Cardiovascular disease claims more than 500,000 women per year, making this disease the number one killer of women. Coronary heart disease in developed countries can be used as a representative classification when dis- cussing cardiovascular disease management. Within the last 10 years research has illuminated the contributing risk factors and disease progression as they uniquely relate to women. Yet, current approaches to the prevention of primary risk factors in the development of cardiovascular disease fail to reach the potential described in sci- entific literature. Traditional prescriptions relied on hormone therapy or pharmacologic intervention to manage coronary heart diseases ignoring the non-hormonal aspects of cardiovascular health. Recent trends have begun to emphasize diet as a tool for the prevention of heart disease in women. This review attempts to highlight nu- trition as a prescription that can be utilized to reduce the significant risk factors that women, who live in devel- oped nations, face throughout their lifetime.
Objective: To assess the nutritional status of adolescents in Ho Chi Minh City, and in particular determine the prevalence of overweight and obesity in adolescents across different sub groups, based on gender, household economic status and geographic location. Design: A cross-sectional survey based on a two-stage cluster sam- pling design. Setting: Secondary high schools in Ho Chi Minh City. Subjects: There were 1504 adolescents involved in the study, of which 50% were girls and the mean age of participants was 13.1 years. Results: Over- all, 4.9% of the students were overweight and 0.6% were obese, while 13.1% of the students were underweight. The prevalence of underweight was significantly higher in boys than girls (p=0.001) and overweight and obe- sity were also higher in boys although these differences were not statistically significant (p=0.074). There was a much higher prevalence of overweight and obesity in students from schools in wealthy urban districts (8.2% and 0.6%, respectively) in comparison to students from schools in rural or semi-rural districts (1.6% and 0.2%, respectively) and these differences were statistically significant (p<0.001). Conclusions: A transition in nutri- tional status is underway in this population of adolescents where overweight and obesity are emerging as a pub- lic health problem, but underweight remains a significant problem.
Intakes of energy, protein, iron and vitamin A in India are usually reported as inadequate. Recognizing that tra- ditional food systems are sustainable, high in species variety, and have rich nutrient sources, we compared die- tary intakes and nutrient sources of Dalit mothers and their children living in villages with and without an inter- vention based on improved access to the traditional Dalit food system. 24-hour recalls were conducted with Dalit mothers and their children aged 6-39 months during summer and rainy seasons in 2003. We found that mothers from intervention villages had significantly higher intakes of energy (mean ± SD: 12,197 ± 3,515 kJ vs. 11,172 ± 3,352 kJ; p= 0.02) and protein (77.5 ± 25.1 g vs. 71.1 ± 25.2 g; p= 0.05) in summer, and higher in- takes of energy (11,168 ± 3,335 kJ vs. 10,168 ± 3,730 kJ; p= 0.04), protein (68.9 ± 22.6 g vs. 60.4 ± 23.8 g; p<0.01) and iron (15.8 ± 6.6 mg vs. 13.7 ± 9.1 mg; p<0.01) during rainy season. There were no differences in children’s intakes between intervention and control villages. In mothers, sorghum contributed 29% of energy, 33% of protein and 53% of iron, and green leafy vegetables contributed 21% of vitamin C and 38% of vitamin A. Our results indicate that traditional food such as sorghum, pulses and green leafy vegetables are major sources of energy, protein, iron, vitamin C and vitamin A, and that mothers from villages with the traditional food intervention had higher intakes of energy, protein and iron.
The objective of this study was to determine the impact of Vitamin A supplementation on health status and ab- senteeism of school children. A randomized double blind placebo controlled trial over a period of 13 months was conducted in a rural area of Sri Lanka involving 613 school children attending Grades 1-5 (aged 5 to 13 years). Children were assigned to either 200,000 IU of Vitamin A (n=297) or placebo (n=316) once every 4 months. Socio-demographic data were obtained at baseline, and anthropometry and haemoglobin concentra- tions were assessed at baseline and post intervention. Serum vitamin A concentrations were assayed by HPLC in a subgroup of children (n=193) before administration of each dose. School absenteeism was recorded. The two groups of children were similar at baseline in all variables. The subgroup of children was comparable to the main study population. The prevalence of vitamin A deficiency (<20 μg/dL) in the subgroup of children was 8.2%. Changes in anthropometric indices and haemoglobin concentrations were similar in the two groups. The major causes for absenteeism were non-health causes and supplemented children lost a fewer number of school days due to illness than placebo children (p=0.053). Vitamin A concentrations improved with each dose and the improvement was greater with better compliance. Vitamin A supplementation with 200,000 IU every 4 months over 13 months improved vitamin A status and school attendance but not anthropometric status of these chil- dren.
People in India have a high prevalence of low vitamin BB12 status and high plasma total homocysteine (tHcy) concentrations. In a proof of principle trial, we studied the effect of oral vitamin B12 (500 μg) and/or 100 g cooked green leafy vegetables (GLV) every alternate day in a 2x2 factorial design over a 6-week period. Forty- two non-pregnant vegetarian women (age 20-50 years) were randomly allocated to four study groups. Clinical measurements were made at the beginning and at the end of the study, and blood samples were collected before, and 2 and 6 weeks after commencement of intervention. Forty women completed the trial. Twenty-six women had low vitamin B12 status (<150 pmol/L) and 24 had hyperhomocysteinemia (>15 μmol/L). GLV supplemen-
tation did not alter plasma folate or tHcy. Vitamin B12 supplementation increased plasma vitamin B12 concen- tration (125 to 215pmol/L, p<0.05) and reduced tHcy concentration (18.0 to 13.0 μmol/L, p<0.05) within first 2 weeks, both of which remained stable for the next 4 weeks. Plasma vitamin B12 and tHcy concentrations did not change in those who did not receive vitamin B12, and there was no change in plasma folate concentration in any of the groups. Blood haemoglobin concentration increased marginally within first two weeks in those women who received vitamin B12 (by 3 g/L, p<0.05) and the number of women with macrocytosis decreased from 2 to zero. There was no change in vibration sensory threshold during the period of the study. High-dose per oral vi- tamin B12 supplementation significantly reduced plasma tHcy within 2 weeks but did not achieve normal plasma tHcy concentration even after 6 weeks.
Background: Sialic acid (N-acetylneuraminic acid), a component of gangliosides and sialylglycoproteins, may be a conditional nutrient in early life because endogenous synthesis is limited. The aim of this study was to in- vestigate the metabolic fate of intravenously administrated N-acetylneuraminic acid 614C (sialic acid) in piglets. Method: Three-day-old male domestic piglets (Sus scrofa) were injected via the jugular vein with 5 μCi (11-12x106 cpm) of N-acetylneuraminic acid-614C (specific activity of 55 mCi/mmol). Blood samples were collected at regular intervals over the next 120 min. The organs were then removed and the urine collected for determination of residual radioactivity. Results: Within 2 min of injection, 80% of the activity was removed from the blood and by 120 min the remaining activity approached 8%. At 120 min, the brain contained signifi- cantly more radioactivity (cpm/g tissue) than the liver, pancreas, heart and spleen, but less than the kidneys. Within the brain, the percentage of total injected activity was highest in the cerebrum (0.175 ± 0.008) followed by the cerebellum (0.0295 ± 0.006, p = 0.00006) and the thalamus (0.029 ± 0.006, p = 0.00003). Conclusions: An exogenous source of sialic acid is capable of crossing the blood-brain barrier and being taken up into vari- ous tissues. The findings suggest that dietary sources of sialic acid may contribute to early brain development in newborn mammals.
Objectives: To compare the effects of wheat flours fortified with NaFeEDTA, FeSO4 and elemental iron (elec- trolytic iron), in improving iron status in anemic students. Methods: Four hundreds anemic students (11 to 18 years old) were divided into four groups and given wheat flour fortified with different iron fortificants at dif- ferent concentrations: control group (no added iron); NaFeEDTA group (20 mg Fe/kg); FeSO4 group (30 mg Fe/kg); and elemental iron group (60 mg Fe/kg). The trial lasted for 6 months and the following parameters were examined every 2 months: whole blood hemoglobin, free erythrocyte protoporphyrin, serum ferritin, se- rum iron, total iron binding capacity and transferrin receptor. Results: The flour consumption in the 4 groups was 300-400 g/person/day, accounted for 70% of total cereal consumption in the diets. There were no signifi- cant differences in flour consumption among the 4 groups. Blood hemoglobin level increased in all the 3 inter- vened groups, but the increment in the NaFeEDTA group was significantly higher and earlier than the other 2 groups; and only 1% of the subjected remained anemic at the end of the trial in the NaFeEDTA group, while 40% and 60% of the subjects in the FeSO4 and electrolytic iron group remained anemic, respectively. The order of improvements in free erythrocyte protoporphyrin, serum ferritin and transferring receptor levels were: NaFeEDTA > FeSO4 > electrolytic iron. No significant changes were found in the control group on all the tested parameters during the trial. Conclusions: The results indicated that even when NaFeEDTA was added at a lower level, it has better effects than FeSO4 and elemental iron in controlling iron deficiency anemia and im- proving iron status in anemic children; while elemental iron was the least effective.
High sodium intake is considered to be the major risk factor for hypertension but studies about so- dium intake on prevention and management of hypertension is limited due to the difficulties in as- sessment of sodium intake. Dietary sodium comes not only from naturally occurring sodium in foods but also from the added sodium during processing, cooking and at the table. Present study was conducted to identify salt usage behavior questions related to urinary sodium excretion among nor- motensive adult Koreans. The test version of the salt usage questionnaire included six items of salt usage behaviors and nine items of high salt containing foods. A survey was conducted in 189 adults over 18 years of age in three age groups in both genders. Each participant answered the question- naire and collected one 24-hour urine and urine samples were analyzed for sodium contents. Corre- lation analyses between scores of the questions and sodium excretion in 24-hour urine were per- formed to identify question items related to sodium excretion. Among fifteen questions, scores of three questions on salt usage behaviors were significantly correlated to urinary sodium excretion (r=0.17~0.19; p <0.05) and the sum of scores of the three questions showed higher correlation coef- ficients. (r=0.26, p <0.001) The salt usage behavior questions developed in this study would be use- ful in predicting sodium intake and in studying the relationship between sodium intake and health among Korean adults.
Asian populations including Koreans are assumed to have a higher isoflavone intake due to the higher consumption of soybean. However, it is difficult to estimate isoflavone intake because there is no isoflavone database in Korea. In this study, an isoflavone database was established with sys- tematic review. Literature with analytical values of Korean soybeans and its products were collected and evaluated to establish an isoflavone database. A total of 142 food items containing isoflavones were selected among 2,932 food items in the Korean Nutrient Database. Among these, only 25 food items were evaluated with analytical values and the remaining 98 items were replaced with adapta- tions or calculations from similar items. Dietary intake of isoflavones was assessed for 426 boys and 365 girls aged 8 to 11 years with 3-day food records. The daily mean isoflavone intake was 8.3 mg among boys and 7.2 mg among girls. More than 70% of subjects had a daily isoflavone intake below 10 mg. The most contributory food item to the isoflavone intake among adolescents was tofu in quantity and soybean sauce in frequency. This database could be used to estimate isoflavone intakes from dietary data among various populations and to evaluate the relationships between isoflavone intake and chronic disease.
Background: Knowledge of traditional African foods and food habits has been, and continues to be, systemati- cally extirpated. With the primary intent of collating data for our online collection documenting traditional Af- rican foods and food habits (available at: www.healthyeatingclub.com/Africa/), we reviewed the Oltersdorf Collection, 75 observational investigations conducted throughout East Africa (i.e. Tanzania, Kenya, and Uganda) between the 1930s and 1960s as compiled by the Max Planck Nutrition Research Unit, formerly lo- cated in Bumbuli, Tanzania. Methods: Data were categorized as follows: (1) food availability, (2) chemical composition, (3) staple foods (i.e. native crops, cereals, legumes, roots and tubers, vegetables, fruits, spices, oils and fats, beverages, and animal foods), (4) food preparation and culture, and (5) nutrient intake and health status indicators. Results: Many of the traditional foods identified, including millet, sorghum, various legumes, root and tubers, green leafy vegetables, plant oils and wild meats have known health benefits. Food preparatory practices during this period, including boiling and occasional roasting are superior to current practices which favor frying and deep-frying. Overall, our review and data extraction provide reason to believe that a diversi- fied diet was possible for the people of East Africa during this period (1930s-1960s). Conclusions: There is a wealth of knowledge pertaining to traditional East African foods and food habits within the Oltersdorf Collec- tion. These data are currently available via our online collection. Future efforts should contribute to collating and honing knowledge of traditional foods and food habits within this region, and indeed throughout the rest of Africa. Preserving and disseminating this knowledge may be crucial for abating projected trends for non- communicable diseases and malnutrition in Africa and abroad.
The objective of the study was to assess the prevalence of sub clinical vitamin A deficiency and anemia in Vietnamese children. For this, a cross-sectional survey was conducted in 40 villages (clus- ters) of four ecological regions in Vietnam during Apr-May 2001. In total 1657 children less than 5 years old were included by a cluster random sampling method. The prevalence of sub clinical vita- min A deficiency (serum retinol <0.70 μmol/L) was 12.0% and the prevalence of anemia (hemoglo- bin <110g/L) was 28.4 %. In the children under 6 months the prevalence of sub clinical vitamin A deficiency was 35.1 % whereas the prevalence of anemia in this group was as high as 61.7%. The prevalence of children with both sub clinical vitamin A deficiency and anemia was 6.1%. Sub clini- cal vitamin A deficiency and anemia prevalence differed significantly across the regions, with high- est prevalence in the Northern Mountainous areas for vitamin A deficiency and in the Northern Mountainous area and Mekong River Delta for anemia. It is concluded that sub clinical vitamin A deficiency and anemia are still important public health problems in Vietnam. Sustainable strategies for combating vitamin A deficiency and nutritional anemia are needed and should concentrate on target groups, especially infants and malnourished children in high risk regions.
Adiponectin, which is secreted specifically by adipose tissue, has been shown to act as an anti-atherosclerotic protein. Several studies have shown that adiponectin levels are lower in individuals with obesity, diabetes and cardiovascular disease. The present study investigated relationships between serum adiponectin levels and body mass index (BMI), waist-to-hip ratio (WHR), blood pressure (BP) and lipid profiles in 300 middle-aged Korean women (mean age 50.6 ± 6.2; BMI 25.8 ± 3.68 kg/m2). The serum adiponectin level was positively associated with high density lipoprotein (HDL)-cholesterol (r = 0.29) and negatively associated with BMI, WHR, percent body fat, triglyceride (TG), systolic BP, and diastolic BP. Multivariable logistic regression analysis revealed that increasing concentrations of adiponectin were associated with lower risk of hypertension. In overall odds ratios (95% CIs) for hypertension, those in the second, third, and fourth (versus the first) quartile of adiponectin after adjustment for age were 0.59 (0.30 – 1.19), 0.47 (0.24 – 0.94), and 0.32 (0.16 – 0.65), respectively. Re- gardless of BMI, WHR and percent body fat, higher adiponectin was independently associated with a lower risk of hypertension. These findings suggest that the serum adiponectin level is decreased with atherogenic lipid phenotype including hypertriglyceridemia and low HDL-cholesterol. Furthermore, low serum adiponectin con- centration may be an independent risk factor for hypertension in middle-aged Korean women.
Vitamin A deficiency (VAD) is the most common cause of childhood blindness in the developing world. It is estimated that by giving adequate vitamin A, in vitamin A deficient populations, child mortality from measles can be reduced by 50%, and mortality from diarrheal disease by 40%. Overall mortality in children 6-59 months of age can be reduced by 23%. This paper reported results from a study of vitamin A status and malnu- trition of the minority ethnic group of Karen hill tribe children aged 1-6 years in the north of Thailand. All children aged 1-6 years (N = 158; 83 boys, 75 girls) from the three Karen villages (Mae Hae Tai, Mae Yot, Mae Raek) of Mae Chaem district in the north of Thailand were studied. The Karen is the largest mountain ethnic minority (“hill tribe”) group in Thailand. All children were examined by a qualified medical doctor and were assessed for their vitamin A intakes using 24 hours dietary recall. Thai food composition table from Ministry of Health, Thailand were used as references. The results were compared with the Thai Recommended Dietary Allowances. Children aged 1-3 years and 4-6 years were separately analysed due to the differences in Thai Recommended Dietary Allowances between the two age groups. A whole blood of 300 μL was obtained by “fingerstick” for determination of serum vitamin A. Community or village’s vitamin A status was assessed by using Simplified Dietary Assessment (SDA) method and Helen Keller International (HKI) food frequency method. Descriptive statistics were used to analyse the data. All families of the study boys and girls had in- come lower than the Thailand poverty line (US $ 1,000/year). On average, 63% of children from Mae Hae Tai village, 1.5% of children from Mae Yot village and none of children from Mae Raek village had serum vitamin A <0.7 μmol/L which indicated VAD. All boys and only girls from Mae Raek village consumed vitamin A more than the Thai RDA but girls from Mae Hae Tai village and Mae Yot village consumed vitamin A less than the Thai RDA. Both boys and girls from Mae Raek village and also girls from Mae Yot village consumed vi- tamin A more than the Thai RDA. Using SDA and HKI methods to assess vitamin A status of the villages to see whether VAD is a village's nutritional problem, it was found that all children from the three villages were at risk of VAD. In order to improve vitamin A status of the Karen children in Mae Chaem district, recommenda- tions were made as follow: (1) increased use of fat and oil, particularly in areas with high risk of VAD; (2) more general work with Karen communities on how children’s diets might be improved in a culturally accept- able manner, so as to bring vitamin A consumption closer to recommended allowance level.
Breastfeeding rate has been low in Hong Kong over the last three decades. This has happened with concomitant rapid economic development and improved living standards. A population-based survey was conducted to evaluate factors influencing decision, duration and early cessation of breastfeeding in 3,204 full-term healthy infants under 6 months throughout Hong Kong in 1993. A self-administered questionnaire was used. The over- all percentage of breastfed infants was particularly low (9.6%), 36.1% had already given up breastfeeding and were being formula-fed (FFBF), 54.3% have been exclusively formula-fed since birth. The proportion of breastfed infants in the 5th month was even lower than in the 1st month (4.2% vs. 14.7%). Mothers who sus- tained breastfeeding tended to have parity ≥2, were less educated, housewives and residing in Hong Kong <5 years when compared to FFBF mothers (p<0.009). Husbands had a decisive role on wives initiating breastfeed- ing while health-professionals had an influence on early switching to FFBF (p<0.003). More breastfeeding mothers perceived breastfeeding benefits than FFBF mothers (p<0.03). The Cox proportional hazard model showed that mother’s residency status ≥5-year (HR=2.4), working mothers (HR=1.5) and health-professionals’ opinions (HR=1.5) were associated with an early cessation of breastfeeding (p<0.001). However, strengthening immunity (HR=0.67) and parity ≥2 (HR=0.72) helped sustain breastfeeding (p<0.001). To conclude, the pro- portion of breastfed infants was low in Hong Kong in the early 1990s. Major factors associated with the deci- sion to breastfeed and early cessation of breastfeeding were identified which would help formulate an inter- disciplinary approach for promotion of breastfeeding up-to 6 months and beyond.
Objectives: In this study we investigated the effects of native inulin in formula-fed babies. The influence of inu- lin on the microbial composition, pH, consistency and amount of faeces, and on frequency of defecation was assessed. Methods: In this study a daily dosage of 0.25 g/kg/d was used: 3 weeks of inulin consumption were followed by 3 weeks without or vice versa. The study group consisted of 14 babies with an average age of 12.6 weeks (± 6.4 weeks) and the average intake of inulin was 1.5 (± 0.3) g/d. Results: The consumption of inulin increased the content of Bifidobacterium and Lactobacillus in the faeces of formula-fed babies, without affect- ing the number of Bacteroides or the total anaerobic count. With inulin there was a trend for stools to become softer and for the amount of faeces to increase significantly. Frequency of defecation was not affected by the consumption of inulin. No adverse effects were reported during the periods of inulin consumption. Conclusions: We conclude that, with native inulin, a prebiotic effect can be observed in formula-fed babies. Inulin may there- fore be a useful ingredient in infant formulae.
The risk of malnutrition is high among elderly population, yet few studies have measured indicators of nutri- tional status among Australian aged-care residents. To determine the relationship between nutritional status and bone density, hand grip strength, and the timed-up and go test, in a group of Australian aged-care residents. Anthropometric and biochemical analysis measured in subjects recruited to be part of a six month multivitamin supplementation study. One hundred and fifteen subjects participated (68% female). The mean (SD) age and body weight was 80.2(10.6) years, and 66.5(15.0) kg, respectively. Eleven percent were underweight (body mass index, BMI, ≤20.0kg/m2), and 20% were obese BMI ≥30kg/m2). Low serum 25-hydroxy-vitamin D (25(OH)D, ≤50 nmol/L) concentrations were found among 79% of subjects. After adjustment for body weight, there was an association between serum 25(OH)D and bone density (heel ultrasound) (r=.204, p=.027). Low serum zinc (≤10.7 μmol/L) concentrations were found among 46% of subjects; this group had a slower timed up and go time compared with those with higher zinc concentrations (n=19, 44.6 ± 5.6 seconds vs. n=27, 30.0 ± 3.3 seconds, p=.020). There were no associations between nutritional markers and hand grip strength. In this group, more than 3⁄4 of subjects had low serum 25(OH)D, and 46% had low zinc concentrations. Serum 25(OH)D was associated a lower bone density and zinc with a slower walking time. This indicates that the eld- erly in long term residential care facilities are at high risk for poor nutritional status, potentially increasing mor- bidity and mortality.
The aims of this study were to obtain the most recent representative data for the prevalence of diabetes in adult populations in the World Health Organisation’s South-East Asia and Western Pacific regions and to quantify the contribution of diabetes to the burden of mortality from cardiovascular diseases in these regions. Previous reports indicate that there are 83 million individuals with diabetes in the Asia-Pacific region, but since many of the country-specific estimates were not from nationally representative studies, this figure may not accurately reflect the current burden of diabetes. Information on the prevalence of diabetes was obtained by searching Medline and government health websites. Data were available from 12 countries representing 78% of the total population of the Asia-Pacific region. Six of 10 countries with complete data reported a prevalence of diabetes exceeding those estimates currently cited by the World Health Organization; three of which have also already exceeded the World Health Organization projections for 2030. In the 12 countries in the region with nationally representative data, the prevalence of diabetes ranged from 2.6% to 15.1%. Hazard ratios from the Asia Pacific Cohort Studies Collaboration were used to calculate population attributable fractions for diabetes for fatal cardiovascular diseases in the region. Population attributable fractions ranged from 2% to 12% for coronary heart disease, 1% to 6% for haemorrhagic stroke, and 2% to 11% for ischaemic stroke. Accurate estimates of the prevalence of diabetes are of great importance and standard methods are needed for periodic surveillance across the Asia-Pacific region and elsewhere.
This study examines the relationship between the nutrient intake, including total dietary fiber (TDF) and fat, and the age-adjusted mortality from breast cancer (MBC) in Japanese females during the period from 1948 to 2000. The information for MBC in females was based on the data in Vital Statistics of Japan. Nutritional data were collected from the National Nutrition Survey reports. The data were analyzed by Pearson's correla- tion and a partial correlation, adjusting for the effect of reproductive factors. The time lag was estimated by measuring the strength of the linear relationship set up for a 0-35-year delay in mortality and statistically evaluated by comparing the correlation coefficients. The partial correlation analysis indicated that the indi- vidual intakes of total fat (r=0.688), animal protein (r=0.657), carbohydrate (r=-0.886), and plant protein (r=- 0.770) were significantly (p<0.01) correlated with MBC. Each of these coefficients of correlation changed and reached a maximum value with increasing time lag. The estimated time lag values for the influence of fat, animal protein and TDF were 20-32 years, 19-31 years and 9-35 years, respectively. It is deduced from the results that the increased MBC in Japanese women is related to the long-term effect from the intake of a high- fat, high-animal protein and low-fiber diet typical in the western world.
There are many Oxford Handbooks for Clinicians, but one in the field of Clinical Nutrition has been a long while coming. The present book has small dimensions, but 730 pages worthy of a place in the clinician’s library of practical information. It enunciates the principles and contemporary science on which clinical (and, in large measure, public health) nutrition should be based. It is systematic and comprehensive for nutrients, some bio- active food components, their food sources, dietary reference values and food labelling, with useful and relevant information about diagnostic nutrition and nutrition intervention and support. Clinical situations and disease states in which nutrition is relevant are succinctly and systematically presented. In regard to diabetes, the glycaemic index is introduced briefly, but the appendices to do with food composition persist with a “carbohydrate exchange” table for foods containing 10g carbohydrate – without regard to impact on blood glucose or insulin response. This points to the limitations of a handbook like this, which can encourage prescriptive, disconnected and even irrelevant approaches to health care. However, ultimately, no hand-book can stand alone from a discussive and critical environment for clinical decision- making.
The broader socio-economic and cultural dimensions of clinical nutrition are sometimes lost, but, to its credit, this handbook addresses nutritional needs, methods and intervention in various settings including poverty, if not in development.
The handbook has a definite national context, that of Britain, which limits its use in other health care systems.
By Mark L Wahlqvist
Duo Li is a Professor of Nutrition and Food Safety in the Department of Food Science and Nutrition, College of Biosystem Engineering and Food Science at Zhejiang University in Hangzhou, China. He is the current Director of the Nutrition and Food Safety Center of the Asia Pacific Clinical Nutrition Society, and is a Deputy Director of the Food Science Institute, Zhejiang University. Duo Li was born on 2nd March 1958 in Tianshui, Gansu Province, China, but has since become an Australian citizen, and also a China permanent resident. After he gained a Bachelor’s Degree in Medicine (Lanzhou University, China) in 1982, he taught pharmacology in Wudu Health School, Gansu Province, and Beijing Medical College for Medical professionals, China. He was a Visiting Researcher at the School of Pharmacy, University of Tasmania from 1989-1990. He completed both his MSc (University of Tasmania, Hobart) and PhD in Nutrition and Food Science (RMIT University, Melbourne) in Australia. He was also a research fellow at Deakin University, and a senior research fellow at RMIT University in Melbourne.
He is a co-editor of the Asia Pacific Journal of Clinical Nutrition, and has also served on numerous editorial boards including the Mahasarakham Journal of Science and Technology, Health Review, China Healthcare & Nutrition, and China Food & Nutrition. He is a member of the, Asia Pacific Clinical Nutrition Society, the Nutrition Society of Australia, the Nutrition Society of China, the Chinese Institute of Food Science and Technology, and the American Oil Chemists Society.
He has the served on numerous government boards. He has been a fellow of China National Food and Nutrition Consultation Committee, a Standing committee member of the China Food Safety Consultation Committee, and a member of the Zhejiang Food Safety Experts Consultation Committee. He is currently the Director of the Ethics Committee and a member of the Scientific Board, College of Biosystem Engineering and Food Science, Zhejiang University.
Duo Li discoveries have been largely in the field of lipid nutrition and metabolism. Amongst them he has found that (1) arachidonic acid is present in animal lipocytes, (2) increased dietary intake of clupanodonic acid (22:5n-3) results in reduced platelet volume, (3) vegetarians may have increased platelet activity caused by low dietary n-3 polyunsaturated fatty acid intake, (4) long- term n-3 fatty acid deficiency leads to an increased plasma homocysteine level, (5) metabolism of arachidonic acid can be suppressed by dietary animal fat intake, (6) high meat intake will lead to an increased tissue stearic level, later associated with an increased plasma coagulation factor VII activity. He first reported that (1) 16:3n-3 was found in green vegetables, (2) alpha-linolenic acid and linoleic acid have equivalent effects in reducing blood cholesterol , (3) stearic acid from plants and animals have different effect son blood and lipoprotein lipids, which may be caused by the arrangement of stearic acid and other fatty acids in plants and animal fats among the three available etherification sites present on the backbone of TAG molecules and on other components which are present in fats.
Duo received an Award for the Promotion of Student Nutrition and Health Tasks in 2004 in China; Australian Postgraduate Awards in 1995, 1996 and 1997; a Zhejiang Science and Technology System award from the Science and Technology Association, Zhejiang Province, China; 1st Prize in Natural Science for the paper: “Relationship between platelet phospholipid fatty acid and mean platelet volume in healthy men”, Academic Committee of Natural Science, Zhejiang Province, China.
He has organized or chaired various international scientific conferences such as the International Symposium on the Evolution of Food Safety and Nutrition, in October 2002, in Hangzhou, China; the Joint ZAST/IUNS/WHO workshop on “Current Patterns and Emerging Challenges of Nutrition cuisine and health”, in October 2003, Hangzhou, China; and the Joint International Clinical Nutrition Conference of the International Union of Nutritional Science (8th ISCN-IUNS) and the Asia Pacific Clinical Nutrition Society (5th APCNS), in Oct 2006, Hangzhou, China.
Duo has published more than 150 scientific papers and several books or book chapters. His supervision of many PhD and Masters Students ha increased the capacity of young nutrition investigators in Asia. His research group has integrated research themes on nutrition and food safety in some five areas. The first is food bioactivity (anti-inflammation, anti-diabetes, anti-hypertension, anti- cancer, hypo-blood lipids etc) using whole foods, food ingredients, natural products, foods for health and functional foods, through in vitro studies, animal models and human clinical trials. The secondly is food safety evaluation, with an emphasis on the long term safety of foods. Third, the relationship between non-communicable diseases and habitual dietary intake. The fourth area is the evaluation of novel food sand potential natural nutrient resources, through compositional and physiological studies. Finally, his work examines how nutrients, food ingredients and natural products influence the expression of select genes.
His commitment to nutrition scholarship and capacity building in the Asia Pacific region make him a most worthy recipient of the Asia Pacific Clinical Nutrition Society Award in 2007.
Widjaja Lukito MD PhD Immediate Past President APCNS
There is growing support for the protective role of soluble fibre in type II diabetes. Soluble fibre β-glucan found in cereal products including oats and barley may be the active component. There is evidence of postprandial blunting of blood glucose and insulin responses to dietary carbohydrates when oat soluble fibre is supplemented into the diet but few trials have been carried out using natu- ral barley or enriched barley β-glucan products. The aim of this trial was to investigate the postpran- dial effect of a highly enriched barley β-glucan product on blood glucose, insulin and lipids when given with a high-carbohydrate (CHO) food and a high-CHO drink. 18 lean, healthy men completed a 4 treatment intervention trial comprising (i) high-CHOfood control, (ii) high-CHOfood+fibre, (iii) high-CHOdrink control, (iv) high-CHOdrink+fibre where a 10g dose of barley β-glucan fibre supplement (Cerogen) containing 6.31g β-glucan was added to food and drink controls. There was an increase of glucose and insulin following all 4 treatments. Addition of the β-glucan supplement significantly blunted the glycaemic and insulinaemic responses on the food (p<0.05) but not drink (p>0.05) treatments when compared to controls. The high-CHO breakfasts decreased total, LDL- and HDL-cholesterol from baseline to 60mins postprandially but there were no differential effects of β-glucan treatment on circulating lipids. We conclude that a high dose barley β-glucan supplement can improve glucose control when added to a high-CHO starchy food, probably due to increased gastro-intestinal viscosity, but not when added to a high-CHO beverage where rapid absorption combined with decreased β-glucan concentration and viscosity may obviate this mechanism.
Fifty obese women with a body mass index (BMI) over 25 kg/m2 were randomly allocated into two groups, 25 in each. Group 1, with a mean (±SEM) age of 40.0±2 years, received water soluble calcium hydroxycitrate (HCA) as Garcinia atroviridis. Group 2, with a mean age of 35.6±1.8 years, received placebo. All subjects were recommended a similar diet with 1000 Kcal/day. The trial lasted for 2 months. At baseline the means BMI of Group 1 and Group 2 were 27.5±0.2 kg.m-2 and 26.7±0.5 kg.m-2, respectively. Group 1 lost significantly more weight (2.8 vs. 1.4 kg, p<0.05) and at a greater rate than Group 2 throughout the study. The decrease in their body weight was due to a loss of fat storage as evidenced by a significant decrease in the triceps skin fold thickness. On a short-term basis, HCA in Garcinia atroviridis was an effective for weight management.
To confirm the cytotoxic effect of instant curry containing combined spices on cancer cells in vivo, cancer was induced by transplanting cancer cells to mice, and the development of cancer upon feeding pure curry were ex- amined. The concentration of lipid peroxide in the groups transplanted with cancer cells which were fed with normal feed was 19.6 nM, and it was increased as the amount of pure curry was increased. The concentration of cytochrome P-450 was decreased in the group transplanted with cancer cells which were fed with pure curry and the group without the transplant which were fed with pure curry when compared with the groups which were fed with normal feed. The activity of cytochrome P-450 was decreased as the concentration of cytochrome P-450 was decreased in the groups transplanted with cancer cells. However, it was increased in the groups without cancer cell transplant when over 2% of pure curry was fed. The amount of glutathione was increased in the groups transplanted with cancer cells when over 2% of pure curry was fed. The activities of glutathione peroxidase and glutathione S-transferase were decreased in the groups transplanted with cancer cells which were fed with over 1% of pure curry, and were restored to the level of the group without cancer cell transplant which were fed with normal feed. The superoxide dismutase activity in the groups transplanted with cancer cells was restored to the level of the group without cancer cell transplant which was fed with normal feed when over 1% of pure curry was fed.
Background: The incidence of hyperlipidemia in children is increasing in Japan, but drug therapy for such chil- dren is limited. The ingestion of 4% phytosterols-containing diacylglycerol (PS/DAG) decreases serum total cholesterol and low density lipoprotein cholesterol (LDL-C) concentrations in adults. In the present study, we examined the effect of PS/DAG as part of a diet therapy in pediatric patients with hyperlipidemia. Methods: Pediatric patients with hyperlipidemia with ≥ 5.18mmol/L (200 mg/dL) serum total cholesterol and/or ≥1.70mmol/L (150 mg/dL) triglycerides (N = 22) ingested bread containing PS/DAG (total daily intake, 10g) for 6 months. Blood chemistry was examined prior to and 2, 4, 6 months after the initiation of ingestion, and 4 months after the ingestion period. Results: No significant differences in energy intake or cholesterol intake during the study period were found. After 4 months of ingestion of PS/DAG, LDL-C, lipoprotein(a) [Lp(a)], free fatty acids and total ketone bodies decreased significantly. In seven patients with familial hypercholes- terolemia, total cholesterol and remnant-like lipoprotein particles (RLP)–cholesterol also significantly de- creased in addition to LDL-C and Lp(a). Conclusions: PS/DAG improves serum lipid metabolism in pediatric patients with hyperlipidemia for whom drug therapy is limited, suggesting that PS/DAG may reduce the risk of developing various diseases induced by hyperlipidemia.
A nutritional status survey of Orang Asli (Aboriginal) adults in Lembah Belum, Grik, has been con- ducted involving a total of 138 subjects. Jahai (58.7%) was the main ethnic group as compared to that of Temiar (41.3%). Based on the Body Mass Index (BMI) characteristics, the majority (63.2%) of the respondents were normal, 26.7% underweight and 10.1% were either overweight or obese. However, by using two different indices of waist circumference and waist-to-hip ratio, 1.6% and 10.8% of the total respondents revealed abdominal obesity, respectively. Measurement of mid upper arm muscle circumference (MUAMC) indicated that about 40% showed nutritional insufficiency whereas 0.8% showed over-nutrition. Body fat classification revealed that 53.4% of the respondents were thin, 45.8% at normal level and only 0.8% were obese. Student’s t-test revealed a significant difference in anthropometric indices of body weight, height, MUAMC, triceps, biceps, MUAC, sub-scapular, supra-iliac and body fat according to gender. Meanwhile, analysis of variance showed significant differences in body weight, waist circumference, WHR and body fat according to different age categories. It was also found that those who smoked had lower BMI compared with non-smokers. Alcohol consumption was associated with higher BMI and WHR among the respon- dents. Pearson correlation test between anthropometric measurements and socio-economic and demographic factors showed that ethnic group was the strongest variable.
The purpose of this cross-sectional study was to examine and compare anthropometric measurements and die- tary intake of Taiwanese Chinese females living in Taiwan and Australia, including any effect of length of Aus- tralian residence. Height, weight, waist and hip circumference and percent total body fat were measured and dietary intake estimated using a 7-day record. Participants were Taiwanese females without systemic disease (100 from Sydney metropolitan area, Australia, 97 from Ping-Tung County, Taiwan). Subjects in Australia had similar body mass index (weight-kg/height-m2) and percent total body fat but higher waist and hip circumfer- ence than those in Taiwan (22.9±3.0 vs. 22.8±3.1 kg/m2, p >0.05; 31.4±5.8 vs. 31.0±6.2 %, p >0.05; 76.2±7.5 vs. 72.1±7.3 cm, p = 0.0001; 97.3±6.2 vs. 93.3±6.2 cm, p = 0.0001, respectively), significance unaffected by age adjustment. Total energy intake was higher in Australia (2367±574 vs. 1878±575 Kcal) as was the caloric adjusted intake of carbohydrate and saturated fat, measured as grams (342.8±91.5 vs. 264.9±91.0 g; 30.7±9.1 vs. 23.0±9.1 g) or as percentage of caloric adjusted intake (57.3±1.4 vs. 55.6±2.3 %; 12.1±0.7 vs. 11.2±1.1 %), all p < 0.001, respectively. There was a trend for anthropometric measures to increase in subjects who had lived in Australia greater than 5 years, and they also have 14 times the odds of having a waist circumference greater than 80 cm compared to those living in Australia less than 5 years (95% CI, 1.84, 112.0). The increase in waist circumference and higher energy and saturated fat intake associated with length of residence in Australia for Taiwanese females suggests an increased risk of cardiovascular disease and diabetes.
Many laboratory-based methods exist to estimate body fat, yet few can be rapidly and easily applied to field studies. Bioelectric impedance analysis (BIA) has developed to include portable foot-to-foot systems that can estimate body fat during field studies, but it is unclear if the data they provide are comparable to anthropometric methods traditionally used in large epidemiological fieldwork. This study analysed the reliability and validity of three BIA devices (low, medium, and high cost), from duplicate measures of mass and percentage body fat (%BF) from 20 young Chinese. Comparisons were made to reference values of %BF derived from 38 duplicated anthropometric measurements and the mean of at least 7 regression equations. All three BIA devices were reliable, with intraclass correlation coefficients never below 0.999, whilst both technical errors of measurement and coeffi- cients of variation (expressed as percentages) were below 1%. Validity analysis revealed all three devices significantly overestimated %BF using the standard measurement setting (no correction for athletic status) compared to the reference method: UM-022 (+3.2%, p< 0.01), BF-350 (+2.6%, p< 0.01), and TBF-410 (+2.1%, p< 0.01). When %BF was corrected for athletic status, neither the BF- 350 (+0.3%, p= 0.72), nor the TBF-410 (-0.2%, p= 0.86) produced a %BF that differed significantly from the reference method. It was concluded that these three BIA devices were reliable and could be recommended as valid field measures of mass and %BF in this sample population provided the de- vice allows a correction for athletic status.