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This special issue on the Nutrition and Health Survey in Taiwan Elementary School Children carried out during 2001-2002 (NAHSIT Children 2001-2002) portrays the current dilemma of the so-called “double nutritional bur- den” in Taiwanese children with papers addressing topics on the dietary characteristics, nutrition-related knowl- edge, attitudes, and behaviors, usage of nutritional supplements, nutritional biochemistry, and various aspects of diet, nutrition, behavior, health and wellbeing in children. The emergence of a double health burden in Taiwanese children is more prevalent in the underprivileged and less urbanized communities than in metropolitan cities. The NAHSIT Children 2001-2002 survey provides age-, and gender- specific percentile values for anthropometric measurements, physiological variables like physical fitness, blood pressure and pulse, respiratory function and bone density; nutritional hematology and biochemistry. For international comparison, these reference data are tabulated in this report and the survey data are made available in the data archive system maintained by the Cen- ter for Survey Research, Academia Sinica.

Bone health status in childhood and adolescence may be important factors influencing the attainment of peak bone mass. The Nutrition and Health Survey in Taiwan Elementary School Children 2000-2001 was carried out to evaluate the overall nutrition and health status of school children aged between 6 and 13 years. The survey was conducted using a multi-stage complex sampling scheme. Townships and city districts in Taiwan were classified into 13 strata. Bone mass measured as broadband ultrasound attenuation was taken at heel by quantitative ultra- sound bone densitometry. A total of 1164 boys and 1016 girls who had complete physical examination data with ultrasound bone scan were included in the current analysis. There were no apparent differences in BUA across all strata for both genders. In both boys and girls, age, height, body weight, BMI, and intake frequencies of vegeta- bles and fruits/juices were significantly related to BUA. Results of multivariate regression showed that age (β=1.36, p=0.0002) and body weight (β=0.40, p<0.0001) were significant predictors for BUA in boys, whereas in girls body weight (β =0.47, p<0.0001), height, (β =0.20, p=0.01), dietary phosphorus intake (β =-0.002, p=0.038), and frequency of fruit/juice intake (β =0.15, p=0.029) remained statistically significant. The differential effects dietary intake variables on BUA in boys and girls may be in part due to the development of puberty. It would be necessary to include levels of physical activity in future analyses for better understanding factors influencing the development of peak bone mass in Taiwanese children.

Metabolic fitness in childhood is of increasing concern in transitional and advanced economies as the metabolic syndrome (MS) is recognized more often in this age group. As the MS appears, so also does hyperuricemia. Stud- ies in Taiwan have identified both indigenous and Chinese with high prevalence of hyperuricemia. Data (1227 boys and 1057 girls, aged 6-12) from the Nutrition and Health Survey in Taiwan Elementary School Children (NAHSIT Children 2001-2002) were used to appraise the association between uric acid (UA) and MS in children. Mean serum urate increases by age, ranging from 5.69 mg/dL to 7.11 mg/dL for boys and 5.61 mg/dL to 6.13 md/dL for girls. Boys have higher UA concentrations (6.07 mg/dL vs. 5.74 mg/dL) and hyperuricemia (UA ≥ 7 mg/dL) rate (26.5% vs. 18.8%) than girls. Children of Mountain areas have higher rates of hyperuricemia (boys: 39.2%, girls: 30.1%). 5.56% of boys and 6.39% of girls were classified as having the MS by ATP III criteria. Se- rum urate was closely correlated with the MS parameters, and waist circumference (WC) in particular (r=0.387). WC alone accounted for 18% of variance of serum urate concentration. Both serum urate and hyperuricemia are significant risk factors for the MS (serum urate in mg/dL, OR: 1.54, 95% CI: 1.36-1.74; hyperuricemia, OR: 3.73, 95% CI: 2.47-5.62). Adjustment for age and region accentuate these relationships. Not only abdominal fatness, but also uric acid status, or both together may be of interest to public health workers and clinicians in regard to the transitional health problem of MS.

To evaluate the prevalence of obesity and its comorbidities among a representative sample of elementary school- children in Taiwan, the Nutrition and Health Survey in Taiwan Elementary School Children used a stratified, multi-staged complex sampling scheme. In total 2,405 children (1,290 boys and 1,115 girls) were included. The prevalence of overweight and obesity was 15.5 and 14.7% in boys and 14.4 and 9.1% in girls. With respect to geographic differences, the prevalence of obesity for boys was highest in the southern area (23.3% for the 3rd stra- tum) and lowest in the mountain area (4.3%). For girls, the prevalence of overweight and obesity was highest in the central area (13.0% for the 3rd stratum) and lowest in the southern area (2.6% for the 3rd stratum). The obese children had higher mean levels of blood pressure, triglyceride, low density lipoprotein-cholesterol, uric acid and serum glutamic pyruvic transaminase, but lower level of high density lipoprotein-cholesterol when compared with the normal weight children. For obese and normal weight boys, the prevalence was 12.9 % vs. 0.3 % for high blood pressure, 31.4 % vs. 19.6 % for dyslipidemia, and 6.4 % vs. 0.8 % for abnormal serum glutamic pyru- vic transaminase level. In conclusion, we found that about one third of the boys and one quarter of the girls were overweight and/or obesity in Taiwan. Furthermore, the prevalence of obesity-related comorbidities was signifi- cantly increased for obese and/or overweight elementary schoolchildren in the Taiwan area.

The “Nutrition and Health Survey of Taiwan’s Elementary School Children (2001-2002)” was to investigate the nutritional status, influential dietary and non-dietary factors, health and development, and school performance, as well as the inter-relationships among these factors. The survey adopted a two-staged stratified, clustered probabil- ity sampling scheme. Towns and districts in Taiwan with particular ethnic and geographical characteristics were designated into 13 strata including Hakka areas, mountain areas, eastern Taiwan, the Penghu Islands, 3 northern regions, 3 central regions and 3 southern regions. Eight schools were selected from each stratum using the prob- abilities proportional to sizes method. Twenty-four pupils were randomly selected within each school. The survey included face-to-face interviews and health examinations. Taking seasonal effects into consideration, the face-to- face interviews were evenly allocated into each of the two semesters. A total of 2,419 face-to-face interviews and 2,475 health examinations were completed. Interview data included household information, socio-demographics, 24-hour dietary recall, food frequency, dietary and nutritional knowledge, attitudes and behaviors, physical activ- ity, medical history, oral health, pubertal development, and bone health. Health exam data included anthropome- try, blood pressure, physical fitness, bone density, dental health, and blood and urine collection. SUDAAN was used to adjust sampling design effect. There were no significant differences in sibling rank and parental character- istics between respondents and non-respondents, which indicates that our survey is representative and unbiased. The results of this survey will increase our understanding on the nutrition and health status of schoolchildren and can be used to shape public health policy in Taiwan.

The aim of the study was to investigate nutrient intake and their dietary sources in Taiwanese children ages 6-12 years by analyzing the 24-hour recall data of 2386 participants from a nationally representative sample. Results showed that children in Taiwan were slightly lower in mean proportion of energy intake from carbohydrates (53.5% of energy intake) and higher in those from fats (30.8%) and protein (15.8%) as based on the recommenda- tions of Department of Health in Taiwan. The mean intake of vitamins and of minerals by children was equivalent to or exceeded Daily Reference Intake of Taiwan (DRI) or other recommended standards with the exception of a seriously insufficient calcium intake and extremely high sodium intake. A substantial proportion of children in different age/gender/location strata had lower mean vitamin and mineral intake by DRI and other recommended standards. These nutrient profiles were mainly related to dietary patterns with relatively low intake of fruits, vege- tables, cereals/grains, and dairy products, but high intake of the protein-rich foods, salt/sauces, and fats/oils. Ac- cording to the suboptimal dietary nutrient profiles of Taiwanese children, particularly in the underprivileged areas, recommendations are made in this article for policy makers and health practitioners to consider in order to im- prove dietary quality of elementary school children.

Dietary supplement consumption practices among 2417 children (1295 boys and 1122 girls) aged 6 to 12 years in Taiwan were derived from the Nutrition and Health Survey in Taiwan Elementary School Children (NAHSIT 2001-2002). The proportion (22%) of boys and girls using supplements was equivalent. Some 77% of the child supplement takers took only one type of supplement. The top five supplements consumed were: multivitamins and minerals, calcium, vitamin C, cod-liver oil and bee propolis in that order. Children in the most urbanized southern Taiwan had the highest usage (33%), but prevalence was lowest in the mountainous areas (5%). Higher parental education level and household monthly income were associated with higher intakes. Supplement users were more competent at school; however, the frequency and number of supplement types were not related to competence.

In The Nutrition and Health Survey of Taiwan Elementary School Children (NAHSIT Children 2001~2002), erythrocyte activity coefficients of transketolase (ETKAC) and glutathione reductase (EGRAC) were chosen as indices for assessing the functional status of thiamin and riboflavin nutriture. Mean values of the ETKAC for boys and girls, both of which were in a normal range, were 1.07±0.00 and 1.06±0.01, respectively. The respective prevalence rates of marginal and deficient thiamin states were 10.4% and 7.8% for boys and 9.3% and 7.3% for girls. Mean values of the EGRAC were 1.18±0.00 for boys and 1.19±0.01 for girls, both of which showed an in- creasing trend with age. The respective rates of marginal and deficient riboflavin states were as high as 32.5% and 3.5% for boys and 35.9% and 4.5% for girls. The marginal and deficient riboflavin statuses of Taiwanese schoolchildren were associated with a low frequency of dairy food consumption and an elevated risk of anemia.

The folate status and dietary folate intake of Taiwanese schoolchildren was investigated by analysis of both se- rum and red blood cell (RBC) folate levels and dietary folate intake in 1105 boys and 958 girls aged 6-13 years sampled from the Nutrition and Health Survey in Taiwan Elementary School Children 2001-2002 (NAHSIT Children 2001-2002). Mean serum folate levels were 18.3±8.8 nmol/L (8.1±3.9 ng/mL) in boys and 20.3±9.7 nmol/L (9.0±4.3 ng/mL) in girls. Mean RBC folate levels were 700±320 nmol/L (308±141 ng/mL) in boys and 751±347 nmol/L (331±153 ng/mL) in girls. The prevalence of serum folate deficiency was 1.4% in boys and girls, and the prevalence of marginal serum folate deficiency (7-14 nmol/L) was 31.1% in boys and 25.8% in girls. In addition, 8.5% of boys and 7.4% girls had RBC folate deficiency (RBC folate < 318 nmol/L), and 17% of chil- dren had marginal RBC folate deficiency (RBC folate of 318-454 nmol/L). Our results suggesting that Taiwanese schoolchildren have poor folate status especially during periods of rapid growth and development such as the transition from childhood to early adolescence (boys at age 12-12.9, girls at age 11-12.9). The average estimated folate intakes were 269±9 μg/d in boys and 259±9 μg/d in girls, and 42% of Taiwanese schoolchildren had a die- tary folate intake below 2/3 of the RDA, indicating a poor dietary folate intake in this population. This study shows that the folate status of Taiwanese schoolchildren is currently inadequate and strategies are needed for im- provement.

The purpose of this study was to investigate magnesium nutritional status and its association with asthma in ele- mentary school children (1277 boys and 1109 girls) participating in the Nutrition and Health Survey in Taiwan (NAHSIT children 2001-2002). Dietary magnesium intake was based on 24-hour dietary recalls. Serum magne- sium was measured. Average magnesium intake was 247 mg and 228 mg for the boys and girls, respectively, which is equivalent to 135-123% of the relevant Taiwanese Dietary Reference Intakes (DRIs). Mean serum mag- nesium concentration was 0.87 mmol/L and 0.86 mmol/L, respectively. The prevalence of serum magnesium <0.8 mmol/L was 10.5-13.5% in both gender in our sample of elementary school children. In Taiwan, asthma was diagnosed in about 5.8% and 4.7% of boys and girls, respectively. In this study, there were no associations be- tween asthma prevalence, dietary magnesium and serum magnesium concentration. In about 40% of our sample of school children, however, dietary magnesium may be suboptimal. This deficit should be targeted though im- proved intake of magnesium-rich foods such as whole grains, green vegetables and soybean products, particularly in Taiwanese school children whose dietary intakes are below the DRIs and/or who have low serum magnesium levels.