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APJCN Vol 2 No 1
Contents:
Editorial:
Food
intake methods in clinical practice. Mark
L Wahlqvist,
Vichai Tanphaichitr,
Akira Okada
- Review
article: Nutrition and HIV infection. Julie R Lustig
- Uses
of anthropometry in the elderly in the field setting with notes
on screening in developing countries. Noel W Solomons, Manolo Mazariegos, Ivan Mendoza
- Urinary
sodium and potassium in a sample of healthy adults in Sydney, Australia.
L Notowidjojo, AS Truswell
- Diet
does not predict incidence or prevalence of non-insulin-dependent
diabetes in Nauruans. Allison M Hodge,
Gary K Dowse And Paul Z Zimmet
- Review
article: Nutrition and health of Victorian Aborigines (Kooris).
Jonathan M Hodgson, Mark L Wahlqvist
Abstracts:
Julie R Lustig
Asia Pacific Journal of Clinical Nutrition (1993)
Volume 2, Number 1: 3-14
Nutritional status may have an impact at all stages
of HIV disease. Many of the clinical features of HIV infection cause
nutritional problems and may also be exacerbated by the presence of
malnutrition. Inadequate food intake, due to a wide variety of aetiologies,
malabsorption and altered metabolism, may all contribute to malnutrition.
Additionally, factors in food, including micronutrients, can modulate
immune function. Reduced micronutrient levels are documented at all
stages of HIV infection although the significance of these findings
and how they may relate to HIV disease severity and prognosis are
still unclear. Body composition changes in adults include loss of
weight with proportionately greater loss of lean mass. Paediatric
HIV infection has received far less research attention, but growth
failure is a significant nutritional complication seen clinically.
Clinical experience suggests that e 1000 arly nutritional intervention
may improve prognosis as well as quality of life. Nutritional management
in HIV disease depends on the clinical state of the patient. Definition
of the benefits of particular food factors and diets, as well as the
most appropriate nutrition support modalities, would allow rational
nutritional counselling. Better definition of the contribution food
makes to health through its social role, and the opportunities this
provides in patient care, would complement the biomedical research
effort.
Noel W Solomons, Manolo Mazanegos, Ivan Mendoza
Asia Pacific Journal of Clinical Nutrition (1993)
Volume 2, Number 1: 15-23
A field setting can be defined as any setting outside
of a fixed, permanent, and sophisticated health facility or research
laboratory. The most important applications of anthropometry at field
level include biological anthropology, epidemiology, clinical application,
and metabolic research. Data collecting in the field setting requires
different levels of accuracy and precision; the standardization should
also consider intra- and inter-observer variability due to the possibility
of more than one observer participating in a given survey. A field
setting, in contrast to the laboratory setting, involves special conditions
that challenge the application of anthropometry. The required equipment
is different and the conditions of data collection are less rigorous.
Issues intrinsic to the target group - of education, culture and sophistication
- might be limiting factors for carrying out anthropometric surveys
in field settings.
Another issue is related to interpretation of the
biological, nutritional and health significance of anthropometric
findings in relationship to the elderly. Uncertainty regarding the
accuracy of chronological age, and geography and differential survival
of the elderly should be considered when designing a survey. In addition,
because the majority of the elderly now live in developing countries,
short stature should be a common finding in the age groups from these
regions. It is in these short-stature elderly populations, that there
is a problem interpreting and applying anthropometric norms or references
for height or weight derived from elderly populations of developed
countries.
In conclusion, although the application of anthropometry
to the field setting is feasible, given its enormous importance to
gerontological biology, nutrition and health, researchers should consider
a series of factors and paradigms when designing and carrying out
anthropometric surveys at the field level.
L Notowidjojo, AS Truswell
Asia Pacific Journal of Clinical Nutrition (1993)
Volume 2, Number 1: 25-33
Australia has had an official guideline for the last
ten years, that people should aim to consume less than 100 mmol sodium
per day (equivalent to 6.0 g NaCl). The only practical way of estimating
sodium intake is from the 24-h urinary sodium excretion. Between 1970
and 1980 average sodium excretions in different Australian surveys
ranged from 130 to 200 mmol/day (middle number 165 mmol/d). These
surveys involved small numbers of subjects (n = 11 to 259) . To see
how Australians are responding to the guidelines and taking advantage
of a range of reduced salt food products now in the supermarkets,
we measured urinary sodium and potassium in 117 healthy adult subjects,
mostly in the university community. In group N (nutrition personnel)
sodium excretion averaged 128 mmol/d in females and 137 mmol/d in
males. In group W (eating a western, traditional Australian diet,
no special knowledge of nutrition) urinary sodiums averaged 133 mmol/d
(female) and 159 mmol/d (male). In group A (eating an Asian diet)
sodiums averaged 140 mmol/d (female) and 195 mmol/d (male). Potassium
excretions were 73, 81, 72, 76, 53, and 65 mmol/day respectively in
the six subgroups. We conclude that these results possibly reflect
a small downward trend in Australian sodium intake and that sodium
intake is lower in mainline Australian diets than Asian diets. But
only a minority of subjects' urinary sodiums were within the recommended
40 to 100 mmol/d. Women excreted consistently smaller amounts of sodium
than men; the guidelines for sodium should perhaps be expressed separately
by gender. In six subjects who provided seven days' urine collections
the coefficient of variation for sodium excretion was between 20 and
35%.
Allison M Hodge, Gary K Dowse, Paul Z Zimmet
Asia Pacific Journal of Clinical Nutrition (1993)
Volume 2, Number 1: 35-41
Cross-sectional and longitudinal relationships between
diet and non-insulin-dependent diabetes (NIDDM) were assessed in Nauruan
adults to determine if a particular component of the diet contributed
to the high prevalence of NIDDM in this population. In 1982, 24-h
dietary recall data were collected from 430 Nauruans over the age
of 20, who were participating in a noncommunicable disease (NCD) survey.
In 1987 a follow-up survey was performed which included 350 of the
subjects from whom dietary data was obtained. Neither cross-sectional
nor longitudinal analyses showed any statistically significant associations
between any of the specific dietary components studied and NIDDM prevalence
or incidence. However, when nutrient intakes were adjusted for energy
intake it appeared that the age- and body-mass-index (BMI)-corrected
mean intakes of total fat, total carbohydrates, alcohol, sugar and
monounsaturated fat were slightly higher in the seven incident cases
than in those who remained healthy, while intakes of protein, fibre
and cholesterol were lower. Despite the inability to demonstrate an
association between NIDDM risk and nutrient intake at the individual
level, Nauruans as a population have total energy intakes 115-135%
greater than recommended for maintenance of healthy weight, protein
intakes about 250% of that required, sugar intakes about twic 1000
e the recommended, fibre intakes only about 30% of current recommended
levels and in men a mean alcohol intake more than three times the
recommended level. This adverse diet undoubtedly contributes to the
high prevalence of obesity in the population and hence, even if there
are no direct dietary effects, to the risk of NIDDM and other diet-related
diseases.
Jonathan M Hodgson, Mark L Wahlqvist
Asia Pacific Journal of Clinical Nutrition (1993)
Volume 2, Number 1: 43-57
Prior to European settlement of Australia, the health
of Aboriginal people was probably better than that of the Europeans.
In the past 200 years there has been a considerable improvement in
the health of non-Aboriginal Australians, and a deterioration in the
health of Aborigines. Some improvement in Aboriginal health has occurred
in recent times. The Aboriginal people who live in Victoria are known
as Kooris. An understanding of traditional Koori diets is important
because people were generally healthy eating these diets. The traditional
Koori diet was high in dietary fibre, unrefined carbohydrates, and
protein, with adequate vitamins and minerals, and low in total fat
and saturated fat, sucrose, salt, and without alcohol. Their lifestyle
also dictated a high level of physical activity resulting in a reduced
likelihood of overweight. The other notable aspect of the traditional
diet was the variety of foods consumed. The present health problems
of the Koori people stem primarily from their loss of ancestral lands,
and social and cultural disruption. Kooris went from a hunter gatherer
society to one almost entirely dependent upon mission handouts. There
are many factors which may now contribute to the continued poor health
and nutrition of Kooris. The relative importance of any of these factors
is unknown. Morbidity and mortality data provide valuable information
about the overall health of populations and their nutrition status.
The Australian population is one of the healthiest in the world. There
is however a remarkable difference between the health of Aboriginal
and non-Aboriginal Australians. The leading cause of death for both
male and female Aborigines is disease of the circulatory system, including
ischaemic heart disease and stroke. Deaths due to circulatory system
disease is 2.2 and 2.6 times higher than the age adjusted Australian
rates for men and women respectively, and between 10 and 20 times
higher for young and middle aged adult Aborigines. Rates of hospital
admission are 2.5-3 times higher than the rest of the population,
with the highest rates being for infants. Although mortality statistics
do not show nutrition related disorders such as obesity, non-insulin
dependent diabetes mellitus (NIDDM), and hypertension to be significant
contributors to mortality, these statistics are not representative
of the problem. Across Australia the prevalence of obesity, NIDDM,
and hypertension are higher for Aborigines than the general population.
Available data on morbidity and mortality for Aborigines in Victoria
are limited, but the indication is that the overall situation is similar
to the rest of Australia. If the situation for Victoria is similar
to the rest of Australia, then this would suggest that the contemporary
Koori diet is too high in fat and perhaps alcohol, and too low in
fibre and variety. Further evidence is required to veri 644 fy this
suggestion.
There are several areas where information on Koori
nutrition is limited or lacking. These include food intake, nutritional
status, and dietary practices, such as cooking methods, salt and sugar
use and meal patterns. It is generally agreed that information on
Koori nutrition should be made available so that the problems can
be identified, and strategies put in place to address the problem
areas.
Copyright © 1993 [Asia Pacific Journal of Clinical
Nutrition]. All rights reserved.
Please note: this article has been scanned and reformatted.
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