APJCN

In 1987, the International Union of Nutritional Sciences (IUNS) subcommittee on Nutrition and Ageing, in conjunction with the World Health Organization (WHO) global program for the elderly, embarked on the 'Food Habits in Later Life' (FHILL): a cross-cultural study to determine to what extent health, social and lifestyle variables, especially food intake, collectively predict survival amongst long-lived cultures. A total of 818 participants aged 70 years and over, were recruited from five IUNS centres. Mortality data were collected after five to seven years. The cohorts included Swedes in Sweden (SWD), Greeks in Greece (GRS) and in Melbourne, Australia (GRM), Anglo-Celts in Australia (ACS) and Japanese in Japan (JPN). Information was obtained on health, lifestyle and diet at baseline. A Cox Proportional Hazard model containing ten potential predictors of survival, adjusted to age at enrolment and ethnicity/locality, was developed to analyse the survival data. Based on up to seven years survival data, it was found that being an elderly Greek in Australia conferred the lowest mortality risk and being an elderly Greek in Greece conferred the highest mortality risk. When the ten potential predictors of survival were entered into the Cox model, the memory score, the Mediterranean diet score, Activities of Daily Living (ADL) and general health status scores showed the greatest effects in significantly reducing mortality hazard ratios by 22%, 13%, 4% and 4%, respectively. For diet score, a one-unit change predicted a significant 13% difference in survival. Of the lifestyle (modifiable) variables entered in the multivariate model, exercise and social activity were not significant predictors of survival suggesting that diet is a more important predictor of survival than these variables. Another lifestyle variable, smoking, significantly increased mortality hazard ratios by 67%, making it a more important predictor of survival than diet. Being male (non-modifiable) also increased risk of death by 63%. Diet, particularly the Mediterranean Diet, operates irrespective and together with other factors as an appreciable contributor to survival, with a strength comparable to or greater than all other measured variables. The independence and strength of the predictiveness of food pattern for survival, and for this to be cross-cultural from Europe to Asia is a novel and important observation for food and health policy.

Previous studies have suggested the need to revise the World Health Organization (WHO) cut-off values for the various indices of obesity and fat distribution in Singapore. The purpose of this study was to delineate cut-off points of body mass index (BMI), waist-hip ratio (WHR), waist circumference (WC), and waist-stature ratio (WSR) as screening tools for cardiovascular risk factors in Singaporean women. Anthropometric indices were measured in a cross sectional survey of 566 subjects (60% Chinese individuals, 28% Malay individuals and 12% Indian individuals). Cardiovascular risk factors were determined by measuring blood pressure, serum lipids, and fasting blood glucose levels. Receiver Operating Characteristic (ROC) curves were constructed to determine cut-off points. Forward logistic regression and area under curves (AUC) were used to determine the best anthropometric index. For at least one cardiovascular risk factor (hypertension, dyslipidaemia and diabetes mellitus), the cut-off points for BMI, WHR, WC and WSR were around 23.6kg/m2, 0.80, 77.8cm and 0.48 for Singaporean females. The AUC of WSR was the highest for all three risk factors in females (0.79 for hypertension, 0.70 for dyslipidaemia, 0.88 for diabetes mellitus). Regression analyses revealed that WSR was independently associated with all risk factors. For Singaporean female adults, the cut-off points were lower than the criteria suggested by the WHO, but were in agreement with those reported for Asians. BMI, WHR, WC and WSR may be used as screening tools for cardiovascular risk factors, of which WSR may be the best anthropometric index.

A cross-sectional study was undertaken to determine anthropometric profile and nutritional status based on body mass index (BMI) of adult Bathudis, a tribal population of Orissa, India. A total of 409 adult (aged > 18 years) Bathudis of three villages of Anandapur, Keonjhar District, Orissa, India, were studied. Anthropometric measurements including height, weight, circumferences and skinfolds as well as BMI and waist-hip ratio (WHR) were measured. Overall, the extent of undernutrition (BMI < 18.5) was found to be very high (57.9%). Moreover, there was a significant (c2 = 8.09674, P = 0.01745) difference in the prevalence of undernutrition between men (52.7%) and women (64.5%). In conclusion, this study demonstrated that the prevalence of adult undernutrition was found to be very high among the Bathudis, a tribal population of Keonjhar District, Orissa. These rates were much higher than those found in several tribal populations from other parts of India. Therefore, immediate nutritional intervention programs are needed for implementation among Bathudis. Moreover, further research is needed not only among this ethnic group but also other tribal populations of India to fully understand the causes and consequences of adult undernutrition.

The aim of this study was to evaluate the utility of the [14C]-sodium bicarbonate/urea technique to detect physical activity-induced increases in total energy expenditure in free-living healthy men. Thirteen healthy males aged 34.1 ± 11.7 yrs with body mass index 24.1 ± 3.1 kg/m2 were studied on three separate occasions, during which [14C]-bicarbonate was infused over 48-hours and urine was collected during the second 24-hours. On three separate occasions and in random order, subjects either remained sedentary, or performed a bout of physical activity on an electro-magnetically braked cycle ergometer sufficient to increase energy expenditure by 7% or 11% above predicted sedentary total energy expenditure. Urine samples were analyzed to evaluate the amount of [14C]-bicarbonate incorporated into urinary urea, thereby reflecting the amount of CO2 produced per day, and upon conversion, the number of kilojoules of energy expended in 24-hours. All 13 subjects successfully completed the two physical activity treatments and there were no adverse events. As measured by the [14C]-urea assay, mean total energy expenditure values were not significantly different between sedentary activity (17902 ± 905 kJ/day), the physical activity treatment designed to increase TEE by 7% (17701 ± 594 kJ/day) and the physical activity treatment designed to increase TEE by 11% (18538 ± 485 kJ/day) (P=0.668). In conclusion, although the [14C]-sodium bicarbonate/urea technique was well tolerated and did not interfere with normal daily activities, it was not able to accurately measure physical activity-induced increases in EE in the range of 7-11% above predicted sedentary total energy expenditure.

The addition of some legume ingredients to bread has been associated with effects on glycaemic, insulinaemic and satiety responses that may be beneficial in controlling type 2 diabetes, cardiovascular disease and obesity. However, the effect of Australian sweet lupin (Lupinus angustifolius) flour (ASLF) is unknown. This investigation examined the effect of adding ASLF to standard white bread on post-meal glycaemic, insulin-aemic and satiety responses and palatability in healthy subjects. Using a randomised, single-blind, cross-over design, 11 subjects consumed one breakfast of ASLF bread and two of standard white bread ³ 7 days apart after fasting overnight. Each breakfast also included margarine, jam, and tea with milk and contained 50g available carbohydrate. On each test day, blood samples were taken after fasting, then several times over 2 hours post-prandially, and analysed for plasma glucose and serum insulin. Subjects rated breakfast palatability and perception of satiety, in the fasting state and over 3 hours post-prandially, after which food intake from an ad libitum buffet and for the rest of the day was recorded. Incremental areas under the curves for glucose, insulin and satiety, glycaemic index, insulinaemic index and satiety index were calculated. ASLF addition to the breakfast reduced its glycaemic index (mean ± SEM; ASLF bread breakfast = 74.0 ± 9.6. Standard white bread breakfast = 100, P=0.022), raised its insulinaemic index (ASLF bread breakfast = 127.7 ± 12.0. Standard white bread breakfast = 100, P=0.046), but did not affect palatability, satiety or food intake. ASLF addition resulted in a palatable breakfast; however, the potential benefits of the lowered glycaemic index may be eclipsed by the increased insulinaemic index.

This study assessed the safety and efficacy of growth hormone (GH) and glutamine (GLN) combined with a modified (high-carbohydrate-low-fat, HCLF) diet in patients with short bowel syndrome. A meta-analysis of all the relevant clinical trials was performed. Clinical trials were identified from the following electronic databases: MEDLINE, EMBASE, the Cochrane Controlled Trials Register, Chinese Bio-medicine Database. The search was undertaken in May 2004. Language was restricted to Chinese and English. Literature references were checked at the same time. Clinical trials were extracted and evaluated by two reviewers independently of each other. The statistical analysis was performed by RevMan4.2 software which was provided by the Cochrane Collaboration. A P value of <0.05 was considered statistically significant. Thirteen trials involving 258 patients were included. The combined results showed that GH, GLN and HCLF diet had positive treatment effect on body weight (weighted mean difference [WMD] = 2.44, 95%CI [1.62, 3.27], P<0.00001), stool output (WMD = -376.49, 95%CI [-600.35, -152.63], P=0.001), lean body mass (WMD = 2.16, 95%CI [0.91, 3.41], P=0.0007), absorption of carbohydrates (WMD = 6.21, 95%CI [5.27, 7.15], P<0.00001), absorption of nitrogen (WMD = 10.83, 95%CI [5.22, 16.44], P=0.0002), absorption of D-xylose (WMD = 0.37, 95%CI [0.29, 0.44], P<0.00001), and off TPN (total parenteral nutrition) (odds ratios [OR] = 64.63, 95%CI [15.51, 269.22], P<0.00001). But there were no improvements in fat mass (WMD = -1.50, 95%CI [-3.48, 0.48], P=0.14), absorption of energy (WMD = 7.48, 95%CI [-7.22, 22.17], P=0.32), and absorption of fat (WMD = 7.16, 95%CI [-2.95, 17.28], P=0.17). Most patients had side effects that are known to occur during treatment with high doses (0.14 mg/kg/day) of GH. No serious adverse effects occurred during active treatment with low doses (£0.1 mg/kg/day) of GH. Treatment with a combination of low-dose GH, GLN and HCLF diet is effective without any major adverse effects in patients with short bowel syndrome. Further trials are required, especially in children, with sufficient size and rigorous design. 

The aim of this study was to examine whether bovine colostrum was able to prevent the NSAID induced small intestinal damage in animals. The animal model population of the study consisted of 4 groups: control group, diclofenac group, diclofenac with 10% low fat milk group and diclofenac with 5% colostrum group. The animals with milk or colostrum were fed with 10% low fat milk or 5% colostral solution for 5 days before the administration of diclofenac. Gut injuries were induced by administration of a single dose of diclofenac (100 mg/kg orally). Epithelial permeability values (24 hour urinary excretion of 51Cr-ethylenediaminetetraacetic acid [51Cr-EDTA]), enteric aerobic bacterial counts, serum biochemical profiles and pathologic findings of distal ileum were measured. Diclofenac caused a marked increase in the intestinal permeability, enteric bacterial numbers and intestinal villous damage, and enteric protein and albumin loss. Combined administration of bovine colostrum reduced the increase in intestinal permeability, enteric bacterial overgrowth, protein losing enteropathy and mucosal villous damage of the small intestine induced by diclofenac. Bovine colostrum may have a beneficial effect in prevention of NSAID induced small intestinal injuries.

The subjects, from Mongolian-style gel tribes, aged 6-79 years, living in three different areas of Inner Mongolia, were asked about their daily food consumption in August 2001 using the 24-hr dietary recall method. There were no significant differences in food intakes between males and females of the same age group in the same area, with a few exceptions, although considerable variation was found among individuals and areas for the amount of foods consumed. Some subjects consumed greater amounts of wheat, vegetables, fruits, and vegetable oils, which suggested they had changed their eating patterns. All subjects drank large quantities of tea, to which was added milk (sheep/goat), cream, butter, parched millet and/or sawa. This traditional tea supplied vitamins and minerals such as vitamin A, iron and calcium.

This cross-sectional study examined the physical status, nutrient intake and dietary pattern of adolescent female factory workers in urban Bangladesh. A total of 1211 postmenarchial girls aged 14-19y from seventeen readymade garment industries spread over the Dhaka City participated in the study. Body weight, height and skin fold thickness were measured for all subjects. The nutrient intake was assessed by 24-h recall method and 7-day food frequency questionnaire was used to investigate their dietary pattern on a sub-sample of 509 girls. Sixty five percent of the girls were short (height-for-age, <3rd percentile of NCHS reference values). Pre-valence of short stature was higher in the older girls. Mean body weight was 38kg for the 14 year old girls, which gradually increased across the age groups to about 42 kg for the 18 and 19 year olds. About 17% of the girls were thin (BMI-for-age <5th percentile of NCHS reference values). Over all, about 23% were lean (TSFT-for-age<5th percentile of NCHS reference values). Food intake data revealed a deficit of 1.62 MJ/day in energy. Mean intake of protein, calcium, iron, vitamin A, thiamin, riboflavin, niacin and vitamin C were below the recommended dietary allowance. Most of the energy and nutrients came from cereal grains. Habitual pattern of food intake revealed poor intake of eggs, milk, meat, and green leafy vegetables. In conclusion, the data show a poor physical status of the adolescent female factory workers in Bangladesh. Simultaneous substantial deficits in energy and several nutrients in their diet stress the need for an appropriate intervention to improve their overall nutritional and physical status of these young females..

The iodine status of pregnant women from different ethnic groups in an Australian population was determined by measuring urinary iodine concentration (UIC) from stored spot urine samples. Study subjects were selected from pregnant women participating in a Down Syndrome screening study at Monash Medical Centre in Melbourne, Australia. In total, 263 Vietnamese, 262 Indian/Sri Lankan (ISL) and 277 Caucasian women were included. The median UIC of Caucasian women (52 µg/L) was significantly lower than that of both Vietnamese women (58 µg/L, P <0.01) and ISL women (61 µg/L, P = 0.03). The proportion of women who had a UIC below 50µg/L was 48.4% of the Caucasian women, 38.4% of the Vietnamese women and 40.8% of the ISL women. These data are consistent with mild iodine deficiency for each of the groups of pregnant women. The evidence for mild iodine deficiency in these groups of pregnant women is consistent with recent Australian studies in pregnant and non-pregnant individuals. The association of ethnicity with iodine status is most likely due to differences in dietary behaviours. Understanding the factors that influence iodine nutrition in a multiethnic population will be important for identifying the most useful approaches to improving iodine status, evaluating different strategies and the development of appropriate monitoring programs. Action to improve iodine status in the Australian population should include consideration of ethnic differences in diet.

This study quantifies the effects of iodine on the intellectual development of children using a systematic manual literature search of Chinese publications related to iodine deficiency disorders. The Chinese Medical Reference Database, Medline, and Cochrane library were searched electronically in Chinese and English. Inclusion criteria included: studies conducted in China, comparing children (<16 ys) living in naturally iodine sufficient (IS) with those in severely iodine deficient (ID) areas, or children in ID areas born before and after the introduction of iodine supplementation. Intelligent Quotient (IQ) was measured using Binet or Raven Scales. The iodine sufficient control groups were comparable socially, economically, and educationally with the study groups. Random effects models were used in the meta-analysis. Effect size was the standard deviation IQ point (SIQP), which is equivalent to 15 IQ. Thirty-seven reported studies, total 12,291 children, were analysed. The effect size was an increase of 0.83, 0.82, and 0.32 SIQP respectively, for the children living in IS communities compared with those living in ID areas with no iodine supplementation, with inadequate iodine supplementation, or children who had received iodine during their mothers' pregnancy and after birth. These equal to 12.45, 12.3, 4.8 IQ points. Compared with that of children whose mothers were persistently exposed to ID, the total effect size of the 21 entries was an increase of 0.58 SIQP (8.7 IQ points) in the group receiving iodine supplementation during pregnancy. Furthermore, there was an increase on 1.15 SIQP of Binet or 0.8 SIQP on Raven Scale (17.25 or 12 IQ points) for children born more than 3.5 years after iodine supplementation program was introduced. The level of iodine nutrition plays a crucial role in the intellectual development of children. The intelligence damage of children exposed to severe ID was profound, demonstrated by 12.45 IQ points loss and they recovered 8.7 IQ points with iodine supplementation or IS before and during pregnancy. Iodine supplementation before and during pregnancy to women living in severe ID areas could prevent their children from intelligence deficit. This effect becomes evident in children born 3.5 years after the iodine supplementation program was introduced.

A 6-month intervention trial was conducted among 542 Filipino children aged 4 to 7 years to determine the effect of vitamin A-fortified coconut cooking oil intake on their vitamin A status and to identify factors that influence this. Children were randomly assigned to the Experimental group, with vitamin A-fortified cooking oil ration; to Control-1 group with unfortified cooking oil ration; and to Control-2 group without cooking oil ration. In all groups, children's serum retinol concentration improved. Relative change in serum retinol con-centration was significantly higher among the Experimental group, with one-third of total vitamin A intake coming from vitamin A-fortified cooking oil intake, than in the Control groups, with more than half of intake from other vitamin A-rich foods. Determinants of post-intervention serum retinol concentration included baseline serum retinol concentration, caregiver's education, receipt of high-dose vitamin A capsule, interaction between consumption of vitamin A-fortified cooking oil and of other vitamin A-rich foods, and between households purchasing cooking oil and food expenditure. Intake of vitamin A-fortified cooking oil combined with vitamin A-rich foods was necessary to increase serum retinol concentration. It is recommended to vi-gorously promote the consumption of vitamin A-fortified cooking oil together with other vitamin A-rich sources to sustain the prevention and control of vitamin A deficiency.

Under- and over-reporting of energy intake are problems in dietary intake assessment. This study was conducted to assess the correlates of under- and over-reporting of energy intake in Tehranians. Dietary data on 947 participants (415 males and 532 females) of the Tehran Lipid and Glucose Study was collected by trained interviewers using two 24-hour recalls. Weight and height were measured by digital scale and tape measure according to standard protocols and recorded to the nearest 100g and 1cm, respectively. Under-, normal- and over-reporting of energy intake was defined as ratio of energy intake to basal metabolic rate (EI: BMR) <1.35, 1.35 - 2.39 and ≥ 2.4, respectively. Mean ± SD of age was 37.3 ± 14.6 and 32.9 ± 13.6 years for men and women, respectively. Men had higher EI: BMR than women (1.72 ± 0.44 vs 1.27 ± 0.44, P<0.001). EI and EI: BMR was highest in the youngest age groups in both sexes. The prevalences of under- and over-reporting were 31% and 5%, respectively. Fewer men than women underreported EI (19% vs 40%, P<0.001). The fraction of over-reporters was significantly higher in men than women (7% vs 3%, P <0.05). EI: BMR decreased with age. Under-reporters were older and had higher BMI than normal-reporters, but their educational level did not differ significantly. Over-reporters were younger and had lower BMI than normal-reporters, but their educational levels did not differ significantly. Most over-reporters had normal BMI. Smoking was more prevalent in overreporters than in the normal-reporters (28% vs 19% in men and 6% vs 1% in women, P<0.01). The results showed a high prevalence of misreporting of energy intake in Tehran. This phenomenon is related to age, obesity and smoking habits.

People of Indian origin develop type 2 diabetes at a relatively young age and low body mass index compared to people of other racial groups, possibly because of preferential accumulation of abdominal fat. We examined the relationship between abdominal fat and body mass index (BMI) in healthy premenopausal women of different racial groups, and compared abdominal fat measurements at different ages. Women of Chinese, European, Indian or Polynesian origin (50 of each, mean age 31) had dual energy x-ray absorptiometry of the lumbar spine, with estimation of the percentage fat in the abdominal area. Polynesian women had a significantly greater mean BMI (P<0.001) than all other groups, and a higher abdominal fat than European and Chinese woman (P<0.001). Although the Indian women had a similar mean BMI to the European and Chinese women, they had a significantly greater abdominal fat (P<0.001). When examined by age tertile, the Indian women had significantly more abdominal fat than Chinese or European women at all ages (P<0.001), with marked differences evident even in the youngest group (mean age 23 years). Compared to other racial groups, women of Indian origin preferentially accumulate abdominal fat - a trait that is well established in young adulthood.