOLLMEYER, JUDITH M WISHART, GARY A WITTERT, MICHAEL HOROWITZ, MAX BELLON AND CHRISTINE FEINLE-BISSET

Asia Pac J Clin Nutr. 2013;22(3):380-390.

doi: 10.6133/apjcn.2013.22.3.11

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Nutritional Status, Dietary Intake, and Body Composition

Effects of sun exposure on 25(OH) vitamin D concentration in urban and rural women in Malaysia
MUSA NURBAZLIN, WINNIE SIEW SWEE CHEE, PENDEK ROKIAH, ALEXANDER TONG BOON TAN, YEE YEAN CHEW, ABD RAHMAN SITI NUSAIBAH AND SIEW PHENG CHAN
Asia Pac J Clin Nutr. 2013;22(3):391-399.

doi: 10.6133/apjcn.2013.22.3.15

 

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Serum ferritin and risk of the metabolic syndrome: a population-based study
JUNG-SU CHANG, SHIUE-MING LIN, TZU-CHIEH HUANG, JANE C-J CHAO, YI-CHUN CHEN, WEN-HARN PAN AND
CHYI-HUEY BAI
Asia Pac J Clin Nutr. 2013;22(3):400-407
.

doi: 10.6133/apjcn.2013.22.3.07

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Overweight among primary school-age children in Malaysia
BALKISH MAHADIR NAIDU, SITI ZURAIDAH MAHMUD, RASHIDAH AMBAK, SYAFINAZ MOHD SALLEHUDDIN,
HATTA ABDUL MUTALIP, RIYANTI SAARI, NORHAFIZAH SAHRIL AND HAMIZATUL AKMAL ABDUL HAMID
Asia Pac J Clin Nutr. 2013;22(3):408-415.

doi: 10.6133/apjcn.2013.22.3.18

 

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Overweight and obesity among internal migrants in India
KIRUBA SANKAR VARADHARAJAN, TINKU THOMAS, DIVYA RAJARAMAN, ANURA V KURPAD AND MARIO VAZ
Asia Pac J Clin Nutr. 2013;22(3):416-425.
doi: 10.6133/apjcn.2013.22.3.14

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Nutritional status and body composition are already affected before oncology treatment in ovarian cancer
VANESSA FUCHS-TARLOVSKY, KAROLINA ALVAREZ-ALTAMIRANO, DEBORAH TURQUIE-SACAL, CAROLINA ALVAREZ-FLORES AND HELLEN HERNANDEZ-STELLER
Asia Pac J Clin Nutr. 2013;22(3):426-430.
doi: 10.6133/apjcn.2013.22.3.12

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Maternal and Child Nutrition

The trans fatty acid content in human milk and its association with maternal diet among lactating mothers in Malaysia
AKMAR ZURAINI DAUD, NORHAIZAN MOHD-ESA, AZRINA AZLAN AND YOKE MUN CHAN
Asia Pac J Clin Nutr. 2013;22(3):431-442.

doi: 10.6133/apjcn.2013.22.3.09

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Determinants of breastfeeding at discharge in rural China
LI TANG, COLIN W BINNS, CHUNMING LUO, ZHIQING ZHONG AND ANDY H LEE
Asia Pac J Clin Nutr. 2013;22(3):443-448.

doi:10.6133/apjcn.2013.22.3.20

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Seasonal variation in the nutritional status of children aged 6 to 60 months in a resettlement village in West Timor
JACQUELINE MILLER, BRETT RITCHIE, CUONG TRAN, SEAN BEGGS, CHRISTINA OLLY LADA, KATHRYN WHETTER AND LYNNE COBIAC
Asia Pac J Clin Nutr. 2013;22(3):449-456.

doi: 10.6133/apjcn.2013.22.3.10

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Nutritional Epidemiology and Public Health

Relationship of dietary factors and habits with sleep-wake regularity
MIWA YAMAGUCHI, HIROKAZU UEMURA, SAKURAKO KATSUURA-KAMANO, MARIKO NAKAMOTO, MINEYOSHI HIYOSHI, HIDENOBU TAKAMI, FUSAKAZU SAWACHIKA, TOMOYA JUTA AND KOKICHI ARISAWA
Asia Pac J Clin Nutr. 2013;22(3):457-465.

doi: 10.6133/apjcn.2013.22.3.01

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Trend in gender disparities of BMI and height between 2004 and 2011 among adolescents aged 17-18 years in Changzhou China
WENYING CHEN AND ZUMIN SHI
Asia Pac J Clin Nutr. 2013;22(3):466-473.

doi: 10.6133/apjcn.2013.22.3.03

 

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Impact of energy intake on the survival rate of patients with severely ill stroke
MAKI WAKITA, AKATSUKI WAKAYAMA, YUKO OMORI, SATOMI ICHIMARU AND TERUYOSHI AMAGAI

Asia Pac J Clin Nutr. 2013;22(3):474-481.

doi: 10.6133/apjcn.2013.22.3.16

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Dietary intakes consistent with the DASH dietary pattern reduce blood pressure increase with age and risk for stroke in a Chinese population
PAO-HWA LIN, WEN-TING YEH, LAURA P SVETKEY, SHAO-YUAN CHUANG, YUAN-CHIN CHANG, CHRISTINE
WANG AND WEN-HARN PAN
Asia Pac J Clin Nutr. 2013;22(3):482-491.

doi: 10.6133/apjcn.2013.22.3.05

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Case Report

Clinical decision-making for vitamin K-1 and K-2 deficiency and coronary artery calcification with warfarin therapy: are diet, factor Xa inhibitors or both the answer?
MARK L WAHLQVIST, KIYOSHI TANAKA AND BING-HSIEN TZENG
Asia Pac J Clin Nutr. 2013;22(3):492-496.

doi: 10.6133/apjcn.2013.22.3.21

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Micronutrient deficiencies in obese Thai children
NARUMON DENSUPSOONTORN, PIPOP JIRAPINYO AND CHANNAGAN KANGWANPORNSIRI
Asia Pac J Clin Nutr. 2013;22(3):497-503.

doi: 10.6133/apjcn.2013.22.3.06

 

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Tokyo Declaration: Food, Mind and Body (APCCN 2013)

 

 

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Future Events

 

Asia Pac J Clin Nutr. 2013;22(3):505.

 

 

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Poverty and the state of nutrition in India
KIRUBA S VARADHARAJAN, TINKU THOMAS AND ANURA V KURPAD
India is often thought of as a development paradox with relatively high economic growth rates in the past few years, but with lower progress in areas of life expectancy, education and standard of living. While serious inequalities in growth, development and opportunity explain the illusion of the paradox at the country level, still, a significant proportion of the world's poor live in India, as do a significant proportion of the world's malnourished children. Poverty and undernutrition coexist, and poor dietary quality is associated with poor childhood growth, as well as significant micronutrient deficiencies. Food security is particularly vulnerable to changes in the economic scenario and to inequities in wealth distribution. Migration from rural to urban settings with a large informal employment sector also ensures that migrants continue to live in food insecure situations. While food production has for the most part kept pace with the increasing population, it has been with regard to cereal rather than of pulses and millet production. Oil seeds, sugar cane and horticultural crops, along with non-food crops are also being promoted, which do not address nutrition security, and, coupled with the increase in the consumption of preprepared food, may indeed predispose towards the double burden of malnutrition. Access to food is also particularly susceptible to poverty and inequality. Many strategies and policies have been proposed to counter undernutrition in India, but their implementation has not been uniform, and it is still too early to assess their lasting impact at scale.
Key Words: poverty, food security, undernutrition, India, agriculture
 

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印度的貧窮與營養狀況
印度在過去幾年有相當高的經濟成長率,但在平均餘命、教育及生活水平方
面的進展卻較緩慢,故常被視為發展的矛盾。雖然成長、發展及機會的嚴重
不平等解釋了國家層次的矛盾假象,印度的貧困人口及營養不良兒童仍佔世
界的一大部分。貧窮與營養不足共存,貧乏的飲食品質與不良的孩童生長及
主要的微量營養素缺乏攸關。糧食安全特別容易受到經濟狀況及財富分配不
均而改變。從鄉村移居到都市區域者,大多數找不到正式工作,因此造成移
居者繼續生活在糧食不安全的狀態。雖然糧食生產大部分跟得上日益增加的
人口數,但那是指穀類,豆類及小米生產卻不盡然。含油種子類、甘蔗及蔬
果作物,及非食用作物也被推廣,但這對營養保障並無多大助益。且由於預
製食品的消費增加,可能朝向營養不良的雙頭負擔。貧窮及不平等對於食物
的可近性也深具影響。很多措施及政策已被提出,以解決印度的營養不足,
但是它們的執行卻沒有一致性,要評估它們有規模的持續效應仍為時太早。
關鍵字:貧窮、糧食安全、營養不足、印度、農業

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Iron status of the Pakistani population-current issues and strategies
SAEED AKHTAR, ANWAAR AHMED, ASIF AHMAD, ZULFIQAR ALI, MUHAMMAD RIAZ AND TARIQ ISMAIL
The present review aims to highlight the magnitude of iron status of Pakistani population and possible remedies to address iron deficiency among vulnerable groups. A computer-based search was carried out on “PubMed”, “Google Search” and “Sciencedirect.com” to retrieve relevant scientific literature published in the last two decades. The search yielded 193 articles, of which 64 were culled and further screening was performed based on the type of vulnerable population groups, age, sex and pregnancy. A thorough review of current literature reveals that iron deficiency (ID) and iron deficiency anemia (IDA) widely persist in Pakistan and necessitate immediate remedial actions. Females of reproductive age and children under 5 years have been shown to be the most IDA affected population segment. Fortification of wheat flour has been suggested as the most viable approach aptly matching Pakistan’s needs for combating IDA. The present review further stresses the need for global involvement to scale up efforts for mitigating ID and IDA to achieve Millennium Development Goals (MDGs) that are fundamentally based upon improving nutritional wellbeing of populations in developing economies by 2015.
Key Words: malnutrition, iron deficiency, iron deficiency anemia, Pakistan

 

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巴基斯坦人的鐵營養狀況-目前的議題及策略
此篇文章回顧巴基斯坦族群鐵營養狀況幅度的重點及可能的補救方針,以解決
那些弱勢族群的鐵缺乏。從電腦網站- PubMed、Google Search 及Sciencedirect.
com 檢索近20 年刊登的相關科學文獻。共搜尋出193 篇文章,再從中挑選出
64 篇,進一步篩選是根據弱勢族群、年齡、性別及懷孕狀態。透過對現今文
獻的詳盡回顧,發現鐵缺乏(ID)及鐵缺乏貧血(IDA)普遍存在巴基斯坦,且必
須立即採取補救措施。大部分鐵缺乏貧血影響的族群為生育年齡女性及5 歲以
下的兒童。麵粉強化已經被建議為最可實行及最適合巴基斯坦對抗IDA 的對
策。本次回顧更進一步強調需要全球的高規格努力,減輕鐵缺乏及鐵缺乏貧血
狀況,以達到千禧年發展目標(MDGs)的根本,在2015 年前改善發展中經濟體
族群的營養安適。
關鍵字:營養不良、鐵缺乏、鐵缺乏貧血、巴基斯坦

 

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Relationship between anthropometric and dual energy X-ray absorptiometry measures to assess total and regional adiposity in Malaysian adolescents
LENG HUAT FOO, PEY SZE TEO, NURUL FADHILAH ABDULLAH, MOHD EZANE AZIZ AND ANDREW P HILLS
The main objective of this paper was to determine the utility of various anthropometric measures to assess total and regional body fatness using dual-energy X-ray absorptiometry (DXA) as the criterion in 454 adolescent boys and girls aged 12-19 years. Multivariable regression analyses of gender-specific and gender-combined models were used to determine anthropometric measures on DXA-derived body fatness models, after adjusting for known confounding biological factors. Partial correlation analyses, after adjusting for age, pubertal growth status and ethnicity in boys and girls, showed that body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-height ratio (WhtR) were significantly correlated with total body fat (TBF), percent body fat (%BF), android region fat (ARF) and trunk fat (TF) (all p<0.0001). BMI was the greatest independent determinant, contributing 43.8%-80.9% of the total variance for DXA-derived body fatness models. Results confirmed that a simple anthropometric index such as the BMI is a good surrogate indicator of body fat levels in Malay and Chinese adolescents.
Key Words: anthropometric measures, body fatness, dual-energy X-ray absorptiometry, ethnicity, adolescents

 

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體位測量和雙能量X 光吸收儀測量法評估馬來西亞青少 年總體及局部肥

胖的相關性
本篇文章主要目的是以雙能量X 光吸收儀(DXA)當作標準,評量各種體位測量
法對估測454 名12-19 歲的青春期男孩和女孩其整體及局部體脂肪的效用。在校
正已知的生物學干擾因子後,利用DXA 衍生的體脂肪模式,以性別分層及合併
模式的多元回歸分析評估各體位測量值的預測性。在校正男女性的年齡、青春
期生長狀況與種族後,淨相關分析顯示身體質量指數(BMI)、腰圍(WC)、腰臀圍
比(WHR)及腰圍身高比(WhtR)與總體脂肪(TBF)、體脂肪百分比(%BF)、腰腹部
脂肪(ARF)及軀幹脂肪(TF)具有顯著相關性(全部p<0.0001)。BMI 為最佳的獨立
預測因子,占DXA 衍生體脂肪模式的總變異43.8%-80.9%。此研究結果證實簡
單的體位測量指標如BMI,為馬來及華裔青少年良好的體脂肪測量替代指標。
關鍵字:體位測量、體脂肪、雙能量X 光吸收儀、種族、青少年


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Effect of soy isoflavone supplementation on vascular endothelial function and oxidative stress in postmenopausal women: a community randomized controlled trial
PUSPARINI, RAHAYUNINGSIH DHARMA, FRANSISCUS D SUYATNA, MUCHTARUDDIN MANSYUR AND ADI HIDAJAT
A 12-month randomized double blind controlled trial was conducted among 182 Indonesian postmenopausal women aged 47 to 60 years to determine the effect of 100 mg/day soy isoflavone supplementation on vascular endothelial function such as vascular cell adhesion molecule-1 (VCAM-1), nitric oxide (NO) and malondialdehyde (MDA) as oxidative stress marker. The subjects were randomized to the intervention group receiving tablets consisting of 100 mg soy isoflavones and calcium carbonate 500 mg, and to the control group receiving 500 mg calcium carbonate. The concentrations of VCAM-1, NO and MDA were measured at baseline, and postsupplementation at 6 months and 12 months. After supplementation, the MDA concentrations were significantly lower in the soy isoflavone group compared with the control group (p=0.001). The concentrations of VCAM-1 and NO were not affected (p=0.992 and p=0.759, respectively). In all group the MDA concentration increased compared with baseline concentrations but the relative change of MDA concentrations was significantly lower in the soy isoflavone group compared with the control group. This study demonstrates that supplemental intake of soy isoflavones for 6 months and 12 months had an effect on oxidative stress by decreasing MDA concentration, but did not improve vascular endothelial function.
Key Words: soy isoflavone, supplementation, vascular endothelial function, oxidative stress, postmenopausal

 

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大豆異黃酮補充劑對於停經後婦女血管內皮細胞功能及氧化壓力的影響:

社區隨機對照試驗
共182 位,年齡介於47 至60 歲,已停經的印尼婦女,參與為期一年的隨機雙
盲對照試驗。研究目的為評估停經後婦女,每日攝取100 毫克大豆異黃酮補充
劑,對於血管內皮功能,如血管細胞黏附分子-1(VCAM-1)、一氧化氮(NO),
以及氧化壓力指標-丙二醛(MDA)的影響。受試者被隨機分派至介入組及控制
組,介入組攝取含有100 毫克大豆異黃酮及500 毫克碳酸鈣的錠片,控制組僅
攝取500 毫克碳酸鈣片。於介入前、介入後6 個月、及介入一年,三個時間點
檢測受試者血管細胞黏附分子-1、一氧化氮以及丙二醛濃度。研究結果顯示,
介入組在攝取大豆異黃酮補充劑後,比起控制組,有較低的丙二醛濃度
(p=0.001),但血管細胞黏附分子-1 及一氧化氮濃度則無顯著差異(p=0.992 與
p=0.759)。兩組別的丙二醛濃度皆增加,但介入組的相對改變量,顯著低於控
制組。本研究證實,攝取大豆異黃酮補充劑6 個月與12 個月,有助於減少丙
二醛的濃度,藉以降低氧化壓力產生,但無法改善血管內皮功能。
關鍵字:大豆異黃酮、補充劑、血管內皮功能、氧化壓力、更年期

 

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Effect of Korean red ginseng on insulin sensitivity in non-diabetic healthy overweight and obese adults
YOUNG HYE CHO, SOON CHEOL AHN, SANG YEOUP LEE, DONG WOOK JEONG, EUN JUNG CHOI, YUN JIN KIM, JEONG GYU LEE, YU-HYUN LEE AND BYUNG-CHEUL SHIN

Background: Korean red ginseng is one of the most popular herbs worldwide due to the belief that it contains ingredients that possess a variety of health enhancing effects including anti-diabetic effects. The objective of this study was to determine whether Korean red ginseng supplement has an effect on insulin sensitivity in healthy overweight or obese adults without overt diabetes and hypertension. Methods: In a double-blinded, placebocontrolled, randomized trial, a total of 68 participants (BMI ≥23 kg/m2) received either 6 g of Korean red ginseng rootlets (n=34) or a placebo each day over a 12 week period. Results: Similar insulin levels and insulin sensitivity index were observed at baseline in the Korean red ginseng and control groups. Korean red ginseng had no significant effect on improving the insulin sensitivity over time. Korean red ginseng does not improve the insulin sensitivity of overweight and obese subjects who do not have diabetes or hypertension.
Key Words: ginseng, overweight, obesity, insulin sensitivity

 

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無糖尿病之過重及肥胖成人攝取韓國紅蔘對其胰島素敏感性之影響
韓國紅蔘是全球知名的中草藥之一,被認為具有多種促進健康的效益,其中包
括糖尿病的預防及改善。本研究目的,為評估韓國紅蔘補充劑,是否影響無糖
尿病及高血壓病史之過重及肥胖成人的胰島素敏感性。研究設計為隨機雙盲對
照試驗,共68 位(BMI ≥23 kg/m2)參與者。介入組34 位,每日給予含有500 毫
克紅蔘粉的膠囊12 顆;控制組則給予安慰劑,共為期12 週。介入前,兩組的
胰島素濃度及胰島素敏感性指標,無顯著差異。研究結果顯示,韓國紅蔘並無
助於提昇無糖尿病及高血壓病史之過重及肥胖成人的胰島素敏感性。
關鍵字:人蔘、過重、肥胖、胰島素敏感性

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Effect of variety and cooking method on resistant starch content of white rice and subsequent postprandial glucose response and appetite in humans
YU-TING CHIU AND MARIA L STEWART
Rice is a staple carbohydrate throughout much of the world. Previous work indicated that resistant starch (RS) content of rice consumed in India varied with rice variety and cooking method. This study quantified RS in 4 white rice varieties (jasmine, long grain, medium grain, and short grain) cooked in three manners (oven baked, conventional rice cooker, and pressure cooker), and analyzed for RS content immediately after preparation or after 3 days of refrigeration at 4°C. The rice varieties with the highest and lowest RS content were selected for a pilot-scale trial to characterize postprandial glycemic response and appetite ratings in healthy adults (n=21). Refrigerated long-grain rice cooked in a conventional rice cooker had the highest RS content (HRS, 2.55 g RS/100 g) and refrigerated short-grain rice cooked in a pressure cooker had the lowest RS content (LRS, 0.20 g RS/100 g). These rice samples were served reheated in the clinical trial. Glucose area under the curve (AUC) were significantly lower with HRS and LRS compared to glucose beverage; however, there was no difference between HRS and LRS. Glycemic indices did not differ significantly between HRS and LRS. Subjects reported an overall increased feeling of fullness and decreased desire to eat based on incremental area under the curve (iAUC) for both HRS and LRS compared to control. This study found that RS naturally occurring in rice had minimal impact on the postprandial glycemic response and appetite.
Key Words: resistant starch, rice, glycemic index, appetite, satiety

 

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不同白米種類與烹煮方式對抗性澱粉產生之影響及其人體餐後血糖與食

慾之變化
在許多國家之中,稻米是平日飲食中澱粉攝取的主要來源。印度的研究指出,
稻米因品種及烹煮方式不同,其抗性澱粉含量有明顯的差異。本研究利用四種
不同品種的稻米(jasmine、long grain、medium grain 及short grain),並以三種不
同的烹煮方式(烤箱、電鍋及壓力鍋)處理後,來檢測其抗性澱粉含量的變化。
米樣品分別於烹煮後立即分析其抗性澱粉含量,以及4°C 冷藏保存三天後,進
行第二次定量分析。本研究根據四種稻米經過不同烹煮方式的抗性澱粉含量結
果,選取其中最高及最低含量的米樣品做為下一階段臨床試驗,給予21 位健
康受試者食用,用以探討稻米中抗性澱粉的含量多寡是否能影響人體之餐後血
糖及食慾。在所有米樣品中,發現使用電鍋烹煮再經過冷藏處理的長米(long
grain)為最高的抗性澱粉含量(HRS, 2.55 g RS/100 g)。而以壓力鍋烹煮再經過冷
藏後的圓米(short grain)為最低含量(LRS, 0.20 g RS/100 g)。因此,受試者食用
加熱過的此兩種米樣品,並於兩小時內,定時檢測餐後血糖及食慾變化。結果
顯示,HRS 及LRS 餐後血糖之曲線下面積顯著低於葡萄糖,但比較HRS 及
LRS 對於餐後血糖的影響及其昇糖指數,皆無統計上的差異。此外,對於食慾
的影響,受試者表示食用HRS 及LRS 比葡萄糖有顯著地增加飽足感,並且有
效降低多食用的慾望。綜合研究結果表示,存在此四種稻米中的天然抗性澱粉
含量,對於人體餐後血糖及食慾之影響並非十分明顯。
關鍵字:抗性澱粉、米、昇糖指數、食慾、飽足感


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Acute effects of oral preloads with increasing energy density on gastric emptying, gut hormone release, thermogenesis and energy intake, in overweight and obese men
NATALIE D LUSCOMBE-MARSH, RADHIKA V SEIMON, ERIN BOLLMEYER, JUDITH M WISHART, GARY A WITTERT, MICHAEL HOROWITZ, MAX BELLON AND CHRISTINE FEINLE-BISSET
This study investigated the effect of high- and low-energy density preloads on gastrointestinal and metabolic factors, which act to regulate acute energy intake. Sixteen overweight and obese men (BMI range: 27.2-36.5 kg/m2) each received 3 oral preloads in randomised order: i) high-energy-density, high-fat (1.5 kcal/g), ii) low-energydensity, high-fat (1.1 kcal/g), and iii) low-energy-density, high-protein (1.1 kcal/g). Over 180 min, gastric emptying, plasma glucagon-like peptide-1 concentrations, and diet-induced thermogenesis were assessed, and subsequent energy intake was determined. Total energy intake did not differ between preloads (high-energy-density, high-fat, 2059±72 kilocalories (kcal); low-energy-density, high-fat, 1876±91 kcal; and low-energy-density, highprotein, 1867±63 kcal). Gastric emptying was slower following the high-energy-density, high-fat preload (158±8 min) compared with the low-energy-density, high-protein preload (130±9 min) (p=0.05), but did not differ between the high-energy-density, high-fat and low-energy-density, high-fat (147±8 min) preloads. Plasma glucagon-like peptide-1 did not differ substantially between preloads. Diet-induced thermogenesis was lower following high-energy-density, high-fat (10.4±0.7 %) than low-energy-density, high-fat (14.9±1.2 %) and low-energydensity, high-protein (18.1±1.1 %) preloads (p<0.01 for both). We conclude that an increased energy density slows gastric emptying and reduces thermogenesis, but that a high fat content overrides the effect of energy density on gastric emptying. The counter-regulatory modulation of these gastric and metabolic factors may explain, at least in part, the lack of differences in subsequent energy intake in response to oral preloads with increasing energy density.
Key Words: gut function, body weight regulation, high-fat diet, high-protein diet, humans

 

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增加能量密度的口服配方對於過重及肥胖男性之胃排空、腸道荷爾蒙釋放

、攝食產熱效應及能量攝取的急性影響
此研究為偵測高能量密度及低能量密度配方,對於調節急性能量攝取的腸胃道
及代謝因子的影響。計16 位過重及肥胖的男性(身體質量指數: 27.2-36.5
kg/m2),每位受試者隨機接受三種口服配方:i)高能量密度高脂配方(1.5
kcal/g),ii)低能量密度高脂配方(1.1 kcal/g),以及iii)低能量密度高蛋白配方
(1.1 kcal/g)。服用配方3 小內,評估胃排空狀況、血漿類升糖激素胜肽-1(GLP-
1)濃度、飲食誘導的產熱效應,並偵測後續的能量攝取。合計後續進食與高能
量密度高脂配方、低能量密度高脂配方或低能量高蛋白配方的平均總能量攝取
分別為2059±72 kcal、1876±91 kcal 及1867±63 kcal,三者無顯著差異。攝入高
能量密度高脂配方,所需胃排空時間較低能量密度高蛋白配方長,但與低能量
密度高脂配方無顯著差異。不同配方對於受試者血漿GLP-1 濃度無顯著差
異。高能量密度高脂配方,所誘導的攝食產熱效應為10.4±0.7%,顯著低於低
能量密度高脂的14.9±1.2%及低能量密度高蛋白的18.1±1.1%。從上述結果,
推論增加能量密度會減緩胃排空及減少攝食產熱效應,但若同時含有高量脂
肪,則會覆蓋能量密度對於胃排空的影響。胃與代謝因子兩者相反的調控模
式,或許可以用於解釋,為何增加能量密度配方的攝入後對於後續總能量的攝
取並無影響。
關鍵字:腸道功能、體重調節,高脂飲食、高蛋白飲食、人類


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Effects of sun exposure on 25(OH) vitamin D concentration in urban and rural women in Malaysia
MUSA NURBAZLIN, WINNIE SIEW SWEE CHEE, PENDEK ROKIAH, ALEXANDER TONG BOON TAN, YEE YEAN CHEW, ABD RAHMAN SITI NUSAIBAH AND SIEW PHENG CHAN
Ultraviolet B sunlight exposure is a primary source of vitamin D. There have been reports of low vitamin D status amongst the Malaysian population despite it being a tropical country. This study was conducted to determine the influence of sun exposure on 25(OH)D concentrations in urban and rural women in Malaysia and factors predicting 25(OH)D concentrations. Women aged above 45 years were recruited from urban (n=107) and rural areas (n=293). Subjects were interviewed regarding their outdoor activities and usual outdoor attire over the previous week. 25(OH)D concentrations were analyzed using the vitamin D3 (25-OH) electrochemiluminescence immunoassay. Median (Q1-Q3) age of the participants was 57 (53-61) years old. Median (Q1-Q3) 25(OH)D concentration of rural women was significantly higher [69.5 (59.0-79.1) nmol/L] compared to urban women [31.9 (26.1-45.5) nmol/L] (p<0.001). Rural women spent more time in the sun compared to urban women (7.83 (3.67-14.7) vs 2.92 (1.17-4.92) hours, p<0.001), although the fraction of body surface area (BSA) exposed to sunlight was significantly higher in the urban group [0.21 (0.21-0.43) vs 0.12 (0.07-0.17), p<0.001]. The calculated sun index (hours of sun exposure per weekfraction of BSA) was significantly higher in rural [0.89 (0.42-1.83)] compared to urban women [0.72 (0.26-1.28)], p=0.018. In the stepwise linear regression, rural dwelling increased the serum 25(OH)D by 31.74 nmol/L and 25(OH)D concentrations increased by 1.93 nmol/L for every unit increment in sun index. Urban women in Malaysia had significantly lower vitamin D status compared to rural women. Rural dwelling and sun index were key factors influencing vitamin D status in Malaysian women.
Key Words: 25(OH)D, sun exposure, body surface area, rural and urban women, Malaysia

 

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陽光曝曬對於馬來西亞城鄉婦女血液中25-羥基維生素D濃度之影響
維生素D 的主要來源,是由陽光中紫外線B 照射皮膚所合成。儘管馬來西亞屬於
熱帶國家,仍有研究指出部分馬來西亞人口處於低維生素D 的狀態。本研究目的
為評估陽光曝曬對於居住在都市與鄉村的馬來西亞婦女,血液25-羥基維生素D
的影響,及其濃度的預測因子。共招募400 位45 歲以上女性,其中107 位居住於
都市,293 位居住於鄉村。面訪參與者以詢問過去一個禮拜的戶外活動情形及通
常的戶外衣著。利用電化學發光免疫分析法,測定血清25-羥基維生素D 的濃
度。參與者的年齡中位數為57 歲(53-61 歲)。鄉村女性維生素D 的中位數值顯著
高於都市女性(69.5 nmol/L 比上31.9 nmol/L;p<0.001)。儘管都市女性暴露在陽光
下的面積較高(0.21 比上0.12;p<0.001),但陽光曝曬的時間顯著低於鄉村女性
(2.92 比上7.83 小時;p<0.001)。比起都市女性,鄉村女性有顯著較高的陽光曝曬
指數(每週陽光曝曬時數x 曝曬體表面積)。逐步線性迴歸顯示居住於鄉村者,血
清25-羥基維生素D 濃度高出31.7 nmol/L;每增加一單位陽光曝曬指數,血清
25-羥基維生素D 濃度升高1.93 nmol/L。馬來西亞都市婦女的維生素D 狀態,顯
著較差於鄉村女性。居住於鄉村及陽光曝曬指數,是影響馬來西亞婦女維生素D
狀態的主要因素。
關鍵字:25-羥基維生素D、陽光曝曬、體表面積、鄉村及都市女性、馬來西亞

 

 

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Serum ferritin and risk of the metabolic syndrome: a population-based study
JUNG-SU CHANG, SHIUE-MING LIN, TZU-CHIEH HUANG, JANE C-J CHAO, YI-CHUN CHEN, WEN-HARN PAN AND CHYI-HUEY BAI

Ferritin concentrations in circulation reflect iron stores in healthy individuals. However, elevated serum ferritin (SF) concentrations have recently been implicated in the pathogenesis of the metabolic syndrome (MetS). We aim to investigate factors associated with elevated SF and to evaluate the association between SF and risk of MetS in Taiwanese adults. Data was collected from 2654 healthy individuals aged ≥19 years old, who participated in the Nutrition and Health Survey in Taiwan (NAHSIT Adults 2005-2008). Mean concentrations of SF were 173±282 ng/mL (men 229±349 ng/mL and women 119±180 ng/mL). Prevalence proportion of MetS was 34.6% (men 43.1% and women 26.5%). Prevalence proportion of iron overload was 18.6% (men 21.5% and women 15.8%) and iron deficiency anemia was 5.2% (2.0% for men and 8.3% for women). Individuals with the highest SF tertile (T3) were more likely to consume higher amount of animal protein (p=0.001), betel nuts (p=0.004), and lower amounts of carbohydrates (p<0.0001), compared with the lowest SF group (T1). After adjustments, individuals with the highest SF tertile were associated with risk of MetS compared with those with the lowest (OR=1.724, 95% CI: 1.21-2.45). Serum ferritin concentrations showed a gradient relationship with individual components of MetS (all p<0.0001). Individuals with the highest SF tertile were significantly associated with fasting serum glucose (OR=2.16, 95% CI: 1.75-2.65) and serum triglyceride (OR=2.58, 95% CI: 1.07-3.22) than those with the lowest. In conclusions, our results highlight the crucial role of serum ferritin in the pathogenesis of the MetS in healthy Taiwanese adults.
Key Words: metabolic syndrome, serum ferritin, National Nutrition and Health Survey in Taiwan, dietary iron intake, obesity

 

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血清鐵蛋白與代謝症候群危險性:族群基礎研究
血清儲鐵蛋白可在健康成年人中反應體內鐵含量,但是最近的研究發現血清儲
鐵蛋白為發炎指標因子。此外,血清儲鐵蛋白濃度也是預測代謝症候群的獨立
危險因子。本次研究的主要目的是利用2005 年至2008 年國民營養調查資料庫
分析臺灣成年人血中儲鐵蛋白指標與代謝症候群的相關性。本次研究總共分析
2654 位參加2005-2008 國民營養調查,年齡≥19 歲的成年人。儲鐵蛋白平均值
為173±282 ng/mL (男性229±349 ng/mL,女性119±180 ng/mL)。代謝症候群的
盛行率為34.6% (男性43.1%,女性26.5%)。鐵質過量的盛行率為18.6% (男性
21.5%,女性15.8%)。缺鐵性貧血的盛行率為5.2% (男性2.0%,女性8.3%)。
血清儲鐵蛋白於最高三等分位的族群與最小三等分位的族群相比,攝取較多動
物性蛋白質(p=0.001)與檳榔(p=0.004)以及較少量的碳水化合物(p<0.0001)。在
多變項校正後的全人口分析中,血清儲鐵蛋白於最高三等分位的族群與最低三
等分位的族群相比,得到代謝性症候群的危險對比值為1.7 倍(OR=1.724,95%
CI:1.21-2.45)。進一步分析儲鐵蛋白與代謝症候群的五個障害分群後發現,高
儲鐵蛋白與得到任一障害都具有風險,其中以空腹血糖過高(OR=2.16,95%
CI:1.75-2.65)及高三酸甘油酯(OR=2.58,95% CI:1.07-3.22)的風險為最高,
且達顯著。總結而言,本研究顯示臺灣健康成年人中,血清儲鐵蛋白與代謝症
候群發展可能有重要關聯。
關鍵字:代謝症候群、血清儲鐵蛋白、臺灣國民營養調查、膳食鐵攝取、肥胖

 


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Overweight among primary school-age children in Malaysia
BALKISH MAHADIR NAIDU, SITI ZURAIDAH MAHMUD, RASHIDAH AMBAK, SYAFINAZ MOHD SALLEHUDDIN, HATTA ABDUL MUTALIP, RIYANTI SAARI, NORHAFIZAH SAHRIL AND HAMIZATUL AKMAL ABDUL HAMID
This study is a secondary data analysis from the National Health Morbidity Survey III, a population-based study conducted in 2006. A total of 7,749 children between 7 and 12 years old were recruited into the study. This study seeks to report the prevalence of overweight (including obesity) children in Malaysia using international cut-off point and identify its associated key social determinants. The results show that the overall prevalence of overweight children in Malaysia was 19.9%. The urban residents, males, Chinese, those who are wealthy, have overweight or educated guardians showed higher prevalence of overweight. In multivariable analysis, higher likelihood of being overweight was observed among those with advancing age (OR=1.15), urban residents (OR=1.16, 95% CI: 1.01-1.36), the Chinese (OR=1.45, 95% CI: 1.19-1.77), boys (OR=1.23, 95% CI: 1.08-1.41), and those who came from higher income family. In conclusion, one out of five of 7-12 year-old-children in Malaysia were overweight. Locality of residence, ethnicity, gender, guardian education, and overweight guardian were likely to be the predictors of this alarming issue. Societal and public health efforts are needed in order to reduce the burden of disease associated with obesity.
Key Words: National Health and Morbidity Survey III, school children, overweight, Malaysia, IOTF

 

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馬來西亞國小學童體重過重的狀況
本研究採用2006 年馬來西亞全國第三次健康及疾病調查(National
Health Morbidity Survey III)的二手資料,這個調查是根據人口抽樣的。共有
7,497 位,年齡介於7-12 歲的兒童納入研究。本研究目的在報告採用國際切
點時,馬來西亞過重(包括肥胖)兒童的盛行率,並確定其相關的主要社會決定
因素。結果顯示,馬來西亞整體兒童過重盛行率為19.9%。居住在城市、男
性、華裔、較富有的、家長為過重或受過教育的,這些兒童顯示有較高的過
重盛行率。在多元分析中發現, 過重的情況較可能發生在: 較年長
(OR=1.15)、居住在城市(OR= 1.16,95%CI: 1.01-1.36)、華裔(OR= 1.45,95%
CI: 1.19 -1.77)、男孩(OR= 1.23,95%CI: 1.08-1.41)、及來自高收入家庭的孩
童。結論是,馬來西亞7-12 歲的孩童中,5 位中就有1 位為體重過重。居住
地、種族、性別、家長教育程度和過重的家長,可能是此要提高警訊的議題
之預測因子。為了減少與肥胖相關的疾病負擔,社會和公共衛生的努力是必
要的。
關鍵字: 第三次全國健康及疾病發病率調查、學童、過重、馬來西亞、國際肥
胖問題工作組人群

 

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Overweight and obesity among internal migrants in India
KIRUBA SANKAR VARADHARAJAN, TINKU THOMAS, DIVYA RAJARAMAN, ANURA V KURPAD AND MARIO VAZ
Migration, chiefly from rural to urban areas has been linked to precursor conditions of cardiovascular diseases. We estimated the odds of overweight/obesity ( BMI ≥25 kg/m2) associated with different patterns of internal migration, using data from the National Family Health Survey 3, a cross-sectional survey that covered 29 states of India in 2005/06. A total of 56,498 non-pregnant women, aged 15 to 49 years, and 42,190 men, aged 15 to 54 years, with BMI >18.5 kg/m2 were included in the final analysis. Odds ratios (ORs) for overweight/obesity were computed for different groups of migrants after adjusting for age, socioeconomic status and parity using binomial logistic regression models. All analyses were performed separately for men and women and weighted using national sampling weights. Rural to urban migrant women but not men, had higher odds of being overweight/obese (adjusted OR (AOR): 1.50, 95% confidence interval (CI): 1.36-1.65) compared to non-migrant rural residents. Increased odds were also noted among women migrating from one urban area to another, compared to non-migrant urban women ( A OR: 1.10, 95% CI: 1.02-1.19). Women migrating from urban to rural areas, however had decreased odds (AOR: 0.75, 95% CI: 0.67-0.83) of overweight/obesity. Thus, apart from confirming rural to urban migration as a risk factor for overweight, this study finds that other patterns of migration are also associated with overweight/obesity.
Key Words: internal migrants, overweight, obesity, India, NFHS 3

 

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印度境內移居者的體重過重與肥胖狀況
境內移居,主要是從鄉村到都市地區,被推測與心血管疾病前兆有關。本研究
資料來自2005/06 年印度全國家庭健康調查3,這是一個涵蓋29 個州的橫斷性
調查。評估體重過重及肥胖(BMI25 kg/m2)的風險與不同模式的境內移居之相
關性。總共有56,498 名年齡介於15-49 歲的非懷孕女性及42,190 名15-54 歲的
男性,合乎BMI>18.5 kg/m2,被納入最後的分析。校正年齡、社經狀況及生育
數,使用二項式羅吉斯回歸模式,計算不同移居組別的過重及肥胖的勝算比
(ORs)。所有分析均將男女性分開計算,並使用全國抽樣權數加權。從鄉村移
居到都市的女性比起非移居的鄉村女性,有較高的體重過重及肥胖的風險(校
正OR(AOR): 1.05,95% CI: 1.36-1.65),男性則無差異。從一個都市移居到另
一個都市的女性比起非移居的都市女性,其風險也增加(AOR: 1.10,95% CI:
1.02-1.19)。女性從都市移居到鄉村地區,其過重及肥胖的風險則是降低(AOR:
0.75,95% CI: 0.67-0.83)。因此,除了確認鄉村移居到都市為體重過重的危險
因子以外,這個研究亦發現,其他移居模式也與體重過重/肥胖有關。
關鍵字:境內移居、體重過重、肥胖、印度、全國家庭健康調查3

 

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Nutritional status and body composition are already affected before oncology treatment in ovarian cancer
VANESSA FUCHS-TARLOVSKY, KAROLINA ALVAREZ-ALTAMIRANO, DEBORAH TURQUIE-SACAL, CAROLINA ALVAREZ-FLORES AND HELLEN HERNANDEZ-STELLER
Poor nutritional status is a common problem among ovarian cancer patients. In order to detect changes in nutritional status and body composition this study investigates anthropometrical and biochemical parameters among these patients. This study included women with ovarian cancer and woman without cancer. Body composition was assessed by bioelectrical impedance analysis (BIA), anthropometrically, and with DXA scan, and total serum protein, albumin, transferrin, hemoglobin, hematocrit levels and total lymphocyte count was also measured. Data from DXA scan and body composition as assessed by BIA was collected from thirty-one women. Student t-test was used to compare differences in means between groups. This study included 120 women, 57 with ovarian cancer and 63 with benign tumors. Both groups of women were overweight. Body fat by skin-fold thickness, arm circumference, serum albumin, total lymphocytes count, as well as transferrin levels were significantly lower in the ovarian cancer group (p<0.05). Ovarian cancer women had lower fat reserves by skin-fold thickness and lower serum proteins even though they were overweight. However, further studies need to use a body composition assessment on all subjects to confirm these results.
Key Words: ovarian Cancer, nutritional status, body composition, nutritional assessment, bioelectrical impedance analysis

 

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卵巢癌患者接受腫瘤治療前的營養狀態及體組成變化
卵巢癌患者營養狀態不佳是常見的問題。本研究以體位及生化參數,評估患
者營養狀態及體組成的變化。研究對象為120 位女性,其中57 位患有卵巢
癌,63 位為良性卵巢瘤,本研究依此將其分為兩組比較。體組成的測量,包
括體脂肪(生物電阻抗法)、體位測量、雙能量骨密度檢測。血液生化值,則包
含總血清蛋白、白蛋白、運鐵蛋白、血紅素、血球容積比,以及總淋巴球計
數。僅31 位女性具有雙能量骨密度檢測及體脂肪資料。獨立t 檢定用於比較
兩組的平均值差異。兩組別婦女皆過重。卵巢癌患者的皮下脂肪厚度、臂
圍、血清白蛋白、總淋巴球計數,以及運鐵蛋白濃度皆顯著較低(p<0.05)。卵
巢癌女性雖過重,但其皮下脂肪儲量以及血清蛋白偏低。然而,此結果仍需
要所有參與者的體組成評估做進一步的確認。
關鍵字:卵巢癌、營養狀態、體組成、營養評估、生物電阻抗分析


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The trans fatty acid content in human milk and its association with maternal diet among lactating mothers in Malaysia
AKMAR ZURAINI DAUD, NORHAIZAN MOHD-ESA, AZRINA AZLAN AND YOKE MUN CHAN
Excessive intake of trans fatty acids (TFA) could reduce the fat density of human milk and impair the desaturation of essential fatty acids. Because the mammary glands are unable to synthesize TFA, it is likely that the TFA in human milk come from dietary intake. Thus, the aim of this study was to investigate the sources of TFA intake for lactating mothers in one of the urban areas in Selangor. In this cross-sectional study, anthropometric measurements, FFQ including 7 food groups and dietary consumption data were collected from 101 lactating mothers. Five major TFA isomers (palmitoelaidic acid (16:1t9), petroselaidic acid (18:1t6), elaidic acid (18:1t9), vaccenic acid (18:1t11) and linoelaidic acid (18:2t9,12) in human milk were measured by gas chromatography (GC). The relationship between food consumption and TFA levels was assessed using the non-parametric Spearman’s rho test. The TFA content in human milk was 2.94±0.96 (SEM) % fatty acid; this is considered low, as it is lower than 4%. The most abundant TFA isomer was linoelaidic acid (1.44±0.60% fatty acid). A sub-experiment (analyzing 3 days of composite food consumption) was conducted with 18 lactating mothers, and the results showed that linoelaidic acid was the most common TFA consumed (0.07±0.01 g/100 g food). Only 10 food items had an effect on the total TFA level and the isomers found in human milk. No association was found between TFA consumption and the TFA level in human milk.
Key Words: human milk, TFA, elaidic acid, vaccenic acid, linoelaidic acid

 

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馬來西亞婦女之哺乳期飲食與其母乳中反式脂肪酸含量的相關性
攝取過多反式脂肪酸會減少母乳的脂肪密度,且阻礙必需脂肪酸的去飽和作
用。由於乳腺無法合成反式脂肪酸,故推測母乳中的反式脂肪酸可能來自於膳
食攝取。此橫斷面研究旨在調查居住於雪蘭莪州都會區的哺乳婦女,其反式脂
肪酸的攝取來源。調查資料包括101 位哺乳母親的體位測量、含7 類食物的飲
食頻率問卷,並收集部分參與者3 天的食物攝取樣本。利用氣相層析,分析母
乳中五種主要的反式脂肪酸異構物,包括反棕櫚油酸(16:1t9)、六反十八碳烯酸
(18:1t6)、反油酸(18:1t9)、十一反十八碳烯酸(18:1t11)、反亞油酸(18:2t9,12)。
以無母數斯皮爾曼檢定測試食物攝取與反式脂肪酸之相關性。研究對象母乳中
總反式脂肪酸的含量為2.94%,低於一般認知的4%;反亞油酸為1.44%,含量
最多。另外進行次研究,以18 位哺乳婦女之3 天飲食樣本進行成份分析,結
果顯示攝取的反式脂肪酸,以反亞油酸最多。只有10 項食物,會影響母乳中
反式脂肪酸濃度,以及異構物的含量。反式脂肪酸的攝取量與母乳中反式脂肪
酸的濃度並無相關。
關鍵字:母乳、反式脂肪酸、反油酸、十一反十八碳烯酸、反亞油酸
 

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Determinants of breastfeeding at discharge in rural China
LI TANG, COLIN W BINNS, CHUNMING LUO, ZHIQING ZHONG AND ANDY H LEE
This study aimed to investigate the rate of breastfeeding at discharge and associated influencing factors in rural China. A prospective cohort study of infant feeding practices was undertaken during 2010-2011 in Jiangyou city, Sichuan Province of China. Logistic regression analysis was performed to ascertain pertinent factors affecting the prevalence of any breastfeeding at discharge. The participants consisted of 695 mothers aged 18-44 years. The breastfeeding rate at discharge was 93.5% (95% CI: 91.7-95.3). Perceived paternal breastfeeding preference was positively associated with actual breastfeeding at discharge (OR=4.46, 95% CI: 2.15-9.28). Other significant determinants
were ‘receiving breastfeeding support’ from staff during hospital stay (OR=3.41, 95% CI: 1.58-7.34) and making the decision on feeding method during pregnancy or after childbirth (OR=0.46, 95% CI: 0.22-0.93). In conclusion, provision of comprehensive breastfeeding support in hospital and education programs targeting expectant and future parents are recommended to further increase the rate of breastfeeding at discharge in rural areas of China.
Key Words: breastfeeding, China, hospital support, paternal attitude, discharge

 

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中国农村地区产妇出院时母乳喂养的影响因素
本篇研究目的是调查中国农村地区产妇出院时的母乳喂养率及其影响因素。
该婴儿喂养调查采用了前瞻性队列研究方法,于2010 年至2011 年期间在中
国四川省江油市进行。统计方法使用了邏輯斯(logistic)回归分析,用于确定产
妇出院时母乳喂养率的影响因素。本研究共调查了695 名母亲,其年龄分布
于18 至44 岁。结果显示,产妇出院时的母乳喂养率为93.5%(95% CI: 91.7-
95.3)。产妇所认为的婴儿父亲对母乳喂养的偏好和实际出院时的母乳喂养情
况呈正相关(OR=4.46, 95% CI: 2.15-9.28)。其余的影响因素包括:住院期间受
到来自医院员工的母乳喂养支持(OR=3.41, 95% CI: 1.58-7.34)和在怀孕期间或
生产之后决定喂养方式(OR=0.46, 95% CI: 0.22-0.93)。总之,建议在住院期间
给予产妇全方面的母乳支持,以及开展针对准父母的教育课程,从而进一步
提高中国农村地区的产妇出院时母乳喂养率。
关键字:母乳喂养、中国、医院支持、父亲的态度、出院


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Seasonal variation in the nutritional status of children aged 6 to 60 months in a resettlement village in West Timor
JACQUELINE MILLER, BRETT RITCHIE, CUONG TRAN, SEAN BEGGS, CHRISTINA OLLY LADA, KATHRYN WHETTER AND LYNNE COBIAC
Childhood malnutrition remains a public health issue in Indonesia with a national prevalence of wasting of 13% and stunting of 36%. In rural areas nutritional status depends on local agriculture and may fluctuate in relation to harvest time. The aim of this study was to characterise seasonal variations in nutritional status in two resettlement villages in the Oesao district, Nusa Tenggara Timur. A cross sectional study was conducted in a convenience sample of children after the wet season (March). Children aged 6 to 60 months were assessed for nutritional status using anthropometric and biochemical measures. A subset of these children was re-assessed for anthropometry after the dry season (November). Weight-for-height z scores improved significantly from mean±SD of -1.7± 0.9 in March to -1.3±0.9 in November (p<0.001). There was no significant change in height between seasons. Prevalence of wasting, (weight-for-height z score <-2), was 42% in March and 19% in November (p<0.001). However, stunting rates increased significantly from 42% in March to 45% in November (p<0.001). Thirty six per cent of children were anaemic (Hb level <11 mg/100 mL), 68% were vitamin A deficient (plasma vitamin A level <0.8 μmol/L) and 50% were zinc deficient (plasma zinc <9.94 μmol/L). All children except one were positive for intestinal parasites. These data indicate seasonal changes in anthropometry with inconsistent effects depending on the anthropometric index measured. Wasting and stunting were higher than the national average, alongside high rates of anaemia, zinc and vitamin A deficiencies.
Key Words: anthropometry, child, preschool, growth, malnutrition, micronutrients

 

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西帝汶移置村中6 至60 個月的孩童在不同季節的營養狀況
印尼全國兒童消瘦及發育遲緩的盛行率,分別為13 及36%,顯見兒童營養不
良仍是印尼重要的公衛議題。鄉村地區居民的營養狀態取決於當地的農業,
且可能隨產季波動。本橫斷面研究,觀察東努沙登加拉省Oesao 區兩個移置村
的兒童在不同季節的營養狀況變化。研究起始於雨季過後(三月),以便利抽樣
的方式召募當地6 至60 個月孩童。以體位及血液生化測量評估孩童的營養狀
況。部分孩童於旱季過後(十一月),再追蹤量測一次體位。三月份的體重-身
高指數Z 值(WHZ)為-1.7±0.9,十一月份顯著改善為-1.3±0.9 (p<0.001)。孩童
身高在兩個季節間,並無顯著變化。三月份消瘦(WHZ<-2)比例為42%,十一
月時顯著下降至19% (p<0.001)。然而,發育遲緩的比例從42%上升至45%
(p<0.001)。受測孩童中36%患有貧血(血色素濃度<11 mg/100 mL);68%為維
生素A 缺乏(血漿維生素A 濃度<0.8 μmol/L);鋅缺乏比例為50%(血漿鋅濃度
<9.94 μ/L)。除一人外,其餘孩童腸道寄生蟲檢驗皆呈陽性。此資料顯示季節
變化對於孩童體位影響不一致,而這取決於不同體位指標的測量。該地區孩
童消瘦與發育遲緩比例皆高於國家平均值,且伴隨貧血、鋅及維生素A 缺乏
的高盛行率。
關鍵字:體位、孩童、學齡前、成長、營養不良、微量營養素酸

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Relationship of dietary factors and habits with sleep-wake regularity
MIWA YAMAGUCHI, HIROKAZU UEMURA, SAKURAKO KATSUURA-KAMANO, MARIKO NAKAMOTO, MINEYOSHI HIYOSHI, HIDENOBU TAKAMI, FUSAKAZU SAWACHIKA, TOMOYA JUTA AND KOKICHI ARISAWA
The purpose of this study was to evaluate the associations between dietary factors and sleep-wake regularity in the Japanese population. We analyzed 1368 eligible subjects (931 men and 437 women) aged 35-69 years who had participated in the baseline survey of a cohort study in Tokushima Prefecture, Japan. Information on individual lifestyle characteristics, including dietary habits and sleep-wake regularity, was obtained by a selfadministrated questionnaire. Logistic regression analyses were performed to evaluate adjusted associations of the intake energy ratios of macronutrients, as well as intake frequency, and the amount of staple foods with sleepwake regularity. The lowest quartile of protein intake as well as the highest quartile of carbohydrates showed significantly higher multivariable-adjusted odds ratios of 2.1 (95% confidence interval, 1.3-3.3) and 2.1 (1.3-3.5), respectively, for poor sleep-wake regularity compared with the respective second quartile that is thought to be moderate intake. Regarding intake of staple foods, low weekly intake frequency at breakfast (<5 times/week), the lowest intake amount (<1 bowl or slice/roll) at breakfast, and the highest intake amount (≥2 bowls or slices/ rolls) at lunch and dinner exhibited significantly high adjusted odds ratios for poor sleep-wake regularity. Additionally adjusting for sleep duration, these results did not substantially alter. Our results suggested that low intake energy ratio of proteins and high intake energy ratio of carbohydrates, skipping intake of the staple foods at breakfast, and excessive intake amount of the staple foods at lunch and dinner may be associated with poor sleep-wake regularity.
Key Words: sleep-wake regularity, dietary factor, macronutrient, staple foods, cross-sectional study

 

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飲食特性與規律睡眠習慣之相關性
本研究之目的,為評估日本民眾的飲食特性與規律睡眠之間的相關性。分析對
象為1368 位參與日本德島縣世代研究,具有完整基礎資料的35-69 歲參與者
(931 位男性與437 位女性)。藉由自填式問卷,獲取個人生活型態的資料,其中
包含飲食特性及睡眠習慣。利用邏輯斯迴歸,分析巨量營養素熱量比、主食攝
取頻率及攝取量,與規律睡眠的校正相關。多變項校正後,蛋白質攝取最低
組,和碳水化合物攝取最高組,比起最適攝取量的第二分位組,睡眠不規律的
風險都為2.1(95%CI 分別為1.3-3.3 和1.3-3.5)。早餐攝取主食頻率小於每週五次
者、早餐飯麵攝取少於一碗或麵包攝取少於一片/卷者,以及午晚餐主食攝取最
高量者,在多變項校正後,有顯著較高睡眠不規律的風險。進一步校正睡眠時
間後,相關依然存在。本研究結果顯示,蛋白質熱量攝取較低、碳水化合物熱
量攝取較高、早餐的主食攝取太少、午晚餐主食攝取過量,會伴隨有睡眠不規
律的情形。
關鍵字:睡眠規律性、飲食特性、巨量營養素、主食、橫斷性研究
 

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Trend in gender disparities of BMI and height between 2004 and 2011 among adolescents aged 17-18 years in Changzhou China
WENYING CHEN AND ZUMIN SHI
Objectives: to describe the trend in gender disparities of overweight/obesity and underweight, as well as height, among Chinese adolescents. Methods: the study is based on population-based data from annual health checks of approximately 7,000 students finishing high school each year between 2004-2011. Height and weight were measured. Overweight/obesity and underweight were defined using International Obesity Task Force (IOTF) criteria. School level socioeconomic status (SES) was constructed based on real-estate prices near each school. Results: there was a slight increase in the prevalence of obesity between 2004 and 2011; 3.7% to 4.7% in boys and 1.1% to 1.5% in girls. The prevalence of overweight was quite stable in both genders (boys: 12%-15%; girls: 7%-10%). In most years, the prevalence of underweight was above 10%. The prevalence of underweight in girls born after 1991 increased dramatically. However, the opposite trend was seen in boys. School SES was positively associated with overweight and inversely associated with underweight among boys. There was a significant increase in height in both genders. Height and BMI was positively associated in boys but this relation was inversely associated in girls. Conclusion: between 2004 and 2011, the prevalence of overweight/obesity was plateauing among adolescents finishing high school. A substantial increase in the prevalence of underweight was observed among girls born after 1991 but this seemed to be positively associated with high SES.
Key Words: Chinese, adolescent, overweight, trend

 

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2004 到2011 年间中国常州市17-18 岁青少年体质指数和身高变化趋势的

性别差异
目的:描述中国青少年超重、肥胖、低体重及身高变化趋势的性别差异。方
法:本研究使用2004 到2011 年间常州市高中毕业生的健康体检数据(每年约
7000 人)。身高和体重由测量获得。超重、肥胖及低体重的定义采用国际肥胖
工作组(IOTF)的标准。学校的经济水平根据学校周围房地产价格来决定。结
果:2004 到2011 年间肥胖率略有增长(男性由3.7%增长到4.7%,女性由
1.1%增长到1.5%),男女生超重率趋于稳定(男性在12%-15%之间,女性在
7%-10%之间)。在大多数年份,低体重的比例在10%以上;1991 年后出生的
女生低体重比例显著上升,男生低体重率则明显下降。在男生中,学校经济
状况和超重及肥胖呈正相关,与低体重呈负相关。男女身高均有显著增长。
男生身高与体质指数呈正相关,女生身高和体质指数則反而呈负相关。结
论:2004 到2011 年间高中毕业生中超重及肥胖率趋于稳定。1991 年后出生
的女生的低体重率明显增加,这一现象可能和经济收入增加有关。
关键词:中国、青少年、超重、趋势
 

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Impact of energy intake on the survival rate of patients with severely ill stroke
MAKI WAKITA, AKATSUKI WAKAYAMA, YUKO OMORI, SATOMI ICHIMARU AND TERUYOSHI AMAGAI
INTRODUCTION: Stroke accounts for approximately 10% of all deaths. We examined whether energy intake influences the survival rate of severely ill stroke patients. METHODS: We analyzed 86 consecutive severely ill stroke patients. Patients’ background was compared between survivors and non-survivors. Average energy intakes in seven different periods from day one to seven following neurosurgical care unit (NCU) admission were compared between two groups, to examine which period is proper to show an energy difference. Groups were stratified by average total energy intake (group E-I, -II, -III, and -IV; ≤8.25, 8.25-16.5, 16.5-25, and >25 kcal/kg/day, respectively), and cumulative survival rate for 90 days after NCU admission was analyzed. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated to examine the effect of confounder factors. RESULT: Patients’ background did not differ significantly between the two groups. Average daily energy intake for the first seven NCU days of non-survivors was significantly lower than that of survivors (p=0.034). The survival rate of group E-II was significantly higher than that of group E-I, which was set as a reference (p=0.030). The adjusted HR of E-II was also significantly lower than that of group E-I (HR=0.19, p=0.047), although E-III did not show significance (HR=0.52, p=0.279). CONCLUSION: Energy intake assessment should be conducted for at least seven days following NCU admission. An average total energy intake ranging from 8.25 to 16.5 kcal/kg/day and enteral feeding increases survival rate in severely ill stroke patients.
Key Words: stroke, outcome, energy intake, glasgow coma scale, neurosurgical care unit

 

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熱量攝取影響重症中風患者的存活率
前言:中風約佔全部死亡人數的10%。本研究分析熱量攝取是否影響重症中風
患者的存活率。方法:分析86 位轉介的重症中風患者資料,比較存活者及非
存活者的患者背景。收集進入神經外科加護病房(NCU)7 天內的熱量攝取,從
第一天開始,每日累計,成7 個時段,分別進行兩組比較,以找出哪個時段適
合呈現熱量攝取差異。按照總熱量的攝取進行分層(層級別E-I、E-II、E-III 及
E-Ⅳ,熱量分別為≤8.25、8.25-16.5、16.5-25 及>25 大卡/公斤/天),分析進入
NCU 90 天後之累積存活率。計算風險比(HR)和95%信賴區間(CI),以檢視干
擾因子的影響。結果:在兩組之間,患者的背景沒有顯著差異;但非存活者在
NCU 的前7 天,平均每日熱量攝取顯著低於存活者(p=0.034)。E-II 層級的患者
存活率顯著高於E-Ⅰ(參考組) (p=0.030)。在校正後,E-II 的風險比仍然顯著低
於E-I (HR=0.19,p=0.047),在E-III 則沒有顯著差異(HR=0.52,p=0.279)。結
論:進入神經外科加護病房之後,應對患者進行至少7 天的熱量攝取評估;重
症的中風患者平均每日總熱量攝取8.25-16.5 大卡/公斤以及腸道餵食,可能增
加存活率。
關鍵字:中風、預後、熱量攝取、格拉斯哥昏迷量表、神經外科加護病房
 

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Dietary intakes consistent with the DASH dietary pattern reduce blood pressure increase with age and risk for stroke in a Chinese population
PAO-HWA LIN, WEN-TING YEH, LAURA P SVETKEY, SHAO-YUAN CHUANG, YUAN-CHIN CHANG, CHRISTINE WANG AND WEN-HARN PAN
The Dietary Approaches to Stop Hypertension (DASH) diet has been proven to effectively lower blood pressure (BP), and associate with a lower cardiovascular disease and stroke risk in mainly non-Asians. Further, it is unclear if adhering to the DASH target nutrients has similar BP impact as adhering to the recommended DASH food groups. Associations between adherence to DASH foods or nutrients and BP or stroke risk were assessed in 1420 and 2061 Taiwanese adults from 1989 to 2002, respectively. The DASH food score (p=0.053), dairy (p=0.030) and calcium (p=0.020) intake were significantly and inversely associated with follow up systolic BP change in univariate analyses. Both dairy (p=0.020) and calcium (p=0.001) also showed a consistent inverse association with systolic BP change in multivariate analysis. None of the factors examined was associated with diastolic BP change. Both DASH nutrient score and magnesium intakes were significantly associated with the hazard ratio (HR) for total stroke in an inverse relationship. The HR of total stroke comparing the highest to the lowest tertile was 0.63 (95% CI: 0.41-0.98, p=0.037) for the DASH nutrient score, and 0.62 (95% CI: 0.40-0.97, p=0.030) for magnesium intake. Similar findings were observed for DASH nutrient score (p=0.011) and magnesium intake (p=0.043) with the HR for ischemic stroke. The HR for total and ischemic stroke for calcium intake also showed a borderline trend (p=0.071 and 0.051, respectively). In conclusion, adhering to the DASH diet is beneficial for long term BP control and reduction of stroke risk in this Chinese population.
Key Words: dietary pattern, diet, blood pressure, hypertension, stroke
 

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遵循DASH 飲食型態降低隨年龄而上升的血壓和中風風險
DASH 飲食型態(Dietary Approaches to Stop Hypertension)已在非亞裔人群中被證
實能有效降低血壓,並且能減低心血管疾病和腦中風的機率。然而,目前的研
究對於遵循DASH 飲食型態所建議的食物群或遵循DASH 營養素是否能達到相
似的降血壓效果尚無結論。本課题分别研究在1420 和2061 位台灣成人裏,從
1989 到2002 年間,有關DASH 飲食型態的食物群或營養素的依從度與血壓和
中風機率的相關性。依據單一回歸分析,DASH 食物評分(p=0.053),乳製品
(p=0.030)和鈣質(p=0.020)的攝取顯著地和追踪的收缩壓呈負相關。在多元回歸
分析裏,乳製品(p=0.020)和鈣質(p=0.001)也一致地與收缩壓呈現顯著的負相
關。没有任何一種食物或營養素與舒張壓呈顯著關係。DASH 營養素評分和鎂
的攝取與總中風機率呈顯著的負相關。以DASH 營養素評分而言,與最低的
DASH 營養素評分三分位組別相比,最高組的總中風的風險比率是0.63(95%CI:
0.41-0.98 ; p=0.037) , 而對鎂攝取量而言則是0.62(95% CI: 0.40-0.97 ;
p=0.030)。DASH 營養素評分(p=0.011)和鎂攝取(p=0.043)與缺血性中風也有類似
的關係。總中風和缺血性中風與鈣攝取亦呈现邊際的顯著關係(p 值各為0.071 和
0.051)。總之,對這個華人族羣而言,依從DASH 飲食型態有助於長期血壓控制
和降低中風的機率。
關鍵字:飲食型態、飲食、血壓、高血壓、中
風学

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Clinical decision-making for vitamin K-1 and K-2 deficiency and coronary artery calcification with warfarin therapy: are diet, factor Xa inhibitors or both the answer?
MARK L WAHLQVIST, KIYOSHI TANAKA AND BING-HSIEN TZENG
Coronary artery calcification is a recognised risk factor for ischaemic heart disease and mortality. Evidence is now strong that Mönckeberg’s arteriosclerosis, a form of vascular calcification, can be attributable to vitamin K deficiency, but that vitamin K-2, especially the MK-4 form from foods like cheese can be protective. Warfarin blocks the recycling of hepatic and peripheral vitamin K leading to secondary vitamin K deficiency with adverse effects on vasculature, bone, kidneys, brain and other tissues and systems (inflammatory, immune function and neoplasia at least). There is individual susceptibility to vitamin K deficiency and warfarin sensitivity, partly explicable in terms of genetic polymorphisms, epigenetics, diet and pharmacotherapy. The emergence of extensive coronary calcification in a man with atrial fibrillation treated for a decade with warfarin is described by way of illustration and to raise the present clinical management conundrums. Finally, a putative set of recommendations is provided.
Key Words: vitamin K deficiency syndromes, coronary artery calcification, warfarin therapy, cheese and natto, apixaban

 

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維生素K 拮抗劑治療而致維生素K-1 和K-2 缺乏及冠狀動脈鈣化的臨床決策:

飲食、第十凝血因子抑制劑或者兩者是解答嗎?
冠狀動脈鈣化被認為是缺血性心臟病及死亡的危險因子。Mönckeberg 型動脈
粥狀硬化是一種血管鈣化,現在有力的證據顯示這可能是維生素K 缺乏所導
致;維生素K-2,特別是來自於食物,像是乳酪的MK-4 型式則具保護作用。
維生素K 拮抗劑-warfarin 阻斷肝及周邊的維生素K 循環,造成次發性維生素
K 缺乏,而引發脈管結構、骨頭、腎臟、腦及其它組織系統的副作用(例如發
炎、免疫功能及腫瘤)。個體對維生素K 缺乏的易感性及warfarin 敏感性,部
分可以基因多型性、表觀遺傳學、飲食及藥物治療所解釋。本文描述一位有心
房顫動的男性病患,在過去十年一直以warfarin 治療,被發現有廣泛性的冠狀
動脈鈣化,因而帶出這個目前臨床管理的難題。最後提出一套推斷的建議。
關鍵字:維生素K 缺乏症狀、冠狀動脈鈣化、維生素K 拮抗劑治療、乳酪及
納豆、apixaban

 

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Micronutrient deficiencies in obese Thai children
NARUMON DENSUPSOONTORN, PIPOP JIRAPINYO AND CHANNAGAN KANGWANPORNSIRI
We reported the cases of 3 obese children who presented variously with costochondral beading, numbness of both hands and feet, and hypochromic-microcytic anemia. Serum ascorbic acid concentration, erythrocyte thiamin pyrophosphate effect, and serum hepcidin concentration were done to investigate these symptoms, respectively, with findings of ascorbic acid insufficiency, thiamin deficiency, and iron deficiency anemia from poor iron absorption due to a hyper-inflammatory state, respectively. This report indicated that obese children not only have energy excess but may also risk being micronutrient deficiencies; therefore, weight management with special attention to an adequate intake of vitamins and minerals should be provided.
Key Words: ascorbic acid, hepcidin, iron deficiency anemia, obese children, Thiamin deficiency

 

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微量營養素缺乏的肥胖泰國兒童
這篇個案報告三位呈現佝僂型串珠、手腳麻木,以及小球性低色素貧血之不同
程度症狀的肥胖兒童。檢測血清抗壞血酸濃度、紅血球硫胺焦磷酸鹽作用及血
清鐵調節素濃度,分別顯示抗壞血酸不足、硫胺缺乏以及高發炎狀態致使鐵吸
收下降造成之缺鐵性貧血。這份報告指出肥胖兒童,不僅熱量攝取過多,還可
能有微量營養素缺乏的風險。因此,體重管理時需特別注意維生素及礦物質的
給予是否足夠。
關鍵字:抗壞血酸、鐵調節素、缺鐵性貧血、肥胖兒童、硫胺缺乏

 

 

Last Updated: August 2013