Iodine deficiency is the most common preventable cause of brain damage with more than 2 billion people from 130 countries at risk. The global problem of iodine deficiency has been redefined by a readily transmitted popula- tion concept, with an easy acronym – the concept of the iodine deficiency disorders (IDD) – referring to all the ef- fects of iodine deficiency in a population, that can be totally prevented by correction of iodine deficiency with special emphasis on brain damage and not just to goitre and cretinism (1983). This was followed by the creation of the International Council for Control of Iodine Deficiency Disorders (ICCIDD) supported by WHO and UNI- CEF with 700 multidisciplinary professionals from more than 100 countries, committed to providing technical as- sistance to national programs for the elimination of IDD (1986). The WHO policy of Universal Salt Iodization (USI) has been widely adopted which requires iodization of all food for human and animal consumption by the use of iodized salt (25-40 mg I/kilo). Simple practical methods for monitoring – by the measurement of salt io- dine and urine iodine were developed and promoted on a large scale with the technical assistance of the ICCIDD.
The World Health Organization reported that inappropriate feeding in children is responsible for one-third of the cases of malnutrition. This cross-sectional study aimed to determine the prevalence of malnutrition and identify the relationship between feeding practices and malnutrition in children below 5 years, in 7 remote and poor coun- ties of China. A sample of 2201 children and 1978 caregivers were obtained with multistage cluster random sam- pling. A survey about feeding practices among the caregivers was implemented using a structured questionnaire, and the health status of children was evaluated using anthropometric measurements. We found 5 problems: first, high prevalence of stunting, underweight and wasting in children below 5 years old (19.3%, 13.1% and 5.5%); second, short duration of breastfeeding for children below 36 months; third, low prevalence of exclusive breast- feeding among children below 6 months of age and continued breastfeeding to 1 year (17.5% and 32.2%). Fourth, although most of the infants (81.1%) between 6 and 8 months of age were given complementary foods, some of the 6- to 8-month-old infants did not receive any complementary foods. Last, a higher prevalence of stunting among Chinese children who had never been breastfed, who had been breastfed for less than 1 year, or had been fed with semi-solid foods of poor quality. Therefore, we suggest that more programs to increase caregivers' feed- ing knowledge and practices be conducted, to improve the health of children in remote and poor areas in China.
Early childhood malnutrition has been associated with delayed development. Limited data exist however about the timing of developmental delay early in life. We assessed motor milestone (MM) achievement using the World Health Organization’s windows of achievement for gross motor milestones. We performed secondary analysis of baseline data of 158 Vietnamese children aged 5-18 months from a randomized community intervention trial. Median age of motor milestone achievement was compared to WHO reported medians. Multivariate logistic re- gression was used to identify socioeconomic, anthropometric and dietary factors associated with motor milestone achievement during the windows of achievement. Thirty four per cent of the children were stunted. Median age of MM achievement of Vietnamese children lagged by 2.4-3.7 months, compared to the WHO median for all MMs. Greater length-for-age increased the odds for walking with assistance, standing alone and walking alone by more than 3 times. Greater weight-for-age increased the odds by 3.6 for hand-and-knees crawling. Likewise, frequency of daily complementary feeding raised the odds by 3.6 for standing with assistance. In this first application of WHO windows of achievement in Viet Nam, pre-schoolers achieved motor milestones later than WHO reported median age. High prevalence of stunting and association of length-for-age with motor milestone achievement un- derscore the importance of addressing chronic malnutrition to optimize children’s growth and development.
Several studies show that intrauterine nutrition restriction is associated with vascular disease. Animal studies have shown that atherosclerosis can be affected by a constrained intrauterine diet, but this relationship in humans is controversial. The purpose of this study was to investigate the relationship between maternal intake during pregnancy and carotid intimal media thickness (CIMT). We measured CIMT in 565 twenty year old young adults whose mothers, while pregnant, participated in a nutritional study during 1989-1990 at two hospitals in Chiang Mai, Thailand. Maternal diet during pregnancy was assessed by two methods in each trimester, namely, the 24 hours food recall method and the food frequency method. Carotid intimal media thickness was greater in males and participants who showed higher blood glucose, higher body mass index and higher systolic blood pressure. Maternal protein intake during the first trimester was negative correlated with thickness of CIMT (p=0.02). The mean CIMT of participants whose mothers were in the lowest quarter of the distribution of protein intake in the first trimester was 0.45 mm (95% confidence interval (CI): 0.44-0.46) more than that of those whose mothers were in the highest quarter of the distribution (0.43 mm 95% CI: 0.42-0.44). In conclusion, lower maternal pro- tein intake during early pregnancy may increase CIMT in adolescents.
This study investigates the dynamic shifts in snacking behaviors and patterns in China. Using four waves (1991, 2004, 2006, and 2009) from the China Health and Nutrition Survey (CHNS), with full socioeconomic and demo- graphic data and 3-day, 24-hour dietary recall data, 45,402 individuals age two and older were studied. Multiple logistic regressions were performed to examine the association of social-demographic factors on snacking behav- iors. Results show that snacking prevalence, frequency of daily snacking occasions, and percentage of total daily energy intake (EI) from snacks increased significantly across all ages between 1991 and 2009, with a dramatic in- crease after 2004. Snacking was much more prevalent among children and higher-income, urban, and educated populations over time. Evening was the preferred snacking occasion, and the proportion of total daily EI from snacks varied between 4.1% and 12.3% for all snackers. Fruits, grains, and beverages were the most popular snacks and the highest contributors to snacking EI over all age groups. A marked transition from a tradition of two or three meals per day toward meals combined with snacks is underway. Further research is needed to de- velop a better understanding of the nutritional implications of Chinese snacking behaviors.
The evidence for a relationship between dietary patterns and uric acid concentrations is scanty. Here, we used a validated food frequency questionnaire for an ethnic Chinese population in Taiwan to investigate the relationship between dietary patterns and uric acid concentrations. A cross-sectional study on 266 adults, who were inter- viewed with a 38-item food frequency questionnaire, was conducted and serum uric acid levels were measured. Three dietary patterns were derived from the questionnaire by exploratory factor analysis. Participants in the higher vegetable and fruit pattern quartiles were more likely to have a lower uric acid concentration (6.5 for the first, 5.7 for the second, 6.0 for the third, and 6.0 mg/dL for the fourth quartile, p = 0.030). For uric acid-prone patterns, as the quartiles increased, the adjusted mean uric acid concentrations increased significantly (5.88, 5.93, 5.99 and 6.38 mg/dL for each quartile, respectively, p = 0.04). However, the significance level was attenuated af- ter adjusting for additional confounding factors. In conclusion, three dietary patterns were identified for ethnic Chinese in Taiwan, and the relationship between these dietary patterns and uric acid was not significant after ad- justment.
With modernization, the Philippines has experienced increasing rates of obesity and related cardiometabolic dis- eases. Studying how risk factors cluster in individuals may offer insight into cardiometabolic disease etiology. We used cluster analysis to group women who share the following cardiometabolic biomarkers: fasting triglyc- erides, HDL-C and LDL-C, C-reactive protein, systolic and diastolic blood pressure, homeostasis model assess- ment of insulin resistance, and fasting glucose. Participants included 1,768 women (36-69 years) in the Cebu Longitudinal Health and Nutrition Survey. We identified five distinct clusters characterized by: 1) low levels of all risk factors (except HDL-C and LDL-C) or “healthy”; 2) low HDL-C in the absence of other risk factors; 3) elevated blood pressure; 4) insulin resistance; and 5) high C-reactive protein. We identified predictors of cluster membership using multinomial logistic regression. Clusters differed by age, menopausal status, socioeconomic status, saturated fat intake, and combinations of overweight (BMI >23) and high waist circumference (>80 cm). In comparison to the healthy cluster, overweight women without high waist circumference were more likely to be in the high CRP cluster (OR=2.26, 95% CI=1.24-4.11), while women with high waist circumference and not overweight were more likely to be in the elevated blood pressure (OR=2.56, 95% CI=1.20-5.46) or insulin resis- tant clusters (OR=4.05, 95% CI=1.39-11.8). In addition, a diet lower in saturated fat uniquely increased the like- lihood of membership to the low HDL-C cluster. Cluster analysis identified biologically meaningful groups, pre- dicted by modifiable risk factors; this may have implications for the prevention of cardiometabolic diseases.
Pacific children and adolescents are burdened with higher prevalences of obesity compared to other groups in New Zealand. Previous research shows Pacific young people purchase their lunch food items significantly more than other groups. The aim of this study is to describe school lunch food consumption patterns and the influences on these among low-income Pacific adolescents and their parents. Using mixed-methodology design; a self- completion questionnaire was administered to 4216 students who participated in the New Zealand arm of the Obesity Prevention In Communities (OPIC) project. Thirty Pacific households (33 adolescents and 35 parents) were interviewed in the qualitative phase of the study. Results found a greater proportion of Pacific students pur- chased school food items compared to other ethnic groups. Purchasing school food was related to having higher amounts of daily food money (≥NZD 6-15) and this was associated with increased quantities of soft drink con- sumption and after-school food purchasing of high-fat, high-sugar snack foods. There were no differences in school food purchasing behaviour by Pacific weight status (n=2485), with both Healthy weight (67.6%) and Obese students (66.9%) sourcing lunch from school canteens or shops outside of school rather than from home. Time-constrained parents confirmed convenience, poverty compensation and valuing students’ independence as three reasons for choosing to make money available for students to purchase lunch food items. The social effects of poverty affect the health-promoting behaviours of Pacific communities in New Zealand. Social policies that decrease social inequities should be the intervention priority.
Environmental and genetic factors influence serum total homocysteine (tHcy), a risk factor for vascular diseases. The gene polymorphism of methylenetetrahydrofolate reductase (MTHFR) is reported to be a genetic factor for influencing tHcy. However, it is not clear whether MTHFR polymorphism influences tHcy in the younger gen- eration. To investigate the influence of MTHFR polymorphism on vascular disease risks in young Japanese fe- males, we determined dietary intakes, serum folate and tHcy, and examined the influence of MTHFR 677C>T polymorphism in healthy junior and high school students (n=192, 12-18y). The relationships between MTHFR polymorphism and folate intake, serum folate or tHcy were investigated by dividing participants into CC, CT and TT types. Among individuals with the TT genotype, folate and tHcy levels were significantly lower (p<0.05) or higher (p<0.0001), respectively, than in those with the other genotypes; although there were no significant dif- ferences in the intake of folate among genotypes. In addition, a significant inverse correlation between folate and tHcy (p<0.05) was noted in all genotypes, even in young females, so far not examined in Asian populations. Therefore, MTHFR genotypes were proven to be a significant determinant for folate and tHcy concentrations. However, the association of increased folate intake with lower tHcy concentration, even in cases of the mutation TT type, indicates the importance of folate intake in young Japanese females for early detection of risk, as well as the prevention of vascular diseases.
The metabolic syndrome is a cluster of abnormalities characterized by obesity, impaired glucose metabolism, hy- pertension or elevated blood pressure, and dyslipidemia. The aim of this study was to investigate the association of the adiponectin gene (ADIPOQ) +45 T > G polymorphism with the metabolic syndrome among Han Chinese in Sichuan province of China. A case-control design was used including 116 patients with the metabolic syn- drome and 108 unrelated controls, matched on age and gender. The ADIPOQ +45G allele (TG+GG) had a sig- nificant association with risk of the metabolic syndrome (odds ratio=1.88, 95% confidence interval: 1.03-3.44, p=0.039) adjusted for education, physical activity, family history of related diseases, smoking and drinking, com- pared with subjects with TT genotype. The association between the ADIPOQ +45 T>G polymorphism and the metabolic syndrome was independent of multiple confounders.
Background/Aims: Dietary pattern and genetic predisposition of each population have different impacts on life- style-related chronic diseases. This study was conducted to evaluate the association and interaction between die- tary patterns and VEGFR2 or KDR gene polymorphisms on physical and biochemical risk factors of cardiovascu- lar disease in two Asian populations (179 Chinese Malaysian and 136 Japanese adults). Methods: Dietary patterns were constructed from food frequency questionnaire using factor analysis. Genotyping of rs1870377 and rs2071559 was performed by real-time PCR using TaqMan probes. Physical measurements: body mass index, systolic and diastolic blood pressures and biochemical parameters: glycated hemoglobin A1c and blood lipids (to- tal cholesterol, triglycerides, LDL-cholesterol, HDL-cholesterol and total cholesterol/HDL-C ratio) were meas- ured. Results: Two dietary patterns were extracted for: Japanese (‘Japanese diet’ and ‘Western diet’) and Chinese Malaysians (‘Balanced diet’ and ‘Meat, rice and noodles diet’). In Japanese, ‘Western Diet’ and rs2071559 were associated with LDL-C and HDL-C, respectively. In Chinese Malaysians, ‘Meat, rice and noodles diet’ was asso- ciated with triglycerides, HDL-C and total cholesterol/HDL ratio while rs1870377 and rs2071559 were associated with total cholesterol and/or LDL-C. The interaction between ‘Western Diet’ and rs2071559 in Japanese and ‘Meat, rice and noodles diet’ and rs1870377 in Malaysians had significant effects on blood lipids after adjusting for confounders. Conclusions: The association and interaction of dietary patterns and VEGFR2 gene polymor- phisms on blood lipids differ between Chinese Malaysian and Japanese subjects by either decreasing or increas- ing the risk of cardiovascular disease.
Anemia is a severe global public health problem with serious consequences for both the human and socio- economic health. This paper presents a situation analysis of the burden of anemia in Cambodia, including a dis- cussion of the country-specific etiologies and future research needs. All available literature on the prevalence and etiology of anemia in Cambodia was collected using standard search protocols. Prevalence data was readily iden- tified for pre-school aged children and women of reproductive age, but there is a dearth of information for school- aged children, men and the elderly. Despite progress in nation-wide programming over the past decade, anemia remains a significant public health problem in Cambodia, especially for women and children. Anemia is a multi- faceted disease and both nutritional and non-nutritional etiologies were identified, with iron deficiency account- ing for the majority of the burden of disease. The current study highlights the need for a national nutrition survey, including collection of data on the iron status and prevalence of anemia in all population groups. It is impossible to develop effective intervention programs without a clear picture of the burden and cause of disease in the coun- try.
Some studies, that consider polymorphisms of the apolipoprotein B (APOB) gene as risk factors for coronary ar- tery disease (CAD), have reported discordant results. The aim of the present study was to search for associations between plasma lipid profiles with the DNA Xba I polymorphism of the APOB gene in CAD patients diagnosed by angiography (CAD+). In the present study we compared 114 Mexican patients (80 men and 34 women) with CAD+ and 132 control patients (59 men and 73 women) without evidence of ischemia or arterial damage (CAD-). The frequency of X+/X+ genotype of Xba I polymorphism, in CAD+ group, was 23% (26/114) compared with 8% (11/132) in the CAD- (OR 3.25, p = 0.002). The patients with X+/X+ for the Xba I genotype APOB gene had higher concentration of triglycerides (TG) and VLDL in plasma than CAD- (p < 0.05). The genotype X+/X+ in the CAD had an effect increasing the TG and VLDL plasma levels when compared with individuals with X-/X- and X-/X+ genotypes. The present study indicated that the X+X+ genotype of Xba I polymorphism is associated with CAD+ patients and high plasma levels of TG and VLDL, in the Mexican population.
A quick and valid method for evaluating percentage body fat is based on the use of skinfold callipers. However, limitations associated to their use and characteristics led the authors to improve a traditional calliper (Harpenden) and to integrate it with a software application. Such a measuring system, LipoTool, is meant to have better accu- racy and reliability, including data processing and digital recording at a very low cost. At first, a sample of 49 older adults was used to evaluate the performance of LipoTool by comparing its results to those obtained with the traditional Harpenden calliper. A strong positive association in %BF was achieved. This digital sensing system was later improved by incorporating wireless communication between the calliper and the software application, adding other functionalities. The software application works in any computer and is flexible to incorporate new coming models, linear regressions or new algorithms. This new system was validated against the standard Dual- Energy X-Ray Absorptiometry system, using a sample of 40 adults with positive results. This solution is a valid and reliable alternative to traditional reference callipers, simplifying the percentage of body fat evaluation and providing a more effective use in daily practice with less expenditure of time and resources. Its implemented guided procedure turns it into a precious training tool based on a non-invasive, portable device, and not requiring special individual preparation. Ongoing activities are focused on the design of a new mechanical structure, with novel functionalities and for exploring other studies.
Hemoglobin (Hb) concentration is the central diagnostic indicator for anemia, including nutritional anemia. The objective of this study was to compare the Hb values determined by two portable, non-invasive devices across a wide Hb spectrum against formal laboratory measurements, and with each other. Eighty Guatemalan adults (40 highland men, 40 lowland pregnant women) provided venous blood for formal Hb colorimetric determination. Hb was also registered sequentially on the Rad-87TM pulse CO-Oximeter with Rainbow Set technology (Masimo) and Haemospect® (MBR Optical Systems) by non-invasive skin-probe contact procedures as per manufacturers’ instructions. Whole blood Hb concentrations ranged from 7.8 to 18.5 g/dL (mean, 12.9±2.3 g/dL and median, 13.3 g/dL). Corresponding descriptive statistics were: range, 9.6 to 16.2 g/dL; mean, 12.1±1.5 g/dL; and median, 11.9 g/L, respectively, with the Rad-87TM (nail bed). They were: range, 8.7 to 15.8 g/dL; mean, 12.7±1.8 g/dL; and median, 13.0 g/dL for the Hemospect® for forearm contact. They were: range, 9.1 to 17.5 g/dL; mean, 13.2±2.1 g/dL; and median, 13.4 g/dL for palm contact. The Pearson correlation coefficient of venous blood Hb with the former device’s Hb values was r=0.59 (p<0.001), and r=0.94 (p<0.001) and r=0.90 (p<0.001) with those of the latter device at the palm and forearm, respectively. The inter-site Lin coefficient was r=0.84. Sensitivity and specificity were variable across devices, depending on Hb cut-off and measurement procedures. With Hb cut- off values of <12.0 g/dL for adult, non-pregnant women and <13.0 g/dL for adult men, the Haemospect® device’s performance here would provide adequate potential for screening purposes.
This paper outlines the methodology to add glycaemic index (GI) and glycaemic load (GL) functionality to food DietPLUS, a Microsoft Excel-based Malaysian food composition database and diet intake calculator. Locally de- termined GI values and published international GI databases were used as the source of GI values. Previously published methodology for GI value assignment was modified to add GI and GL calculators to the database. Two popular local low GI foods were added to the DietPLUS database, bringing up the total number of foods in the database to 838 foods. Overall, in relation to the 539 major carbohydrate foods in the Malaysian Food Composi- tion Database, 243 (45%) food items had local Malaysian values or were directly matched to International GI da- tabase and another 180 (33%) of the foods were linked to closely-related foods in the GI databases used. The mean ± SD dietary GI and GL of the dietary intake of 63 women with previous gestational diabetes mellitus, cal- culated using DietPLUS version3 were, 62 ± 6 and 142 ± 45, respectively. These values were comparable to those reported from other local studies. DietPLUS version3, a simple Microsoft Excel-based programme aids calcula- tion of diet GI and GL for Malaysian diets based on food records.
The effective treatment of cow milk allergy in infants consists of elimination of cow milk protein and the intro- duction of formulas based on an extensively hydrolyzed protein formula or an amino acid-based formula. How- ever, about 10% of these infants are still allergic to an extensively hydrolyzed protein formula and an amino acid- based formula is very expensive. We conducted a study to verify whether the new chicken-based formula will be better tolerated than an extensively hydrolyzed protein formula for the treatment of cow milk allergy in infants. One hundred infants, diagnosed with cow milk allergy by double-blind, placebo-controlled food challenge tests, were enrolled in a double-blind, randomized, cross-over study to compare a response to an extensively hydro- lyzed protein formula and the chicken-based formula. Subjects were randomly given one of the two formulas for 2 weeks. There was a 2-week washout period of taking an amino acid-based formula before being switched to the other formula for another 2 weeks. If the subjects showed allergic symptoms during the 2 weeks of test formula, they would be announced as intolerance or allergic to that formula. Sixty seven of 80 confirmed subjects agreed to enroll their infants. Fifty-eight subjects completed the study. Twenty and 33 infants were tolerant whereas and 38 and 25 infants were intolerant to an extensively hydrolyzed protein formula and the chicken-based formula, respectively. The chicken-based formula showed significantly better tolerance than an extensively hydrolyzed protein formula in the management of cow milk allergy in infants.
This study aimed to assess the prevalence of overweight misperception, unhealthy diet practices, and factors as- sociated with these weight-related behaviors among Korean adolescents. The subjects were a nationally repre- sentative sample of non-overweight students (52,515 in 2005, 64,084 in 2006, and 67,113 in 2007) in middle and high schools who completed the Korea Youth Risk Behavior Web-Based Survey. The prevalence of weight- related behaviors and factors associated with these behaviors were assessed using a complex sampling design. Of non-overweight students, 14.9% of boys and 22.2% of girls reported their weight as overweight/obese. Dieting within the last year was reported by 19.8% of boys and 41.8% of girls. Of those who attempted dieting, 17.1% of boys and 24.6% of girls indicated practicing at least one unhealthy diet behavior within the last month. Over- weight misperceptions were independently associated with diet attempts and unhealthy diets after adjustment for weight status, and demographic, social, and psychological factors. Additionally, these weight-related behaviors were also associated with psychosocial factors such as low school achievement, sadness, suicidal ideation, in- creased stress perception, and cigarette or alcohol use. In conclusion, the high prevalence of inappropriate weight-related behaviors suggests a need for comprehensive approaches to improve weight-related behaviors in non-overweight Korean adolescents.
Excess body weight is a cardiovascular risk factor. The relationship between anthropometric indices and cardio- vascular health is not completely understood. Carotid Intima-Media Thickness (CIMT) is a subclinical marker of atherosclerosis. This study aimed to investigate the best anthropometric obesity indicator for diagnosis of initial stage of atherosclerosis by CIMT. This cross-sectional study included 100 adult women, aged 18-50 years. An- thropometric indices were measured with standard protocol and CIMT was measured by non-invasive ultrasound. Receiver Operating Characteristics (ROC) curve analysis was carried out to determine the optimal cut-off values of anthropometric indices, and the best indices for atherosclerosis diagnosis. On ROC curve analysis the sug- gested appropriate cut-offs of waist circumference (WC), waist to hip ratio (WHR), waist to height ratio (WHtR), body mass index (BMI) and percentage body fat (%BF) were 96 cm, 0.86, 0.64, 31.29 kg/m2 and 30.42%, respec- tively. The area under the ROC curve of BMI (AUC=0.74, 95%CI=0.62-0.86) and WHtR (AUC=0.74, 95%CI=0.63-0.85) were greater than other anthropometric indices. The AUC for WHR was the lowest among the studied obesity indices AUC=0.68 (95% CI=0.54-0.81). In our study, WHtR and BMI were the best diagnostic parameters of initial stage of atherosclerosis while WHR was the worst based on AUC.
Obesity is an epidemic health problem related to morbidity and mortality of metabolic and cardiovascular dis- eases. However, little is known regarding the development of cardiometabolic diseases in an obese subgroup with a healthy metabolic risk profile. This study examined the prevalence of baseline metabolically healthy obese sub- jects and its impacts on the incidences of cardiometabolic diseases using a nation-wide population cohort. Metab- olically healthy obese were prevalent in 8.2% of the baseline population and 28.5% of the obese subjects. Sub- jects included were 1,547 men and women (age range, 18–59 years), who were free of components of the meta- bolic syndrome except waist criteria. During an average 5.4-year follow-up, the cumulative incidences of hyper- tension, type 2 diabetes and the metabolic syndrome were 7.8%, 1.2% and 5.6%, respectively. The hazard ratios (95% CIs) for the metabolic syndrome incidence were significantly higher at BMI levels of ≥23.0 kg/m2 [4.68 (2.22-9.86)] for BMI of 23-24.9 kg/m2; 8.82 (4.01-19.4) for BMI of 25-26.9 kg/m2; and 24.4 (12.3-48.4) for BMI of ≥27 kg/m2). The hazard ratios for diabetes or hypertension incidence were significantly higher at BMI levels of ≥25.0 kg/m2. Each kg/m2 of BMI gained was associated with an 18% increase in the risk of developing hyperten- sion and a 26% increase in risk for the metabolic syndrome. We conclude that metabolically healthy obese indi- viduals are at higher risk to develop hypertension, type 2 diabetes and the metabolic syndrome than their non- obese counterparts. Our data provide further evidence that opposes the notion of metabolically healthy obese as harmless conditions.