Background and Objectives: The 68th United Nations General Assembly declared 2016 the International Year of Pulses. Therefore it is timely to review the current evidence of the benefits of legumes for human health with a focus on Australian sweet lupins. Methods and Study Design: Medline, Pubmed, Cochrane library were searched to identify cross-sectional/epidemiological studies, randomised controlled trials (RCTs) and systematic reviews. Results: The strongest evidence appears to be for links between eating legumes and reduced risk of col- orectal cancer as well as eating soy foods and reduced LDL cholesterol. However, epidemiological studies and RCTs suggest that replacing several meat-based meals a week with legumes can have a positive impact on lon- gevity, diabetes, cardiovascular disease and weight management, potentially via favourable effects on the gut mi- crobiome. Sweet lupins are unique among legumes with one of the highest combined amounts of digestible plant protein (38%) and dietary fibre (30%). Unlike other legumes, their low amount of anti-nutritional factors negates the need for soaking/cooking and they can therefore be eaten uncooked. Sweet lupins may lower blood pressure, improve blood lipids and insulin sensitivity and favourably alter the gut microbiome. There is growing interest in pulses, especially sweet lupins, as ingredients to improve the nutritional value of baked goods (particularly gluten free) and to create novel products to replace meat. Conclusion: Legumes form part of most traditional diets. They, including sweet lupins, can play a useful role in health maintenance.
Background and Objectives: To determine the effect of a low carbohydrate diet and standard carbohydrate counting on glycaemic control, glucose excursions and daily insulin use compared with standard carbohydrate counting in participants with type 1 diabetes. Methods and Study Design: Participants (n=10) with type 1 diabe- tes using a basal; bolus insulin regimen, who attended a secondary care clinic, were randomly allocated (1:1) to either a standard carbohydrate counting course or the same course with added information on following a carbo- hydrate restricted diet (75 g per day). Participants attended visits at baseline and 12 weeks for measurements of weight, height, blood pressure, HbA1c, lipid profile and creatinine. They also completed a 3-day food diary and had 3 days of continuous subcutaneous glucose monitoring. Results: The carbohydrate restricted group had sig- nificant reductions in HbA1c (63 to 55 mmol/mol (8.9-8.2%), p<0.05) and daily insulin use (64.4 to 44.2 units/day, p<0.05) and non-significant reductions in body weight (83.2 to 78.0 kg). There were no changes in blood pressure, creatinine or lipid profile and all outcomes in the carbohydrate counting group were unchanged. There was no change in glycaemic variability as measured by the mean amplitude of glycaemic excursion in ei- ther group. Conclusions: A low carbohydrate diet is a feasible option for people with type 1 diabetes, and may be of benefit in reducing insulin doses and improving glycaemic control, particularly for those wishing to lose weight.
In this study, we investigated the association between food form (mixed vs separated) and eating rate. The exper- iment used a within-subjects design (n=29, young healthy women with normal weight). Test meals (white rice and side dishes) with the same content and volume were served at lunch in a mixed or separated form. The form in which the food was served had significant effects on consumption volume and eating rate; subjects ate signifi- cantly more (p<0.05) when a test meal was served as a mixed form (285 g, 575 kcal) compared to a separated form (244 g, 492 kcal). Moreover, subjects also ate significantly faster (p<0.05) when the test meal was served as a mixed form (22.4 g/min) as compared to a separated form (16.2 g/min). Despite consuming more when the test meal was served as a mixed form than when served as a separated form, the subjects did not feel significantly fuller. In conclusion, we confirmed that meals served in a separated form might lower the eating rate and, moreo- ver, slower eating might be associated with less energy intake, without compromising satiety.
Epidemiological studies indicate lower prevalences of breast and prostate cancers and cardiovascular disease in Southeast Asia where vegetarianism is popular and diets are traditionally high in phytoestrogens. This study as- sessed plasma isoflavones in vegetarian and non-vegetarian Malaysian men according to age. Daidzein, genistein, equol (a daidzein metabolite), formononetin, biochanin A, estrone, estradiol and testosterone were measured by validated liquid chromatography tandem mass spectrometry (LCMSMS). Plasma isoflavone and sex hormone concentrations were measured in 225 subjects according to age (18-34, 35-44 and 45-67 years old). In all age groups, vegetarians had a higher concentration of circulating isoflavones compared with non-vegetarians espe- cially in the 45-67 year age group where all isoflavones except equol, were significantly higher in vegetarians compared with omnivores. By contrast, the 18-34 year group had a significantly higher concentration of daidzein in vegetarians and significantly higher testosterone and estrone concentrations compared with non-vegetarians. In this age group there were weak correlations between estrone, estradiol and testosterone with some of the isofla- vones. This human study provides the first Malaysian data for the phytoestrogen status of vegetarian and non- vegetarian men.
The strong social pressure for thinness in Japanese society has produced a dramatic increase in underweight (body mass index: <18.5 kg/m2) among young women. Being underweight is associated with several negative health outcomes, including nutritional deficiency, osteoporosis, and unfavourable pregnancy outcomes. However, evidence which would help deal with this problem from a public health perspective is scarce. Here, we aimed to identify the dietary characteristics of underweight female university students, particularly those with a desire for thinness. Data on dietary habits and other lifestyle variables, including the desire for thinness, were obtained through a self-administered questionnaire survey conducted at 54 academic institutions in Japan, from which we selected 3634 female students for analysis. The subjects were divided into three groups of normal weight (84.3%), and underweight with (6.4%) or without (9.3%) a desire for thinness. After adjusting for potential confounders, the underweight subjects with a desire for thinness consumed less cereal and rice, whereas those without a desire for thinness consumed more cereal and rice than the normal weight subjects. In addition, those without a desire for thinness consumed less confectionaries, including candies and ice cream, and less fats and oils than the nor- mal weight subjects. These results suggest that dietary habits differ between underweight women with and with- out a desire for thinness. Although both groups require nutritional education to maintain appropriate body weight, underweight women with a desire for thinness require particular attention to improve recognition of their consti- tution and dietary habits.
Children and adolescents tend to lose weight, which may be associated with misperceptions of weight. Previous studies have emphasized establishing correlations between eating disorders and an overestimated perception of body weight, but few studies have focused on an underestimated perception of body weight. The objective of this study was to explore the relationship between misperceptions of body weight and weight-related risk factors, such as eating disorders, inactivity, and unhealthy behaviors, among overweight children who underestimated their body weight. We conducted a cross-sectional, descriptive study between December 1, 2006 and February 15, 2007. A total of 29,313 children and adolescents studying in grades 4-12 were enrolled in this nationwide, cross- sectional survey, and they were asked to complete questionnaires. A multivariate logistic regression using maxi- mum likelihood estimates was used. The prevalence of body weight misperception was 43.2% (26.4% overesti- mation and 16.8% underestimation). Factors associated with the underestimated perception of weight among overweight children were parental obesity, dietary control for weight loss, breakfast consumption, self-induced vomiting as a weight control strategy, fried food consumption, engaging in vigorous physical activities, and sleeping for >8 hours per day (odds ratios=0.86, 0.42, 0.88, 1.37, 1.13, 1.11, and 1.17, respectively). In conclu- sion, the early establishment of an accurate perception of body weight may mitigate unhealthy behaviors.
Background and Objectives: Nutrition is a fundamental component of care of critically ill children. Determin- ing variation in nutritional practices within paediatric intensive care units (PICUs) allows for review and im- provement of nutrition practices. Methods and Study Design: The aim was to survey the nutrition practices and perspectives of paediatric intensivists and dieticians in Asia-Pacific and the Middle East. A questionnaire was de- veloped to collect data on (1) the respondent’s and institution’s characteristics, (2) nutritional assessments and nu- trient delivery practices, and (3) the perceived importance and barriers to optimal enteral feeding in the PICU. Results: We analysed 47 responses from 35 centres in 18 different countries. Dedicated dietetic services were on- ly present in 13 (37%) centres and regular nutrition assessments were conducted in only 12 (34%) centres. In cen- tres with dedicated dieticians, we found greater use of carbohydrate, fat additives and special formulas. Two thirds [31 (66%)] of respondents used total fluids to estimate energy requirements. Only 11 (31%) centres utilized feeding protocols. These centres had higher use of small bowel feeding, acid suppressants, laxatives and gastric residual volume thresholds. When dealing with feed intolerance, they were also more likely to start a motility agent. There was also a lack of consensus on when feeding should start and the use of adjuncts. Conclusions: Nutrition practices and barriers are unique in Asia-Pacific and the Middle East and strongly reflect a lack of die- tetic services. Future effort should focus on developing a uniform approach on nutrition practices to drive paedi- atric critical care nutrition research in these regions.
Background and Objectives: The aim of this study was to evaluate the influence of body composition, especial- ly distribution of body fat, and insulin resistance on nonalcoholic fatty liver disease (NAFLD) in obese children. Methods and Study Design: One hundred obese children (66 boys, 34 girls) with (n=60) and without NAFLD (n=40) were assessed. Anthropometry, laboratory tests, abdominal ultrasonography, and dual energy x-ray ab- sorption metry (DXA) were evaluated in all subjects. Results: Subject age and measurements of liver enzymes, γ- glutamyl transpeptidase (γGT), uric acid, high-density lipoprotein cholesterol, and insulin resistance were signifi- cantly different between the non-NAFLD group and NAFLD group. Body fat and trunk fat percentage were sig- nificantly different between the two groups (p<0.001 and p=0.003), whereas extremity fat percentage was not (p=0.683). Insulin resistance correlated significantly with body fat and trunk fat percentages, age, liver enzymes, γGT, and uric acid in obese children. Multiple logistic regression analysis indicated that insulin resistance and trunk fat percentage significantly affected the development of NAFLD in obese children. Conclusions: Body fat, especially abdominal fat, influences the development of insulin resistance and subsequent NAFLD in obese chil- dren. Therefore, body composition measurement using DXA, in conjunction with biochemical tests, may be bene- ficial in evaluating obese children with NAFLD.
Background and Objectives: Over the past two decades, food environment has changed, and the obesity and overweight rates have increased dramatically in China. Previous studies have suggested an association between food environment and obesity, while most studies were based on the data from developed countries, and few were conducted in developing countries. Methods and Study Design: The current study evaluated the influence of food establishments (distance to and types of grocery store, free market, restaurant, and food stall) on body mass index (BMI) in 348 children aged 6-17 years, surveyed in the 2009 and 2011 China Health and Nutrition Survey in nine provinces. Food establishments were assessed using geographic information system (GIS) data. Weight and height of children were directly measured. Results: Our longitudinal analysis suggested boys in the 2nd quar- tile of the proximity to the nearest grocery store had higher BMI (by 1.6 kg/m2, 95% CI, 0.07 to 3.24) as com- pared to those in the 1st quartile, while girls in higher quartiles had lower BMI (-1.78 kg/m2, 95% CI: -3.38 to - 0.18, 2nd quartile; -1.62 kg/m2, 95%: -3.22 to -0.01, 3rd quartile) as compared to those in the 1st quartile. Boys and girls in the 2nd quartile of the proximity to the nearest Chinese restaurant had lower BMI (-1.69 kg/m2, 95% CI: - 3.27 to -0.12; -1.76 kg/m2, 95% CI: -3.26, -0.27, respectively) as compared to those in the 1st quartile. Conclu- sions: Food environment may affect children’s BMI in China, while the association is inconsistent with previous studies. Further research is needed.
The objective of this study was to determine iodine nutrition status and whether iodine status differs across salt intake levels among a sample of women aged 18-45 years living in Samoa. A cross-sectional survey was com- pleted and 24-hr urine samples were collected and assessed for iodine (n=152) and salt excretion (n=119). The median urinary iodine concentration (UIC) among the women was 88 μg/L (Interquartile range (IQR)=54-121 μg/L). 62% of the women had a UIC <100 μg/L. The crude estimated mean 24-hr urinary salt excretion was 6.6 (standard deviation 3.2) g/day. More than two-thirds (66%) of the women exceeded the World Health Organiza- tion recommended maximum level of 5 g/day. No association was found between median UIC and salt excretion (81 μg/L iodine where urinary salt excretion ≥5 g/day versus 76 μg/L where urinary salt excretion <5 g/day; p=0.4). Iodine nutrition appears to be insufficient in this population and may be indicative of iodine deficiency disorders in Samoan women. A collaborative approach in monitoring iodine status and salt intake will strengthen both programs and greatly inform the level of iodine fortification required to ensure optimal iodine intake as pop- ulation salt reduction programs take effect.
Background and Objectives: To assess the distribution of serum ferritin, serum soluble transferrin receptor and body iron among girls and women by age and anaemia. Methods and Study Design: Serum ferritin, serum solu- ble transferrin receptor and high sensitive C-reactive protein of 1625 and 1372 women in general and anaemic were measured in the National Health and Nutrition Survey commenced in 2010. Results: The distributions of serum ferritin, serum soluble transferrin receptor and body iron for 6-11-y, 12-17-y, 18-44-y, 45-59-y and ≥60-y subgroups were significantly different. Both in population-representative women and those anaemic, the iron sta- tus of 18-44-y women was the lowest and that of 12-17-y girls the second lowest. The iron status of anaemic women was lower than that in representative women at ages 12-17 y, 18-44 y, 45-59 y and ≥60 y. Conclusion: Iron status in women of different ages and anaemic had different distributions, but consistently lower than that of population-representative women. The observed iron status of Chinese urban women supports program planning for iron nutrition promotion in women. Iron status information is also needed for men and to understand the path- ogenesis which may be related to intake or loss.
The estimation of calories in foods is central in the maintenance of body weight and energy regulation. Conven- tional laboratory analysis using bomb calorimetry to determine calorie content is expensive and time-consuming. There is a need to explore alternative techniques for calorie estimation that requires less processing and resources. The potential of using near infrared spectroscopy for calorie measurements with Calorie AnswerTM was evaluated in this study. The caloric content of 105 different foods was measured, and compared against values reported on nutrition labels. The average percentage relative standard deviation for triplicate measurements was 1.7% for all foods. The percentage difference between stated and measured calories was modest, at 4.0% for all foods. Stated and measured calorie contents were significantly and highly correlated (R2=0.98, p<0.001). The use of near infra- red spectroscopy, using Calorie AnswerTM, is a rapid, reproducible and cost-effective way of measuring calorie content in a diverse range of foods. Its application in many parts of Asia Pacific and other emerging nations will generate much needed information on the calorie content of complex foods consumed by people living in these regions.
Background and Objectives: We aimed to investigate the prevalence of maternal health problems in the post- partum period and their association with traditional Chinese postpartum diets and behaviours in three selected re- gions in Hubei province, China. Methods and Study Design: A cross-sectional study was conducted in urban, suburban and rural areas. A total of 2100 women who had given birth to full-term single infants in the past two years were enrolled. Their postpartum diet, personal behaviours, and health problems were surveyed by trained interviewers. Results: During the puerperium women consumed plentiful eggs, fish, poultry and meats; however, fruit, vegetable and milk consumption were limited. A high prevalence of health problems potentially related to pregnancy and the puerperium were found. At least one such problem was reported by 59.3% of women. The pu- tative postpartum problems were backaches (29.6%), arthralgia or leg clonus (12.7%), breast problems (19.6%), constipation (18.7%), haemorrhoids (11.7%), dizziness or headaches (14.8%), anaemia (10.0%). Multiple logistic regression analysis showed that leafy vegetable intake and frequent recipe change in the puerperium were posi- tively associated with less anal diseases. Bathing or hair washing did not increase the risk of maternal infection as belief would have suggested. However, bathing was a risk factor for backache or arthralgia, and tooth brushing was a risk factor for bleeding gums. Excessive housework was a risk factor for anal diseases and disordered uter- ine involution. Conclusion: Postpartum maternal health problems were prevalent in Hubei province. These were in part associated with postpartum traditional Chinese diets and behaviours.
Background and Objectives: This study evaluated the associations between the characteristics of high school students and irregular breakfast consumption and explored the association with knowledge regarding diet and die- tary education in a community in Japan. Methods and Study Design: A cross-sectional survey using a self- administered questionnaire was conducted in 2007 among all the high school students in the second grade in Ima- ri, Saga. Data for 318 male and 292 female students were analyzed. Irregular breakfast consumption was defined as consuming breakfast three times or less in a week. The associations between the characteristics of students and irregular breakfast consumption were assessed using logistic regression with adjustments for sex and school. Re- sults: Among male students, a strong association between the consumption of juice or pop and irregular breakfast consumption was observed (OR comparing “≥2 servings” vs “rarely”=8.97, 95% CI=2.99–26.9). The associations with wake times and bed times were strong among male students, and the association with regular bowel move- ments was strong among female students. Students who had knowledge of regional agricultural and livestock products were more likely to consume breakfast regularly, and this association was significant among female stu- dents (OR=2.89, 95% CI=1.23–6.82). Significant associations were also observed with the consumption of snacks, and traditional greeting before meals. Conclusions: Several characteristics, including specific knowledge, were associated with the irregular consumption of breakfast. The results are of interest to policy makers, nutrition spe- cialists, and educators working to enhance regular breakfast consumption among students.Background and Objectives: This study evaluated the associations between the characteristics of high school students and irregular breakfast consumption and explored the association with knowledge regarding diet and die- tary education in a community in Japan. Methods and Study Design: A cross-sectional survey using a self- administered questionnaire was conducted in 2007 among all the high school students in the second grade in Ima- ri, Saga. Data for 318 male and 292 female students were analyzed. Irregular breakfast consumption was defined as consuming breakfast three times or less in a week. The associations between the characteristics of students and irregular breakfast consumption were assessed using logistic regression with adjustments for sex and school. Re- sults: Among male students, a strong association between the consumption of juice or pop and irregular breakfast consumption was observed (OR comparing “≥2 servings” vs “rarely”=8.97, 95% CI=2.99–26.9). The associations with wake times and bed times were strong among male students, and the association with regular bowel move- ments was strong among female students. Students who had knowledge of regional agricultural and livestock products were more likely to consume breakfast regularly, and this association was significant among female stu- dents (OR=2.89, 95% CI=1.23–6.82). Significant associations were also observed with the consumption of snacks, and traditional greeting before meals. Conclusions: Several characteristics, including specific knowledge, were associated with the irregular consumption of breakfast. The results are of interest to policy makers, nutrition spe- cialists, and educators working to enhance regular breakfast consumption among students.
Background and Objectives: Screen time among youth has been increasingly recognized as a public health problem because of its link with obesity. This has been demonstrated in many studies conducted in developed countries but few studies have addressed the problem in developing countries, despite an increase literature about the emergence of obesity and a greater access to screen devices in a country like Vietnam. Our study aimed at as- sessing screen time and its relationship with BMI in adolescents of Ho Chi Minh City (HCMC), Vietnam. Meth- ods and Study Design: In a cross-sectional study of 2024 junior high school students aged 11-14 of HCMC, stu- dents were measured for BMI and questioned on time spent watching television/Video/DVD or using computer for fun. High users were defined as time ≥2 h/d. International Obesity Task Force BMI cutoffs were used to de- fine overweight and obesity. Results: Adolescents spent 2.2 h/d in screen time, with higher values for boys than girls (p<0.001). 53.8% of the respondents were high users. Time spent using computers for fun increased with age, and with the household wealthy index. The overall prevalence of overweight and obesity was 21.1%. Using multiple logistic regression, overweight and obesity was higher in boys (adjusted OR=2.66, 95% CI: [2.06; 3.44], p<0.001) and in children aged 11-12 who had a screen time ≥2 h/d (adjusted OR=1.48, 95% CI: [1.09; 1.99], p<0.02). Conclusions: In HCMC, a majority of adolescents spent ≥2 h/d on screen time. High screen time is as- sociated with an increased prevalence of overweight and obesity in young adolescents. Public health intervention programs are needed to reduce screen time among youth.
To examine the association between socioeconomic status (SES) and adolescent alcoholic beverage preferences and the associated drinking patterns in China. The study used cross-sectional data collected from 136 junior or senior high schools, using a self-administered questionnaire. A total number of 7,075 subjects of drinking stu- dents were selected from three metropolises (Beijing, Shanghai, and Guangzhou) via a two-stage stratified sam- pling method. Among the adolescent drinkers, 87.8% (95% CI: 86.5-89.0) reported that they drunk alcohol during the past years preceding the study, while 42.4% (95% CI: 40.4-44.4) of the subjects stated that they had drunk alcohol during the past 30 days. There were gradual increases in the usual quantity (>1 Standard Drink, SD) of alcoholic beverages with increasing SES, with highest rates reported by the high-level SES. Beer and grape wine were the most widely consumed alcoholic beverage, regardless of SES. Our findings suggest that high-level SES students have an increasing prevalence of drinking behaviour. Their confirmation by future studies which extend the sampling regions is required to further the prevention of adolescent alcohol abuse in China.
Background and Objectives: Alcohol consumption has a relatively large impact on energy intake in drinkers, and several studies reported different dietary habits from non-drinkers. However, few studies have investigated the influence of alcohol consumption on the validity of the Food Frequency Questionnaire (FFQ). To investigate its influence, we conducted a validity test in a population with high alcohol consumption. Methods and Study Design: The study subjects were 66 residents living on an island in the south-western part of Japan. We conduct- ed the FFQ and 12-day-weighed dietary records (12d-WDRs) in each 3 day of each 4 season. We calculated Pear- son correlation coefficients (CCs) and agreement rates according to quartile classification after adjusting for en- ergy. Results: The intake energy (kcal) estimated from 12d-WDRs and FFQ was 1,641 and 1,534 in women, and 2,093 and 1,979 in men, respectively. The cumulative percentage contribution of the alcohol energy was 6.7% in men. De-attenuated, log-transformed Pearson’s median CCs between the nutrients quantified with the 12d-WDRs and FFQ were 0.51 in women and 0.38 in men. The CCs for carbohydrate and saturated fatty acids intake of men were lower than those in the previous Tokai study using the same FFQ. The findings in agreement rates were consistent with the Tokai study. Conclusion: This study suggested that the FFQ can be used for epidemiological studies using categorical comparisons in this population, although the underestimation of carbohydrates and other nutrients in the FFQ should be taken into consideration.
Background and Objectives: Cultural and/or environmental barriers make the assessment of dietary intake in rural populations challenging. We aimed to assess the accuracy of a meal recall questionnaire, adapted for use with impoverished South Indian populations living in rural areas. Methods and Study Design: Dietary data col- lected by recall versus weighed meals were compared. Data were obtained from 45 adults aged 19-85 years, liv- ing in rural Andhra Pradesh, who were recruited by convenience sampling. Weighed meal records (WMRs) were conducted in the household by a researcher aided by a trained field worker. The following day, field workers conducted a recall interview with the same participant. Eight life size photographs of portions of South Indian foods were created to aid each participant’s recall and a database of nutrients was developed to calculate nutrient intake. Pearson correlations were used to assess the strength of associations between intake of energy and nutri- ents calculated from meal recalls versus WMRs. Least products regression was conducted to examine fixed and proportional bias. Bland-Altman plots were constructed to measure systematic or differential bias. Results: Significant correlations were observed between estimates for energy and nutrients obtained by the two methods (r2=0.19-0.67, p<0.001). No systematic bias was detected by Bland-Altman plots. Recall method underestimated the intake of protein and fat in a manner proportional to the level of intake. Conclusions: Our culturally adapted meal recall questionnaire provides an accurate measure for assessment of the intake of energy, macronutrients and some micronutrients in rural Indian populations.
Background and Objectives: MC4R (melanocortin-4 receptor) gene polymorphisms have been associated with serum triglycerides (TG) in Caucasians and Japanese, but no reports are available Chinese. The purpose of this study was to find whether there was an association of rs17782313 polymorphisms at the MC4R gene with serum TG in elderly Chinese. Methods and Study Design: 2,012 over 40 years participated in a cross-sectional study in which their body mass index (BMI), TG, high density lipoprotein-cholesterol (HDL-C), and MC4R rs17782313 polymorphisms were determined. Results: For women, carriers of the T/T genotype had significantly lower se- rum TG than those with C/C genotype (p=0.006). Carriers of the C/C genotype of this polymorphisms exhibited significantly lower fasting HDL-C levels compared with T/T and T/C genotypes (p=0.025), and increased glyco- sylated hemoglobin (HbA1c) (p=0.043), but no change in blood pressure. Higher serum TG in carriers of the C/C genotype of MC4R gene remained stable after adjustment for age, smoking, drinking, BMI, waist circumference (WC) and three or more components of the metabolic syndrome (MS) by multivariable linear regression (p=0.01) in women. The carriers of the C/C genotype of MC4R gene showed significantly greater odds ratio for TG than T/C and T/T genotypes, even when adjusted for age, smoking, drinking, BMI and WC in women. Conclusions: The rs17782313 C/C genotype is associated with higher TG levels in older Chinese women.
Background and Objectives: Malnutrition is highly prevalent in Malaysian dialysis patients and there is a need for a valid screening tool for early identification and management. This cross-sectional study aims to examine the sensitivity of the Dialysis Malnutrition Score (DMS) and Malnutrition Inflammation Score (MIS) tools in predict- ing protein-energy wasting (PEW) among Malaysian dialysis patients. Methods and Study Design: A total of 155 haemodialysis (HD) and 90 peritoneal dialysis (PD) patients were screened for risk of malnutrition using DMS and MIS and comparisons were made with established guidelines by International Society of Renal Nutri- tion and Metabolism (ISRNM) for PEW. Results: MIS cut-off score of ≥5 indicated presence of malnutrition in all patients. A total of 59% of HD and 83% of PD patients had PEW by ISRNM criteria. Based on DMS, 73% of HD and 71% of PD patients exhibited moderate malnutrition, whilst using MIS, 88% and 90%, respectively were malnourished. DMS and MIS correlated significantly in HD (r2=0.552, p<0.001) and PD (r2=0.466, p<0.001) pa- tients. DMS and MIS had higher sensitivity values in PD (81% and 82%, respectively) compared to HD (59% and 60%, respectively) patients. Conclusions: The MIS cut-off scores for malnutrition classification were established (score ≥5) for use amongst Malaysian dialysis patients. Both DMS and MIS are valid tools to be used for nutri- tion screening of dialysis patients especially those undergoing peritoneal dialysis. The DMS may be a more prac- tical and simpler tool to be utilized in the Malaysian dialysis settings as it does not require laboratory markers.
Subacute combined degeneration of the spinal cord (SCD) is often found in vitamin B-12 deficiency and typically shows hyperintensity on T2-weighted images of the lateral and posterior columns. The purpose of the study was to evaluate the use of conventional magnetic resonance examination in diagnosing SCD. Thirty-six patients were clinically confirmed and retrospectively analyzed; conventional spine MRIs were available for all patients and eight of them had contrast enhancement MRIs. 19 out of 36 patients showed abnormal signal intensity on T2 weighted images with a sensitivity of 52.8%, among which 18 in the posterior aspect of the spinal cord and 1 in the anterior horn of the thoracic spinal cord The spinal cord abnormalities were seen at the cervical spine in 12 patients (33.3%) and at the thoracic spine in the other 7 patients (19.4%). Axial T2-weighted images showed symmetric linear T2-hyperintensity as an “inverted V” at the cervical spinal cord in 5 patients, which has been reported as a typical sign of SCD. For patients with thoracic spinal cord abnormalities, the bilateral paired nodular T2-hyperintensity looked like “binoculars” at the thoracic spinal cord. Only one out of the eight patients showed slight enhancement after injection with contrast agent. All the 36 patients reported clinical improvement after appropriate vitamin B-12 treatment. The two follow-up spine MRIs showed a decreased extent of the lesion. Therefore, conventional MRI is useful in the diagnosis and management of SCD caused by vitamin B-12 deficiency.
This cross-sectional study (February 2012 to March 2013) was conducted to estimate daily salt intake and basic characteristics among 793 community-dwelling participants at high risk of cardiovascular disease (Framingham risk score >15%), who had visited diabetes or hypertension clinics at health centres in the Muang district, Chiang Rai, Thailand. We performed descriptive analysis of baseline data and used an automated analyser to estimate the average of 24-hour salt intake estimated from 3 days overnight urine collection. Participants were divided into two groups based on median estimated daily salt intake. Mean age and proportion of males were 65.2 years and 37.6% in the higher salt intake group (≥10.0 g/day, n=362), and 67.5 years and 42.7% in the lower salt intake group (<10.0 g/day, n=431), respectively (p=0.01, p<0.01). The higher salt intake group comprised more patients with a family history of hypertension, antihypertensive drug use, less ideal body mass index (18.5-24.9), higher exercise frequency (≥2 times weekly) and lower awareness of high salt intake. Among higher salt intake partici- pants, those with lower awareness of high salt intake were younger and more often had a family history of hyper- tension, relative to those with more awareness. Our data indicated that families often share lifestyles involving high salt intake, and discrepancies between actual salt intake and awareness of high salt intake may represent a need for salt reduction intervention aiming at family level. Awareness of actual salt intake should be improved for each family.
Background and Objectives: Compared with total parenteral nutrition (TPN), enteral nutrition is more suitable for patients post-operatively. Our aim was to determine the safety and feasibility of early enteral nutrition (EEN) using a jejunum feeding tube in neonates after undergoing a partial gastrectomy. Methods and Study Design: This was a retrospective review of 46 patients who underwent partial gastrectomies for gastric perforation in our hospital. These patients were categorized into two groups (EEN group [n=24 patients], a jejunal feeding tube was inserted during surgery; and a control group [n=22 patients], a jejunal feeding tube was not placed). Differences in operative time, time to first defecation post-operatively, time to first oral feeding post-operatively, length of hospital stay post-operatively, nutrition indices, and post-operative complications (died due to septic shock, cho- lestasis, pneumonia, abdominal distension, and diarrhea) were reviewed. Results: There were no significant dif- ferences in the operative time and the time to first oral feeding post-operatively between the two groups; however, the time to first defecation post-operatively in the EEN group and the hospital length of stay post-operatively for the EEN group were significantly shorter than the control group. The levels of albumin, retinol binding protein, and prealbumin were not significantly different between the two groups pre-operatively and 14 days post- operatively. The incidence of cholestasis and abdominal distention in the EEN group was significantly lower than the control group. Conclusion: EEN using a jejunal feeding tube in neonates who have undergone a partial gas- trectomy for gastric perforation is safe, easy, and has fewer complications than TPN.
This study aimed to investigate the effects of parenteral nutrition (PN) administration of amino acids (AA) on physical changes among very low birth weight infants in a local hospital setting in Malaysia. A retrospective study was carried out at a hospital in Malaysia. Records of neonates prescribed PN in the neonatal unit in 2012 were screened for eligibility. A total of 199 premature neonates received PN support in the year 2012 and, of these, 100 fulfilled the inclusion criteria. The median value of AA intake on the first day of PN was 2.00 (<28 weeks group); 1.00 (28-31 weeks group) and 0.75 (>31 weeks group). Neonates in the <28 weeks group were more likely to receive AA at an earlier time and higher initial dose compared with the other age groups. The study also found that there was no statistically significant difference in the dose of AA on the first day of PN ad- ministration and that the significant variations in nutritional parameters among the subjects did not lead to differ- ences in physical outcomes. This study identified that when PN is provided in the local hospital setting, it is likely that the current nutritional practices are inadequate to achieve the standard growth recommendations. Our find- ings call for a need to optimize AA and calorie intake since growth restriction is a morbidity which will affect the infants’ growth and development. Current prescriptions for PN in this hospital need to be reviewed in order to improve patient outcomes.
Background and Objectives: Folic acid (400 μg/d) taken during the periconceptional period reduces neural tube defect (NTD) risk by >75%. Achieving red cell folate (RCF) or plasma folate (PF) >905 nmol/L and >35 nmol/L, respectively, has been associated with a low risk of NTDs. We determined whether daily consumption of folic ac- id fortified milk increases blood folate concentrations to levels associated with a low risk of NTDs in Singapore- an women of childbearing age. Methods and Study Design: In this double-blind placebo-controlled trial, 70 non-pregnant women (21-35 y) were randomly assigned to receive fortified milk (FM) powder providing 400 μg folic acid per day or unfortified placebo milk (PM) powder for 12 weeks. Blood samples were collected at base- line and at 6 and 12 weeks. Results: At 12 weeks, mean (95% CI) RCF and PF concentrations were 376 (240, 512) and 39 (26, 51) nmol/L higher in the FM group compared with the PM group (p<0.001). Of the women re- ceiving FM, 71% (n=25) and 86% (n=30) achieved a RCF and PF associated with a very low risk of NTDs, re- spectively. Conclusion: Folic acid fortified milk increased blood folate concentrations in women of childbearing age to levels associated with a reduced risk of an NTD-affected pregnancy.
Background and Objectives: Vitamin D deficiency is associated with a variety of chronic metabolic diseases. In vitro and animal studies suggest that vitamin D may play a crucial role in obesity and related metabolic disorders. Limited evidence regarding vitamin D deficiency exists within the Chinese population. The aims of the present study were to assess whether supplementation with vitamin D would improve metabolic indices in a middle-aged urban Chinese population. Methods and Study Design: We designed a randomized placebo controlled trial in- volving 126 metabolic syndrome sufferers with vitamin D deficiency, allocated to receive either a daily oral tab- let contain 700 IU vitamin D or a matching placebo. Metabolic indices including body mass index, plasma glu- cose, lipid profile and other parameters were measured in subjects who completed a 12 months intervention trial. Results: There were significantly higher serum 25(OH)D and lower serum parathyroid hormone in vitamin D treatment group after the 12 months intervention, but no significant effect was observed for the metabolic varia- bles which included body mass index, blood pressure, blood glucose and lipids in both treatment and control groups. Conclusions: Correction of hypovitaminosis D did not improve the metabolic syndrome in this urban Chinese cohort. Further studies are warranted in order to elucidate the cause-effect relation between vitamin D status, obesity and related metabolic disorders.