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1 Asia Pacific Journal of Clinical Nutrition
       Volume 26, 4

         (June 2017)


Abstracts

Contents

Abstract PDF

Review Articles

Food components and ocular pathophysiology: a critical appraisal of the role of oxidative mechanisms
REINLESH RAMAN, EHSAN VAGHEFI AND ANDREA J BRAAKHUIS
doi:
10.6133/apjcn.082016.01

Asia Pac J Clin Nutr. 2017;26(4):572-585.

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Original Research Communications

Clinical Nutrition or Feeding Studies

Enteral nutritional support in non-ICU hospitalized patients: current practice in Mexico
ARIANNE I LUPIÁN-ANGULO, LUIS A ORTÍZ-REYES, LILIA CASTILLO-MARTÍNEZ AND AURORA E SERRALDE-ZÚÑIGA

doi: 10.6133/apjcn.072016.05
Asia Pac J Clin Nutr. 2017;26(4):586-590.

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Prevalence and risk factors for complications in adult patients with short bowel syndrome receiving long-term home parenteral nutrition
GUOHAO WU, YI JIANG, XIAOPING ZHU, DAYONG JIN, YUSONG HAN, JUN HAN, ZHAOHAN WU AND ZHAOGUANG WU
doi: 10.6133/apjcn.082016.08
Asia Pac J Clin Nutr. 2017;26(4):591-597.

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Dietary fiber intake is associated with chronic kidney disease (CKD) progression and cardiovascular risk, but not protein nutritional status, in adults with CKD
LU LU, YAN-FENG HUANG, MING-QING WANG, DE-XIU CHEN, HENG WAN, LIAN-BO WEI AND WEI XIAO
10.6133/apjcn.072016.08
Asia Pac J Clin Nutr. 2017;26(4):598-605.

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The effect of an Annona muricata leaf extract on nutritional status and cytotoxicity in colorectal cancer: a randomized controlled trial
LILI INDRAWATI, PURWANTYASTUTI ASCOBAT, BUDIMAN BELA, MURDANI ABDULLAH AND INGRID S SURONO
doi: 10.6133/apjcn.022016.02
Asia Pac J Clin Nutr. 2017;26(4):606-612.

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Dietary galacto-oligosaccharides improve skin health: a randomized double blind clinical trial
YANG HEE HONG, UN JAE CHANG, YOUNG SUK KIM, EUN YOUNG JUNG AND HYUNG JOO SUH
doi: 10.6133/apjcn.052016.05
Asia Pac J Clin Nutr. 2017;26(4):613-618.

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Lactobacillus intake for 60 days favors antioxidant status of human breast milk: an RCT
REZA MAHDAVI, LEILA NIKNIAZ, ALIREZA OSTADRAHIMI, ZEINAB NIKNIAZ AND ZHILA KHAMNIAN
doi: 10.6133/apjcn.062016.05
Asia Pac J Clin Nutr. 2017;26(4):619-623.

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Snack bar compositions and their acute glycaemic and satiety effects
MARY R YAN, ANDREW PARSONS, GILLIAN A WHALLEY, JOHN KELLEHER AND ELAINE C RUSH
doi: 10.6133/apjcn.072016.04
Asia Pac J Clin Nutr. 2017;26(4):624-629.

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Nutritional Status, Dietary Intake, and Body Composition

Symptomatic efficacy of buckwheat products in Non-Celiac Gluten Sensitivity (NCGS)
MONICA DINU, DONATELLA MACCHIA, GIUDITTA PAGLIAI, ANNA MARIA GORI, FRANCESCA CESARI, ROSSELLA MARCUCCI, FRANCESCO SOFI AND ALESSANDRO CASINI
doi: 10.6133/apjcn.072016.07

Asia Pac J Clin Nutr. 2017;26(4):630-636.

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Body mass index above 24 is beneficial for the 6-month survival rate in hepatocellular carcinoma patients with extrahepatic metastases
YUEH-SHIH CHANG, JEN-SENG HUANG, CHO-LI YEN, RONG-NAN CHIEN, CHENG-HSU WANG, CHIEN-HONG LAI, TSUNG-HAN WU, YII-JENG LAN AND KUN-YUN YEH
doi: 10.6133/apjcn.062016.03

Asia Pac J Clin Nutr. 2017;26(4):637-641.

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Dietary choline and folate relationships with serum hepatic inflammatory injury markers in Taiwanese adults
CHIN-PAO CHENG, CHIEN-HUNG CHEN, CHANG-SHENG KUO, HSING-TAO KUO, KUANG-TA HUANG, YU-LI SHEN, CHIN-HAO CHANG AND RWEI-FEN S HUANG
doi: 10.6133/apjcn.082016.03
Asia Pac J Clin Nutr. 2017;26(4):642-649.

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Determination of new anthropometric cut-off values for obesity screening in Indonesian adults
JANATIN HASTUTI, MASAHARU KAGAWA, NUALA M BYRNE AND ANDREW P HILLS
doi: 10.6133/apjcn.072016.09
Asia Pac J Clin Nutr. 2017;26(4):650-656.

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Dietary behaviours, weight loss attempts and change in waist circumference: 15-year longitudinal study in Australian adults
SIMIN ARABSHAHI, PETRA H LAHMANN, MARIA CB HUGHES, GAIL M WILLIAMS AND JOLIEKE C VAN DER POLS
doi: 10.6133/apjcn.062016.04
Asia Pac J Clin Nutr. 2017;26(4):657-664.

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Nutritional status and dietary diversity of Kamea in Gulf Province, Papua New Guinea
JANNY M GORIS, NIENKE ZOMERDIJK AND VICTOR J TEMPLE
doi: 10.6133/apjcn.052016.09
Asia Pac J Clin Nutr. 2017;26(4):665-670.

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Goitre and urinary iodine in coastal and inland areas with low and high iodized salt coverage in Zhejiang province, China
ZHE MO, XIAO F WANG, GUANG M MAO, WEN M ZHU, PEI W XU, YAN ZOU, YUAN Y WANG AND XIAO M LOU

doi: 10.6133/apjcn.052016.06
Asia Pac J Clin Nutr. 2017;26(4):671-679.

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Maternal Status and Clild Nutrition

 

The influence of mandatory iodine fortification on the iodine status of Australian school children residing in an iodine sufficient region
ANNA J SAMIDURAI, ROBERT S WARE AND PETER SW DAVIES
doi: 10.6133/apjcn.052016.04
Asia Pac J Clin Nutr. 2017;26(4):680-685.

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Body mass index is associated with fat mass in normal, overweight/obese, and stunted preschool children in central Thailand
TIPPAWAN PONGCHAROEN, KUNCHIT JUDPRASONG, SIWAPORN JITNGARMKUSOL, WANTANEE KRIENGSINYOS AND PATTANEE WINICHAGOON
doi: 10.6133/apjcn.052016.02

Asia Pac J Clin Nutr. 2017;26(4):686-691.

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Normal-weight central obesity is associated with metabolic disorders in Chinese postmenopausal women
PENG JU LIU, FANG MA, HUI PING LOU AND YAN NING ZHU
doi: 10.6133/apjcn.052016.08

Asia Pac J Clin Nutr. 2017;26(4):692-697.

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Nutritional Epidemiology and Public Health

 

High consumption of salt-fermented vegetables and hypertension risk in adults: a 12-year follow-up study
HONG JI SONG, SEON-JOO PARK, DAE JA JANG, DAE YOUNG KWON AND HAE-JEUNG LEE
doi: 10.6133/apjcn.042016.13
Asia Pac J Clin Nutr. 2017;26(4):698-707
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Bimodal distribution of fasting plasma glucose in the Uyghur and Han populations of Xinjiang, China
HAIYING GONG, LIZE PA, KE WANG, HEBULI MU, FEN DONG, SHENGJIANG YA, GUODONGXU, NING TAO, LI PAN, BIN WANG, SHAOPING HUANG AND GUANGLIANG SHAN
doi:
10.6133/apjcn.052016.07
Asia Pac J Clin Nutr. 2017;26(4):708-712.

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Metabolic syndrome in Korean adolescents and young adult offspring and their parents
KAYOUNG LEE
doi: 10.6133/apjcn.082016.02
Asia Pac J Clin Nutr. 2017;26(4):713-718.

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Awareness of coeliac disease among chefs and cooks depends on the level and place of training
MICHAEL SCHULTZ, SEONG SHIN AND KIRSTEN J COPPELL
doi: 10.6133/apjcn.072016.03
Asia Pac J Clin Nutr. 2017;26(4):719-724.

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Associations of self-efficacy, social support, and knowledge with fruit and vegetable consumption in Japanese workers
OSAMU KUSHIDA, YAE IRIYAMA, NOBUKO MURAYAMA, TOSHIKO SAITO AND KATSUSHI YOSHITA
doi: 10.6133/apjcn.062016.06
Asia Pac J Clin Nutr. 2017;26(4):725-730.

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Differences in health-related behaviors between middle school, high school, and college students in Jiangsu province, China
WEINA LIU, MIKE Z HE, YUNLE WANG, YAN WANG, YONGLIN ZHOU, MING WU, ZHEN TANG, YUE DAI, BAOJUN YUAN, SHIQI ZHEN AND LAWRENCE J CHESKIN
doi: 10.6133/apjcn.072016.06

Asia Pac J Clin Nutr. 2017;26(4):731-737.

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Rising food accessibility contributed to the increasing dietary diversity in rural and urban China
HUI WANG, CHAO LIU, HONG FAN AND XU TIA
doi: 10.6133/apjcn.052016.03
Asia Pac J Clin Nutr. 2017;26(4):738-747.

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Future Events

Asia Pac J Clin Nutr. 2017;26(4):748.

 

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Food components and ocular pathophysiology: a critical appraisal of the role of oxidative mechanisms
REINLESH RAMAN, EHSAN VAGHEFI AND ANDREA J BRAAKHUIS
Background and Objectives: Three of the major ocular diseases, namely cataracts, age-related macular degeneration and glaucoma are associated with oxidative damage. Disease risk and progression may be reduced through consumption of dietary components. To critically examine the literature on dietary and supplemental intakes of fruit and vegetables, meat, antioxidants (vitamins C, E and A), calcium, folate, iron, and their association with ocular disease. Methods and Study Design: Google Scholar and key references from texts and publications were searched using search terms (eye disease, antioxidants), (vision, nutrition), no date restriction, only articles in English were included. Results: We found probable evidence that dietary intake of fruits and vegetables, and vitamin C lowered incidence of cataracts and age-related macular degeneration. In high supplemental doses, vitamin C increases macular degeneration risk. Vitamin A from food was protective for cataracts and glaucoma, but not in supplemental form. Vitamin A was associated with lower incidence of macular degeneration. We also found probable evidence that higher intakes of meat increased the risk of cataracts and macular degeneration. Dietary calcium and iron appeared protective against glaucoma, but not in supplemental form. Conclusions: While a nutrient rich diet high in fruit and vegetables, and associated antioxidants appeared to be protective, we would caution intake of supplementary antioxidants for those with ocular disease.
Key Words: antioxidants, ocular pathology, diet, nutrition, vision
 

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Enteral nutritional support in non-ICU hospitalized patients: current practice in Mexico
ARIANNE I LUPIÁN-ANGULO, LUIS A ORTÍZ-REYES, LILIA CASTILLO-MARTÍNEZ AND AURORA E SERRALDE-ZÚÑIGA
Background and Objectives: Patients receiving ≥80% of their energy requirements by enteral nutrition (EN) have better clinical outcomes; unfortunately, there are discrepancies between the amount prescribed and amount received. The aim of this study was to explore the nutritional clinical practice, determine the adequacy and identify reasons for underfeeding. Methods and Study Design: A retrospective study was conducted in hospitalized, non-intensive care unit, adult patients receiving EN for ≥72 h. The following data were recorded: the prescribed target of energy and protein per day, daily energy intake, and the percentage of adequacy of the energy and protein requirement up to hospital day seven. Complications during administration or reasons for interruption and the proportion of patients who received ≥80% of the energy goals on days four and seven were also recorded. Results: In total, 52 patients were included (61.5% women), with a median age of 57.5 years; 20.4% and 6.1% of the patients received ≥80% of their energy and protein goals, respectively, on day four, which improved to 28% (p<0.005) and 19% (p<0.001), respectively, on day seven. During the first seven days, a statistically significant (p<0.001) difference was observed between the amount of prescribed and administered energy over 24 h. The patients who received <80% of their total energy requirement remained hospitalized for 29 days (IQR 16.5-45.5), while those who received ≥80% were hospitalized for 18 days (IQR 13.3-28.8) (p<0.05). Conclusions: Significant energy and protein deficits were documented. Furthermore, it is necessary to use strategies such as the implementation of an algorithm to optimize EN.
Key Words: enteral nutrition, malnutrition, nutritional support, energy deficit, complications

 

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Prevalence and risk factors for complications in adult patients with short bowel syndrome receiving long-term home parenteral nutrition
GUOHAO WU, YI JIANG, XIAOPING ZHU, DAYONG JIN, YUSONG HAN, JUN HAN, ZHAOHAN WU AND ZHAOGUANG WU

Background and Objectives: Short bowel syndrome (SBS) is a complicated and challenging disease where home parenteral nutrition (HPN) is widely used. The complications of long-term HPN-dependent in adult patients with SBS are poorly documented. This study was mainly aimed to assess the prevalence and risk factors of HPNassociated complications in adult patients with SBS, especially the catheter-related sepsis and HPN-associated liver/biliary disorders. Methods and Study Design: 47 non-malignant adult patients with SBS who received HPN for more than 2 years in our clinical nutrition center were included. Patients were divided into two groups according to whether HPN-associated complications were present or not. Student’s t-test and χ2 test were applied to compare the differences between the two groups. Results: The mean frequency of catheter-related sepsis was 0.31±0.05 per catheter year of HPN. An higher incidence of catheter-related infections (p<0.001) and shorter delay between HPN onset and first infection (p<0.001) were identified as risk factors for catheter-related sepsis. A total of 25 patients (53.2%) developed HPN-associated liver/biliary diseases. The identified risk factors for HPNassociated liver/biliary disorders were higher rate of catheter-related infections (p=0.009), shorter delay between HPN onset and first infection (p=0.017), higher energy content of HPN (p=0.014), higher glucose rate of HPN (p=0.009), and lower lipid rate of HPN (p=0.022). Conclusion: Our study revealed that adult patients with SBS receiving long-term HPN treatment developed a low prevalence of catheter-related sepsis but a rather high prevalence of HPN-associated liver/biliary disorders. We also identified several risk factors for HPN-associated complications which should be taken notice of in clinical practice.
Key Words: long-term home parenteral nutrition, short bowel syndrome, adult patients, complications, risk factors

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Dietary fiber intake is associated with chronic kidney disease (CKD) progression and cardiovascular risk, but not protein nutritional status, in adults with CKD
LU LU, YAN-FENG HUANG, MING-QING WANG, DE-XIU CHEN, HENG WAN, LIAN-BO WEI AND WEI XIAO
Background and Objectives: Evidence suggests that dietary fiber benefits patients with chronic kidney disease (CKD); however, this conclusion requires further validation. In this study, we examined the effects of dietary fiber on kidney function, inflammation, indoxyl sulfate, nutritional status, and cardiovascular risk in patients with advanced CKD. Methods and Study Design: We performed linear regressions to assess the association between dietary fiber intake and CKD parameters. The aforementioned parameters were compared over an 18-month follow-up period. Kaplan–Meier analysis was used to investigate the association between fiber intake and Cardiac vascular disease (CVD). Results: In total, 157 patients were included in this study. Dietary fiber and inflammatory indices were associated (interleukin [IL]-6: β=−0.024, p=0.035). The differential estimated glomerular filtration rate (ΔeGFR) as well as levels of C-reactive protein, IL-6, indoxyl sulfate, and serum cholesterol in the higher fiber intake (≥25 g/day) group were lower than those in the lower fiber intake (<25 g/day) group (p<0.05). Differences in IL-6 and indoxyl sulfate levels were more significant in patients in the higher protein intake group (p<0.05). Dietary fiber intake may be a protective factor associated with CVD (hazard ratio=0.537 and 0.305–0.947). The protein nutritional status was not different between the two groups (p>0.05). Conclusions: Our results suggest that increasing fiber intake can retard the decrease in the eGFR; can reduce the levels of proinflammatory factors, indoxyl sulfate, and serum cholesterol; and is negatively associated with cardiovascular risk, but does not disrupt the nutritional status of patients with CKD.
Key Words: chronic kidney disease, dietary fiber, inflammation, indoxyl sulfate, cardiovascular event
 

 

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The effect of an Annona muricata leaf extract on nutritional status and cytotoxicity in colorectal cancer: a randomized controlled trial
LILI INDRAWATI, PURWANTYASTUTI ASCOBAT, BUDIMAN BELA, MURDANI ABDULLAH AND INGRID S SURONO

Background and Objectives: Annona muricata leaf infusion has traditionally been consumed to maintain health, but is now considered for use in treating cancer patients. The objective of this study was to elucidate the effects of A. muricata leaf extract in humans and human cell lines. Methods and Study Design: Thirty outpatients with colorectal cancer who had undergone primary tumor resection were enrolled in a randomized double-blind placebo-controlled pre–post-trial. They were divided into two groups: those who ingested A. muricata leaf extract (n=14) and those who ingested a placebo (n=14) daily for 8 weeks. Twenty-eight subjects completed the trial; they were equally distributed between the two groups. Serum from patients of both groups was compared for cytotoxicity against colorectal cancer cell lines. The nutritional status of patients was monitored throughout the study. Results: Ex vivo and clinical studies showed higher cytotoxicity in the supplemented group compared with the placebo group. Further research is required to investigate the long-term effect of A.muricata leaf extract, particularly on parameters directly related to cytotoxic activity toward colorectal cancer cells and nutrition status.
Key Words: Annona muricata, leaf extract, nutrition status, colorectal cancer, cytotoxicity
 

 

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Dietary galacto-oligosaccharides improve skin health: a randomized double blind clinical trial
YANG HEE HONG, UN JAE CHANG, YOUNG SUK KIM, EUN YOUNG JUNG AND HYUNG JOO SUH
Background and Objectives: To study the effects of galacto-oligosaccharides (GOS) on the skin, we investigated skin-related parameters in healthy adults who received GOS for 12 weeks. Methods and Study Design: This double-blind, randomized, placebo-controlled study included subjects divided into two groups (control and GOS) by stratified block randomization. The GOS group received 1.0 g of GOS twice a day, whereas the control group received only vehicle. Results: The results showed that the increase in corneometer values from baseline to week 12 was significantly greater in the GOS group than in the control group (6.91 vs 2.88 arbitrary units, p<0.05). The transepidermal water loss (TEWL) in the GOS group was reduced significantly after 12 weeks of GOS treatment (20.1 g/h/m2 at baseline vs 17.5 g/h/m2 at week 12, p<0.05). The differences in total and percentage of wrinkle areas between the two groups were statistically significant after 12 weeks of GOS treatment (p<0.05). Conclusion: Our findings support that oral treatment with GOS is beneficial to the skin and present the possibility of new nutritional strategies for skin care.
Key Words: galacto-oligosaccharide, prebiotics, probiotics, skin hydration, wrinkle

 

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Lactobacillus intake for 60 days favors antioxidant status of human breast milk: an RCT
REZA MAHDAVI, LEILA NIKNIAZ, ALIREZA OSTADRAHIMI, ZEINAB NIKNIAZ AND ZHILA KHAMNIAN
Background and Objectives: This study aimed to evaluate the effects of lactobacillus supplementation on trends of breast milk antioxidant parameters. Methods and Study Design: In an interventional study, 50 lactating women were randomly allocated to receive a daily supplement of lactobacillus (n=25) or a placebo (n=25) for 60 days. Daily dietary intake, anthropometric measures and breast milk antioxidant parameters were determined at the onset, and days 30 and 60 of the study. Repeated-measures ANOVA were performed to assess the change over time in the anthropometric and biochemical parameters between the two groups. The main effect of treatment was compared by using Bonferroni’s procedure for CI adjustment. The significance level was set at p<0.05. Results: There was a significant increase in breast milk total antioxidant capacity (TAC) between onset of study and day 30 (p=0.01) and day 60 (p=0.001) after lactobacillus supplementation; however, breast milk TAC level did not change significantly between days 30 and 60 (p=0.7). In the placebo group, breast milk TAC levels decreased significantly after 60 days (p=0.001). Breast milk malondialdehyde (MDA) levels decreased progressively during the study in the lactobacillus group (p=0.001); however, there was a significant increase in MDA with time in breast milk samples in the placebo group (p=0.015). Conclusions: Based on the findings, lactobacillus supplementation for 60 days could significantly increase breast milk TAC and decrease breast milk MDA levels, compared with baseline; however, further studies are needed to confirm these results.
Key Words: lactobacillus, breast milk, total antioxidant capacity (TAC), malondialdehyde (MDA), trend
 

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Snack bar compositions and their acute glycaemic and satiety effects
MARY R YAN, ANDREW PARSONS, GILLIAN A WHALLEY, JOHN KELLEHER AND ELAINE C RUSH
Background and Objectives: Maintaining blood glucose within homeostatic limits and eating foods that sup-press hunger and promote satiety have beneficial impacts for health. This study investigated the glycaemic re-sponse and satiety effects of a serving size of a healthier snack bar, branded Nothing Else, that met the required nutrient profiling score criteria for a health claim, in comparison to two top-selling commercial snack bars. Methods and Study Design: In an experimental study, 24 participants aged ≥50 years were recruited. On three different days blood glucose concentration was measured twice at baseline and 15, 30, 45, 60, 90 and 120 minutes after consumption of a serving size of each bar. Satiety effects were self-reported hunger, fullness, desire to eat, and amount could eat ratings on visual analogue scales. Results: The incremental area under the blood glucose response curve (iAUC) over two hours for the Nothing Else bar was 30% lower than commercial Bar 2 (p<0.001). At 45 minutes after eating, the Nothing Else bar induced the highest fullness rating and lowest hunger rating among the three snack bars. At two hours, fullness induced by the Nothing Else bar was twice that of Bar 2 (p=0.019), but not different to Bar 1 (p=0.212). Conclusions: The Nothing Else snack bar developed using the nutrient profiling scheme as a guideline, with its high protein and dietary fibre contents, had a lower glycaemic impact and induced a higher subjective satiety than the two commercial snack bars of equal weight.
Key Words: macronutrient, nutrient profiling, glycaemic response, hunger, satiety
 

 

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Symptomatic efficacy of buckwheat products in Non-Celiac Gluten Sensitivity (NCGS)
MONICA DINU, DONATELLA MACCHIA, GIUDITTA PAGLIAI, ANNA MARIA GORI, FRANCESCA CESARI, ROSSELLA MARCUCCI, FRANCESCO SOFI AND ALESSANDRO CASINI

Background and Objectives: Buckwheat (Fagopyrum esculentum) is a gluten-free grain with acclaimed benefi-cial effects on human health. Our aim was to assess the effect of buckwheat products on intestinal/extra-intestinal symptoms and biochemical parameters in patients with Non-Celiac Gluten Sensitivity (NCGS). Methods and Study Design: A randomized, crossover trial with two intervention phases was conducted on 19 NCGS patients over a 12 week-period. The participants were assigned to consume products made from buckwheat or to maintain their normal gluten-free diet for 6 weeks in a random order. Symptoms due to NCGS were evaluated using two questionnaires. Results: During the intervention period with buckwheat products, patients experienced a signifi-cant decrease in the severity of abdominal pain and bloating (p=0.03). In contrast, the control group showed a significant worsening trend for the majority of NCGS symptoms such as nausea, headache, joint/muscle pain, and attention disorders. The replacement diet with buckwheat products also resulted in a significant increase of serum magnesium (+4.7%) and a significant reduction in the circulating levels of some pro-inflammatory cytokines such as interferon gamma (-33.3%) and monocyte chemotactic protein-1 (-46.5%). Conclusion: The study supports the positive effects of buckwheat for NCGS patients, showing that this alternative cereal can contribute to the re-duction of both negative gastro-intestinal and related symptoms, and nutritional deficiencies, and lead to an im-provement in inflammatory profile.
Key Words: NCGS, buckwheat, diet, symptoms severity, inflammatory profile

 

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Body mass index above 24 is beneficial for the 6-month survival rate in hepatocellular carcinoma patients with extrahepatic metastases
YUEH-SHIH CHANG, JEN-SENG HUANG, CHO-LI YEN, RONG-NAN CHIEN, CHENG-HSU WANG, CHIEN-HONG LAI, TSUNG-HAN WU, YII-JENG LAN AND KUN-YUN YEH
Background and Objectives: To investigate the effect of overweight status on the 6-month survival rate in patients with extrahepatic hepatocellular carcinoma (HCC). Methods and Study Design: We retrospectively analyzed the records of 51 patients with hepatocellular carcinoma and extrahepatic metastases between 2007 and 2010 before treatment. The associations among overweight status (body mass index [BMI] >24 kg/m2), demographic variables, and survival outcome were analyzed by univariate and multivariate analysis. Results: BMI>24 kg/m2 was significantly associated with the 6-month survival rate (p=0.042). Gender (p=0.149), Child Pugh classification (p=0.149), Okuda staging (p=0.093), and albumin concentration >3.5 mg/dL (p=0.082) showed marginal survival benefits in univariate analysis. Multivariate analysis confirmed that BMI >24 kg/m2 was an independent prognostic factor for the 6-month survival rate (p=0.03). Conclusions: BMI >24 kg/m2 was associated with an improved 6-month survival rate in patients with extrahepatic metastatic hepatocellular carcinoma.
Key Words: hepatocellular carcinoma, body mass index, 6-month survival, metastasis, extrahepatic
 

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Dietary choline and folate relationships with serum hepatic inflammatory injury markers in Taiwanese adults
CHIN-PAO CHENG, CHIEN-HUNG CHEN, CHANG-SHENG KUO, HSING-TAO KUO, KUANG-TA HUANG, YU-LI SHEN, CHIN-HAO CHANG AND RWEI-FEN S HUANG
Background and Objectives: The relationships of dietary choline and folate intake with hepatic function have yet to be established in the Taiwanese population. We investigated the associations of choline and folate intake with hepatic inflammatory injury in Taiwanese adults. Methods and Study Design: Blood samples and data on dietary choline components and folate intake from 548 Taiwanese adults without pathological liver disease were collected. Dietary intake was derived using a semiquantitative food-frequency questionnaire. Serum liver injury markers of alanine transaminase, aspartate transaminase, and hepatitis viral infection were measured. Results: Elevated serum hepatic injury markers (>40 U/L) were associated with low folate and free choline intake (p<0.05). Folate intake was the most significant dietary determinant of serum aspartate transaminase concentration (beta=−0.05, p=0.04), followed by free choline intake (beta=−0.249, p=0.055). Folate intake exceeding the median level (268 μg/d) was correlated with a reduced rate of hepatitis viral infection (p=0.032) and with normalized serum aspartate transaminase (odds ratio [OR]=0.998, 95% confidence interval [CI]=0.996-1, p=0.042) and alanine transaminase (OR=0.998, 95% CI=0.007-1, p=0.019). Total choline intake exceeding the median level (233 mg/d) was associated with normalized serum aspartate transaminase (OR=0.518, 95% CI=0.360-0.745, p=0.018). Conclusions: The newly established relationships of dietary intake of total choline and folate with normalized hepatic inflammatory markers can guide the development of dietary choline and folate intake recommendations for Taiwanese adults.
Key Words: choline intake, folate intake, hepatitis injury marker, Taiwanese population, hepatitis
 

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Determination of new anthropometric cut-off values for obesity screening in Indonesian adults
JANATIN HASTUTI, MASAHARU KAGAWA, NUALA M BYRNE AND ANDREW P HILLS
Background and Objectives: Body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-stature ratio (WSR) have increasingly been used as screening tools for obesity. However, optimal cut-off values may be different between populations. The current study determined the optimum cut-off values for BMI, WC, WHR, and WSR for obesity screening in Indonesian adults using receiver-operating characteristic
(ROC) analysis. Methods and Study Design: Stature, body weight, waist and hip circumferences were measured on 600 Indonesians aged 18-65 years (males, n=292; females, n=308) and BMI, WHR, and WSR calculated. Percentage of body fat (%BF) was determined using the deuterium isotope (D2O) dilution technique. Some existing cut-off points for obesity determination were evaluated for sensitivity and specificity. Results: The existing cutoff values showed low sensitivity in our sample (between 18.4 and 71.1%) and new proposed cut-offs increased the sensitivity to reach 66.7 to 88.5%. The new cut-offs for BMI, WC, WHR, and WSR for determination of obesity were 21.9 (kg/m2), 76.8 (cm), 0.86, and 0.48, respectively, for males and 23.6 (kg/m2), 71.7 (cm), 0.77, and 0.47, respectively, for females. Conclusions: WC and WSR are the most predictive both for males and females, and therefore are considered as better screening tools for obesity in this population.
Key Words: anthropometric measures, cut-off values, obesity screening, percentage of body fat, Indonesian adults

 

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Dietary behaviours, weight loss attempts and change in waist circumference: 15-year longitudinal study in Australian adults
SIMIN ARABSHAHI, PETRA H LAHMANN, MARIA CB HUGHES, GAIL M WILLIAMS AND JOLIEKE C VAN DER POLS
Background and Objectives: Dietary behaviours are suitable as clearly identifiable targets of dietary counselling to prevent weight gain. We therefore investigated associations between dietary behaviours, weight loss attempts and waist circumference change. Methods and Study Design: Participants were a community-based sample population residing in Nambour, Australia, including 1,317 adults, aged 25-75 years at baseline. Waist circumference was measured in 1992 and 2007, and dietary behaviours data were derived concurrently from repeated self-completed short dietary questions. Multivariable models, stratified by sex, were adjusted for potential confounders. Results: In men, consumption of visible fat on meat and in women, weight loss attempts in the last 10 years were the most important predictors of waist circumference gain independent of socio-demographic and lifestyle characteristics and energy intake. Men who consumed most visible fat on meat had a 2.6 times larger yearly increase in waist circumference than men who tended to cut the fat off meat: 0.47 (95% CI 0.23, 0.72) vs 0.18 (95% CI 0.01, 0.34) cm/year, p=0.01. Women who reported that they were always trying to lose weight had a 2.7 times larger yearly increase in waist circumference than women who never tried to lose weight: 0.78 (0.54, 1.02) vs 0.29 (0.06, 0.52) cm/year, p=0.0001. Other dietary behaviours were not associated with change in waist circumference. Conclusions: Consumption of visible fat on meat by men and more frequent attempts to lose weight by women were main dietary behaviours associated with gain in abdominal adiposity in Australian adults.
Key Words: waist circumference change, dietary behaviours, weight loss attempts, longitudinal studies, abdominal obesity
 

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Nutritional status and dietary diversity of Kamea in Gulf Province, Papua New Guinea
JANNY M GORIS, NIENKE ZOMERDIJK AND VICTOR J TEMPLE
Background and Objectives: To assess the nutritional status of infants, children and non-pregnant women and underlying factors, dietary diversity and community food security, in the Kamea community in Gulf Province, Papua New Guinea. Methods and Study Design: Prospective cross sectional study. Study population 69 infants (0-59 months), 151 children (6-12 years) and 79 non-pregnant women from 10 villages in Kotidanga Local Level Government, Kerema District, Gulf Province, Papua New Guinea. Results: Among infants prevalence of moderate stunting, wasting and underweight were 38.9%, 8.3% and 44.4%, respectively; after adjusting Hb concentration for altitude, the anaemia prevalence was 53.8%. Among children prevalence of severe stunting was 21.2%; moderate stunting, wasting and underweight were 57.6%, 12.2% and 48.5%, respectively; anaemia was 30.3%; median urinary iodine concentration was 32.0 μg/L and iodine deficiency was prevalent among 88.1%. Among women, mean height, weight and BMI were 1.46±0.04 m, 43.9±5.91 kg and 20.4±2.32 kg/m2, respectively; low BMI (<18.5 kg/m2) and anaemia were prevalent among 22.8% and 35.4%, respectively; median urinary iodine concentration was 36.0 μg/L and iodine deficiency was prevalent among 80.3%. Exclusive breastfeeding was universal for young infants; complementary foods were limited in variety and frequency. Dietary diversity was limited, implementation of the universal salt iodisation strategy restricted and community food security was inadequate. Conclusions: The high prevalence of malnutrition and anaemia among the three age groups, including moderate status of iodine deficiency among women and children, are significant public health concerns. Improvements in dietary diversity, adequate use of iodised salt and community food security are needed.
Key Words: malnutrition, iodine deficiency, dietary diversity, food security, Papua New Guinea
 

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Goitre and urinary iodine in coastal and inland areas with low and high iodized salt coverage in Zhejiang province, China
ZHE MO, XIAO F WANG, GUANG M MAO, WEN M ZHU, PEI W XU, YAN ZOU, YUAN Y WANG AND XIAO M LOU
Background and Objectives: WHO recommended that iodized salt are more than 90% of households in USI programs, which may not be suitable for all regions, especially in coastal areas. This study intended to find out levels of iodine nutrition and give advice from the USI programs for areas with different iodized salt coverage. Methods and Study Design: Coastal and inland areas were selected according to geographical regions in Zhejiang Province, China. The water iodine concentration (spectrophotometer analysis), salt iodine concentration (the colorimetric titration method), salt intake, urinary iodine concentration (spectrophotometer analysis), and thyroid volume examination (ultrasonography), as well as questionnaire, were measured in the two areas. Results: Mean Urinary Iodine concentration (MUIs) of children in coastal areas was 149 μg/L, which was significantly lower than that in inland areas (191 μg/L). MUIs of pregnant women in coastal and inland areas were111 and 138 μg/L, respectively. Pregnant women who consumed iodine-containing supplements had higher MUIs (207 μg/L) than those did not (134 μg/L) in inland areas. Prevalence of goitre in children reached 7.0% and 6.6% in coastal and inland areas, respectively. The lowest prevalence of goitre was reached when the urinary iodine concentration was approximately 120-160 μg/L in coastal areas. Conclusion: Iodine levels of coastal and inland areas were in the adequate range. Advice from the USI program should be specialized for different areas to appropriately reduce the salt iodine concentrations in inland areas and to determine an appropriate proportion of households using iodized salt in coastal areas. Moreover, iodine supplement intake during pregnancy should officially be recommended.
Key Words: urinary iodine concentration, goitre prevalence, children, pregnant women, generalized additive models
 

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The influence of mandatory iodine fortification on the iodine status of Australian school children residing in an iodine sufficient region
ANNA J SAMIDURAI, ROBERT S WARE AND PETER SW DAVIES
Background and Objectives: To counter emerging iodine deficiency mandatory iodine fortification of bread was introduced throughout Australia in 2009. This study investigated the impact of iodine fortification on the iodine status of school aged children living in the iodine replete state of Queensland, and investigated which foods had greatest influence on overall iodine status. Methods and Study Design: A convenience sample of 30 children aged 8.0-10.9 years living in south east Queensland, Australia, provided spot morning and afternoon urine samples on two consecutive days. Iodine status was categorised by the World Health Organization criterion. Semiquantitative food questionnaires (FFQ) completed by carers were used to investigate which foods were having the greatest influence on UIC. Analysis of variance was used to reduce the within person variation observed in urinary iodine concentrations (UIC) and the data were log transformed before statistical analysis. Results: Adjusted median UIC was 144 ug/L (IQR 120-210 ug/L) indicating iodine sufficient status. No samples were above the cut off for excessive UIC. Bread was the only statistically significant contributor to UIC (standardized β=0.37, p=0.04) with 14% of variation in UIC explained by bread consumption. UIC increased by 8.7% for each additional serve of bread. Conclusions: Iodine fortification of bread has increased the iodine status of school aged children in this Queensland cohort. Despite the small sample size in this study, improvements in methodology allowed its findings to be comparable to other, larger surveys.
Key Words: iodine, school children, iodine fortification, bread fortification, urinary iodine concentration
 

 

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Body mass index is associated with fat mass in normal, overweight/obese, and stunted preschool children in central Thailand
TIPPAWAN PONGCHAROEN, KUNCHIT JUDPRASONG, SIWAPORN JITNGARMKUSOL, WANTANEE KRIENGSINYOS AND PATTANEE WINICHAGOON
Background and Objectives: Body mass index (BMI) is widely used as a surrogate measure of adiposity. The relationship between BMI and body fatness varies by race, sex, and age and more variations have been found among children. This study investigated the relationship between BMI and fat mass among 3-5 year old children having different nutritional status. Methods and Study Design: A cross-sectional study was conducted in 15 daycare centers in central Thailand. 137 healthy preschool children were recruited according to their nutritional status: thin [BMI for age Z scores, (BAZ) <-2 SD], normal BMI (-2 SD≤ BAZ ≤+2 SD), overweight/obese (BAZ >+2 SD), and stunted [height for age Z scores < -2 SD]. Fat-free mass was determined by deuterium dilution technique. Fat mass (FM) in kilograms (TFM) and in percentage (FM%), and fat mass index (FMI, FM/height2) were calculated. Results: FM and FMI were the highest in the overweight/obese groups. In the thin group, girls had higher FMI compared to boys (3.2 vs 2.8 kg/m2, p<0.05). The relationship between BMI with FMI and FM differed by nutritional status. BMI was more strongly associated with FMI, TFM, and FM% in the overweight/ obese (r=0.97, 0.95, 0.80, p<0.05) and the normal (r=0.88, 0.84, 0.68, p<0.05) groups but not in the stunted group, and inconsistent in the thin group. Conclusions: The inconsistency in the relationship between BMI and body fatness suggests that BMI is appropriate for reflecting adiposity in normal and overweight/obese children, but not undernourished preschool children.
Key Words: preschool children, fat mass, BMI, deuterium, nutritional status
 

 

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Normal-weight central obesity is associated with metabolic disorders in Chinese postmenopausal women
PENG JU LIU, FANG MA, HUI PING LOU AND YAN NING ZHU
Background and Objectives: This cross-sectional study examined whether normal-weight central obesity, defined as a high waist-to-height ratio (WHtR), is associated with metabolic disorders in Chinese postmenopausal women. Methods and Study Design: We recruited 634 community-dwelling postmenopausal women with a normal body mass index (BMI) who participated in an annual health checkup. Normal-weight obesity (NWO) was defined as a normal BMI and WHtR in the highest tertile of the study population. The updated National Cholesterol Education Program/Adult Treatment Panel III criteria were used to assess metabolic abnormalities, and binary logistic regression models were employed to estimate the associations between NWO and metabolic disorders. Results: The prevalence of each metabolic disorder showed a graded increase (p<0.05) across the WHtR tertiles in the study population. NWO was significantly associated with some non-adipose components of metabolic syndrome (MetS) (p<0.05) after adjusting for age, smoking status, drinking status, inflammatory markers, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), body fat percentage (BF%), and the remaining non-adipose MetS components. Participants in the highest WHtR tertile had a higher odds ratio [2.00 (1.19–3.33), p<0.01] for the presence of at least two non-adipose MetS components than those in the lowest tertile after adjusting for age, lifestyle factors, inflammatory markers, TC, LDL-c, and BF%. Conclusions: NWO is significantly associated with metabolic disorders, suggesting that a clinical assessment of abdominal obesity indices should be conducted in postmenopausal women, even in those with a normal BMI.
Key Words: normal-weight obesity, waist-to-height ratio, metabolic disorder, metabolic syndrome, body mass index
 

 

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High consumption of salt-fermented vegetables and hypertension risk in adults: a 12-year follow-up study
HONG JI SONG, SEON-JOO PARK, DAE JA JANG, DAE YOUNG KWON AND HAE-JEUNG LEE
Background and Objectives: The aim of this study was to investigate the causal relationship between high consumption of salt-fermented vegetables and hypertension risk in adults. Methods and Study Design: Data came from the Korean Genome and Epidemiology Study, an ongoing community-based cohort study that began in 2001. In the final analysis, a total of 5,932 participants (men=2,822, women=3,110) was included. Daily energy, nutrient, and major salt-fermented vegetables for Korean (kimchi) intakes were assessed using a semi-quantitative food frequency questionnaire. Relative risks and 95% CIs associated with kimchi intake by gender and body mass index (BMI) were estimated using the multivariate Cox proportional hazards regression model. Results: Out of the 5,932 participants, 1,798 (905 men, 893 women) developed hypertension during the 12-year follow-up period. A significant difference in baseline BMI was shown between the non-hypertension and hypertension groups. There was no significant difference with regard to the risk of developing hypertension across quintiles for total kimchi intake and quartile or quartiles for specific kimchi intake in multivariate models by gender and baseline BMI. The trend for increased risk of hypertension according to increasing quartile of watery kimchi intake was significant for obese men in the multivariate model (p<0.05). Conclusion: High consumption of salt-fermented vegetables was not shown to be associated with increased risk of hypertension. The trend for increased risk of hypertension according to increasing quartile of watery kimchi intake was significant only in obese men.
Key Words: salt, fermentation, vegetable, hypertension, cohort
 

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Bimodal distribution of fasting plasma glucose in the Uyghur and Han populations of Xinjiang, China
HAIYING GONG, LIZE PA, KE WANG, HEBULI MU, FEN DONG, SHENGJIANG YA, GUODONGXU, NING TAO, LI PAN, BIN WANG, SHAOPING HUANG AND GUANGLIANG SHAN
Background and Objectives: Bimodality in fasting plasma glucose (FPG) distribution has been detected in several populations. However, information regarding this phenomenon among Chinese ethnic groups is minimal. This study aimed to describe and update the distribution of FPG in the Uyghur and Han populations of Xinjiang, China, as well as to estimate the cut points of FPG on the basis of bimodal distribution. Methods and Study Design: A cross-sectional study was performed among the Uyghur and Han populations of Xinjiang, China in 2013. Questionnaire survey and FPG tests were conducted among 5,923 participants aged 20-80 years. We fitted the unimodal and bimodal distributions into the FPG data by ethnicity, age, gender, and location to test whether the FPG values were consistent with a bimodal distribution. Results: The FPG distribution could be described as bimodal, except for the age group of 50 years old and below among the Uyghur and Han populations and the age group of 70-80 years old among the Uyghur population (p<0.01). However, most of the cut points estimated using this method did not fall between the corresponding means of the first and second modes. Conclusions: Although a bimodal distribution of FPG was observed in the Uyghur and Han populations of Xinjiang, China, the cut points estimated using this method were not biologically meaningful, and thus, a bimodal distribution of FPG was not useful for defining cut points to diagnose diabetes in Xinjiang.
Key Words: bimodal distribution, fasting plasma glucose, diabetes, Uyghur population, Han population

 

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Metabolic syndrome in Korean adolescents and young adult offspring and their parents
KAYOUNG LEE
Background and Objectives: Studies have investigated the associations between parental metabolic syndrome (MetS) and offspring MetS. This study aimed to uncover parental-offspring associations for MetS and its components according to offspring sex and age. Methods and Study Design: A cross-sectional study in 1,403 fathers, 1,451 mothers, and 1,532 offspring (340 male and 404 female offspring aged 10-18 years; 283 male and 505 female offspring aged 19-25 years) using the Korea National Health and Nutrition Examination Survey data between 2010 and 2013. Results: All categorized MetS components in fathers and mothers were significantly associated with the same components in male offspring, while high waist circumference, high triglycerides, and low high-density lipoprotein in fathers and mothers were associated with the same components in female offspring. The number of categorized MetS components which were significantly associated between parent-offspring pairs was greater in offspring aged 19-25 years than in those aged 10-18 years. All categorized MetS components were significantly associated between father-male offspring aged 19-25 years pairs, but not in other parent-offspring pairs. The MetS per se in fathers and mothers was significantly associated with that in male offspring aged 10-18 years. Conclusions: There were differential associations according to offspring sex and age group and parent’s sex with respect to parental-offspring associations for MetS and its individual components. The associations for MetS and its components were stronger in young adult versus adolescent offspring, in male offspring versus female offspring.
Key Words: metabolic syndrome, offspring, parent, sex, age
 

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Awareness of coeliac disease among chefs and cooks depends on the level and place of training
MICHAEL SCHULTZ, SEONG SHIN AND KIRSTEN J COPPELL
Background and Objectives: Coeliac disease is triggered by gluten. The only treatment is lifelong avoidance of dietary gluten. Dining out and travelling are particular challenges with a huge impact on quality of life. We examined the knowledge about coeliac disease and gluten-free food preparation among chefs and cooks, and culinary students in Dunedin, New Zealand. Methods and Study Design: Outlets serving gluten-free food were identified. The head chefs or cooks were invited to complete a questionnaire regarding demographics, education, qualification, experience and knowledge of coeliac disease and gluten-free food preparation. Ninety restaurant chefs and cooks, and 35 first-year culinary students participated. Results: Half of participating chefs and cooks had received no formal training, but all were aware of the term gluten-free diet. Twelve (13%) were unaware of coeliac disease, all of whom were non-European and worked at an ethnic restaurant which did not have gluten-free policies in place. There was no significant difference in awareness of coeliac disease between chefs and students (p=0.36). However, students were significantly more aware of necessary gluten-free food preparation (p=0.007) and scored better in the gluten-free quiz (p=0.01) than chefs and cooks. Conclusions: Awareness of coeliac disease did not necessarily mean that policies were in place to prepare contamination-free gluten-free meals. Chefs and cooks from countries with a low incidence of coeliac disease lacked knowledge about gluten-free food preparation and had difficulties recognising gluten containing foods. Patients with coeliac disease wanting to dine out should be advised to choose a restaurant with care.
Key Words: coeliac disease, gluten-free diet, quality of life, restaurants, chefs
 

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Associations of self-efficacy, social support, and knowledge with fruit and vegetable consumption in Japanese workers
OSAMU KUSHIDA, YAE IRIYAMA, NOBUKO MURAYAMA, TOSHIKO SAITO AND KATSUSHI YOSHITA
Background and Objectives: Previous studies have suggested that self-efficacy, social support, and knowledge are primary psychosocial predictors of dietary behavior in adults. The present study aimed to investigate the associations of self-efficacy, social support, and knowledge with fruit and vegetable consumption in Japanese workers. Methods and Study Design: From September to November 2014, a self-administered questionnaire was completed by Japanese workers at 8 workplaces in Niigata, Japan. Self-efficacy and social support for fruit and vegetable consumption were measured using a 3-item Likert scale across particular situations. Knowledge was measured using a single item about the recommended guidelines for fruit and vegetable consumption in Japan. Fruit and vegetable consumption was assessed using a validated, brief-type self-administered diet history questionnaire. Results: Of the 457 respondents, 395 participants’ data were analyzed. Scores in self-efficacy and social support showed a significant and positive association with fruit (p<0.001, p=0.002) and vegetable consumption (p=0.001, p=0.015). Knowledge was significantly and positively associated with vegetable consumption (p=0.015) but did not statistically differ in fruit consumption (p=0.645). Conclusions: The findings of this study suggest that selfefficacy and social support are positively associated with fruit and vegetable consumption in Japanese workers.
Key Words: fruit, vegetables, self-efficacy, social support, knowledge
 

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Differences in health-related behaviors between middle school, high school, and college students in Jiangsu province, China
WEINA LIU, MIKE Z HE, YUNLE WANG, YAN WANG, YONGLIN ZHOU, MING WU, ZHEN TANG, YUE DAI, BAOJUN YUAN, SHIQI ZHEN AND LAWRENCE J CHESKIN
Background and Objectives: Increasing rates of obesity among Chinese adolescents has become a major public health concern in recent years. Studies have shown that factors such as food choices, physical activity, and screen time play important roles in fostering obesity. We examined a number of biological and social determinants that influence these factors. To determine whether dietary behavior, physical activity, and screen time varied among students in different stages of their education. Methods and Study Design: Students in 13 cities across Jiangsu Province completed an anonymous survey assessing demographics and various health-related behaviors in a controlled setting. The survey population ranged from middle school students to undergraduates. 55,361 surveys were returned, and 46,611 (84.2%) were usable for the analysis. Multiple linear regression models were used to investigate the relationship between four behavioral factors (dietary behavior, screen time, physical activity, and moderate exercise) and seven predictors (gender, age, BMI, mother’s education, nearsightedness, allowance, and geographic region). Results: Baseline characteristics of the survey population analyzed by education level (middle school, high school, college and beyond) showed moderate differences in demographics among the three groups. Physical activity, moderate exercise, and dietary behavior decreased with educational level, while screen time increased. All predictors in the four considered regression models were statistically significant. Conclusions: This unique, large-scale survey of Chinese students in a region of contrasting economic development revealed numerous relationships between health-related diet and physical-activity, region, and education level. These findings can inform the development of measures to counteract the rise of obesity in China.
Key Words: diet, nutrition, pediatric obesity, screen time, China
 

 

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Rising food accessibility contributed to the increasing dietary diversity in rural and urban China
HUI WANG, CHAO LIU, HONG FAN AND XU TIAN
China has undergone a dramatic transition in food consumption in the past few decades. Diet composition has changed significantly because of an increase in food accessibility and lifestyle changes. To investigate dietary changes in China from the perspective of dietary diversity, we assessed the trend of dietary diversity in China by using the following 4 indicators: count index, dietary diversity score, entropy, and Simpson index. Data of 24,542 adults (age 18 y) were obtained from the China Health and Nutrition Survey (CHNS) conducted in 2004, 2006, 2009, and 2011. Furthermore, the association between dietary diversity and the number of food facilities was investigated using multivariable regression and local polynomial regression. Results indicate that dietary diversity increased over time and was unequally distributed among regions and families. Urban residents had a significantly more diverse diet compared with their rural counterparts (p<0.01). Moreover, dietary diversity was positively associated with food accessibility (p<0.01), and it was affected by socioeconomic factors such as the family income, household size, gender, age, education, and region. Taken together, these data suggest that the increase in dietary diversity in China in the past decade can be partially attributed to the increase in food accessibility.
Key Words: dietary diversity, food accessibility, China, urban, rural
 

 

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Last Updated: June 2017