Akira Okada was a founding Editor with Vichai Tanpaichitr and Mark Wahlqvist of the APJCN (Asia Pacific Journal of Clinical Nutrition) in 1992. He was also the first President of the Asia Pacific Clinical Nutrition Society. He played a vital role in various nutrition societies, including the Japanese and Chinese Societies for Parenteral and Enteral Nutrition and on several editorial boards other than APJCN. He was a key figure in the development of Clinical Nutrition in the Asia Pacific Region, especially North-East Asia. In due course, he was bestowed the Society’s Annual Award for contributions to human health in the Asia Pacific region through the application of nutrition science.1
Dr. Okada was born in Hyogo, Japan on 29 November 1938 and took his medical doctor's degree at Osaka University Medical School. In 1968, He obtained his PhD with work on Hirschsprung's Disease. Following this, he went to the University of Minnesota and spent 2 years as a surgical research fellow from 1969 to 1971, with opportunities to learn from the pioneering work of Dudrick and Wilmore on central venous nutrition. He then returned to the Surgical Department of Osaka University where he became Professor and Chair of Paediatric Surgery.
He made great contributions to the science of nutrition support and nutrient requirements. Although Ananda Prasad was the first to describe zinc deficiency in humans in 1961, Akira Okada was the first to report it in the course of clinical nutrition support, in 1975, at the International Nutrition Congress in Kyoto and with a Japanese publication,2 followed by a report in English in 1976.3
Sadly, he died, aged 68 years of metastatic thyroid cancer on August 19th 2007 following several months of illness. After he retired from the Medical Directorship of Osaka University Hospital and the Chair of Paediatric Surgery in 2002, he became Director of Maternal and Child Welfare for Osaka. About 18 months before his death, he returned to work at the Okada Hospital, founded by his medical father, and it was where he died.
He loved music, especially Mozart, and was a good pianist. He was a gracious chaperone for many of his colleagues, their families and his friends into Japanese culture.
He is survived by his wife Utako, his son, Minoru (in Japan), his daughter, Yumiko, his grandson, Sohichiro, and grand daughter, Haruka. (in the USA).
Objective: To predict the percent body fat (%BF) cutoff values corresponding to overweight and obesity rec- ommended by the International Obesity Task Force (IOTF) in Korean children and to compare those values with the published cutoff values in Caucasian children. Research methods and procedures: The sample consisted of 1083 Korean children and adolescents (555 boys and 528 girls) aged 7-18 years from 3 schools. Body mass index (BMI) and %BF using a bioelectrical impedance analyzer were measured. The classification of overweight and obesity was based on the age- and sex-specific BMI cutoff values of the IOTF guidelines. Results: The pre- dicted %BF cutoff values for overweight and obesity varied by age and sex: overweight, 17-22% in boys and 24- 37% in girls; obesity, 24-30% in boys and 30-53% in girls. Those %BF cutoff values in older Korean boys tended to be lower than the published %BF cutoff values in Caucasian boys. While %BF cutoff values for over- weight in Korean girls were similar to the values in Caucasian girls, %BF cutoff values for obesity in Korean girls aged 13~18 years were higher compared to cutoff values in Caucasian girls. Conclusion: The %BF values associated with the IOTF-recommended BMI cutoff values for overweight and obesity may require age- and sex- specific cutoff values in Korean children aged 7-18 years.
The objective of this study was to determine the population-specific cut-points of body mass index (BMI), mid- arm circumference (MAC) and calf circumference (CC) for identifying subnormal nutritional status in elderly Taiwanese, and to evaluate the possibility of improving the functionality of the Mini Nutritional Assessment (MNA) by adopting these cut-points. This study analyzed data from 1583 men and 1307 women, 65 years or older, of a national survey. The survey involved in-home, face-to-face, interviews and anthropometric measure- ments. Results showed that based on the cumulative percentile curves, the fifth percentile values were: BMI, 17 kg/m2 for both men and women; MAC, 22.5 cm for men and 21 cm for women; and CC, 28 cm for men and 25 cm for women. Substitution of these population-specific cut-points for respective values in the MNA screen re- sulted in lowered proportions of elderly classified malnourished or at risk of malnutrition. The prevalence of malnutrition was reduced from 1.7% to 1.4% in men and from 2.4% to 1.5% in women. The proportions classi- fied at risk of malnutrition were reduced from 10.1% to 8.9% for men and 16.8% to 12.8% for women. In con- clusion, results suggest that the MNA is a valuable tool for geriatric nutritional risk assessment. However, in populations where significant differences exist in anthropometric measurements from the Caucasian populations, population-specific cut-points should be used.
Body fatness, physical activity, and nutritional behaviours were assessed in 112 (50 male, 62 female) Asian In- dians living in New Zealand. Participants were aged 44-91 years (mean 67.5 ± 7.6) and had lived in New Zea- land on average 51 months. Height, weight, and waist circumference were measured to determine body mass in- dex (BMI) and central adiposity. Bioelectrical impedance was used to derive fat free mass, fat mass, and per- centage body fat. Pedometers were worn to record daily steps taken over each of seven consecutive days. A life- style and health questionnaire was administered to collect information on nutrition behaviours. Average BMI for the sample was 27.2 ± 4.7 kg/m2 with females (28.0 ± 5.4 kg/m2) significantly higher than males (25.6 ± 5.4 kg/m2). Using Asian Indian specific cut-offs 69% of the sample was obese (BMI≥25 kg/m2) and a further 13.7% overweight (23≥BMI<25 kg/m2). Average percentage body fat for the sample was 41.1 ± 9.1 with females sig- nificantly higher than males. The majority (74%) reported some form of chronic condition, with 35% diagnosed with diabetes. Physical activity levels for the sample were low (5,977 ± 3,560 steps/day) and significantly differ- ent between males (6,982 ± 4,426) and females (5,159 ± 2,401). Higher pedometer steps were associated with lower waist circumference. After adjustment for age, physical activity was lower, but nutritional habits better for those who had spent a longer time in New Zealand. In summary, Asian Indian immigrants to New Zealand have low physical activity levels and high levels of overweight/obesity and lifestyle disease.
The objective of this study was to assess the impact of a group diet and physical activity intervention on body composition, blood lipid profile and insulin resistance in migrant Asian Indian volunteers. Total body and ab- dominal fat, waist girth, serum glucose, insulin and lipids were measured one month before and immediately prior to an intervention designed to encourage increased physical activity and improved diet. Measurements were repeated after a 5-month period of altered exercise and dietary habits. Over this period monthly group edu- cation sessions were held on diet and physical activity and the importance of lifestyle changes to reduce risk fac- tors for chronic disease. Forty one (21M, 20F) volunteers (aged >50 y) were recruited from Asian Indian com- munity groups in urban Auckland, New Zealand. Body weight, total and percentage body fat, waist girth and abdominal fat decreased in men following the intervention (p<0.006) while these changes were not statistically significant in women. In both men and women high density lipoprotein (HDL) levels increased and LDL and to- tal cholesterol/HDL ratio decreased (p<0.002) without changes in serum glucose, insulin and triglycerides. Re- duction in systolic and diastolic blood pressure was associated with an increase in HDL cholesterol in women (r=0.63, p=0.003, r=0.48, p=0.03) but not in men (r=0.09, p=0.69, r=0.04, p=0.86). Over a five month period, an Asian Indian community group diet and physical activity intervention resulted in significant reductions in total and abdominal body fat and blood lipid risk factors but not in insulin sensitivity or resistance.
This study aimed to investigate the relation of obesity and changes in body weight through adulthood with risks of type 2 diabetes. This study of 954 middle-aged women free of diabetes (mean age, 37.1±9.6 years) was con- ducted in a hospital. The baseline and biannual health check-ups were performed from 1993 to 2003. The cumu- lative incidence rate of type 2 diabetes was 3.64 per 1000 person-years during the mean follow-up period of 10 years. 73.3% of subjects who developed type 2 diabetes were overweight (16.6%) or obese (56.7%). Obese sub- jects (body mass index more than 25 kg/m2) had a relative risk of type 2 diabetes of 10.4 (95% confidence inter- val 2.95-36.9) compared with subjects with an optimal body mass index (18-22.9 kg/m2). Long-term weight gain was strongly related to the risk of type 2 diabetes. Each 1 kg of weight gain was associated with a 16% increase in risk of developing diabetes. This study indicated that obesity at young adult and weight gain appreciably in- crease risk for type 2 diabetes. Maintaining a lean weight throughout adulthood seems to be beneficial in the primary prevention of type 2 diabetes.
Objective: To investigate lay peoples’ knowledge of health risks of overweight, accuracy of self-perception of body weight and perceived benefits of weight loss. Method: A nine item questionnaire was administered to a cross sectional survey of adults in metropolitan shopping centres, height and weight were measured. Results: Two hundred and nine (57% female) adults completed the survey. Thirty eight percent had a healthy BMI (18.5- 24.9), 38% were overweight (BMI 25-29.9) and a further 22% were obese (BMI>30). However only 46% per- ceived themselves ‘overweight’, 50% considered themselves ‘just about right’ and 4% considered themselves ‘underweight’. Of those with a BMI of 25 or greater 28% considered their weight ‘just about right’. Over 80% thought ‘being overweight’ was ‘likely’ or ‘very likely’ to be a risk factor for cardiovascular disease, hyperten- sion, diabetes and stroke; however 20% of overweight or obese individuals did not think their health would im- prove if they lost weight. Conclusion: A significant proportion of overweight or obese individuals do not accu- rately perceive their body weight and do not recognise the health advantages of weight loss despite recognising excess body weight as a risk factor for chronic diseases. Implications: Increasing the awareness of an individ- ual’s BMI and promoting the benefits of modest weight loss maybe two underutilized strategies for population level weight control.
Objective: To evaluate waist-to-height ratio (WTHR), waist girth and body mass index (BMI) as predictors of cardiovascular risk factors in Australian Aborigines. Design: Indices were examined as predictors of mean blood pressures (BP), blood lipids, glucose, insulin and as predictors of hypertension, decreased HDL-cholesterol, ele- vated glucose and type 2 diabetes. Setting: Aboriginal communities in remote north-west Australia. Partici- pants: Four hundred and one adults. Results: More than 80% of participants had WTHR ≥0.5 or BMI >22 kg/m2 and 78% had increased waist girth (>90 cm men; >80 cm women). Adverse BP, blood lipids, glucose and insulin were associated with classification above the cutpoint for each index. For fasting glucose ≥5.6 mmol/L, sensitiv- ity was 91% with WTHR, 87% with waist girth and 88% with BMI; respective specificities were 29%, 29% and 44%. Area under receiver operating characteristic (AUROC) curves gave only “fair” accuracy for any discrimi- natory variable. With diabetes AUROC for BMI (0.59, 95% CI 0.53, 0.65) was significantly lower than with other indices (WTHR 0.74, 95% CI 0.69, 0.79; girth 0.72, 95% CI 0.67, 0.78) but did not differ significantly for fasting glucose, HDL-cholesterol or hypertension. AUROC did not differ significantly between men and women for any outcomes. Conclusions: The indices did not discriminate well for diabetes or cardiovascular risk factors in these Aborigines, but waist girth or WTHR appeared more useful than BMI. Appropriate cutpoints are needed. WTHR is simple, does not need sex-specific cutpoints and could be useful in developing public health strategies.
Although hyperhomocysteinemia is considered to be a key risk factor for atherosclerosis, especially in Western countries, its role in the Asian population is still controversial. In this study, we evaluated the determinants of homocysteine and carotid intima-media thickness, a clinical marker for the detection of atherosclerosis, in Japa- nese. In 289 Japanese adults (age 37-86 yrs), we screened plasma total homocysteine by high performance liquid chromatography and evaluated maximum carotid intima-media thickness by ultrasound. Other blood chemistry values were also measured. Total homocysteine levels were higher in men than in women and increased with age. In multiple regression analysis, adjusted for age and sex, serum creatinine was a powerful determinant of homo- cysteine (β=3.3, p<0.01). Maximum carotid intima-media thickness was higher in men than in women and in- creased with age. When adjusted for age and sex, systolic blood pressure was independently correlated with maximum carotid intima-media thickness (β=0.001, p<0.01). Our current results support previous findings that in addition to age and sex, serum creatinine and systolic blood pressure are independent determinants of homo- cysteine and carotid intima-media thickness, respectively.
Introduction: Earlier studies in India have demonstrated an inverse relationship between physical activity and birth weight in rural women who had high levels of physical activity related to agricultural and domestic activi- ties. There are no data on urban Indian women from a wide range of socio-economic backgrounds with varying levels of physical activity. This study assessed the role of different domains of physical activity during preg- nancy and its relation to birth weight. Methods: Data on maternal anthropometry and maternal physical activity level were collected at the 1st trimester (baseline), the 2nd trimester and the 3rd trimester of pregnancy. Birth weight for 546 live born babies was measured immediately after delivery. Results: The time spent in sedentary activities (median “cut-off” of 165 min/d) was significantly associated with maternal body weight in the first trimester of pregnancy (51.2 kg vs. 54.1 kg, p<0.001). Women in the highest tertile of physical activity level in the 1st trimester were 1.58 times (95% CI: 1.02-2.44) more likely of having a baby in the lowest tertile of birth weight with reference to the first tertile. This significant association continued after adjustment for maternal weight and energy intake. Conclusion: The present study shows that physical activity in the first trimester is as- sociated with low birth weight in Indian babies.
Objective: To determine whether chicken-based formula can replace soy-based formula in infants with cow milk allergy. Subjects and Methods: Thirty-eight infants with cow’s milk allergy, aged between 2-24 months of age were randomized to receive either chicken-based formula or soy-based formula for 14 days. Results: In the group of soy-based formula, 12 out of 18 infants had evidence of intolerance and could not continue with the formula. However, only 4 out of 20 infants in the chicken-based formula group had evidence of clinical intoler- ance. All other 16 infants were fed the chicken-based formula with success. The number of infants who were in- tolerant to chicken formula was significantly lower than the number of those fed soy-based formula (p = 0.009). Conclusion: Chicken-based formula can be used more effectively than soy-based formula in infants with cow milk allergy.
There is currently no single dietary or lifestyle intervention that is effective in long-term weight loss. Traditional weight loss diets tend to be low in total fat and therefore often restrict nut consumption. However, nuts are an important source of many vitamins, minerals, monounsaturated and polyunsaturated fatty acids. This paper re- viewed all the available evidence from the literature in relation to nut consumption and body weight. The find- ings show that the role of nut consumption in body weight management is varied. Nuts, when included as part of an energy-controlled diet, were found in some instances to assist with weight loss. However, when nuts were added to an existing diet without controlling for energy intake, body weight increased, although to a lesser extent than theoretically predicted. There is limited evidence on the effect nut consumption has on type 2 diabetes, al- though available evidence indicates that nuts as part of a healthy diet do not cause weight gain and can have a positive influence on the fatty acid profile of a person with diabetes. This review shows there is a lack of evi- dence to support the restriction of nut consumption in weight management, indicating that further research is needed to assess the role of nuts in weight management.
Objectives: This study hypothesized that besides iron deficiency, intestinal parasites infection is also a determi- nant of anemia in schoolchildren in rural Vietnam. Methods: 400 primary schoolchildren from 20 primary schools in Tam Nong district, a poor rural area in Vietnam, were randomly selected from enrolment lists. Venous blood (5ml) was collected in a cross sectional study and analyzed for hemoglobin (Hb), serum ferritin (SF), se- rum transferrin receptor (TfR), serum C-reactive protein (CRP) and total immunoglobulin E (IgE). Stools sam- ples were examined for hookworm, Trichuris, and Ascaris infection. Logistic regression was used to assess the effect of intestinal parasites on anemia. Results: The prevalence of anemia (Hb<115g/L) was 25%. Iron defi- ciency (TfR >8.5mg/L) occurred in 2% of the children. The prevalence of intestinal parasites was 92% with the highest prevalence for Trichuris (76%) and Ascaris (71%). More than 30% and 80% of the children showed an elevated CRP (≥ 8 mg/L) and IgE (> 90 IU/mL) concentration. Anemia status was borderline significantly asso- ciated with SF and not associated with TfR and CRP. The prevalence odds ratio for Trichuris infection was 1.96 (95%CI 1.07-3.59) and 2.00 (95% CI 1.08-3.65) with iron deficiency reflected by TfR and SF, respectively. Conclusion: Anemia is highly prevalent among schoolchildren in Vietnam but may not be associated with iron deficiency. Trichuris infection is associated with a doubled risk of anemia, not mediated through iron deficiency. Chronic infection may play a role in anemia, but needs further investigation.
We conducted a cross sectional study to examine the association of intestinal parasitic infections and protein en- ergy malnutrition (PEM) with iron-status indicators and anaemia among Orang Asli children in Selangor, Ma- laysia. A total of 281 children aged 2 - 15 years were studied. The data were collected using structured question- naires, anthropometric measurements and laboratory analysis for blood and faecal samples. All children were in- fected either by A. lumbricoides, T. trichiura or hookworm and almost 19%, 26% and 3% of the children had se- vere infection of ascariasis, trichuriasis and hookworm infection respectively. The prevalence of giardiasis among them was 24.9%. Overall, 41.5% of the children were anaemic (haemoglobin < 11.0 g/dL). Of these 61.0% of the children had iron deficiency and 36.5% had iron deficiency anaemia (IDA), which accounted for 88.0% of anaemia in this population. Severe trichuriasis had the most significant correlation with anaemia and iron deficiency in this population. It contributed to low concentrations of haemoglobin, serum iron and serum ferritin and high total iron binding capacity (TIBC). Significant underweight and stunting were associated with low concentrations of haemoglobin and serum iron while significant wasting was significantly associated with low concentration of serum ferritin. Logistic regression analysis confirmed that severe trichuriasis was a strong predictor of IDA. It also confirmed that children who were significantly underweight and whose mother was working were independent predictors of IDA in this population.
This investigation aims to observe the intelligence and psychomotor development of the schoolchildren in iodine deficiency (ID) areas after the adoption of Universal Salt Iodization (USI), and evaluate the effect of the adop- tion of USI on their intelligence and psychomotor development. 564 schoolchildren (306 males and 258 females, age range from 8 to 13 yrs) from areas with severe, moderate, and mild ID were investigated. Intelligence quo- tient (IQ) was measured by Combined Raven’s test, second edition. Psychomotor development was examined by Jinyi Psychomotor Test Battery (JPB). We found that the IQ scores of all subjects in the severe and moderate ID areas were 102±15.6 and 99.5±16.6 respectively, lower than those in the mild ID areas (108±12.4, p<0.01). The IQ scores correlated negatively with age (partial r=-0.17; β=-1.95; p<0.0001). The total T scores of JPB of all subjects in the severe and moderate ID areas were 316±42.3 and 330±47.7 respectively, lower than those in the mild ID areas (342±48.1, p<0.05). The total T scores of JPB correlated negatively with age (partial r=-0.15; β=- 4.94; p=0.0006). We may conclude that after the adoption of USI in the ID areas investigated, USI has probably made a contribution to the partial recovery of intelligence and psychomotor development injured by ID in schoolchildren, and should be strengthened.
Objectives: This study aimed to evaluate the food intake patterns of adolescents with respect to the Australian Guide to Healthy Eating, and to examine variations in food intake patterns by age, gender and region of resi- dence. Design: Cross-sectional online food survey administered through schools. Participants and setting: In 2004-2005, 3841 secondary students in years seven (12-13 years) and nine (14-15 years) drawn from 37 secon- dary schools in Victoria, Australia completed an online food intake patterns survey. Outcome measures: Food intake was measured by a Food Frequency Questionnaire (FFQ), and categorized according to the five basic food groups (fruit, vegetables, meat, dairy, cereal) and the ‘extra’ food group as defined by the Australian Guide to Healthy Eating (AGHE). The foods groups were examined in the study population and compared across age, gender and region. Results: Many adolescents in this sample reported food intakes that deviated substantially from recommendations of the AGHE. For example, two-thirds of participants failed to consume foods from the five recommended food groups daily; over a third reported eating fruit ‘rarely or never’; and 22% reported eating fast foods every day. Food intakes were generally more in line with dietary guidelines among girls than boys. Regional differences were less consistent, and there were few differences by age. Conclusion: A significant proportion of adolescents have food intakes that fall short of the recommendations outlined in the Australian Guide to Healthy Eating. This highlights the need for public health initiatives to promote healthier food intake patterns among adolescents.
Many adolescents have diets that are less than optimal, particularly adolescents of low socioeconomic position (SEP). The determinants of SEP differences in adolescent dietary intake are poorly understood. This study exam- ined the home food environments of adolescents and specifically investigated whether low SEP adolescents have less supportive home meal environments, fewer eating rules and poorer home availability of fruit and vegetables than adolescents of high SEP. A cross-sectional, self-reported survey was administered to 3,264 adolescents in years 7 and 9, from 37 secondary schools in Victoria, Australia. Adolescent perceptions of the home meal envi- ronment, eating rules and home food availability were described and compared across SEP, which was measured using maternal education. Maternal education was linked to various aspects of the home meal environment, as well as home food availability, but not to eating rules. Low SEP adolescents were more likely to report that they were always allowed to watch television during meal times, and that unhealthy foods were always or usually available at home. In contrast, high SEP adolescents were more likely to report that vegetables were always served at dinner, that the evening meal was never an unpleasant time and always or usually a time for family connectedness, and that fruit was always or usually available at home. This study highlights aspects of the home food environment that might explain SEP variation in adolescent diets. Feasible ways of increasing home avail- ability of healthy foods, and encouraging home meal environments to be supportive of healthy eating should be explored, particularly in households of low SEP adolescents.
Diet and nutritional status have been shown to play pivotal roles in the occurrence of many chronic diseases. In this study, we examined the patterns of dietary habits and their relationships with risk factors for cardiovascular and chronic diseases in Hong Kong working populations. In April 2000, a 5-year territory-wide health promotion campaign supported by the Li Ka Shing Foundation was launched in Hong Kong by the Health InfoWorld of Hospital Authority. Between July 2000 and March 2002, 4841 Chinese subjects [2375 (49.1%) men and 2466 (50.9%) women, mean age: 42.4 ± 8.9 years (median: 43.0 years, range: 17-83 years)] from the general working class were recruited. Subjects were randomly selected using computer generated codes according to the distribu- tion of occupational groups. A dietary questionnaire was used to assess 6 core dietary habits: daily fruit intake, vegetable intake, fluid intake, sugary drinks, regularity of daily meals and number of dining out each day. Over- all, men had a worse cardiovascular risk profile and less desirable dietary habits than women. Those who had more unhealthy dietary habits were more likely to be obese and current smokers. Using logistic regression analy- sis with the dietary habits as independent variables, we found that obesity, smoking and constipation were inde- pendently associated with various unhealthy dietary patterns. In conclusion, there were close associations be- tween dietary habits and risk factors for cardiovascular diseases in Hong Kong. More effective community edu- cation about healthy lifestyle is required in Hong Kong.
Food frequency questionnaire is an important assessment tool for public health nutrition research. We describe the development history and conducted the validity and reproducibility studies for a meal-based Chinese food frequency questionnaire (Chinese FFQ) by five meal sequences. A total of 51 subjects were recruited to collect dietary information twice (6 months apart) with one 24-hr recall, 7-day food records and the Chinese FFQ. Combining data from both time sets, Chinese FFQ showed strong correlations of macro and micronutrients with 7-day records (n=60, r=0.29-0.50, p<0.05), but not with 24-hr recalls (n=60, r=0.01-0.23, p>0.05). The repro- ducibility of this Chinese FFQ (n=22) was consistently high for most nutrients, with Spearman correction coeffi- cients between 0.42 for vitamin A to 0.79 for vitamin B12. From a larger sample of 231 subjects who completed the Chinese FFQ and one 24-hr recall, we found the energy distributions of breakfast, lunch, dinner, afternoon and evening snacks combined from Chinese FFQ were 20%, 37%, 37% and 6%, and from 24-hour recalls were 19%, 36%, 44% and 1%, respectively. These results showed acceptable reproducibility and relative validity of this meal-based Chinese FFQ.
In the mid to late 19th century organic chemistry surged ahead, especially in Giessen, Germany, with the brilliant chemist and scientific father and grandfather of many ultimate Nobel Prize winners, Justus von Liebig. Most of today’s giant industrial chemical, pharmaceutical and food industries were spawned by him or his scientific progeny. The book by Randall Fitzgerald is an instalment in this incredible saga, as was “Silent Spring” by Rachel Carson in 1962. But these books concentrate on the down-side and consider the overall risk-benefit equations in this more-than-a-hundred-year story. The picture in brief is that hundreds, may be thousands, of novel chemi- cals have been isolated or synthesized during this period and that human exposure to them is unlikely to have coped with the biological challenge. Homo sapiens evolved over hundreds of thousands of years and will not have been able to adapt to this recent onslaught of foreign chemicals, it is argued. The author reasons that we have managed longer and healthier lives, more in the face of this challenge than because of the presumed benefits.
The book title and chapter headings are provocative, even emotive, and alert the potential reader to the book possibly being “at the edge” of science and reason. “From the Womb to the Grave”, “Wizards of Oz: the Food In- dustry”, “Sorcerer’s Apprentices: The Drug and Medical Industries”, “Are we becoming a Mutant Species?”, “Be- yond Apocalypse Now”, “When Western Medicine Fails” are the captions. But the substance of these pages is actu- ally well-researched and I found myself reviewing some of my own well-formatted views, in particular in regard to fluoridation of the water supply and the many currently non-diagnosable symptom sets one encounters in clinical practice and which may have certain novel chemical(s), or their combination, as causative exposures. On the other hand, in some areas with which I am quite familiar, like non-nutritive sweeteners and the failure of Western Medicine (and the alternatives), I found the evidence ad- duced to be not as robust as the author has implied. In these days of Evidence-Based Medicine (EBM), people look for certain kinds and hierarchies of evidence to be confident and measured in policy-setting. These EBM approaches themselves have limitations and the appeal for portfolios of evidence with avoidance of implied causality from intervention studies (showing effect but not neces- sarily cause) along with sound logic and integrative think- ing grows. Fitzgerald makes a contribution to this re- appraisal of the nature of evidence.
One of the author’s most important contributions is to address the belief system and culture which has devel-
oped in regard to synthetic chemicals. This culture affects individuals, communities, nations and their governments. Somehow, even though we may be relatively science and health-literate, we ignore the warnings and the phenom- ena around us and “trust the government” or its agencies even if we purport otherwise. The telling example of a warning at the entrance to a Californian Wal-Mart about products possibly containing dangerous chemicals yet universally ignored, opens chapter one. Possibly, there is a well-developed sense of risk analysis in consumers’ minds, but probably there is not.
The increasingly recognised pharmaceutical industry strategy of medicalising behaviours and the extremes of population distribution curves for mood, feelings, symp- toms or bio-markers to create new markets for products is ably described.
Some books of this type seek to create a sense of credi- bility by heavy, if inappropriate, referencing. By contrast, Fitzgerald references with relevance the countless exam- ples he gives to make his case.
Even to the skeptic, he leaves an impression and mes- sage that all is not well in the realm of synthetic chemi- cals and their governance. No doubt their contribution to human health and development has been over-rated. But we are still left wondering whether our options are not few and fewer as the countdown for planetary sustainabil- ity proceeds.
By Mark L Wahlqvist
It is increasingly difficult for a nutrition textbook to be all things to those who are interested in or wish to learn about the discipline. But, invariably, one must ask about a textbook which claims to be the “Essentials of human nutrition” as to how comprehensive it is. One way, now espoused by the International Union of Nutrition Science (IUNS), is to ask if it embraces the 3 dimensions of bio- medical, socio-economic and environmental science. The present book is strong in the first, reasonable in the sec- ond and almost silent on the third of these. Only here and there does it have a “food systems” approach to human nutrition, although the chapter by James and Rigby on Chronic Diseases comes close. There are segments on “Food Groups” with several provided by authors from the food industry, without a cohesive approach to eco- systems or their relevance to human health.
Nutrition is an ever-changing science, as science should be, but the international and national regulatory systems like Codex Alimentarius, the role of the United Nations, and governance in food security are surely worth a chapter in this day and age. At the same time, it is
pleasing to see chapters on Nutritional Crises and on pov- erty and food insecurity from other points of view.
The book includes a life course approach, with several eminent authors. In this approach, with tenuous connec- tion to it, is a thorough chapter on Sports Nutrition by Louise Burke from the Australian Institute of Sport who has written earlier versions in other textbooks of nutrition. If it is Clinical Nutrition the reader seeks, Nutritionally Related Disorders (NRD ) are reasonably covered, nutri- tion assessment is accorded a section , there is a chapter on dietary counselling (in another section) and chapters on HIV and AIDS and on nutrition support in another section. In other words, clinical nutrition is somewhat scattered in the book. The important global health prob- lem, for public health and clinical medicine, of nutrition, immune function and infection is not systematically ad- dressed. There is no chapter dealing with the process of nutritional diagnosis.
In the Introduction, the “Tools of the Trade” are enu- merated, but one of the crucial tools, that of body compo- sitional studies, is omitted. Fortunately, it appears, with- out cross-reference, in the section on “Nutritional As- sessment”.
The book is multi-author, including many high profile figures in nutrition. Their different writing styles show as do their peculiar emphases, insights, expertise, biases and approaches to classification of information. Some mate- rial is more prosaic than scientific; expressions like “dead drunk” in the alcohol chapter and assertions like “our ancestors originally ate fruits for their sweetness” (did they or did they not? how do we know? what are the al- ternative constructs?) are at least provocative, if not inap- propriate in a learned text, Likewise, unless one expects one’s readership to be principally Christian, the sundry Biblical references, interspersed with science, are not impressive. Perhaps they are intended as a literary flour- ish, but they fail in this.
Having observed some textual weaknesses which de- tract from credibility, a great strength of the book is the Evidence Based Nutrition (EBN) approach taken by Jim Mann in all the chapters he has authored and by Martin Wiseman in the prototype EBN work on nutrition and cancer which he and the World Cancer research Fund (WCRF) have executed and released on November 1st 2007, which is reflected in his chapter.
Is the book up-to-date? What should we expect to be reflected in a textbook when evidence is changing so rap- idly? The most expert contributors can write ahead of their published (and review article) field and this is evi- dent in some of the chapters. An example of what this book does is in the well-established field of micro- nutrient nutrition-an illuminating history, a reliable syn- thesis of the classical knowledge, a sense of its impor- tance in international health, and some pointers to new directions. As the book went to press, however, new con- cerns had emerged about folic acid (as opposed to folacin) fortification of food-stuffs with increased twinning rates and colo-rectal cancer incidence; there were newly- recognized functions of vitamin D in the CNS (central nervous system), and in pulmonary, metabolic (insulin- resistance syndrome) and immune (especially in regard to tuberculosis) functions. No textbook can be truly up-to-
date, but can provide some judgements about the “state of play” of the science. By and large this book does so for the topics it canvasses.
One must ask what the future of textbooks like this is, in the age of information explosion and the internet. A group of disciplinary scholars, since one or two will no longer suffice, with responsibility for their field of knowledge, could be expected to bring together the pre- vailing understanding and wisdom in that field from time to time. Perhaps textbooks will continue to serve this function, but alternatives will rapidly emerge. Encyclope- dias are now evolving (or giving way) to “Wikipedias” which are the product of people-at-large, with more and more iterative forms of learning in curricula and in con- tinuing education. The present textbook of nutrition stands at the interface between the old and the new in the field of compilation and interpretation of disciplinary knowledge. It offers the transitional facility of an adjunc- tive web-site, www.oxfordtextbooks.co.uk/orc/mann3e. It serves as a valuable sign post, directing its readership to what constitutes a fairly agreed body of scientifically – based nutrition knowledge, but is not sufficiently antici- patory of its imminent crises through food system failure or changing patterns of NRDs.
By Mark L Wahlqvist
Nutritional anaemia remains one of the world’s most prevalent health problems, affecting some 800 million women and children under the age of 5 years. Put another way, almost half of preschool children and pregnant women and nearly one third of non-pregnant women suf- fer from anaemia. Most of this is in Africa and Asia, Iron deficiency accounts for about half of anemia in develop- ing countries. The situation, its recognition and epidemi- ology, contributory factors, be they socio-cultural or bio- medical, health and societal consequences and what can be done about it are thoroughly reviewed in this 2007 multi-authored book edited by Klaus Kramer and Michael B Zimmermann. All of the authors have the credentials to be authoritative with their contribution. This does not mean that all the answers are in or the material is un- controversial as the persistence of this global epidemic shows.
Understanding the complexity of anaemia, the extent to which it is nutritional, the importance of its interplay with infectious and inflammatory diseases and with haemoglo- binopathies, its food-based and multimicro-nutrient
nature and the need for intersectoral and diverse interven- tions is espoused in this publication.
Inevitably, then, there are chapters which address the strengths and weaknesses of supplementation and various forms of food fortification, with biofortificaton showing promise as a more sustainable intervention where de- pendency on iron (and micronutrient)-poor staples char- acterize the food supply.
The companion Guidebook to the parent Textbook is most useful for its factual summaries of the problems and possible solutions, especially for those who must be ad- vocates to policy makers and mentors of those in the field. Material is also available on www.sightandlife.org
By Mark L Wahlqvist
The frequency of lactase persistence varies widely in human populations. Study showed that the T allele of a C/T transition 13910bp upstream from exon 1 of lactase gene (LCT) was completely associated with lactase persis- tence in a Finnish population. To evaluate if the frequency of -13910T allele was in concordance with the lactase persistence in northern Chinese populations, in this study, we used Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) to detect the lactase -13910T allelic frequency in 5 northern Chinese populations for the first time. Results showed that the T allele frequency was low in these populations and that it did not match the lactase persistence phenotype in these populations. Therefore the -13910T allelic frequency can not serve as a predictor of the lactase persistence in these populations and this suggests the exis- tence of other possible mechanisms of lactose tolerance in Chinese populations.
The potential benefit of aerobic exercise upon cardiovascular disease (CVD) through an increasing high-density lipoproteins (HDLs) is acknowledged. However, its effects on low-density lipoproteins (LDLs) and their sub- populations, are unknown in Thailand. Twenty sedentary Thai women undertook a 12-week exercise training program (60% heart rate reserve) comprising 25-minute cycling followed by 10-minute warm-up/cool-down 3 times a week with a group of 20 matched sedentary subjects as control. Triacylglycerols (TGs) and cholesterol (C) of plasma lipoproteins including triacylglycerol-rich lipoproteins (TRLs), large, buoyant LDL (lb-LDL), small, dense LDL (sd-LDL) and HDLs were analyzed while serum fatty acid profiles were also assessed. It was found that plasma TGs, TRL-TGs, sd-LDL-C and sd-LDL-C/lb-LDL-C (S/L) ratio decreased significantly after 12-weeks of exercise to -9%, -8%, -17% and -19% respectively from baseline (p<0.05). Serum fatty acid profiles remained unchanged. No alteration of any parameters was found in the control group without exercise. These findings suggest that moderate exercise training, even without a change of HDLs, impedes the shift of lb-LDL to more atherogenic sd-LDL, thus possibly preventing cardiovascular disease in healthy, sedentary Thai women.
The aim of this study was to evaluate the effect of the consumption of purple sweet potato leaves (PSPLs) on the immune response and the modulation of that response in 15 basketball players during a training period. They completed the 7-week study consisted of a run-in period (week 1), a PSPLs diet (200 g PSPLs/d; weeks 2, 3), a washout period (weeks 4, 5), and a control diet (low polyphenols content and carotenoid content adjusted to the same level as that of PSPLs diet; weeks 6 and 7). Blood, urine, and saliva samples were collected for biochemi- cal analysis. The results showed that the plasma polyphenols concentration increased significantly in the PSPLs period. Compared with the control period, the PSPLs consumption produced a significant increase in the prolif- eration responsiveness of peripheral blood mononuclear cells (PBMC), cytotoxic activity of nature killer (NK) cells, and secretion of interferon (IFN)-γ. However, no significant increase in the secretion of salivary immu- noglobulin A (sIgA), interleukin (IL)-2, or interleukin-4 was observed after PSPLs consumption. In conclusion, consumption of a PSPLs diet for 2 weeks can modulate the immune response of basketball players during a training period.
We examined the plasma levels of carotenoids in young adults after a dietary intervention composed of increased intakes of fruits and stir-fried vegetables from a Taiwanese mixed diet. Thirty-four apparently healthy, non- smoking subjects who normally ingested less than two and a half servings of fruits and vegetables daily were se- lected for the study. Meals changed were lunch and dinner on weekdays for a period of 4 weeks. The test meal consisted of three servings of stir-fried vegetables and two servings of fresh fruits. Plasma carotenoid levels in subjects significantly increased from 19%-32% for β-carotene, 15%-47% for lycopene and 59%-88% for β- crytoxanthin (p < 0.05) from week 1 to 4. However, these concentrations of β-carotene and lycopene signifi- cantly decreased after stopping the consumption of the test meals. This study reveals the importance of a con- tinuous consumption of carotenoid rich foods in order to maintain high levels of plasma carotenoids for the po- tential prevention of chronic diseases in individuals.
Dietary plant sterols supplementation has been demonstrated in some studies to lower plasma total and LDL cho- lesterol in hypercholesterolemic subjects. The cholesterol lowering action of plant sterols remains to be investi- gated in subjects with the metabolic syndrome. In a randomized, crossover study of 2 x 4 week therapeutic peri- ods with oral supplementation of plant sterols (2 g/day) or placebo, and two weeks placebo wash-out between therapeutic periods, we investigated the effects of dietary plant sterols on lipoprotein metabolism in nine men with the metabolic syndrome. Lipoprotein kinetics were measured using [D3]-leucine, gas chromatography-mass spectrometry and compartmental modeling. In men with the metabolic syndrome, dietary plant sterols did not have a significant effect on plasma concentrations of total cholesterol, triglycerides, LDL cholesterol, HDL cho- lesterol, apolipoprotein (apo) B, apoA-I or apoA-II. There were no significant changes to VLDL-, IDL-, LDL- apoB or apoA-I fractional catabolic rates and production rates between therapeutic phases. Relative to placebo, plasma campesterol, a marker of cholesterol absorption was significantly increased (2.53 ± 0.35 vs. 4.64 ± 0.59 μg/ml, p<0.05), but there was no change in plasma lathosterol, a marker of endogenous cholesterol synthesis. In conclusion, supplementation with plant sterols did not appreciably influence plasma lipid or lipoprotein metabo- lism in men with the metabolic syndrome. Future studies with larger sample size, stratification to low and high cholesterol absorbers and cholesterol balance studies are warranted.
A Indonesian Advisory Group on Fatty Acid Nutrition and Health was established in 2004 to consider the increasing incidence of nutritionally-related cardiovascular disease in Indonesia. Emerging international recommendations often focused on dietary fat and may not have been relevant to the national situation. Tradi- tional dietary patterns were apparently protective against ischaemic heart disease often with fat derived domi- nantly from a particular source like coconut, soy, peanut or fish. These fats were used in ways which promoted the use of potentially cardioprotecive foods like legumes, vegetables, fruits and aquatic food. Optimal intakes of polyunsaturated fatty acids in Indonesia are likely to reflect both absolute intakes and the relationships between n–3 and n–6 fatty acids of longer chain lengths. This leaves some issues for active and continuing review, like the intakes of trans fatty acids, and the regulatory and food labelling implications. Some studies underway and others which need implementation will enable the Advisory Group to prepare a second report with more basis in Indonesian evidence. In the meantime, the Advisory Group has recommended that the AHA (American Heart Association) and ISSFAL (International Society for the Study of Fatty Acids and Lipids) recommendations ob- tain until the end of 2007.
Objective: to investigate the accuracy of bioelectric impedance analysis and anthropometry to assess percentage body fat (BF %) against underwater weighing (UW). Design and Methods: a cross sectional study, 102 girls, aged 11-15, were recruited from two Junior High Schools in Jakarta. Measurements: measurements of percent- age body fat (BF%) using underwater weighing (UW), bioelectrical impedance analysis (BIA), Tanita BIA, body mass index (BMI) and skinfold equations. Results: Correlation between different methods was significant (p < 0.001).The mean difference of BF % from BIA, Tanita, BMI and skinfold compared to UW were 1.87+3.14, - 3.46+3.28, 1.57+2.90 and -0.360+3.09, respectively. Assessments between UW and other methods were signifi- cantly different (p < 0.0001) except for skinfolds (p = 0.3031). Conclusion: The results between UW and other methods was significantly different, except for skinfolds. There was overestimation and underestimation of BF%. The agreement between skinfold measurement and underwater weighing was also influenced by menarche status.