Nutritional deficiencies have been variably observed in thalassaemia and the aetiology of many of the immune abnormalities in thalassaemic children are poorly defined. Therefore, we tested the hypothesis that certain immune abnormalities have a nutritional basis. Nutritional status, selective quantitative and functional indices of immunity were studied in twelve children (7 females, 5 males; mean age 28 months, SD 5 and range 19.8-35.5), with thalassaemia major before and after a one month period of intensive nutrition support (the study diet consisted of 'Enfapro' liquid formula (Mead Johnson) with added dextrose and corn oil to achieve a caloric density of 1.1 kcal/cc in addition to vitamins and minerals). Each child was provided approximately 150 kcal/day and 4 g of protein/day. Lymphocyte proliferation to Concanavalin A (Con A) (P = 0.008) and Purified Protein Derivative (PPD) (P = 0.002) was depressed upon entry into the study, however the response to Con A attained normal values by the end of the intervention. Compared to baselines, the proliferative response to Con A (P=0.005) and Phytohemagglutinin A (PHA) (P = 0.031) both improved after the nutrition support. Although there was no general correlation of zinc status with lymphocyte proliferation, normal baseline zinc status was associated with improvement of proliferation. The %CD4 increased (P = 0.036), primarily because of a decrease in total lymphocytes and to lesser extent a decrease in CD8 lymphocytes. Serum immunoglobulin concentrations were found to be elevated on admission but were not significantly affected by the nutrition intervention. C3 concentrations were uniformly depressed on admission but increased by the end of the study protocol (P = 0.037). C4 and CH50 activity were not significantly influenced by the intervention. In conclusion, children with beta thalassaemia have abnormalities of lymphocyte function as well as key complement components that are responsive to nutrition support. In addition, zinc status appears to have an important role in lymphocyte function in these children.
Childhood obesity is a serious public health problem because of its strong association with adulthood obesity and the related adverse health consequences. The published literature indicates a rising prevalence of childhood obesity in both developed and developing countries. However no data exists on the prevalence in Northeast Thailand, one of the poorest regions of the country and one that has experienced a recent economic transition. The objective of this study was to estimate the prevalence of obesity in seven to nine year old children in urban Khon Kaen, Northeast Thailand. A cross-sectional school based survey was conducted to determine the prevalence of obesity in children of urban Khon Kaen, Thailand. Multi-staged cluster sampling was used to select 12 school clusters of 72 children each between the ages of 7 and 9 years, in primary school grades 1, 2 and 3 from government, private and demonstration schools. A total of 864 seven to nine year old school children were studied. Anthropometric measurements of standing height and weight were taken for all subjects to the nearest tenth of a centimetre and tenth of a kilogram respectively. Childhood obesity was defined as a weight-for-height Z-score above 2.0 standard deviations of the National Center for Health Statistics/World Health Organisation reference population median. The prevalence of childhood obesity was 10.8% (95% CI: 7.6, 13.9). Obesity was significantly more prevalent in boys than girls. The biggest difference was observed between the three school types, with the highest prevalence of obesity found at teacher training demonstration schools and the lowest at the government schools. This study provides the first data on childhood obesity prevalence in Northeast Thailand. The prevalence of 10.8 per cent is lower than that found in two other urban areas of Thailand but slightly higher than expected for this relatively poor region. If this prevalence rate increases, as observed in other countries in economic transition, the incidence of non-communicable diseases associated with obesity is also likely to increase, thus raising cause for concern and reason for intervention to both control and prevent obesity during childhood.
The weight, height, body mass index (BMI), waist/hip ratio, serum retinol and a-tocopherol and lipid profiles of 16 overweight (BMI ³ 25.0 kg/m2) Thai males and 56 overweight females, compared with 14 males and 58 females in a control group (BMI 18.5-24.9 kg/m2), were investigated. Subjects for the study were those persons who turned up regularly for physical check-up at the Outpatient Department, General Practice Section of Rajvithi Hospital, Bangkok. The study was conducted between December 2000-March 2001. Higher levels of cholesterol, LDL-C, LDL-C/HDL-C ratio were found in the overweight compared with the control subjects. Statistically significant higher triglyceride levels were found in the overweight compared with the control subjects. The median serum retinol concentration in overweight subjects was 2.80 mmol/L (range 0.53-4.62 mmol/L) compared with 2.97 mmol/L (range 1.21-4.12 mmol/L) in control subjects (p=0.0736). The median serum a-tocopherol concentration in overweight subjects was 17.30 mmol/L (range 6.29-28.65 mmol/L) compared with 18.75 mmol/L (range 5.30-30.28 mmol/L) in control subjects (P<0.05). The median values of retinol and a-tocopherol serum concentrations in the overweight and obese males were lower than those of the overweight and obese females. A total of 6.3% (1 out of 16) and 12.5% (2 out of 16) of the overweight/obese males had decreased retinol and a-tocopherol levels, while the overweight/obese females had decreased retinol and a-tocopherol level of 1.8% (1 out of 56) and 10.7% (6 out of 56), respectively. A total of 12.5% and 39.3% of the overweight/obese males and females had cholesterol concentrations of ³ 6.48 mmol/l. However, the prevalence of low HDL-C (HDL-C £ 0.91 mmol/l) was found to be 50% in the overweight and obese males and 10.7% in the overweight and obese females. Statistically significant associations were found between age, cholesterol, LDL-C, and serum a-tocopherol in the overweight and obese male and female subjects. A negative correlation was found between weight, BMI, AC, MAMC, hip circumference and serum retinol in both the overweight and obese subjects. A negative correlation was found between weight, BMI, MAMC, waist, hip circumferences and serum a-tocopherol in both the overweight and obese subjects.
Height is an important clinical indicator to derive body mass index (BMI), creatinine height index and also to estimate basal energy expenditure, basal metabolic rate and vital capacity through lung function. However, height measurement in the elderly may impose some difficulties and the reliability is doubtful. Equations estimating height from other anthropometric measures have been developed for Caucasians, but only one study has developed an equation (based on arm span only) for an Asian population. Therefore, a cross sectional study was conducted to develop equations using several anthropometric measurements for estimating stature in Malaysian elderly. A total of 100 adults (aged 30 to 49y) and 100 elderly subjects (aged 60 to 86y) from three major ethnic groups of Malays (52%), Chinese (38.5%) and Indians (9.5%) participated in this study. Anthropometric measurements included body weight, height, arm span, half arm span, demi span and knee height were carried out by trained nutritionists. Inter and intra observer errors and also % Coefficient Variation (%CV) were calculated for each anthropometric measurement. Equations to estimate stature were developed from the anthropometric measurements of arm span, demi span and knee height of adults using linear regression analysis according to sex. Elderly subjects were shorter and lighter compared to their younger counterparts. The %CV of anthropometric measurements in adults and elderly subjects ranged between 5 to 6%, with standing height having the lowest %CV. When the equations derived from adults were applied to elderly subjects, it was found that percentage difference between actual height and the estimated value ranged from 1.0 to 3.3%. However, the percentage difference between estimated height from the equations developed in this study compared to those derived from the equations of other populations ranged between 0.2 to 8.7%. In conclusion, standing height is an ideal technique for estimating the stature of individuals. However, in cases where its measurement is not possible or reliable, such as in elderly subjects, height can be estimated from proxy indicators of stature. In this study arm span showed the highest correlation with standing height, which is in agreement with other studies. It should be borne in mind that equations derived from taller statured populations (e.g. Caucasians) may be less accurate when applied to shorter statured populations.
The primary aim of this study was to assess the biochemical vitamin B12 and folate status of a representative group of elderly women (70-80 y) living in Dunedin, New Zealand. A second aim was to determine the prevalence of hyperhomocysteinaemia and to explore the determinants of homocysteine (hcy) concentration in this population. A cross-sectional study was carried out between June and August of 2000. Two hundred and fifty women were randomly selected from the 1998 electoral roll. Fasting blood samples were analysed for folate, vitamin B12, total hcy, creatinine, and haematological parameters. Of the women selected, 87 did not respond, 37 were not traceable, 23 were not eligible or had died, and 103 agreed to participate. The overall response rate was 46%. Based on a cut-off of 150 pmol/L for serum B12, 13 % of participants would be classified as having sub-optimal vitamin B12 status. Of the women, 3 and 5 %, respectively, had low serum (<6.6 nmol/L) and erythrocyte folate (<317 nmol/L) concentrations. No participant had megaloblastic anaemia. The prevalence of hyperhomocysteinaemia (>15 mmol/L) in this population was 18%. Hyperhomocysteinaemia in this group may be partly explained by renal insufficiency because there was a significant association between serum creatinine and plasma hcy (P<0.001). Blood folate levels but not serum B12 were significantly inversely associated with hcy. In conclusion, there was a moderately high prevalence of hyperhomocysteinaemia and suboptimal plasma vitamin B12 concentrations but not low blood folate concentrations in this elderly female population.
Low circulating folate concentrations lead to elevations of plasma homocysteine. Even mild elevations of plasma homocysteine are associated with significantly increased risk of cardiovascular disease (CVD). Available evidence suggests that poor nutrition contributes to excessive premature CVD mortality in Australian Aboriginal people. The aim of the present study was to examine the effect of a nutrition intervention program conducted in an Aboriginal community on plasma homocysteine concentrations in a community-based cohort. From 1989, a health and nutrition project was developed, implemented and evaluated with the people of a remote Aboriginal community. Plasma homocysteine concentrations were measured in a community-based cohort of 14 men and 21 women screened at baseline, 6 months and 12 months. From baseline to 6 months there was a fall in mean plasma homocysteine of over 2 ?mol/L (P = 0.006) but no further change thereafter (P = 0.433). These changes were associated with a significant increase in red cell folate concentration from baseline to 6 months (P < 0.001) and a further increase from 6 to 12 months (P < 0.001). In multiple regression analysis, change in homocysteine concentration from baseline to 6 months was predicted by change in red cell folate (P = 0.002) and baseline homocysteine (P < 0.001) concentrations, but not by age, gender or baseline red cell folate concentration. We conclude that modest improvements in dietary quality among populations with poor nutrition (and limited disposable income) can lead to reductions in CVD risk.
The overall objective of the Nepal Micronutrient Status Survey (NMSS) was to assess the distribution and severity of micronutrient malnutrition, and to measure the progress achieved by different interventions. Data presented in this paper concern the prevalence of vitamin A deficiency (VAD) and the outreach and coverage of the National Vitamin A Supplementation activity. A multi-stage cluster sample design was employed that provided statistically representative data for each of thirteen eco-development strata (because of low population density, the West Mountains, Mid-west Mountains and Far-west Mountains were combined into a single stratum). The design allowed for aggregate estimates to be made at the national and ecological zone level. The survey showed a significant improvement in the status of clinical vitamin A deficiency in Nepal. The prevalence of both Bitot's spots and night-blindness among preschool children decreased from levels observed in surveys conducted in the previous twenty years. However, the prevalence of night-blindness was found to be 5% among women, and over 1% among school-aged children, which indicates that the entire population is vulnerable to VAD. These observations support findings from other surveys that have noted a high prevalence of maternal night-blindness in Nepal. Biochemical data collected as part of the survey indicated a high prevalence of low serum retinol (< 0.70 mmol/l), particularly among preschool children. Almost one of every three children (32.3%) and one of every six women (16.6%) had low serum retinol values. Low serum retinol among preschool children was associated with young age (6-11 months), rural location, wasting, presence of night-blindness and Bitot's spots, and residence in the Terai or Mountains. Similarly, sub-clinical VAD in women was associated with age (less than 20 years), pregnancy, the presence of night-blindness and residence in the Terai or Mountains. In the 42 districts covered by the National Vitamin A Programme (NVAP), more than 87% of preschool children were reached with vitamin A capsules. In addition to this, the National Immunisation Day (NID) provided oral polio vaccine drops to an estimated 95.7% of children 12-59 months. Awareness of the importance of vitamin A was, however, much higher in the NVAP districts than in non-programme districts. As would be expected, clinical VAD was most prevalent among children who had not received vitamin A during the most recent vitamin A capsule distribution. Indeed, the data show that vitamin A capsule receipt among children conferred a 59% protective effect for night-blindness and a 51% effect for Bitot's spots. These results point to significant progress having been achieved by the NVAP and NID capsule distribution activities.
To investigate early infant feeding practices in Jinan, China, a cross-sectional study was carried out in April-May 2000. Data were collected through structured interviews among nearly all the mother-infant pairs (247) in four communities in the city with infants under seven months of age. All but one was born in a hospital and rooming-in (infant sleeping in same room as mother) was widely practised. Breastfeeding was practiced universally, but first contact with the new- born was delayed one or more hours for 51% of subjects. Colostrum was given to 94% of the infants, yet during the first three days, all but 34% were given water, artificial baby milk, glucose or other prelacteal feeds. Among infants under 4 months of age, 35% were currently exclusively breastfeeding, but at two months only 40% were, and only half that many had received nothing but breast-milk since birth. Exclusive breastfeeding has probably increased in China, but further promotion is still needed in this area.
The purpose of this study was to assess whether there are any differences in postprandial physiological responses to skim milk powder enriched with milk calcium (SMP + milk calcium) and skim milk powder enriched with calcium carbonate (SMP + CaCO3), with each of the milks providing 1200 mg calcium. This was a randomised, controlled, crossover study involving 16 men and 29 women over 55 years of age. Measurements of calcium and bone metabolism were taken after an overnight fast before each drink, and postprandially every hour for 8 h. The impact of time and drink on the responses was analysed by repeated measures of analysis of variance. Serum calcium was significantly higher between 2 and 8 h after consumption of SMP + CaCO3 compared with SMP + milk calcium (P < 0.0001). Serum phosphate was significantly higher between 2 and 5 h after drinking the SMP + milk calcium compared with SMP + CaCO3 (P < 0.0001). The level of parathyroid hormone (PTH) was virtually unchanged after consumption of SMP + milk calcium, but decreased between 1 and 4 h after SMP + CaCO3 (P = 0.02). The serum C-telopeptide level, a marker of bone resorption, was significantly lower after SMP + CaCO3, compared with SMP + milk calcium, between 4 and 8 h after drinking the milk (P < 0.05). We conclude that serum calcium levels have a higher increase after SMP + CaCO3 consumption than after SMP + milk calcium consumption, and that this is associated with lower serum PTH concentrations and a more prolonged postprandial decrease in bone resorption.
Exercise training is known to induce physiological adaptations that improve exercise performance and alter patterns of energy substrate utilization to favour fatty acid oxidation. L-Carnitine is an essential cofactor for the oxidation of fatty acids under all physiological conditions, including exercise. This study evaluated the effect of acute exercise on carnitine concentrations in tissue and serum, liver carnitine palmitoyltransferase-I activity and expression, and serum lipids in both trained and untrained rats as compared to non-exercised rats. Serum acyl- and total carnitine was significantly higher in the trained animals, whether exercised or not, suggesting an exercise-induced increase in a renal threshold for carnitine. Untrained rats had significantly higher acylcarnitine in skeletal muscle and an acyl/free carnitine ratio of 0.63 ± 0.06 compared with 0.31 ± 0.16 in trained animals receiving an identical acute bout of exercise, demonstrating that untrained animals utilized a significantly higher percentage of free carnitine reserves during exercise. This study suggests that free carnitine reserves may be reduced during exercise in untrained rats, an effect that has the potential to impair both carbohydrate and fat metabolism during exercise.
There is mounting evidence that nutrition plays an important role in the aetiology and management of many diseases affecting Australians. Nutrition counselling provides a strategy for not only reducing patient suffering, but also for reducing the health care costs associated with these illnesses. At the forefront of providing nutrition counselling to Australians are General Practitioners (GPs) and Dietitians. Australian data shows that GPs encounter many patients with the chronic diseases that have nutrition in their aetiology and management. Although this presents opportunities to provide nutrition counselling, overseas literature suggests that often nutrition counselling opportunities are not taken up. At present, there is little evidence to support whether this problem exists in Australia, or the magnitude of the problem. Whilst evidence suggests there are barriers for GPs in providing nutrition counselling, there is conflicting evidence on how these influence the GP's decision to provide such counselling. Overseas studies have also identified barriers for GPs to refer to dietitians to provide nutrition counselling, however there is no evidence to identify whether these barriers exist in Australia. Whilst various strategies have been implemented to aid in the provision of effective nutrition management to the Australian public, there is little evidence on the efficacy of these. Research is needed in the above areas if effective patient nutrition management is to be implemented in Australia.
Besides being a source of nutrients, foods, particularly plant foods, are a rich source of bioactive phytochemicals or bionutrients. Studies carried out during the past 2-3 decades have shown that these phytochemicals have an important role in preventing chronic diseases like cancer, diabetes, coronary heart disease and hyper-cholesterolaemia. The major classes of phytochemicals with disease-preventing functions are dietary fibre, antioxidants, detoxifying agents, immunity-potentiating agents and neuropharmacological agents. Each class of these functional agents consists of a wide range of chemicals with differing potency. For example, antioxidant function is exhibited by some nutrients, such as vitamin E, vitamin C and provitamin A. Other phytochemicals that have antioxidant properties are carotenoids, phenolic compounds, flavonoids and isothiocyanates. Some of these phytochemicals have more than one function. Foods rich in these chemicals and exhibiting disease-protecting potential are called functional foods. Indian habitual diets, which are based predominantly on plant foods like cereals, pulses, oils and spices, are all good sources of these classes of phytochemicals, particularly dietary fibre, vitamin E, carotenoids and phenolic compounds. There is, however, much scope for further systematic research in screening Indian foods and diets for these phytochemicals and assessing their potential in protecting against chronic diseases.
Consumption figures for 15 major commodities (cereals, wheat, rice, maize, potato, pulses, olive oil, other vegetable oils, vegetables, fruits, wine, meats, animal fats, milk + products, and fish + seafood) were collected from FAO Food Balance Sheets during the 1960s (1961-1969) and late 1990s (1995-1999). For some nutritionists the "model Mediterranean diet" is the Italian or Greek diet of the 1960s, for others the concept of Mediterranean countries is more general. Analysis shows: (1) In the 1960s, Australia consumed more meat, milk, animal fat than Italy or Greece and less cereals, wheat, pulses, olive oil, vegetables, fruits and wine. (2) In the 1960s, Australia's olive oil, vegetables, fruits and wine consumption were within the range for all 18 Mediterranean countries (i.e. Spain, France, Italy, Malta, Croatia, Bosnia, Albania, Greece, Cyprus, Turkey, Syria, Lebanon, Israel, Egypt, Libya, Tunisia, Algeria and Morocco). (3) In the 1990s, food consumptions have evolved; Australia's wine and milk consumption is now similar to Italy and Greece; consumption of wheat, olive oil, vegetables, fruits and fish are lower; consumption of potato, pulses, other vegetable oils and meat are higher than Italy or Greece. (4) Australia's consumption of the 15 commodities is within the range of all Mediterranean countries in the late 1990s, except wheat consumption was lower.
Understanding the reasons that people have for choosing their food, and why these choices vary, may affect the dietary advice and assumptions about the nutrient adequacy of future food intake. One group of respondents living in Jakarta, Indonesia completed two interviews with the same combined food frequency and qualitative technique, called Food Choice Map (FCM) over a one-month period. Another group of Indonesian respondents from a town in Java completed an FCM interview and a 24-hour recall interview. The Food Choice Map identified the same major foods as contributing to individual intakes as are identified by a 24-hr recall interview. The FCM also identified reasons for changes in food choice. The reasons for food choices varied less than the different food items chosen. The FCM links data on dietary behaviours with perceptions that respondents use to explain of those behaviours. Such data can be used to develop communication strategies for health promotion.
Commonly recommended plant sources of provitamin A, such as dark green leafy vegetables, are not acceptable in many population groups. The objective of this study was to identify other indigenous foods that may be effectively promoted to alleviate vitamin A deficiency (VAD) and to gather information relevant to identification, production, acquisition, and consumption of foods relevant to a food-based VAD prevention strategy in the Federated States of Micronesia. An ethnographic study on edible pandanus cultivars, involving key informant interviews and observation was carried out. Analyses revealed a great range in carotenoid content. Several orange-coloured pandanus cultivars, all highly acceptable, contained high levels of carotenoid, almost meeting daily requirements in usual consumption patterns, whereas light yellow-coloured cultivars contained low levels. Availability has decreased substantially in recent years due to increased consumption of imported foods and general neglect of indigenous foods. High-carotenoid pandanus should be promoted for general enjoyment and health benefits.
Macro mineral contents were estimated in commonly consumed green leafy vegetables in India, namely: Koyyathotakura and Peddathotakura (varieties of Amaranthus species); Erragogu and Tellagogu (variety of Hibiscus species); Gangabayalakura (Portulaca olereceo) and Palak (Spineces olerecea) at three different stages of maturity. Varietal differences were also observed. The results of the study showed that as the plant matured from stage I (15 days) to stage II (30 days) calcium and magnesium content increased. In contrast, phosphorus content decreased as the plant matured. Varietal differences were also observed at different stages of maturity. The results also indicated that the consumption of green leafy vegetables at stage I (15 days) and stage II (30 days) potentially provide the greatest amount of minerals.
In view of previously reported anti-inflammatory bioactivity of the New Zealand Green Lipped Mussel (NZGLM), the overall lipid profile and fatty acid and sterol composition of the NZGLM from various sites in New Zealand (Hallam Cove, Port Ligar, Little Nikau) were investigated using thin layer chromatography (TLC) and gas liquid chromatography (GLC). Samples were either frozen (F) or freeze-dried (FD) soon after collection. It was also thought prior to the study, there may be differences in the dietary sources of phytoplankton between the sites, responsible for the bioactivity, however data collected in New Zealand reported no difference in the type of phytoplankton, but a difference in the quantity. There were no major significant differences in the major compo-nents of the lipid, fatty acid and sterol composition between FD or frozen samples, nor were there any significant differences in the major composition between sites. The only major difference was between total lipid composition of the freeze-dried and frozen samples due to the removal of water during freeze-drying. Total lipid content on a dry weight basis in FD samples was 8.4 g/100g tissue and was significantly higher than frozen samples (P < 0.05) and there was no significant site variation. The lipid class content between sites was also not significantly different as judged by TLC. Triglyceride (TG) lipid fraction appeared to be the most prominent in the frozen and FD samples. The free fatty acid (FFA) band was the next most prominent band and was visually more prominent in the frozen samples. Sterol esters (SE) were detected in higher amounts in the frozen samples compared with the FD samples. Phospholipid (PL) and sterols (ST) were distributed throughout all samples. Polyunsaturated fatty acids (PUFA) were the main group of fatty acids in both FD and frozen samples (45-46%), most of which were omega-3 (n-3) fatty acids (40-41%). Saturated fatty acids (SFA) accounted for approximately one quarter of total fatty acids, with little variation between FD and frozen samples. The major fatty acids of the NZGLM were docosahexaenoic acid (DHA; 22:6n-3) (19% in both FD and frozen samples), eicosapentaenoic acid (EPA; 20:5n-3) and palmitic acid (16:0) (15% in both FD and frozen samples). Cholesterol was the most prominent sterol (31% of total sterols). Other major sterols included desmosterol/ brassicasterol (co-eluting), 24-methylenecholesterol, trans-22-dehydrocholesterol, 24-nordehydrocholesterol and occelasterol. This study is unique as it compares the lipid composition of the NZGLM from three sites in New Zealand with the additional effect of processing. This is the second comparative study investigating the lipid, fatty acid and sterol composition of the NZGLM with added interest in the effect of freeze-drying on the lipid content of the mussel. This study showed that there were no major significant differences in lipid, sterol and fatty acid composition between the FD and frozen samples of the NZGLM for three sites in New Zealand. Food chain studies and further research is warranted to investigate the presence and role of major and minor lipid components of the NZGLM.