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1 Asia Pacific Journal of Clinical Nutrition
       Volume 24, Supplement 1

         (December 2015)


Abstracts

Contents

Abstract PDF

Reviews

From ‘lactose intolerance’ to ‘lactose nutrition’
WIDJAJA LUKITO, SAFARINA G MALIK, INGRID S SURONO AND MARK L WAHLQVIST
Asia Pac J Clin Nutr. 2015;24(Suppl 1):S1-S8.

doi: 10.6133/apjcn.2015.24.s1.01

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Lactose intolerance
YVAN VANDENPLAS
Asia Pac J Clin Nutr. 2015;24(Suppl 1):S9-S13.

doi: 10.6133/apjcn.2015.24.s1.02

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Dairy foods and health in Asians: Taiwanese considerations
MEEI-SHYUAN LEE, MARK L WAHLQVIST AND CHEAU-JANE PENG
Asia Pac J Clin Nutr. 2015;24(Suppl 1):S14-S20.

doi: 10.6133/apjcn.2015.24.s1.03

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Lactose nutrition in lactase nonpersisters
MARK L WAHLQVIST

Asia Pac J Clin Nutr. 2015;24(Suppl 1):S21-S25.

doi: 10.6133/apjcn.2015.24.s1.04

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Traditional Indonesian dairy foods
INGRID S SURONO

Asia Pac J Clin Nutr. 2015;24(Suppl 1):S26-S30.

doi: 10.6133/apjcn.2015.24.s1.05

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Lactose intolerance in Indonesian children
BADRIUL HEGAR AND ARIANI WIDODO
Asia Pac J Clin Nutr. 2015;24(Suppl 1):S31-S40.

doi: 10.6133/apjcn.2015.24.s1.06

 

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From ‘lactose intolerance’ to ‘lactose nutrition’
WIDJAJA LUKITO, SAFARINA G MALIK, INGRID S SURONO AND MARK L WAHLQVIST

The concept of lactose intolerance has become embedded in Western medicine and developing economy medicine. It is based on evidence that intestinal lactase activity persists into later childhood and throughout life in only a minority of the world’s population, notably northern European–derived populations. These people have the T single nucleotide polymorphism (SNP) of the rs49882359 allele (C/T), also known as C/T-13910, the MCM6 gene which positively influences the lactase LCT gene. Other lactase persistent (LP) populations are found in Africa and the Middle East with different genetic variants. These SNPs represent co-evolution with dairying since the agricultural revolution and nutrient-dependent ecological adaptation. That said, gastrointestinal symptoms considered due to small intestinal lactose malabsorption are poorly correlated with lactase non-persistence (LNP), the situation for most people. With LNP, colonic microbiome lactase enables lactose fermentation to occur so that none is found in faeces. Whether the short chain fatty acids (SCFAs) and gases (hydrogen, carbon dioxide and methane) produced cause symptoms is dose-dependent. Up to 25 g of lactose at any one time can usually be consumed by a LNP person, but its food and meal pattern context, the microbiomic characteristics, age and other factors may alter tolerance. Thus, the notion that lactose intolerance is a disorder or disease of LNP people is misplaced and has been one of cultural perspective. What actually matters is whether a particular dairy product as normally consumed give rise to symptoms. It is, therefore, proposed that lactose tolerance tests be replaced with dairy food tolerance tests.
Key Words: Lactase persisters (LP), Lactase non-persisters (LNP), rs49882359 allele, gut microbiome, dairy food tolerance test (DFTT)
 

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從“乳糖不耐”到“乳糖營養”
乳糖不耐症的概念建構在西方及開發中經濟體的醫學。其證據為佔全球少數的
北歐衍生族群,其腸道乳糖酶活性續存至兒童晚期及整個生命週期。這些人擁
有rs49882359 等位基因(C/T)的T 單核甘酸多型性(SNP),又被稱為C/T-
13910,其MCM6 基因正向影響乳糖酶LCT 基因。其他在非洲及中東的乳糖酶
續存族群,他們有不同的基因變異。這些SNPs 代表自農業革命及營養依賴的
生態適應與乳品業的共同演化。意即,多數人因為小腸乳糖吸收不良產生的腸
胃道症狀與其是否為乳糖酶非續存(LNP)關係不大。LNP 者,大腸菌相的乳
糖酶能夠發酵乳醣,所以糞便中並無乳糖存在。短鏈脂肪酸(SCFAs)及氣體
(氫氣、二氧化碳及甲烷)是否引起症狀,端看其劑量。一個LNP 者,在任
何時間均可消化最多25 公克的乳糖。食物或餐點內容、腸道菌相的特性、年
齡及其他因素,才是影響其耐受性原因。因此,LNP 者的乳糖不耐是一種失調
或是疾病的主張是一種錯置及文化觀點。真正重要的是常被攝取的乳製品是否
會引起症狀。也就是說,建議以乳製品耐受性測試取代乳糖不耐症測試。
關鍵字:乳糖酶持續者(LP)、乳糖酶非持續者(LNP)、rs49882359 等位
基因、腸道微生物、乳製品耐受性測驗(DFTT)

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Lactose intolerance
YVAN VANDENPLAS
Lactose is the main carbohydrate in infant feeding, but its impact decreases as the child gets older and consumes less milk and dairy products. Congenital lactose intolerance is a very rare condition. However, lactase activity may be low and need to mature during the first weeks of life in many infants. However, the evidence that unabsorbed lactose is causing infantile crying and colic is contradictory. Unabsorbed lactose has a bifidogenic effect and improves calcium absorption. Lactose malabsorption may occur secondary and thus temporally to other etiologies such as infectious gastroenteritis, cow’s milk allergy and celiac disease. One the cause is treated, lactase activity will gradually return to normal. The vast majority of Asian children will develop late onset congenital lactase deficiency. However, this entity only exceptionally causes symptoms before the age of 4-5 years. Symptoms are abdominal cramps, flatulence and watery, acid stools, and decrease the quality of life but lactose intolerance is not associated with “true disease”. The diagnosis is made on clinical grounds and confirmed with a lactose breath test, if needed. These patients need to have a lifetime long reduced lactose intake to improve their quality of life.
Key Words: hydrogen breath test, lactose intolerance, lactase

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乳糖不耐症
乳糖是嬰兒主要的醣類來源,它的影響會隨著兒童年紀增長與牛奶及乳製品攝
取降低而遞減。先天性乳糖不耐症是一種很罕見的情形。許多嬰兒出生的第一
週,其乳糖酶活性可能較低,並需要時間逐漸成熟。然而,未被吸收的乳糖是
否是引起嬰兒哭鬧及絞痛的證據仍是矛盾的。未被吸收的乳糖可作為雙岐桿菌
生長之用,及促進鈣吸收。乳糖吸收不良也可能是次發性的,起因於其他暫時
的病因,如腸胃道感染、對牛奶過敏或乳糜瀉。一旦疾病被治癒,乳糖酶活性
會逐漸回復正常。亞洲兒童絕大多數為晚發型先天性乳糖酶缺乏症。但是,只
有少部分在4-5 歲前就有症狀。症狀為腹部絞痛、脹氣、水便或酸便及降低生
活品質,但乳糖不耐症與真正的疾病並無相關。如果需要,可經臨床表現及乳
糖呼吸測試確診。這些病人需要終身降低乳糖攝取,以改善他們的生活品質。
關鍵字:氫氣呼吸測試、乳糖不耐症、乳糖酶

 

 

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Dairy foods and health in Asians: Taiwanese considerations
MEEI-SHYUAN LEE, MARK L WAHLQVIST AND CHEAU-JANE PENG

The health relevance of dairy products has mostly been judged by their abundant nutrients (protein, calcium and riboflavin) and recommendations for these derived in lactase-persistent Caucasian populations. Extrapolation to Asians who are generally lactase non-persisters may not be biologically, culturally or environmentally sound. A number of studies, especially among north-east Asians as in Taiwan, provide guidance for their optimal dairy intakes. In Taiwan, the NAHSIT (Nutrition and Health Surveys in Taiwan) linked to the National Health Insurance and Death Registry data bases provide most of the evidence. Cultural and socio-economic barriers create population resistance to increase dairy consumption beyond one serving per day as reflected in food balance sheet and repeat survey trend analyses. For the morbidity and mortality patterns principally seen in Asia, some, but not too much, dairy is to be preferred. This applies to all-cause and cardiovascular, especially stroke, mortality, to the risk of overfatness (by BMI and abdominal circumference) and diabetes and very likely to fracture and its sequelae. In Taiwan, there is no apparent association with total cancer mortality, but among Europeans, there may be protection. Historically, while fermented mammalian milks have been consumed in south Asia and various Asian subgroups and regions, most of the uptake of dairy in Asia after World War 2 has been from imported powdered milk or fresh liquid milk, encouraged further by the use of yogurts and popularization of milk teas and coffee. Asian dietary guidelines and clinical nutrition protocols need to encourage a modest, asymptomatic dairy intake.
Key Words: dairy, health, stroke, lactase persistence, Taiwan

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亞洲人的乳製品與健康:臺灣經驗
乳製品與健康的關聯,絕大多數取決於其富含的營養素(蛋白質、鈣和核黃
素),而這些建議多半衍生自乳糖酶續存之高加索人群。這些建議外推至多
數為乳糖酶非續存的亞洲人,就生物,文化和環境層面可能不恰當。一些研
究,尤其是在東北亞的臺灣,提供了他們最佳奶品建議量的指引。在臺灣,
NAHSIT(臺灣營養與健康變遷調查),串連到全民健保和死亡登記資料庫,
提供了大部分證據。從食物平衡表及重複調查的趨勢分析,反映出文化和社
會經濟障礙,產生讓民眾增加乳製品消費的阻力,而無法達成每日一份奶品
的建議攝取量。對於亞洲常見的疾病及死亡原因,只要少量而不是太多的乳
製品是首選。這適用於全死因和心血管疾病死亡率,特別是中風;疾病方面
包括過重(測量BMI 和腹圍)、糖尿病、骨折及其後遺症的風險。在臺灣,
奶類與總癌症死亡率無關,在歐洲人則可能是保護的。從歷史上看,儘管南
亞和亞洲部分族群和地區早就食用發酵哺乳動物的奶,但大部分亞洲人的乳
品攝取起源於第二次世界大戰後進口的奶粉或鮮奶。透過鼓勵攝取優格,及
茶與咖啡的普及,增加了奶品的攝取量。亞洲膳食指南和臨床營養方案,需
要鼓勵適度且無症狀的乳製品攝入量。
關鍵詞:乳製品、健康、中風、乳糖酶持久性、臺灣


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Lactose nutrition in lactase nonpersisters
MARK L WAHLQVIST
Lactose handling by the human gut by most people, beyond being breast-fed, has been considered a disorder rather than physiological. A non-human mammalian milk source is novel for the majority. During the first 6 months of life, when neonates and infants are best breast-fed, lactose along with other macronutrients, provides energy, but may have other functions as well. At birth, babies are endowed with their mother’s vaginal microbiome, but not if they are born by Caesarean section. How much maternal milk lactose survives the infant’s small intestine and is processed by this unique gut microbiome and to what end is still uncertain, but no lactose or galactose appears in the faeces. Once intestinal lactase activity declines in most infants, lactose may enhance innate immunity through the cathelicidin antimicrobial peptide (CAMP), which is best achieved by lactose synergy with other colonic fermentation metabolites such as butyrate. It is of interest whether this lactose function or a variant of it persists. It might not be evident when lactase is persistent, as it is in most people of northern European ancestry. Population genomics indicate that lactase persistence became prevalent only about 3000-1000 BC, the Bronze Age of Eurasia. Gastrointestinal symptoms (GIS) in lactase nonpersisters who consume dairy foods are partly dose dependent and not usually evident with single lactose intakes ≤25 g per day. Spreading intake across the day reduces the risk as can various dietary patterns. Nevertheless, individual differences in GIS lactose sensitivity may merit public health and clinical consideration.
Key Words: lactase persisters, lactose nutrition, lactose intolerance, cathelicidin antimicrobial peptide (CAMP), innate immunity 

 

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乳糖酶非續存者的乳糖營養
多數人在斷奶後,如果他們的腸道無法消化乳糖,會被認為是一種失調,而
非生理反應。非人類的哺乳類乳源,對多數的人而言是新奇的食物。以母乳
哺育新生兒及嬰兒是最佳的,在前六個月的生命時期,乳糖及其他巨量營養
素,除了提供能量之外,可能還有其他功能。出生時,自然產嬰兒從產道,
獲得母親的菌相,如果是剖腹產則無。有多少的母乳乳糖,可以通過嬰兒的
腸子而不被消化,再被這種獨特腸道菌相作用,及其最後的作用,仍不確
定。但可以確定的是糞便中並沒有乳糖或半乳糖。大部分的嬰兒,一旦小腸
乳糖酶活性下降,乳糖可透過cathelicidin 抗菌胜肽促進先天免疫。當乳糖與
腸道發酵代謝產物,如丁酸,一起作用時,其結果最佳。這到底是乳糖的功
能,或是它持續的一種變異,是一個有趣的問題。大多數乳糖酶續存的北歐
血統的人,上述現象就不明顯。族群基因學指出,乳糖酶續存在公元前3000-
1000 年才出現在青銅時代的歐亞大陸。乳糖非續存者攝取乳製品的腸胃道症
狀(GIS)雖為部分劑量依賴,但每日單次攝取小於等於25 公克乳糖並不會
有症狀。將攝取量分散在一天之內,如不同的飲食型態,可以降低風險。然
而,乳糖敏感性的GIS 個體差異,可能值得公共衛生及臨床考量。
關鍵字:乳糖酶續存者、乳糖營養、乳糖不耐症、cathelicidin 抗菌胜肽
(CAMP)、先天免疫

 

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Traditional Indonesian dairy foods
INGRID S SURONO

Indonesia is the largest archipelago blessed with one of the richest mega-biodiversities and also home to one of the most diverse cuisines and traditional fermented foods. There are 3 types of traditional dairy foods, namely the butter-like product minyak samin; yogurt-like product dadih; and cheese-like products dali or bagot in horbo, dangke, litsusu, and cologanti, which reflect the culture of dairy product consumption in Indonesia.
Key Words: Indonesian dairy foods, minyak samin, dadih, dali, dangke, litsusu, cologanti
 

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傳統印尼乳製品

印尼是全球最大的群島,具有最豐富的生物多樣性國家之一,並擁有最多元的
料理及傳統發酵食物。印尼有三種傳統的乳製品,名為類奶油製品minyak
samin;類優格製品dadih;及類起士製品dali 或bagot in horbo(水牛奶)、
dangke、 litsusu 及 cologanti,這些反映出印尼乳製品消費特有的文化。
關鍵字: 印尼乳製品、minyak samin 、dadih 、dali 、dangke 、litsusu、
cologanti

 

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Lactose intolerance in Indonesian children
BADRIUL HEGAR AND ARIANI WIDODO
“Lactose intolerance (LI)” is considered a common problem in Asians, and in many parts of the world. Its prevalence and age of manifestation varies between by Asian country, for possible genetic or cultural reasons. Studies in Indonesian children 3-15 years old (y) are available within the past two decades, using a pure lactose tolerance test. The prevalences of lactose malabsorption (LM) in pre-elementary (3-5 y), elementary (6-11 y), and junior high (12-14 y) school-children were 21.3%, 57.8%, and 73%, respectively. An increasing trend for LM prevalence was seen within the pre-elementary group, from 9.1% at 3 y to 28.6% at 5 y. The most frequent symptoms of LI in junior high school (JHS) group were abdominal pain (64.1%), abdominal distention (22.6%), nausea (15.1%), flatulence (5.7%), and diarrhea (1.9%), mostly within one hour of lactose ingestion. In children with regular and irregular milk drinking, LM occurred in 81.2% and 69.6%; LI was found in 56.2% and 52.1%, respectively. Most JHS children with dairy-associated recurrent abdominal pain (RAP) symptoms proved to be malabsorbers. Dairy products most related to RAP were milk and yogurt. LI was found in 81% of RAP children with abdominal pain most frequently, followed by nausea, bloating, diarrhea, borborygmi, and flatulence. Symptom onset occurred 30 minutes after lactose ingestion, especially nausea, bloating, and abdominal pain. In RAP children LI symptoms mostly found in breath hydrogen concentration >20 ppm. More LI symptoms were found in lactose malabsorbers, but symptoms were mild and generally disappeared in 7 hours, and in most by 15 hours.
Key Words: lactose intolerance, lactose malabsorption, children, lactase deficiency, Indonesia

 

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印尼兒童的乳糖不耐症
在亞洲及世界的許多地區,“乳糖不耐症(LI)”被認為是一個常見的問題。它
的盛行率及好發年齡依亞洲國家而有所差異,這可能與基因或是文化因素有
關。過去二十年來,印尼有3-15 歲兒童採用純的乳糖耐受性試驗的研究,可
作為探討此議題之用。乳糖吸收不良(LM)的盛行率在學齡前(3-5 歲)、國
小(6-11 歲)及初中(12-14 歲)學童分別為21.3%、57.8%及73%。LM 盛行
率在學齡前兒童有增加的趨勢,從3 歲的9.1%至5 歲的28.6%。初中生組
(JHS) LI 最常見的症狀為腹痛(64.1%)、腹部脹氣(22.6%)、噁心
(15.1%)、腸胃脹氣/排氣(5.7%)及腹瀉(1.9%),大部分是在攝取乳糖一
個小時內出現。規律與不規律飲用牛奶的兒童,LM 發生分別為81.2%及
69.2%;LI 則為56.2%及52.1%。大部分初中生如有乳製品相關再復發腹痛
(RAP)症狀者,即認為是吸收不良者。與RAP 最相關的乳製品是牛奶及優
格。81%的RAP 兒童被發現有LI,其中以腹痛最常發生,再來是噁心、腹
脹、腹瀉、腹鳴及腸胃脹氣/排氣。通常在攝取乳糖30 分鐘後,開始有症狀,
特別是噁心、腹脹及腹痛。在RAP 學童,LI 症狀最常發生在BHC 大於20
ppm。很多LI 症狀可在吸收不良者發現,但症狀輕微且通常於7 小時內消失,
至多為15 小時。
關鍵字:乳糖不耐症、乳糖吸收不良、兒童、乳糖酶缺乏、印尼


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Last Updated: December 2015