APJCN

For the last decade, the focus of nutritional advice for prevention of chronic disease has been to limit or reduce total fat intake and to consume large amounts of carbohydrate. However, this advice is inconsistent with many lines of evidence indicating that unsaturated fats have beneficial metabolic effects and reduce risk of coronary heart disease. More recent evidence has also shown that the large majority of carbohydrates in Western diets, consisting of refined starches and sugars, have adverse metabolic effects and increase risks of coronary heart disease and type 2 diabetes. Unfortunately, a major opportunity for health improvement has been lost by failing to distinguish healthy from unhealthy forms of carbohydrates and fats. Recent analyses indicate that moderate changes in diet, together with regular physical activity and not smoking, can prevent the large majority of heart disease, type 2 diabetes, and some forms of cancer. These findings have substantial relevance for many popula- tions in Asia, where incidence of type 2 diabetes is rising rapidly.

Genetic studies of metabolic syndrome provide a means to identify key pathways that predispose individuals to various phenotypes of the metabolic diseases and risk factors to type 2 diabetes and cardiovascular disease. Both genome wide linkage and association studies have been attempted to answer this issue. In this minireview, I will address genetic studies in Chinese in both family and population samples. The works of genome scan of were reported from the SAPPHIRe cohort as an example to address the linkage approaches to unraveling genetics of various traits composing the metabolic syndrome. In addition, some of the important biological candidate genes were also discussed. Finally, the success of finding genes through genome wide association for the metabolic syndrome remains to be explored.

The prevalence of diabetes mellitus (DM) and the metabolic syndrome (MetS) are rapidly increasing in Asia including Korea. In 2005, the Third Korea National Health and Nutrition examination survey (KNHANES III) reported that the prevalence of DM and MetS in adults was estimated to be 8.7% and 32.6%, respectively. In our study of 688 type 2 DM patients, MetS prevalence was 46.9 % for males, and 65.1% for females. Patients with T2DM and MetS showed significantly higher insulin resistance than T2DM without MetS, confirming that insulin resistance is an important feature of MetS in T2DM patients. Patients with T2DM and MetS showed higher BMI, waist circumference, blood triglycerides, atherogenic index, C-reactive protein and lower HDL- cholesterol. In recent years, concerns with regard to the association of diet with MetS have grown. In our study with non-DM elderly people, higher % energy from carbohydrate, and lower intakes of antioxidant vitamins were considered to be associated with the risk of MetS. Patients with T2DM and MetS showed significant posi- tive correlations between intakes of energy, carbohydrate, protein and lipids with BMI, weight, as well as waist circumference. These associations were not found in patients with T2DM without MetS. Nutritional risk factors for MetS among middle-aged T2DM subjects would be excessive carbohydrate intake with low intakes of fat, protein, vitamins, and minerals.

Dietary Reference Intakes (DRIs) are nutrient standards that may be used to plan nutrient intakes. Thus, they are useful as the basis for formulating dietary guidelines. The guidelines are often presented to the public as a food guide that will promote nutrient adequacy without risk of excessive intake. Such guides typically use the Recommended Dietary Allowances (RDAs) as intake targets because intake at the RDA is associated with a high probability of nutrient adequacy for healthy persons. During the development of the MyPyramid food guide for the United States, several questions were addressed: (1) What energy levels will be covered by the specific food patterns within the food guide? Each pattern should promote nutrient adequacy for the targeted energy intake level, which may include different age and gender groups. (2) What nutrients will be targeted by the food patterns? They should promote nutrient adequacy while also ensuring that intakes are not excessive for food components such as sodium, saturated fat, and cholesterol. (3) What food groups will be included in the food patterns, and how will their nutrient profiles be determined? After these decisions have been made, then the recommended amounts of each food group can be determined. A unique approach has been used to develop Canada’s Food Guide, which included a simulation of the effect of differing food choices within each food group. Dietary guidelines and food guides which are based on the DRIs have the potential to improve nutrient intakes for consumers who follow them.

With rapidly changing dietary environment, dietary guidelines for Koreans were revised and relevant action guides were developed. First, the Dietary Guidelines Advisory Committee was established with experts and government officials from the fields of nutrition, preventive medicine, health promotion, agriculture, education and environment. The Committee set dietary goals for Koreans aiming for a better nutrition state of all after a thorough review and analysis of recent information related to nutritional status and/or problems of Korean population, changes in food production/supply, disease pattern, health policy and agricultural policy. Then, the revised dietary guidelines were proposed to accomplish these goals in addition to 6 different sets of dietary ac- tion guides to accommodate specific nutrition and health problems of respective age groups. Subsequently, these guidelines and guides were subjected to the focus group review, consumer perception surveys, and a pub- lic hearing for general and professional comments. Lastly, the language was clarified in terms of public under- standing and phraseology. The revised Dietary guidelines for Koreans are as follows: eat a variety of grains, vegetables, fruits, fish, meat, poultry and dairy products; choose salt-preserved foods less, and use less salt when you prepare foods; increase physical activity for a healthy weight, and balance what you eat with your ac- tivity; enjoy every meal, and do not skip breakfast; if you drink alcoholic beverages, do so in moderation; pre- pare foods properly, and order sensible amounts; enjoy our rice-based diet.

In early 1980’s, the first edition of dietary guidelines for Taiwanese was established by the Department of Health (DOH), Executive Yuan. The main purposes of the guidelines were to guide nutritional professionals and dieti- cians to plan diet for preventing general population from diseases. Besides the amount of daily cholesterol intake, the percentages of calories from carbohydrate, protein, and fat was recommended. Dietary guidelines were re- vised concurrently as the results of national nutrition survey showed dietary or nutrient deficits of Taiwanese population. The recent dietary guidelines were then revised for general publics and consist of 8 items, including: maintain ideal body weight, eat well-balanced meals from all food groups, eat whole grains as staples for main meals, eat more high-fiber foods, eat less fat, less salt, and less sugar, consume plenty of high calcium content foods, drink plenty of water, if you drink alcohol, do so in moderation. In addition to these qualitative guidelines, a daily food guide was also established to instruct the general public to consume portions from six food groups. The suggested portions for food groups were calculated and based on basic balanced meal principles and the recommended energy, protein for different age groups from DRIs. The pictorial representation of the daily food guide was plum blossom which is the national flower. Leaflets, posters, and slides were developed for nutrition education. As the eating behavior and disease patterns may change, the governments and nutrition societies should keep revising dietary guidelines and daily food guides to encourage population health.

Although under-nutrition problems have been decreasing in Thailand, non-communicable diseases have become leading causes of death and disability. Food-Based Dietary Guidelines (FBDGs) is a key strategy to promote healthy daily food consumption and appropriate lifestyles. The development consists of qualitative and quantita- tive parts. The purposes were 1) to assist consumers in making healthy dietary choices and disease prevention; 2) to guide governmental agencies in nutrition implementations, promotion of healthy food products and education programs; 3) to assist national and local agencies in policy formulations and implementations; 4) to assist health- care providers in primary diseases prevention efforts. The procedures to develop FBDGs specifically were to 1) set nutritional goals based on Thai DRI and RDI; 2) assign the units used for one portion of each food group; 3) quantify the size and number of servings of the major food groups, using the nutritive value calculated by the popularity vote method from secondary data; 4) evaluate the nutritive value of recommended amounts from combinations; 5) develop and test several food guide models based on Thai people’s understanding and cultures; 6) implement through educational tools for the nationwide public units; 7) offer training programs, monitoring and evaluation in various populations to be performed by Ministry of Public Health (MOPH) and other academic sections. In long run successful FBDGs, there must not only be support from policy makers and cooperation be- tween nutritionists from universities and the MOPH, but also application of ongoing activities such as “Sweet Enough Campaign Network” or “School Lunch Program”.

Single nutrients are no solution to the problem of malnutrition. It is essential that food based dietary guidelines (FBDG) are developed and implemented to overcome the diet related diseases and promote health in the popu- lation. A multidisciplinary group was constituted to develop FBDGs in India. A manual with scientific details and an abridged version were prepared with 6 goals and 14 dietary guidelines covering all age groups to over- come the public health nutritional problems. The guidelines are based on dietary patterns and specific outcomes of health and disease. Dietary diversification has been suggested as the practical approach. Diets from locally available and culturally accepted foods in household measures have been suggested to ensure optimal health. For successful implementation of FBDGs, political/bureaucratic commitment are essential. It must become a tool in the developmental plans for food, nutrition, agriculture, rural, educational and biotechnology policies. Workshops and meetings were organized to sensitise the administrative set-up. The intersectoral nature of FBDG for implementation was highlighted. The department of women and child development, which is respon- sible for implementing the National Nutritional Policy, was recognized as nodal agency. Meetings were organ- ised for secondary target audiences. The press was invited to participate in popularisation of the FBDGs. Social marketing strategies were used to match the local dietary and cultural aspects. Interpersonal communication and professional societies were used for better dissemination. Industry and legislative bodies were requested to take active action in this regard. The FBDGs have to be implemented to achieve food and nutrition security and the Millennium Development Goals.

Consumption patterns are changing globally. As a result both researchers and policy makers require simple, easy to use measures of diet quality. The Healthy Eating Index (HEI) was developed as a single, summary measure of diet quality. The original HEI was a ten component index based on the US Dietary Guidelines and the Food Guide Pyramid. Research on the HEI indicates that the index correlates significantly with the RDA’s for a range of nutrients and with an individual’s self-rating of their diet. The revised HEI provides a more dis- aggregated version of the original index based on the 2005 Dietary Guidelines for Americans. Within each of the five major food groups, some foods are more nutrient dense than others. Nutrient Density algorithms have been developed to rate foods within food groups. The selection of the most nutrient dense foods within food groups lead to a dietary pattern with a higher HEI. The implications of using the HEI and nutrient density to develop interventions are discussed in this presentation.

Dietary Guidelines for the promotion of overall good health and the prevention of disease often play an impor- tant role in setting nutritional policy and in the education of the public about healthy food choices. Although much has been written about adherence to such guidelines, until recently there was no evidence on whether ad- herence to specific dietary guidelines is associated with better health. As an outcome variable for such analyses, we have used the incidence of major chronic disease, which includes incidence of any major cardiovascular disease, cancer, or death from any cause excluding violence. We have evaluated the Dietary Guidelines for Americans using a scoring system called the Healthy Eating Index developed by the Department of Agriculture to quantify adherence to these guidelines. We found that adherence to the Dietary Guidelines and the Food Guide Pyramid was associated with only a small reduction in major chronic disease risk in a population of over 100,000 US adult men and women. We also assessed whether an alternate index, which took into account the type of fat and quality of carbohydrate, would better predict risk. In contrast with the original Healthy Eating Index, adherence to the alternative index predicted lower rates of major chronic disease, and particularly car- diovascular disease, suggesting that the Dietary Guidelines were not offering optimal dietary guidance. These analyses suggest that dietary guidelines should be evaluated for their ability to predict the occurrence of major illness, and that such analyses can help refine these guidelines.

Dietary intake and nutritional factors have been shown to be associated with many chronic diseases, such as heart disease, obesity, diabetes, and cancer. There are many approaches to studying dietary intake in relation- ship to disease; each approach has its strengths and weaknesses. Examples of different methods of studying die- tary patterns will be reviewed. In most cultures, consumed and preferred foods are based on cultural and socie- tal influence. Thus, it is important to consider dietary patterns within the context of culture in addition to the standard nutrients or food groupings approach. Traditional Chinese Medicine (TCM) offers another dimension to food analysis. Our approach classifies dietary intake based on Traditional Chinese Medicine principles of yin and yang, hot and cold, and acidic and alkaline forming food concepts in a case-control study of dietary fac- tors and breast cancer. Our results complement previously reported findings of an increased risk of breast can- cer associated with dietary fats in Taiwanese women. Our discussion will focus on the implication of using this dietary pattern research and the challenge of combining this research with culturally sensitive messages to im- prove health. Our ultimate goal is to design an intervention strategy for disease prevention and health promo- tion that is culturally appropriate for specific populations.

A number of imperatives require a re-think of science in general and of nutrition science in particular. Nutrition science has never been a body of knowledge in its own right and many other sciences have been nutritional in their orientation. At its best "nutrition science" has been integrative as well as reductionist. It has worked across disciplines. The IUNS, (International Union of Nutritional Sciences) undertook to re-examine nutrition science from a policy point of view and to do so with knowledge-makers in general and with the International Science Council. There is now a Sciences for Health and Wellbeing (SHWB) initiative involving all branches of science. It is expected that innovative, integrative, sustainable, and cost-effective approaches to human well-being and health will emerge. Some of the pressing needs for such collaboration have been in the areas of sustainable food systems, potable water, more nutritious crops, food and human behaviour, to reduce the burden of nutri- tionally-related disease (NRD) and make health care affordable. An IUNS Task Force met in Giessen in 2005. It concluded that nutrition science should develop on 3 fronts, the biomedical, societal and environmental. This will encourage new and more effective initiatives for nutrition and its partners to address local, regional and global concerns about planetary and personal health and well-being. Some important and critical areas already require collective attention. Unlike our predecessors in nutrition science, we will be unable to fulfil the expecta- tions of us unless we progress this wider and less anthropocentric form of our science.

Incorporating the Healthy Eating Index concept, we have developed a global dietary quality index, the Overall Dietary Index (ODI). We have evaluated the relationships between ODI and chronic disease in a 1998 Taiwan- ese Health Screening program with over 46,000 members (51.2% females) aged 19-84. However, it could not predict health status adequately. Therefore, we revised this ODI which became ODI-R (Revised). The revision added a quality evaluation for staples (whole grains) and protein-rich foods (fish and soy) and reduced the im- pact of dietary fat quantity. ODI-R comprises nine items with a maximal score of 100. It has 5 food categories: dairy products, protein rich foods (eggs/legumes/fish/meats), vegetables, fruits and cereals; 2 dietary fat quali- ties (P/S ratio and cholesterol); and 2 descriptors: dietary moderation (alcohol, salt and sugar as one item) and dietary variety. The mean ODI-R was lower than ODI (64.4 vs. 68.1 in men and 65.5 vs. 69.0 in women) and the distribution. The correlations between macronutrients and ODI-R were weaker than for ODI, especially for fat (from –0.52 to –0.07) as well as for cholesterol and all fatty acid types by degree of saturation. For dietary fiber and micronutrients, the correlations became either less negative or more positive, signaling that the ODI-R reflects food quality more appropriately than ODI in regard to micronutrients. Empirically, a subtraction scor- ing approach for the overeating of protein rich foods, did not meaningfully decrease ODI-R in Taiwanese eld- erly or children. ODI-R provides an effective measure of dietary quality over quantity.

Crop plants provide essential food nutrients to humans and livestock, including carbohydrates, lipids, proteins, minerals and vitamins, directly or indirectly. The level and composition of food nutrients vary significantly in different food crops. As a result, plant foods are often deficient in certain nutrient components. Relying on a single food crop as source of nutrients thus will not achieve a balanced diet and results in malnutrition and defi- ciency diseases, especially in the developing countries, due mainly to poverty. The development and applica- tion of biotechnology offers opportunities and novel possibilities to enhance the nutritional quality of crops, particularly when the necessary genetic variability is not available. While initial emphasis of agricultural bio- technology has been placed on input traits of crops such as herbicide tolerance, insect resistance and virus resis- tance, increasing effort and promising proof-of-concept products have been made in output traits including en- hancing the nutritional quality of crops since 1990s. Advancements in plant transformation and transgene ex- pression also allow the use of plants as bioreactors to produce a variety of bio-products at large scale and low cost. Many proof-of-concept plant-derived healthcare products have been generated and several commercial- ized.

Scientific and technological developments in the agricultural sectors in the recent past has resulted in increased food production and at the same time led to certain public health concerns. Unseasonal rains at the time of har- vest and improper post harvest technology often results in agricultural commodities being contaminated with certain fungi and results in the production of mycotoxins. Consumption of such commodities has resulted in human disease outbreaks. Naturally occurring toxins, inherently present in foods and either consumed as such or mixed up with grains, had been responsible for disease outbreaks. Other possible causes of health concern include the application of various agrochemicals such as pesticides and the use of antibiotics in aquaculture and veterinary practices. Foodborne pathogens entering the food chain during both traditional and organic agricul- ture pose a challenge to public health. Modern biotechnology, producing genetically modified foods, if not regulated appropriately could pose dangers to human health. Use of various integrated food management sys- tems like the Hazard Analysis and critical control system approach for risk prevention, monitoring and control of food hazards are being emphasized with globalization to minimise the danger posed to human health from improper agricultural practices.

In knowledge-based economies, nutrition concepts evolve with advances in agriculture. As people around the world become more health conscious, national health becomes one of the main directives for agricultural poli- cies, including that of functional foods and their global markets. This article evaluates the development of the functional food industry in Taiwan and other countries through analysis of R&D capacity and bibliometrics. It attempts to identify future trends in nutrition with technology foresight research. Taiwan has a wide variety of indigenous herbal plants, although its functional food related literature is not large compared with some other Asian countries. However, there are quality papers on the immunologic functions of edible plants Globally there is much interest in edible plants with antioxidant activity and those phyto-nutrients which might help re- duce the burden of chronic illness as well as in the nutrigenomics that will lead to the design of foods with these properties. To make the most of available agricultural resources, countries like Taiwan should relate agricul- tural development to the nutritional status of their populations. This strategy will add significant value to global agriculture

Iron deficiency anaemia is a major public health problem. The high incidence is either due to insufficient in- take of iron or poor bio availability. Enhancing the bio availability is as important as increasing the intake. The absorption could be enhanced by including ascorbic acid and β carotene containing fruits and vegetables into recipes of iron containing food preparations. The effect of supplementation of iron bio-availability enhanced mung bean preparations was studied on 75 women who were compared against 75 who served as controls and another 75 who consumed regular traditional recipes. The methodology included identification of suitable mung bean variety, assessing iron in vitro bio availability, mapping the anaemic women, estimating their iron levels, supplementation for one year and studying the effect of supplementation. Mung bean supplementation had increased serum protein levels from 5.36 to 6.73 g/dl, serum iron levels had increased from 16.6 to 46.7 μg/dl. The TIBC levels decreased from 555 to 508 μg/dl while serum ferritin levels increased from 3.56 to 5.94μg/dl and Hb levels from 7.54 to 8.29 g/dl. Thus, improving the bioavailability of iron of food preparations, will improve the iron status of women.

The main dietary sources of micronutrients are animal source foods, fruits, vegetables and legumes. Animal source foods are the only source of some micronutrients and the main dietary source of others. Micronutrient status and child development are improved by animal source food interventions in populations that habitually consume low amounts. Of particular concern is the high global prevalence of vitamin B12 depletion, which is associated with low animal source food intake. Some fruits and vegetables can supply vitamin A requirements even with the lower amounts of fat typically consumed in many countries. However, plant source foods are unlikely to supply enough iron, zinc and vitamin B12, even if strategies such as consuming ascorbic-acid rich foods to increase iron absorption are adopted. Identification of mineral-rich varieties of cereals and legumes may improve the future situation. Complementary foods for infants and young children are unlikely to meet mi- cronutrient requirements, especially for iron and zinc, unless they are fortified. Other strategies to improve mi- cronutrient status, such as fortification and supplementation, have limitations and should not replace food-based strategies. Moreover, food-based strategies will improve dietary quality in general and are consistent with the global need to lower the risk of chronic disease and overweight.

Community based nutrition programmes (CBNP) are increasingly being seen as a key turning point in imple- mentation strategies leading to food and nutrition improvement as a sound basis for socio-economic develop- ment. In order to be effective and successful, CBNP require a constellation of methods and services planned from the community along with policy support for effective implementation, reaching the unreachable and em- powering those at the grass roots. These also need to be guided and monitored using a set of indicators such as essential minimum needs indicators specific to the community's needs. The community based approach has also been embraced at the global level with the Millennium Development Goals, advocating achieving a set of eight goals ranging from reducing poverty and hunger to improving educational opportunities for all children and forming stronger global partnerships for development. Lessons learned from CBNP in Asia show that in order to be effective, the programmes must be adopted at national level and implemented at community level. National level leadership and commitment to sound nutrition improvement policies and goals, must be com- bined with basic services, mass mobilization, people empowerment and actions at community level.

Estimates of FAO indicate that 14% of the population worldwide or 864 million in 2002-2004 were undernourished in not having enough food to meet basic daily energy needs. Asia has the highest number of undernourished people, with 163 million in East Asia and 300 million in South Asia. Meanwhile obesity and diet-related non-communicable diseases continue to escalate in the region. The double burden of malnutrition also affects the poor, which is a serious problem in Asia, as it has the largest number of poor subsisting on less than $1/day. As poverty in the region is predominantly rural, agriculture-based strategies are important for improving household food security and nutritional status. These measures include shifting toward production of high-value products for boosting income, enhancing agricultural biodiversity, increasing consumption of indigenous food plants and biofortified crops. Urban poor faces additional nutritional problems being more sensitive to rising costs of living, lack of space for home and school gardening, and trade-offs between convenience and affordability versus poor diet quality and risk of contamination. Time constraints faced by working couples in food preparation and child care are also important considerations. Combating the double burden among the poor requires a comprehensive approach including adequate public health services, and access to education and employment skills, besides nutrition interventions.

In addition to the burden of undernutrition, many recent studies in Vietnam demonstrate that over- weight/obesity and a number of nutritionally- related chronic diseases (NRCD) (hypertension, diabetes, cardio- vascular diseases) are on the rise at an alarming rate. This could be the result of dietary and life style changes. The double burden of malnutrition (DBM) - a typical phenomenon during nutrition transition in developing countries, has been clearly reported in our country. Controlling nutritional deficiencies and newly emerging nu- trition problems to reduce the double burden of malnutrition in Vietnam requires comprehensive and appropri- ate measures as set out in the National Nutrition Strategy 2001 – 2010, as well as a greater research effort on transitional nutrition.

Obesity is a complex disease, which in many cases appears as a polygenic condition affected by environmental factors (mainly unbalanced dietary patterns and physical inactivity). In this context, the weight loss response to dietary interventions varies widely and predictive factors of successful slimming including those concerned with the individual’s genetic make-up are poorly understood. Indeed, a number of genes involved in the regula- tion of energy expenditure, appetite, lipid metabolism and adipogenesis have been reported to affect the risk of treatment failure in some obese subjects. Some candidate genes for the prognosis of weight loss response re- lated to energy expenditure are those codifying for the adrenergic receptors (ADBRs) and uncoupling proteins (UCPs), while genes related to appetite potentially affected by energy restriction are leptin (LEP), leptin recep- tor (LEPR), melanocortin pathways genes (MC3R, POMC) and the serotonin receptor. Furthermore, adipo- genesis related genes such as peroxisome proliferator-activated receptor (PPARγ2) and genes related to cyto- kines such as interleukin-6 (IL-6) and lipid metabolism including hepatic lipase (LIPC), perilipin (PLIN) and lipoprotein lipase (LPL) have also been associated to the weight lowering outcome induced by hypocaloric di- ets. Therefore, this review shows preliminary evidence from human studies that support the existence of a ge- netic component in the fat reduction process associated to a negative energy balance.

One of the two major goals of nutrigenomics is to make full use of genomic information to reveal how genetic variations affect nutrients and other food factors and thereby realize tailor-made nutrition (nutrigenetics). The other major goal of nutrigenomics is to comprehensively understand the response of the body to diets and food factors through various “omics” technologies such as transcriptomics, proteomics, and metabolomics. The most successfully exploited technology to date is transcriptome analysis, due mainly to its efficiency and high- throughput feature. This technology has already provided a substantial amount of data on, for instance, the novel function of food factors, the unknown mechanism of the effect of nutrients, and even safety issues of foods. The nutrigenomics database that we have created now holds the publication data of several hundred of such ‘omics’ studies. Furthermore, the transcriptomics approach is being applied to food safety issues. For ex- ample, the data we have obtained thus far suggest that this new technology will facilitate the safety evaluation of newly developed foods and will help clarify the mechanism of toxic effects resulting from the excessive in- take of a nutrient. The ‘omics’ data accumulated by our group and others strongly support the promise of the systems biology approach to food and nutrition science.

Berries contain a number of compounds that are proposed to have anticarcinogenic properties. We wanted to see if pure ellagic acid, natural ellagitannins and three wild berries have any effect on the adenoma formation in Apc- mu- tated Min/+ mice. Min/+ mice were fed high-fat AIN93-G diets containing 10% (w/w) freeze-dried bilberry (Vac- cinium myrtillus), lingonberry (Vaccinium vitis-idaea), cloudberry (Rubus chamaemorus), cloudberry seeds or cloudberry pulp or pure ellagic acid at 1564 mg/kg for 10 weeks. β-Catenin and cyclin D1 protein levels in the ade- nomas and in the normal-appearing mucosa were determined by Western blotting and immunohistochemistry. Early changes in gene expression in the normal-appearing mucosa were analyzed by Affymetrix microarrays. Three wild berries significantly reduced tumour number (15-30%, p < 0.05), and cloudberry and lingonberry also reduced tu- mour size by over 60% (p < 0.01). Cloudberry resulted in decreased levels of nuclear β-catenin and cyclin D1 and lingonberry in the level of cyclin D1 in the large adenomas (p < 0.05). Affymetrix microarrays revealed changes in genes implicated in colon carcinogenesis, including the decreased expression of the adenosine deaminase, ecto-5’– nucleotidase and PGE2 receptor subtype EP4. Ellagic acid had no effect on the number or size of adenomas in the distal or total small intestine but it increased adenoma size in the duodenum when compared with the control diet (p < 0.05). Neither cloudberry seed nor pulp had any effect on the adenoma formation. Berries seem to have great po- tential as a source of chemopreventive components.

In Western culture, excess visceral fat accumulation or obesity has reached epidemic proportions, resulting in metabolic syndrome. However, more than 10 years of research has shown that adipocytes also function as endo- crine cells that release various bioactive substances, so called “adipocytokines or adipokines”, that play a major role in the regulation of food intake, insulin sensitivity, energy metabolism, and the vascular microenvironment. Adiponectin, an adipocytokine, is considered to improve insulin sensitivity. Recently, monocyte chemoattractant protein (MCP)-1 has been reported to be a novel adipocytokine involved in the development of obesity-associated insulin resistance and atherosclerosis. Nuclear receptors, especially peroxisome proliferator-activated receptor-α (PPARα) and PPARγ are ligand-activated transcription factors that regulate the metabolism of glucose and lipids. PPARγ is strongly expressed in adipocytes and plays a significant role in the transcriptional activation of adipo- cytokines including adiponectin. PPARα, another PPAR isoform, is involved in the control of lipid metabolism in the liver and skeletal muscle. PPARα activation causes lipid clearance via β-oxidation enhancement. We showed that various dietary terpenoids and other natural ingredients regulate the transcription of PPAR target genes, in- duces the expression and secretion of adiponectin, and inhibits those of MCP-1 in adipocytes and β-oxidation in liver. These findings indicate that dietary factor acts as an agonist of PPARs and is a valuable medical and food component for the gradual improvement of metabolic syndrome.

A high omega-6/omega-3 ratio, as is found in today’s Western diets, promotes the pathogenesis of many chronic diseases, including cardiovascular disease. Increased dietary intake of linoleic acid (LA) leads to oxida- tion of low-density lipoprotein (LDL), platelet aggregation, and interferes with the incorporation of essential fatty acids (EFA) in cell membrane phopholipids. Both omega-6 and omega-3 fatty acids influence gene ex- pression. Omega-3 fatty acids have strong anti-inflammatory effects, suppress interleukin 1β (IL-1β), tumor ne- crosis factor-α (TNFα) and interleukin-6 (IL-6), whereas omega-6 fatty acids tend to be pro-inflammatory. Be- cause inflammation is at the base of many chronic diseases, including coronary heart disease, dietary intake of omega-3 fatty acids plays an important role in the manifestation of disease, particularly in persons with genetic variation, as for example in individuals with genetic variants at the 5-lipoxygenase (5-LO). Increased dietary arachidonic acid (AA) significantly enhances the apparent atherogenic effect of genotype, whereas increased dietary intake of omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) blunts this effect. The diet-gene interaction further suggests that dietary omega-6 fatty acids promote, whereas marine omega-3 fatty acids EPA and DHA inhibit leukotriene-mediated inflammation that leads to atherosclerosis in this subpopulation.

The growth years provide an important window of opportunity for building peak bone mass. More than one- fourth of adult bone mass is acquired between the ages of 12 to 14 years in girls and 13 to 15 years in boys. Al- though genetics determine 60-80% of peak bone mass, lifestyle choices including diet and physical activity are also predictors of bone accrual during growth. Calcium and vitamin D are two nutrients that are most likely to be deficient. Dietary calcium predicts 10-15% of skeletal calcium retention during adolescence with race and sexual maturity in the models. Boys retain more calcium than girls and black girls retain more calcium than whites girls. The role of Vitamin D status on peak bone mass is not well understood. Results of randomized, controlled trials are mixed and the effects of vitamin D supplementation on calcium absorption in children has not been studied. Dietary salt increases urinary calcium excretion. Exercise can enhance the effect of dietary calcium through enhanced bone geometry.

Dietary reference intakes (DRIs) for Vitamin D (VitD) have been traditionally established based on plasma 25- OHD concentration sufficient to prevent rickets and osteomalacia. While nutritional rickets is still prevalent in developing countries, hypovitaminosis D is becoming widespread around the world regardless the latitude. Emerging evidence has unravelled the physiological roles of VitD beyond calcium homeostasis. Hypovitami- nosis D has been linked to cancers, diabetes, CVD, periodontal diseases and influenza. Hypovitaminosis D is multifactorial and is related to VitD scarcity in foods, latitude, solar-irradiation, atmospheric-pollution, skin- pigmentation, clothing, sunscreen-use and indoor activities, etc. Plasma 25-OHD concentration range from 25- 138 nmol/L. A higher plasma 25-OHD concentration is linked to higher bone-mass in adolescents, pre- and post-menopausal women. Plasma 25-OHD ≥75 nmol/L has been shown to enhance calcium absorption, sup- press PTH elevation, reduce the risks of bone loss and fractures, and certain extra-skeletal diseases. VitD sup- plementation with 10ug/d is insufficient to lower fracture risks. Combined VitD and calcium supplementation in higher doses has been found superior to VitD alone to increase bone-mass in adolescents and to reduce non- vertebral fractures in postmenopausal women. In future, DRIs for VitD are likely to be established beyond its skeletal roles to include multiple health outcomes. However, the desirable level of VitD has yet to be defined. Furthermore, redefining the upper-tolerable-level of VitD intake is necessary to prevent hypercalcemia and tox- icity. There is also a urgent need to harmonize laboratory methods in VitD assay in different laboratories.

Adlay (Coix lachryma-jobi L. var. ma-yuen Stapf ) is a grass crop, which has been used in traditional Chinese medicine and also as a nourishing food. Recently, some studies have indicated that adlay possesses some phar- macological effects including anti-allergic, anti-mutagenic, hypolipemic, and anti-diabetic effects. However, the effect of adlay on osteoporosis is still unknown. In this study, we investigated and evaluated the effect of adlay seed on the osteoporosis prevention. The methods of in vitro cultures of neonatal rat calvaria tissues or adult rat femoral metaphyseal tissues of bones isolated from normal or ovariectomized female rats were used for further investigation. Treatment with water extract of adlay seed could reverse the decreased alkaline phos- phatase activities and calcium levels and increased tartrate-resistant acidic phosphatase activities induced by parathyroid hormone in cultured metaphyseal tissues. In ovariectomized rats, the alkaline phosphatase activities and calcium levels were significantly decreased and tartrate-resistant acidic phosphatase activities were in- creased in femoral metaphyseal tissues as compared with sham-control. Treatment with water extract of adlay seed could counteract these effects in ovariectomized rats. Taken together, these findings imply that adlay is capable of reversing the osteoporotic status in rats, and may be a helpful healthy food for osteoporosis preven- tion.

Much existing data on the effects of calcium or milk products on bone mineral accretion are based on bone mineral content (BMC) or areal bone mineral density (aBMD), neither of which accounts for changing bone size during the growing period. The aim of this study was to investigate the effects of 2-year milk supplementa- tion on total body size-corrected BMD in Chinese girls with low habitual dietary calcium intake. Chinese girls aged 10 years were randomised, according to their school, to receive calcium fortified milk (Ca milk), or cal- cium and vitamin D fortified milk (CaD milk) for two years or act as unsupplemented controls. Dual-energy X- ray absorptiometry total body bone measures were obtained from 345 girls at baseline and 2 years. Size- corrected total body and regional BMD was calculated as: BMDsc = BMC/BApc, where pc was the regression coefficient of the natural logarithm transformed total body BMC and bone area. After 2 years, both supple- mented groups had significantly greater gain in BMDsc of total body (3.5-5.8%, p < 0.05) and legs (3.0-5.9%, p < 0.05) than did the control group. Milk supplementation showed positive effects on bone mineral accretion when accounting for the changing skeletal size during growth. The effects were mainly on the lower limbs.

With the unsatisfaction of monoamine-based pharmacotherapy and the high comorbidity of other medical ill- ness in depression, the serotonin hypothesis seems to fail in approaching the aetiology of depression. Based upon the evidence from epidemiological data, case-control studies of phospholipid polyunsaturated fatty acids (PUFAs) levels in human tissues, and antidepressant effect in clinical trials, PUFAs have shed a light to dis- cover the unsolved of depression and connect the mind and body. Briefly, the deficit of n-3 PUFAs has been reported to be associated with neurological, cardiovascular, cerebrovascular, autoimmune, metabolic diseases and cancers. Recent studies revealed that the deficit of n-3 PUFAs is also associated with depression. For ex- ample, societies that consume a small amount of omega-3 PUFAs appear to have a higher prevalence of major depressive disorder. In addition, depressive patients had showed a lower level of omega-3 PUFAs; and the an- tidepressant effect of PUFAs had been reported in a number of clinical trials. The PUFAs are classified into n-3 (or omega-3) and n-6 (or omega-6) groups. Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), the major bioactive components of n-3 PUFAs, are not synthesized in human body and can only be obtained di- rectly from the diet, particularly by consuming fish. DHA deficit is associated with dysfunctions of neuronal membrane stability and transmission of serotonin, norepinephrine and dopamine, which might connect to the aetiology of mood and cognitive dysfunction of depression. On the other hand, EPA is important in balancing the immune function and physical healthy by reducing arachidonic acid (AA, an n-6 PUFA) level on cell mem- brane and prostaglandin E2 (PGE2) synthesis. Interestingly, animals fed with high AA diet or treated with PGE2 were observed to present sickness behaviours of anorexia, low activity, change in sleep pattern and atten- tion, which are similar to somatic symptoms of depression in human. Therefore, the deficit of EPA and DHA in depression might be associated with mood disturbance, cognitive dysfunction, medical comorbidity and so- matic symptoms in depression. Indeed, the role of n-3 PUFAs in immunity and mood function supports the promising psychoneuroimmunologic hypothesis of depression and provides an excellent interface shared by body and mind.

Brain docosahexaenoic acid (DHA, 22:6n–3) levels are associated with learning memory performance, but it is not known the mechanism of DHA on enhancing memory effect. The aim of this study was to examine effect of brain DHA levels on cytoskeleton expression. Rats were fed a chow or sunflower oil-based n–3 fatty acid- deficient diet supplemented with or without fish oil starting from embryo and through postnatal day 140. The various DHA levels were from 5.0% to 15.6% of total fatty acids in hippocampus, 3.9% to 13.7% in visual cortex, and 5.3% to 14.4% in olfactory bulbs. The expression of the cytoskeleton markers tyrosine tubulin, acetylated tu- bulin, and β-actin in the hippocampus, visual cortex and olfactory bulb was not affected by brain DHA levels.

Both insulin resistance and reactive oxygen species (ROS) have been reported to play essential pathophysi- ological roles in cardiovascular diseases. However, the mechanistic link between ROS and insulin resistance in the vasculature remains unclear. Recently we have shown that insulin causes KATP channel activation mediated by PI3K in cultured vascular smooth muscle cells (VSMCs). KATP channel in VSMCs is critical in the regula- tion of vascular tonus. Here we examined the effects of ROS induced by a thol-oxidizing agent, diamide, on the insulin signalling pathway and KATP channel activities in cultured VSMCs (A10 cells). Diamide (100 μM) increased intercellular ROS and extracellular signal-regulated kinases (ERK) activitiy. Treatment with 100 μM diamide suppressed significantly insulin-induced IRS and Akt phosphorylation. In addition to IRS and Akt, diamide inhibited insulin receptor auto-phosphorylation. Patch-clamp study showed that diamide suppressed insulin-induced but did not pinacidil-induced KATP channel activities in A10 cells. From these data, we con- clude that ROS inhibit critical insulin signal transduction components including IRS and Akt, and these effects cause down-regulation of insulin’s action in the vasculature including KATP channel activation. This study may contribute to our understanding of mechanisms of insulin resistance-associated cardiovascular disease.

Weight loss can be achieved by any means of energy restriction, but the challenge is to achieve sustainable weight loss and prevent weight ‘creep’ without increasing the risk of chronic disease. The modest success of low fat diets has prompted research on alternative dietary strategies including high protein diets and low glyce- mic index (GI) diets. Conventional high carbohydrate diets, even when based on wholegrain foods, increase postprandial glycaemia and insulinemia and may compromise weight control via mechanisms relating to appe- tite stimulation, fuel partitioning and metabolic rate. This paper makes the case for the benefits of low glycemic index diets over higher protein diets. Both strategies are associated with lower postprandial glycemia and both are commonly labelled as ‘low glycemic load’ but the long-term health effects are likely to be different. There is now a large body of evidence comprising observational prospective cohort studies, randomised controlled tri- als and mechanistic experiments in animal models, that provides robust support for low GI carbohydrate diets in the prevention of obesity, diabetes and cardiovascular disease. While lower carbohydrate, higher protein di- ets also increase the rate of weight loss, cohort studies and meta-analyses of clinical trials suggest the potential for increased mortality.

Tea is the most widely consumed beverage in the world after water. Tea is known to be a rich source of flavon- oid antioxidants. However tea also contains a unique amino acid, L-theanine that may modulate aspects of brain function in humans. Evidence from human electroencephalograph (EEG) studies show that it has a direct effect on the brain (Juneja et al. Trends in Food Science & Tech 1999;10;199-204). L-theanine significantly increases activity in the alpha frequency band which indicates that it relaxes the mind without inducing drowsiness. How- ever, this effect has only been established at higher doses than that typically found in a cup of black tea (~20mg). The aim of the current research was to establish this effect at more realistic dietary levels. EEG was measured in healthy, young participants at baseline and 45, 60, 75, 90 and 105 minutes after ingestion of 50mg L-theanine (n=16) or placebo (n=19). Participants were resting with their eyes closed during EEG recording. There was a greater increase in alpha activity across time in the L-theanine condition (relative to placebo (p<0.05). A second study replicated this effect in participants engaged in passive activity. These data indicate that L-theanine, at re- alistic dietary levels, has a significant effect on the general state of mental alertness or arousal. Furthermore, al- pha activity is known to play an important role in critical aspects of attention, and further research is therefore focussed on understanding the effect of L-theanine on attentional processes.

Several studies have shown that high protein meals and foods are more satiating than high carbohydrate or high fat meals when assessed by subjective ratings of satiety. Few of these studies were able to control for poten- tially confounding variables. Test meals differ widely in physical and sensory properties so it cannot be con- cluded that it is protein conferring these effects. When sensory properties are controlled up to 10-30% more calories are eaten at a subsequent meal with a high carbohydrate liquid meal than a high protein liquid meal with no difference in protein sources or BMI status. Weight loss studies examining the metabolic effects of iso- caloric high protein energy restricted diets with high carbohydrate structured diets have not shown differences in kilojoule intake and weight loss despite expected satiety differences. Such studies do not allow the effects of increased satiety attributable to protein to be expressed as the dietary protocols have required all foods to be consumed. However, several longer term studies have noted improvements in body composition on a higher protein pattern despite similar weight loss. An interaction between protein intake and exercise on improved lean mass retention has also been observed. Studies comparing ad libitun high protein diets to high carbohydrate di- ets have usually shown greater weight loss on the high protein pattern and that enhanced satiety was the most important factor in the weight loss.

Recent data indicate a rise in obesity both in children and adolescents in developing countries. The overall preva- lence of overweight/obesity in urban children in New Delhi has shown an increase from 16% in 2002 to about 24% in 2006-2007. Our recent data show that the prevalence among adolescent children was 29% in private schools and 11.3% in government funded schools. While India already has highest number of patients with type 2 diabetes mellitus (T2DM) globally, rapid rise of obesity in children is the prime reason for increasing insulin resistance, the metabolic syndrome, dyslipidemia, polycystic ovarian syndrome and raised levels of C-reactive protein. Excess body fat, thick truncal subcutaneous fat, and abdominal adiposity are important predisposing fac- tors for development of insulin resistance in Asian Indian children. As compared to other ethnic groups, children with ancestral origin in South Asia manifest adiposity, insulin resistance and metabolic perturbations earlier in life and these derangements are of higher magnitude than white Caucasian children. Since the metabolic syn- drome and obesity track into adulthood, these clinical entities need to be recognized early for effective preven- tion of T2DM and coronary heart disease. Therapeutic lifestyle changes, maintenance of high levels of physical activity and normal weight are most important prevention strategies. Both high-risk surveillance and cost- effective population intervention programs are urgently needed. In this context, we have launched one of the largest program (“MARG”, The Path) to curb childhood obesity in India.

The increase in obesity and chronic diseases such as diabetes and heart disease worldwide reflects the complex interactions of biology, personal behaviour and environment. Consequently there has been a greater recognition of the importance of nutrition education. An analysis of the evidence from 300+ studies shows that nutrition education is more likely to be effective when it focuses on behaviour/ action (rather than knowledge only) and systematically links theory, research and practice. There are three essential components to nutrition education: 1. A motivational component, where the goal is to increase awareness and enhance motivation by addressing beliefs, attitudes through effective communication strategies. 2. An action component, where the goal is to fa- cilitate people’s ability to take action through goal setting and cognitive self-regulation skills. 3. An environ- mental component, where nutrition educators work with policymakers and others to promote environmental supports for action. Each component needs to be based on appropriate theory and research. The procedure for program design can use the logic model: Inputs are the resources needed as well as the needs analysis process. The outputs are the activities within the three components of nutrition education described above. Here the be- havioural focus is selected and theory and research are used to design appropriate educational strategies to achieve the targeted behaviours. The outcomes are the short, medium or long-term impacts of the nutrition pro- gram. These are evaluated through the use of appropriate designs and instruments. Nutrition education pro- grams that link research, theory, and practice are more likely to be effective.

The objective of this paper was to identify the necessity of a theory incorporating “a holistic view of food and nutrition dynamics”. The generation of this theory and its potential to effect nutrition education practices, was also examined using examples of practice in Japan. The necessity and potential of a nutrition theory with “a holistic view of food and nutrition dynamics” was shown through discussions about the “Food Education Ba- sic Law” (The Basic Law on Shokuiku) enacted in 2005 in Japan and the following case examples: a study of daily fish consumption of 2,110 school children in Japan from the viewpoint of human and food ecology; a study of school children’s eating habits with their families which involved drawing a meal picture; a nutrition intervention that used a 5 point meal box system (3:1:2 meal box magic) to measure the quantity and quality appropriate for one meal; and a nutrition education program for school-aged children. Finally, a definition of nutrition education aimed at the sustainable and harmonious coexistence of both quality of life (QOL) and quality of environment (QOE) was suggested.

We and others have demonstrated that provision of n–3 long chain polyunsaturated fatty acids (n–3 LCPs) in preterm and term babies is associated with retinal electrical responses to light stimuli, and to brain cortex related visual acuity maturation, that are similar to those observed in human milk fed infants. Our follow up results in young children suggest that neurodevelopment and cognitive abilities are also enhanced by early provision of n– 3 LCPs through breast milk or DHA-fortified foods. Breast fed infants also require n–3 LCPs after weaning to achieve optimal visual acuity at 12 months of age. Good quality evidence supporting a role for n–3 LCP con- sumption to enhance learning and/or behaviour in school-age children is currently lacking.
Evidence supporting the potential importance of n–3 LCP consumption for good cognitive health in older age is now beginning to emerge. Recent cross-sectional surveys have reported that higher fatty fish/n–3 LCP con- sumption and or higher n–3 LCP blood concentrations are associated with reduced risk of impaired cognitive function. Similarly, prospective cohort studies have shown that increased fish consumption and higher n–3 LCPs in blood lipid sub-fractions are associated with decreased risk of dementia in older people. We are presently conducting a large randomised controlled trial in a group of adults aged 70-79 years to assess whether an n–3 LCP supplement will preserve retinal function and prevent age related cognitive decline.

The metabolic syndrome is increasingly prevalent in worldwide. The quality and quantity of dietary lipids could be important modulators associated with the cardiovascular morbidity and mortality. At present, functional lipids such as conjugated linoleic acid (CLA) and phospholipids have attracted considerable at- tention because of their beneficial biological effects in attenuating metabolic syndrome. Supplementation of CLA reduces abdominal white adipose tissues, serum triacylglycerol (TAG) level, and liver TAG level in obese Otsuka Long-Evans Tokushima Fatty OLETF rats. These effects were attributed to enhanced fatty acid beta-oxidation and suppressed fatty acid synthesis in the liver. In addition, CLA enhanced en- ergy expenditure in these rats. Anti-hypertensive properties of CLA have also been demonstrated. In obese/diabetic OLETF and Zucker rats, feeding of CLA prevented the development of obesity-induced hypertension. This was associated with an altered production of physiologically active adipocytokines, such as adiponectin, leptin and angiotensinogen. In addition, CLA could alleviate the development of insu- lin resistance and fatty liver. Dietary phospholipids have physiological functions that are different to die- tary TAG. We recently reported that phosphatidylcholine (PC) alleviated orotic acid-induced fatty-liver through the suppression of hepatic lipogenesis in rats, and omega3-PC from salmon roe prevented the de- velopment of obesity-related diseases through the suppression of lipogenic gene expressions and the en- hancement of lypolytic gene expressions in the liver of obese rats. However, reports which studying the nutritional functions of minor phospholipids, such as phosphatidylinositol (PI), are scarce. Our study indi- cated that dietary PI lowered lipids in the plasma and liver by suppressing hepatic TAG synthesis.

Many oxygenated fatty acids are bioactive compounds. Nocardia cholesterolicum and Flavobacterium DS5 convert oleic acid to 10 hydroxy stearic acid and linoleic acid to 10-hydroxy-12(Z)- octadecanoic acid. Pseudomonas aeruginosa PR3 converts oleic acid to the new compounds, 7,10-dihydroxy- 8(E)-octadecenoic acid (DOD) through 10-hydroxy-8-octadecenoic acid, and racinoleic acid to 7,10,12-trihydroxy-8- octadecenoic acid. DOD showed antibacterial activity including against food-borne pathogens. Bacillus megaterium ALA2 converted n-6 and n-3 PUFAs to many new oxygenated fatty acids. For example: linoleic acid was converted to12,13-epoxy-9-octadecenoic acid and then to 12,13-dihydroxy-9-octadecenoic acid (12,13- DHOA). From here, there are two bioconversion pathways. The major pathway is: 12,13-DHOA

Fucoxanthin has a unique structure including an unusual allenic bond and 5, 6-monoepoxide in its molecule. We found that abdominal white adipose tissue (WAT) weights of rats and mice fed fucoxanthin were significantly lower than those fed a control diet. The daily intake of fucoxanthin in mice also caused a significant reductions of body weight. Clear signals of uncoupling protein 1 (UCP1) and its mRNA were detected by Western and Northern blot analyses in abdominal WAT in mice fed fucoxanthin, although there is little expression of UCP1 in WAT in mice fed a control diet. UCP1 expression in WAT by fucoxanthin intake leads to oxidation of fatty acids and heat production in WAT mitochondria. Substrate oxidation can directly reduce WAT in animals. Fucoxanthin intake also significantly reduced blood glucose and plasma insulin. Furthermore, feeding fucoxan- thin significantly increased the level of hepatic docosahexaenoic acid (DHA), a most important n-3 functional polyunsaturated fatty acid in biological systems. These multi-functionalities of fucoxanthin indicate that it is an important bioactive carotenoid that is should be beneficial for the prevention of the metabolic syndrome.

Carotenoids are lipophilic pigments in plant foods that are of particular interest as precursors of vitamin A, a nu- trient required for vision, cell differentiation, and the immune system. In order to mediate such activities, carote- noids and their metabolites must be absorbed for delivery to tissues. Unlike many other dietary lipids, the effi- ciency of carotenoid absorption is typically inefficient, being affected by food matrix, style of processing, other dietary components, and nutritional and physiological status. Thus, reliable prediction of carotenoid bioavailabil- ity is problematic. We have developed a relatively simple and cost effective procedure to study the potential bioavailability, i.e., the bioaccessibility, of carotenoids. The method involves simulated oral, gastric and small intestinal digestion of test samples to access the efficiency of incorporation into micelles, an obligatory step for absorption of lipophilic compounds. The model can be further expanded by adding micelles generated during small intestinal phase of digestion to monolayers of Caco-2 human intestinal epithelial cells to investigate apical uptake, cellular metabolism and transepithelial transport of carotenoids. Recent work by Borel and associates has demonstrated that the relative bioaccessibility of carotenoids observed in vitro is highly correlated with in vivo observations and results from bioavailability trials with human subjects. Results from recent studies using the in vitro model to screen relative bioaccessibility of β-carotene in various cultivars of cassava, impact of amount and types of fatty acyl groups in triglycerides on micellarization of carotenoids, and the mechanism of digestion and intestinal cell uptake of xanthophyll esters are presented.

The vulnerability of large segments of Asia's population to micronutrient deficiency is more a consequence of cul- tural evolution and demography than of economic inequities. We evolved in a hunter-gatherer lifestyle with vigor- ous energy expenditure, wide dietary variety and a nutrient-dense diet (meat, viscera), and wound up 10,000 years ago as agriculturalists cultivating cereal and tuber crops for 70% of our dietary calories. Obtaining rice, maize and wheat is less energy intensive than needed for hunters' fare, while grains are distinctly less rich in available vitamins and minerals. Recurrent infectious episodes, transmitted in crowded societies, further deplete micronutrient nutriture. A fast-track option to address historically unprecedented life conditions includes chemical- or bio-fortification of ubiquitous condiments or widely consumed staples. With little or no change in habitual eating individuals will con- sume recommended micronutrient intakes and uptakes. Generous intakes of nutrients such as vitamin A and zinc counteract the adverse environmental effects on quality of life and survival in poverty situations. One size may not fit all, and over-consumption of certain micronutrients in heterogeneous societies is to be avoided. For the rice bowl to support the descendants of the caveman in the third millennium requires both imagination and technological in- genuity.

We previously reported that a novel alkylphospholipid type antitumor agent edelfosine (ET-18-O-CH3 ; 1-O- octadecyl-2-O-methyl-glycero-3-phosphocholine) induced apoptosis in human breast epithelial cells transfected with the H-ras oncogene (MCF10A-ras) which was causally linked to cyclooxygenase-2 (COX-2) up-regulation and production of 15-deoxy-Δ12,14-prostaglandins J2 (15d-PGJ2). ET-18-O-CH3 treatment also enhanced the pro- duction of prostaglandin E2 (PGE2), a major COX-2 product. In this study, we found that ET-18-O-CH3 treat- ment resulted in elevated mRNA expression of the PGE2 receptor subunit, EP2 receptor. Exogenously added PGE2 inhibited the growth of MCF10A-ras cells and induced proteolytic cleavage of caspase 3. ET-18-O-CH3 also inhibited constitutive activation of ERK1/2, p38 MAPK, and Akt/protein kinase B, which was blunted by a selective COX-2 inhibitor SC58635. In addition, ET-18-O-CH3 inhibited DNA binding activity of NF-κB in MCF10A-ras cells, and this was again attenuated by SC58635. Based on these findings, it is likely that ET-18- O-CH3 inactivates ERK1/2, Akt, and NF-κB signaling via COX-2 induction in MCF10A-ras cells, thereby in- ducing apoptosis of these cells.

Human papilloma virus-induced recurrent laryngeal papillomatosis is considered a troublesome and dangerous disease, because it can cause airway obstruction. Better understanding of metabolic pathways followed under pathological conditions can contribute to improved therapies by which growth and recurrence may be obviated. Part I of this study presents a clinically relevant total lipid fatty acid profile for papilloma cells, analyzed by gas liquid chromatography and a phosholipid red blood cell profile for RLP patients, analyzed by thin layer chroma- tography. In the papilloma cells virus interference with delta-6 and delta 5- desaturase activities is prevalent and the n–9 FA metabolic pathway is followed. It is plausible that up-regulated fatty acid synthase and Δ9 desaturase activities occur, since enhanced saturated fatty acids and monounsaturated fatty acid levels are also prevalent. High saturated fatty acid levels are known for their propensity to interfere with delta-6 and delta-5 desaturase ac- tivities and this is reflected in the blood profile of the RLP patients. It is also known that enhanced saturated fatty acid levels can contribute to enhanced cyclooxygenase-2 activity. Furthermore, cumulative oxidative stress with an oxidative burst is responsible for complete exhaustion of exogenous dietary arachidonic acid intake in these patients. The role of linoleic acid needs to be defined. The dietary intakes of lipids and micronutrients in RLP patients and a rationale for adjuvant FA therapy in the management of these patients are discussed in parts II and III of the study.

Evidence indicates that dietary trans fatty acids (TFA) obtained from partially hydrogenated vegetable oils (PHVO) increase the risk of coronary heart disease (CHD). Studies have implicated TFA in increasing the risk and incidence of diabetes. Furthermore, TFA may compromise fetal and early infant growth and development. In rats, partial substitution of either linoleic acid (18:2 n–6) with saturated fatty acids (SFA, 6 en %) or SFA with TFA (3 en % from vanaspati) decreased peripheral insulin sensitivity, but these effects were greater in TFA group. Since a large proportion of Indian population is insulin resistant, the TFA content in Indian edible fats/oils and foods should be reduced. Vanaspati (PHVO) provides up to 40% TFA, is used in Indian cooking and in the preparation of commercially fried, processed, bakery, ready-to-eat and street foods. TFA in biscuits and sweets range 30-40 and 6-26% of total fatty acids respectively. There is no regulation on TFA content in vanaspati, bakery fats and shortenings. Reduction in Indian edible fats/ oils and foods can be achieved by: a) specifying limits of TFA in vanaspati, bakery fats and shortenings by upgrading technology; b) advocating the substitution of natural plant oils containing lower percent of polyunsaturated fatty acids for PHVO. Indian edible oil industry needs to develop and adopt alternative technologies to produce zero TFA. Consumer educa- tion about negative health effects of TFA and providing food based guidelines to reduce TFA consumption in the entire population need to be actively pursued.

Menstrual pain (dysmenorrhea) is one of the main complaints in clinics for women. The pain is often accompa- nied by other symptoms such as headache, nausea, constipation or diarrhea, urinary frequency, and vomiting which often leave the patients incapacitated for work or school for a few days. Dietary supplementation with polyunsaturated fatty acids (PUFA) has been shown to alleviate the menstrual pain. The purpose of the present study was to compare the effect of dietary supplementation with PUFA (sunflower seed oil, borage oil and fish oil concentrate) for three months on RBC membrane fatty acid composition in healthy and dysmenorrheica young women. Conversion of linoleic acid, via gamma-linolenic acid, to dihomo-gamma-linolenic acid(a pre- cursor of anti-inflammatory prostaglandin E1) in dysmenorrheic subjects as compared to the controls was slower whereas the level of arachidonic acid (a precursor of pro-inflammatory PGE2) was not affected by the supple- mentation. Since there are no known side-effects associated with supplementation of these nutrients, manage- ment of dysmenorrhea through nutrition modulation should be an acceptable alternative to drug treatments.

The brain contains two main polyunsaturated fatty acids (PUFA), arachidonic acid (AA) and docosahexaenoic acid (DHA). These PUFA are located almost exclusively in the sn2-position of phosphoglycerides which are found in the neural cell membranes. Liberation of these PUFA from the phosphoglycerides occurs via the ac- tion of specific phospholipases (PLA2). Free AA can be metabolised by cyclooxygenases to prostaglandins and thromboxane, while both AA and DHA can be metabolised by lipoxygenases to form hydroxy derivatives and leukotrienes. AA is also metabolised to lipoxins via the 5-lipoxygenase pathway. The eicosanoids formed play important roles in neural function including sleep induction (PGD2), long term potentiation, spatial learning and synaptic plasticity (PGE2), resolution of inflammation (lipoxins) and anti-inflammatory and neuroprotective bioactivity (dihydroxy-docosatriene, neuroprotectin D1, formed from DHA). COX-inhibitors have been shown to reduce oxidative stress and cognitive impairment. Additionally, drugs which are used to treat depression have been shown to reduce the turnover of AA to PGE2 in the brain. Diets deficient in omega 3 PUFA lead to reduced DHA in the brain and increased turnover of AA to eicosanoids, an effect which is overcome by restor- ing the omega 3 PUFA to the diet. In neural trauma and neurodegenerative diseases, there is a dramatic rise in the levels of AA-derived eicosanoids. In contrast, DHA-derived compounds can prevent neuroinflammation. Clearly, the eicosanoids are very important for the normal functioning of the brain, while the PUFA themselves are important in membrane structure and function.

During the last two decades, the public and private sectors have made substantial research progress internation- ally toward improving the nutritional value of a wide range of food and feed crops. Nevertheless, significant numbers of people still suffer from the effects of undernutrition. As newly developed crops with nutritionally improved traits come closer to being available to producers and consumers, scientifically sound and efficient processes are needed to assess the safety and nutritional quality of these crops. In 2004, a Task Force of interna- tional scientific experts, convened by the International Food Biotechnology Committee (IFBiC) of ILSI, pub- lished recommendations for the safety and nutritional assessment of foods and feeds nutritionally improved through modern biotechnology (J. Food Science, 2004, 69:CRH62-CRH68). The comparative safety assess- ment process is a basic principle in this publication and is the starting point, not the conclusion, of the analysis. Significant differences in composition are expected to be observed in the case of nutritionally enhanced crops and must be assessed on a case-by-case basis. The Golden Rice 2 case study will be presented as an example of a food crop nutritionally enhanced through the application of modern biotechnology (i.e., recombinant DNA techniques) to illustrate how the 2004 recommendations provide a robust paradigm for the safety assessment of “real world” examples of improved nutrition crops.

Methods of analysis for products of modern biotechnology are required for national and international trade in seeds, grain and food in order to meet the labeling or import/export requirements of different nations and trad- ing blocks. Although many methods were developed by the originators of transgenic events, governments, uni- versities, and testing laboratories, trade is less complicated if there exists a set of international consensus- derived analytical standards. In any analytical situation, multiple methods may exist for testing for the same analyte. These methods may be supported by regional preferences and regulatory requirements. However, tests need to be sensitive enough to determine low levels of these traits in commodity grain for regulatory purposes and also to indicate purity of seeds containing these traits. The International Organization for Standardization (ISO) and its European counterpart have worked to produce a suite of standards through open, balanced and consensus-driven processes. Presently, these standards are approaching the time for their first review. In fact, ISO 21572, the “protein standard” has already been circulated for systematic review. In order to expedite the review and revision of the nucleic acid standards an ISO Technical Specification (ISO/TS 21098) was drafted to set the criteria for the inclusion of precision data from collaborative studies into the annexes of these stan- dards.

Of the 102 million hectares that made up the global area of biotech crops in 2006, less than 8% (7.6 million ha) were in Asia. Three biotech crops are currently planted in significant areas in four Asian countries with govern- ment regulatory approval; namely, cotton, corn (maize), and canola. However, the amount of GM crop material imported into the Asian region for processing into food and animal feed is very substantial, and almost every country imports GM food. The issues which concern Asian scientists, regulators, and the lay public resemble those of other regions – biosafety, food safety, ethics and social justice, competitiveness, and the “EU” trade question. Most Asian countries now have regulatory systems for approving the commercialization of GM crops, and for approving food safety of GM crops. In Asia, because of the varied cultures, issues concerning the use of genes derived from animals arouse much emotion for religious and diet choice reasons. Because many Asian producers and farmers are small-scale, there is also concern about technology dependency and to whom the benefits accrue. All consumers surveyed have expressed concern about potential allergenic and long-term toxic effects, neither of which is grounded on scientific facts. Because of Asia’s growing demand for high volumes of quality food, it is likely that GM crops will become an increasing feature of our diet.

The introduction of GM foods has led to the evolution of a food safety assessment paradigm that establishes safety of the GM food relative to its conventional counterpart. The GM foods currently approved and marketed in several countries have undergone extensive safety testing under a structured safety assessment framework evolved by international organizations like FAO, WHO, Codex and OECD. The major elements of safety as- sessment include molecular characterization of inserted genes and stability of the trait, toxicity and allergenicity potential of the expressed substances, compositional analysis, potential for gene transfer to gut microflora and unintentional effects of the genetic modification. As more number and type of food crops are being brought un- der the genetic modification regime, the adequacy of existing safety assessment protocols for establishing safety of these foods has been questioned. Such crops comprise GM crops with higher agronomic vigour, nutritional or health benefit/ by modification of plant metabolic pathways and those expressing bioactive substances and pharmaceuticals. The safety assessment challenges of these foods are the potential of the methods to detect unin- tentional effects with higher sensitivity and rigor. Development of databases on food compositions, toxicants and allergens is currently seen as an important aid to development of safety protocols. With the changing global trends in genetic modification technology future challenge would be to develop GM crops with minimum amount of inserted foreign DNA so as to reduce the burden of complex safety assessments while ensuring safety and utility of the technology.

The inhibition of tumorigenesis by tea extracts and tea polyphenols has been demonstrated in different animal models, including those for cancer of the skin, lung, oral cavity, esophagus, stomach, small intestine, colon, bladder, liver, pancrease, prostate, and mammary glands. Caffeine is also active in inhibition of tumorigenesis on the skin, lung, and perhaps other organs. In spite of many in vitro and in vivo studies, the molecular mecha- nisms for the cancer preventive actions of these compounds are not clearly known. The relationship between tea consumption and cancer risk has not been conclusively demonstrated, and the relationship may become more clear if we consider the effects of specific types of tea, at defined doses, in populations with certain dietary pat- terns or genetic polymorphisms. Human intervention trials and large prospective studies are needed to further assess the cancer preventive activities of tea constituents.

Food fortification generally refers to the addition of micronutrients and other favourably bio-active food comp- nents to food-stuffs where there are recognised deficiencies in the target population. Each forticant has had or could have regulatory implications. It is understandable, although arguable, in the face of a limited food supply skewed, for the majority, in the direction of starchy staples of low essential nutrient density. Efforts, with plant breeding, to biofortify such foods are underway and likely to be safer, more sustainable and affordable than chemical additions. Unfortunately, with an increasingly refined and naturally tasteless food supply (salty, fatty, sugary and starchy), and where energy requirements are falling because of physical inactivity, micronutrient fortification is being used as a nutritional ‘fix-it’ strategy. In Asia, there are several critical micro- nutrients. No one national fortification program can deal with all deficiencies is likely to be highly selective for the nutri- ents which have the greatest advocacy or are most recognisable. They also leave the other health promoting food properties like intactness, nutrient spectrum, and phytonutrient content un-addressed. A variety of food- stuffs, with different biological origins, is the preferred approach. Where an optimal food system is not in place, there may be justification for fortification if thereis regular monitoring and surveillance of the food supply and health outcomes occurs; is a clear cost-risk-benefit advantage in such a strategy; are programs in place to im- prove the nutritional value of the basic food supply and is an ‘exit strategy’ for the fortification program.

Alk(en)yl sulfides are characteristic flavor components of garlic. Several lines of epidemiological study indicate that the risk of a certain cancer can be prevented by consumption of garlic. In this manuscript, we examined the anticancer property of garlic-derived alk(en)yl sulfides, and the molecular basis especially for diallyl trisulfide which is a major constituent of the garlic oil. Alk(en)yl sulfides with different numbers of sulfur atom (i.e., mono-, di-, and trisulfide) were synthesized and purified (>99%). The anticancer activity of the alk(en)yl sul- fides was primarily examined using human colon cancer cells HCT-15 and DLD-1. The growth of the cells was significantly suppressed by diallyl trisulfide, but neither diallyl monosulfide nor diallyl disulfide showed such an effect. The number of cells arrested at G2/M phase, the cells with a sub-G1 DNA content, and the cells with cas- pase-3 activity were dramatically increased by diallyl trisulfide treatment. Diallyl trisulfide disrupted micro- tubule network formation of the cells, and microtubule fragments could be seen at the interphase. There was a specific oxidative modification of cysteine residues Cys12β and Cys354β, forming S-allylmercaptocysteines in the tubulin molecule. These results suggest that diallyl trisulfide is responsible, at least in part, for the epidemi- ologically proven anticancer effect for garlic eaters.

Angiogenesis means the formation of new blood vessels from preexisting vascular, is of fundamental impor- tance in several pathological states such as tumor growth, rheumatoid arthritis, and diabetic retinopathy. An- giogenesis involves a set of steps, including activation and movement of endothelial cells and tube formation. Control of these steps by drugs or dietary food components is a hopeful approach for the prevention of angio- genic disorders. Based on these backgrounds, we searched the anti-angiogenic food components. As a result, we found that tocotrienol (T3), especially δ, β, and γ-T3 has the potent anti-angiogenic activity in vitro and in vivo experiments. T3, which is rich in rice bran and palm oil, inhibited growth factor-induced proliferation, migration and tube formation in human umbilical vein endothelial cells. T3 showed inhibition of tumor cell- induced angiogenesis in mouse dorsal air sac (DOS) assay. These results indicated that T3 is a potent anti- angiogenesis compound. Tocopherol (Toc) did not inhibit angiogenesis. The anti-angiogenic mechanism of T3 and Toc was evaluated by western blotting. T3 inhibited activation of growth factor-induced extracellular signal-regulated kinase, Akt (protein kinase B), and endothelial nitric oxide synthase (eNOS), which are located downstream of the various growth factor receptors. T3 suppressed phosphorylation of vascular endothelial growth factor (VEGF) receptor 2. These effects were dose-dependent manner. Anti-angiogenic mechanism of T3 mediates inhibition of growth factor induced survival, migration and angiogenesis signals. These findings suggested that T3 may have potential for preventing angiogenic disorders in humans.

Large bowel cancer is one of the leading causes of deaths from cancer in Western countries, and the incidence of colorectal cancer is increasing with the steady increase in life expectancy. Modification of diet and lifestyle provide measures of reducing the risk of developing colon cancer. Evidence suggests that the components of the insulin-like growth factor (IGF) system may be appropriate targets for cancer prevention and therapy. A positive correlation was found between dietary and lifestyle, plasma IGF-I, and colon cancer incidence rates. Diet, nutrition, and other lifestyle features affect the expression and production of IGF-1 and other members of the IGF family. The purpose of this review is to examine current evidence obtained from our recent studies and others that investigated the role of dietary components in the regulation of the IGF system and colon cancer cell growth.

Hyperglycemia is the most important factor for the onset and progress of diabetic complications. A growing body of evidence indicates that the increase in reactive carbonyl intermediates such as methylglyoxal (MG) is a consequence of hyperglycemia in diabetes. Several studies have shown that higher levels of MG are present in diabetic patients’ plasma compared to non-diabetics. Glyoxal (GO) and MG, the two major α-dicarbonyl com- pounds found in humans, are very reactive and lead to nonenzymatic glycation in vivo. Glycation is a complex series of reactions between reducing sugars and amino compounds, and it will lead to the formation of ad- vanced glycation end products (AGEs). AGEs and dicarbonyl species are both linked to possible clinical sig- nificance in chronic and age-related diseases. It is well-known that tea is rich in polyphenolic compounds and that it has potential health benefits, including the prevention of diabetes. We have shown in a previous study that all tea polyphenols have very good MG trapping abilities. In this study, using time course, we have further indicated that one molecule form black tea, theaflavins-3,3′-digallate, can trap two molecules of MG under simulated physiological conditions. In addition, we have discovered that commercial carbonated beverages contain extremely high levels of MG. The potential hazardous effects of dietary MG on humans remain to be explored.

India has been recognized all over the world for spices and medicinal plants. Both exhibit a wide range of physiological and pharmacological properties. Current biomedical efforts are focused on their scientific merits, to provide science-based evidence for the traditional uses and to develop either functional foods or nutraceuti- cals. The Indian traditional medical systems use turmeric for wound healing, rheumatic disorders, gastrointesti- nal symptoms, deworming, rhinitis and as a cosmetic. Studies in India have explored its anti-inflammatory, cholekinetic and anti-oxidant potentials with the recent investigations focusing on its preventive effect on pre- carcinogenic, anti-inflammatory and anti atherosclerotic effects in biological systems both under in vitro and in vivo conditions in animals and humans. Both turmeric and curcumin were found to increase detoxifying en- zymes, prevent DNA damage, improve DNA repair, decrease mutations and tumour formation and exhibit anti- oxidative potential in animals. Limited clinical studies suggest that turmeric can significantly impact excretion of mutagens in urine in smokers and regress precancerous palatal lesions. It reduces DNA adducts and micro- nuclei in oral epithelial cells. It prevents formation of nitroso compounds both in vivo and in vitro. It delays induced cataract in diabetes and reduces hyperlipidemia in obese rats. Recently several molecular targets have been identified for therapeutic / preventive effects of turmeric. Fenugreek seeds, a rich source of soluble fiber used in Indian cuisine reduces blood glucose and lipids and can be used as a food adjuvant in diabetes. Simi- larly garlic, onions, and ginger have been found to modulate favourably the process of carcinogenesis.

Chemoprevention refers to the use of defined non-toxic chemical regimens to inhibit, reverse or retard the process of multi-stage carcinogenesis that involves multiple signal transduction events. A new horizon in che- moprevention research is the recent discovery of molecular links between inflammation and cancer. Compo- nents of the cell signaling network, especially those that converge on the ubiquitous eukaryotic redox-sensitive transcription factor, nuclear factor-kappa B (NF-κB), have been implicated in the pathogenesis of many in- flammation-associated disorders. A wide variety of chemopreventive and chemoprotective phytochemicals and phytonutrients can alter or correct undesired cellular functions caused by abnormal pro-inflammatory signal transmissions, mediated by NF-κ B. Modulation of cellular signaling involved in chronic inflammatory re- sponses, induced by anti-inflammatory agents, hence provides a rational and pragmatic strategy in molecular target-based chemoprevention and cytoprotection. Induction of phase-2 detoxifying or antioxidant genes repre- sents an important cellular defence in response to oxidative and electrophilic insults. Nuclear transcription fac- tor erythroid 2p45 (NF-E2)-related factor 2 (Nrf2) plays a crucial role in regulating phase-2 detoxify- ing/antioxidant gene induction. Many antioxidants derived from dietary and medicinal plants have been found to activate this particular redox-sensitive transcription factor, thereby potentiating the cellular antioxidant or de- toxification capacity.

Tea catechins reduce serum cholesterol concentrations and suppress postprandial hypertriacylglycerolemia in experimental animals and humans. These effects are mainly ascribed to the gallate esters of catechins, (-)- epicatechin gallate (ECG) and (-)-epigallocatechin gallate (EGCG). During pasteurization of tea drinks, tea cate- chins are epimerized to so-called heat-treated tea catechins such as (-)-catechin gallate (CG) and (-)- gallocatechin gallate (GCG). We showed that both tea catechins and heat-treated tea catechins with the galloyl moiety lowered intestinal absorption of cholesterol by inhibiting micellar solubility of cholesterol. Since they in- hibited pancreatic lipase in vitro and slowed down lymphatic absorption of triacylglycerols, it is suggested that delayed intestinal absorption of triacylglycerols after the feeding of catechin preparations causes suppression of postprandial hypertriacylglycerolemia. It has been reported that tea catechins and heat-treated tea catechins with the galloyl moiety suppress deposition of visceral fat in experimental animals and humans. Some studies suggest that the stimulation of hepatic β-oxidation might be a cause for reduced deposition of visceral fat. However, our study did not show any acceleration of β-oxidation in rat livers. Although there are some controversial observa- tions, results obtained suggest a possibility that tea catechins and heat-treated tea catechins with the galloyl moi- ety improve lipid metabolism and contribute to the prevention of the metabolic syndrome.

Flavonoid contents as aglycones (for quercetin, kaempherol, isorhamnetin, luteolin and apigenin) were reported for 115 edible plants (91 species). Plant materials mostly originated in tropical zones were grown and harvested from AVRDC, Taiwan. Acid extraction and HPLC were used as analytical methods. Total flavonoid contents ranged from 0 to 254 mg/100g fresh weight. About 75% of samples were found to contain flavonoids > 0.5 mg/100g with the group mean 33 ± 48 mg/100g. Data for only 30 samples (20 species) in this study are also available (measured as raw vegetables) in the USDA flavonoid database. This study can expand the flavonoid database and contribute to measurement of flavonoid intake, especially for populations consuming tropical and underutilized vegetables.

There has been growing interest in the potential cardiovascular benefits associated with cocoa consumption. As a result of accurate analytical methodologies, there is evidence to support that the flavanols in cocoa can be ab- sorbed, are bioactive, and may be responsible for the cardiovascular benefits associated with regular cocoa con- sumption. The flavanols in cocoa exist in a multitude of different stereochemical configurations, thus giving rise to a unique and complex mixture of compounds. Given this complexity, the quantitative analysis of cocoa flavanols in foods can be challenging. While there are published methods suitable for the analysis of these compounds, these methods require sophisticated instrumentation and can be challenging to set up. As such, simpler techniques that measure such things as total phenolic content or antioxidant potential have been used as indicators of flavanol content. However, as these simpler assays are prone to interferences and are not specific for flavanols, these methods are not appropriate for use in studies that aim to examine the physiological effects of cocoa flavanols. It is only through the use of methods that can accurately quantify these flavanols that it will be possible to make meaningful dietary recommendations regarding the consumption of cocoa flavanol contain- ing foods.

Epidemiologic investigations support the hypothesis that regular consumption of flavonoid-containing foods can reduce the risk of cardiovascular diseases (CVD). While flavonoids are ubiquitous in plants, cocoa can be particularly rich in a sub-class of flavonoids known as flavanols. A number of human dietary intervention trials with flavanol-containing cocoa products have demonstrated improvements in endothelial and platelet function, as well as blood pressure. These studies provide direct evidence for the potential cardiovascular benefits of fla- vanol-containing foods and help to substantiate the epidemiological data. In this review, results from selective published trials with cocoa and chocolate focused on risk for CVD will be discussed along with a study we re- cently completed evaluating the effects of the daily consumption of flavanol-containing dark chocolate (Co- coaViaTM) with and without plant sterol esters on CVD markers in a normotensive population with mild hyper- cholesterolemia. In this study, the daily consumption of flavanol-containing dark chocolate was associated with a significant mean reduction of 5.8 mmHg in systolic blood pressure. Together the results of these human die- tary intervention trials provide scientific evidence of the vascular effects of cocoa flavanols and suggest that the regular consumption of cocoa products containing flavanols may reduce risk of CVD.

Calcium recommendations in North America set in 1997 were determined as the intake for maximal retention in age groups for which these data were available. Because there is a linear relationship between bone density and fracture risk and because 99% of calcium resides in the bone, it was thought that maximizing calcium re- tention is an optimal goal for bone health. Typically, data for only one gender and race were available in an age group. Recent evidence suggests that calcium intakes for maximal retention may not vary by subgroup even if calcium retention is vastly different at any given intake. Issues that are receiving attention currently in- clude possible catch up growth, dairy vs. calcium intake, and how to establish optimal intakes.

Drinking tea could have a significant impact on public health. Health benefits are believed to be largely due to the presence of high levels of flavonoids. Tea is a rich source of flavonoids, and often the major dietary source. Tea intake and intake of flavonoids found in tea have been associated with reduced risk of cardiovascular dis- ease in cross-sectional and prospective population studies. In addition, flavonoids have consistently been shown to inhibit the development of atherosclerosis in animal models. A variety of possible pathways and mechanisms have been investigated. The focus of this review is on the potential of tea and tea flavonoids to improve endothelial function, and reduce blood pressure, oxidative damage, blood cholesterol concentrations, inflammation and risk of thrombosis. There is now consistent data to suggest that tea and tea flavonoids can improve endothelial function. This may be at least partly responsible for any benefits on risk of cardiovascular disease. Additional studies are needed to investigate whether regular consumption of tea can reduce blood pressure, inflammation and the risk of thrombosis. The evidence for benefit on oxidative damage and choles- terol reduction remains weak.

Studies have suggested that dietary flavonoids are helpful in the prevention of atherosclerosis and cardiovascu- lar disease. Antioxidant activity should be noted as underlying mechanism of their health impact in the vascular system, as atherosclerosis is closely related to oxidative events such as oxidized LDL accumulation in the macrophages. Vegetables contain a variety of flavonoids, such as flavonols, flavones and anthocyanidins. We focused on quercetin (3,3’,4’,5,7- pentahydroxyflavone), a major flavonoid in onion, and its anti-atherosclerotic effect was examined from the aspect of the bioavailability and translocation to the target site. Although quercetin exists as its glucoside form in onion, it is metabolized into several glucuronides and/or sulfate conju- gates with or without methylation during its intestinal absorption. We found that these metabolites circulating in the human blood stream were mostly localized in plasma albumin fraction, but not LDL fraction. Onion con- sumption failed to enhance the antioxidant activity of plasma fraction against LDL oxidation, indicating that the level of quercetin metabolites bound to albumin is insufficient to exert the antioxidative effect in vivo. In con- trast, we discovered that quercetin metabolites accumulate in the aorta tissue and exerted their antioxidant activ- ity, when rabbits were fed with quercetin glucoside and high cholesterol diet. Furthermore, quercetin metabo- lites were detected in human atherosclerotic aorta exclusively. These imply that quercetin metabolites are in- corporated into the atherosclerotic region and act as complementary antioxidants, when oxidative stress is loaded in the vascular system. It is likely that plasma albumin is a carrier for translocation of quercetin metabo- lites to vascular target.

Dietary assessment provides information on what people eat and how well they eat. Recent trends in changes of health problems related to diet require more accurate evaluation of diet since now we know that both under- and over-consumption of nutrients can bring health risks. Non-traditional new components have been identified to be related to health. Also new evaluation tools, such as Dietary Reference Intakes or Food Guides are devel- oped and used for dietary assessment. Dietary assessment in Asian region poses several challenges because of characteristics in diet, eating behaviours, and tools used in the process. Since many of these characteristics of Asian diet are considered to be related to health, either beneficial or detrimental, efforts are needed to develop methods and tools suitable to be used for Asian diet.

Micronutrients (vitamins and minerals) are present mostly in small amounts, or concentrated in certain foods. Traditional Asian diets are very diverse and consist largely of foods of plant sources, including several herbs and spices. Challenges in assessing dietary intake include difficulties in collecting information on ingredients in dishes as well as in meals shared by family members, and cooking effects. Variations in intakes of micronutri- ents are determined by frequency of consumption, and how common or concentrated the nutrients are in spe- cific foods. Moreover, assessing only nutrient intake is inadequate, since other food components affect its bioavailability. Non-nutrient food constituents, such as, phytate and polyphenols interfere with the bioavailabil- ity of iron and zinc. Bioconversion and bioefficacy of precursor nutrients, such as, carotenoids, also affect the estimated intake of vitamin A in its active form. Different strategies are required to deal with these challenges in assessing dietary intakes of micronutrients in order to establish the prevalence of inadequate intake, as well as the association between intake and nutritional status.

Nutrient standards such as the Dietary Reference Intakes (DRIs) may be used to assess diets of both individuals and of population groups. The goal is to estimate the probability of dietary adequacy (or inadequacy) for an in- dividual and the prevalence of dietary adequacy for a group. The DRI that is needed to estimate the probability of dietary adequacy is the estimated average requirement for a nutrient (EAR), as well as an estimate of the standard deviation of the requirement. The probability of adequacy for an individual should be based on usual long-term intake, because the DRIs apply to a person’s usual intake, rather than to intake on only a few days. Due to day-to-day variation in intakes, it is usually necessary to record or observe a person’s intake for a large number of days. For population groups, the prevalence of adequacy can be calculated as the average of each person’s probability of adequacy, and should correspond to the proportion of the population with nutrient in- takes exceeding nutrient needs. A short-cut method to estimating the prevalence of adequacy simply calculates the proportion of intakes that are above the EAR. It is not necessary to have usual long-term intake for each person in the group, but a statistical procedure must be used to remove the effect of day-to-day variation from the intake distribution before the prevalence of adequacy within a group is estimated. With the new DRIs, a more informative assessment of both individual and group intakes is possible.

The nutrient and related databases are essential for calculating intake values in epidemiological studies. To suit our research needs, we have developed an integrated management system not only for processing individual dietary questionnaires including 24-hour recalls, food records and Chinese food frequency questionnaires (CFFQ), but also for maintaining and tracking updated food composi- tion databases. The recall and record calculation system (Normal University Food and Nutrient Calculation System: NUCAL system) considers date of recall/record, number of days and meal separations. The CFFQ editing system (CFFQES system) contains the management of food list, and frequency and portion size selections to facilitate processing the various versions of CFFQ. Since the extension of many bioactive compounds including polyphenols, pollutants and carcinogens in foods and water is considered by epidemiological hypotheses, limitation of current food composi- tion tables needs to be noticed and improved. Laboratory analyses are the foundation of food data- bases, more resources and efforts are urgently needed for analysing the local food items. In practi- cal uses of efficient data processing procedures, the multiple grouping and nomenclature systems need further attention in the future. Nutrient databases need multidisciplinary efforts and play the key role for the success of epidemiological studies.

Data on the functionalities of L-carnitine on obesity, diabetes, and as an ergogenic aid are summarized as fol- lows: Obesity: Total lipid, triglyceride, and total protein increased during the 3T3-L1 cell differentiation. How- ever, nonesterified carnitine (NEC), acid-soluble acylcarnitine (ASAC), and acid-insoluble acylcarnitine (AIAC) concentrations were lower in the differentiated 3T3-L1 cells. In addition, the exogenously added car- nitine inhibited the increases in triglyceride and total lipid levels. In an animal study, L-carnitine supplementa- tion reduced serum leptin and abdominal fat weight caused by high-fat diet in C57BL/6J mice. Diabetes: In an animal study, streptozptpcin-induced diabetic rats had markedly lower IGFBP-3 than normal rats, and IGFBP-3 was increased by L-carnitine treatment, demonstrating that L-carnitine treatment of diabetic rats modulates the IGFs/IGFBPs axis. A study of Korean diabetics indicated that there is a remarkable abnormality in lipid and carnitine metabolism in Korean diabetic patients. Ergogenic aids: We investigated the separate and combined effects of L-carnitine and antioxidant supplemenation on carnitine and lipid concentrations in trained and non- trained animal and humans. Supplementation of L-carnitine and antioxidants improve lipid profiles and exercise ability in exercise-trained rats. Also, both exercise training and supplementation of carnitine and antioxidants improved lipid profiles and carnitine metabolism in humans, suggesting that carnitine and antioxidant supple- mentation may improve exercise performance.

The feeling of warmth after a meal is caused by the ingestion of nutrients and the sensation is known as nutri- tion-induced thermogenesis or specific dynamic action. Core body temperature (Tb) is constantly maintained within a narrow range, but thermoregulation can become impaired by the inhalation or intravenous administra- tion of anesthetics that inhibit hypothalamic thermoregulation. Hypothermia during surgery is directly associated with postoperative complications. Devices are available to maintain heat during surgery and thus prevent hypo- thermia. On the other hand, intravenous amino acid (AA) administration can attenuate hypothermia during an- aesthesia, prompting many clinical trials of AA mixtures to maintain Tb. However, although the thermal effect of AA during anaesthesia is obvious, the underlying mechanism of metabolic heat production and accumulation remains obscure. A nutritional physiological approach using a rat model will be introduced in this symposium. Data from our recent studies suggest that the administration of an AA mixture during anaesthesia stimulates muscle protein synthesis via insulin-mTOR-dependent activation of the translation initiation factors, 4E-BP 1 and S6K1, as a result of increased insulin concentrations. Thus, heat accumulation in the body is facilitated. Fur- thermore, the content of the AA mixture applied during anaesthesia alters the thermal effect and branched chain AAs are necessary, but not sufficient, for the prevention of hypothermia.

L-Serine plays a versatile role in intermediary metabolism in eukaryotic cells. The physiological significance of its de novo biosynthesis, however, remains largely unexplored. We demonstrated previously that neurons lose the ability to synthesize L-serine after their final differentiation and thus depend on astrocytes to supply this amino acid. This is due to a lack of neuronal expression of 3-phosphoglycerate dehydrogenase (Phgdh), which initiates de novo L-serine synthesis via the phosphorylated pathway from the glycolytic intermediate 3- phosphoglycerate. In rodent brain, Phgdh is expressed exclusively by the neuroepithelium/radial glia/astrocyte lineage. In humans, serine deficiency disorders can result from a deficiency of Phgdh or other enzymes involved in serine biosynthesis in the phosphorylated pathway. Patients with such disorders have lower serine levels in plasma and cerebrospinal fluid; they exhibit severe neurological symptoms including congenital microcephaly, feeding disabilities, and psychomotor retardation. L-Serine supplementation can attenuate developmental defects in these patients. To define the physiological importance of de novo L-serine production, we generated Phgdh knockout mice using targeted gene disruption technique. Phgdh deletion drastically reduced serine and glycine levels in the body. Phgdh knockout mice exhibited overall growth retardation with severe brain malformation, culminating in embryonic lethality. These observations highlight the vital role of de novo L-serine synthesis in the formation and function of the mammalian central nervous system. Furthermore, the embryonic lethal pheno- type of Phgdh knockouts indicates that L-serine must be synthesized endogenously in mouse (and probably hu- mans) during embryonic development.

Numerous studies have reported the protective properties of carotenoid supplementation against skin and eye as- sociated diseases. However, conflicting data concerning the efficacy of β-carotene in the pathogenesis of cancers and cardiovascular disease exist. It has been shown that β-carotene is an effective antioxidant on its own or in combination with other antioxidants. Red palm oil (RPO) is a potent anti-oxidant rich oil which consists of caro- tenoids, tocopherols, tocotrienols and lycopenes as well as lipid fractions such as squalene, saturated and unsatu- rated fatty acids (which maximize absorption of these anti-oxidants) and Co-enzyme Q10. α and β-carotene ac- count for more than 90% of the total carotene in RPO. It is known that ischaemia/reperfusion-induced injury causes an imbalance in oxygen supply which can lead to oxidative stress in the heart. It has been shown that the mitogen-activated protein kinases (MAPKs), PKB/Akt and the NO-cGMP all play vital roles in ischae- mia/reperfusion injury in the heart. Therefore, our review mainly focuses on the signaling pathways involved in functional recovery induced by a natural carotenoid oil after ischaemia/reperfusion injury.

Calcium is important for bone health. Over the last 15 years, reference calcium intakes in Western countries have been revised upwards for maximizing bone mass at skeletal maturity and for prevention of osteoporotic fractures. Some of these reference figures have also been adopted for use in Asian countries. However, the sci- entific data based on for revising reference calcium intakes in the West was largely based on Caucasians. Lim- ited human studies relating to calcium requirements and bone mineralization have been conducted in Asians in Asia. In children and adolescents, a trial has confirmed no effects of calcium supplementation on bone gains in adolescent girls after 7 years. A meta-analysis has also revealed that calcium supplementation has little benefi- cial effects on bone gain. Given that genetic factors, hormonal status, body size, bone structure, diets, physical activity, vitamin D status and adaptation could modify calcium retention and bone integrity, these factors need to be considered collectively to promote bone health in Asian populations. Furthermore, studies to identify in- digenous foods rich in calcium and high in bioavailability are needed to widen sources of dietary calcium. Eth- nic differences in calcium retention, hormonal status, bone structure, bone mineral accretion and peak bone mass are evident among Asians, Caucasians and Blacks in USA. Hence, reference calcium intakes for Asians are likely to be unique and different from those of Caucasians. More research has to be conducted in Asian populations in order to develop appropriate reference calcium intakes for the region.

The bulk of fatty acids found in our diets consists of long-chain fatty acids (LCFA), which are molecules con- taining 12 or more carbon atoms. In contrast, medium-chain fatty acids (MCFA) are composed of 8-10 carbon atoms, and are found in palm kernel oil, among other types of foods. MCFA have attracted attention as being part of a healthy diet, because they are absorbed directly into the portal vein, transported rapidly to the liver for β-oxidation, and thus increase diet-induced thermogenesis. In contrast, long-chain triacylglycerols are absorbed via the intestinal lymphatic ducts and transported by chylomicrons through the thoracic duct into the systemic circulation. Because medium-chain triacylglycerols (MCT) containing solely MCFA have a few disadvantages when used for deep frying, we have developed a new kind of triacylglycerol product: medium- and long-chain triacylglycerol (MLCT). MLCT is produced by lipase-catalyzed enzymatic transesterification. Long-term clini- cal trials have demonstrated that MLCT and MCT result in less body fat accumulation in humans. MLCT oil has been approved as FOSHU (Food for Specified Health Use) for use as cooking oil with a suppressing effect on body fat accumulation.

Alterations in dietary protein intake have an important role in prevention and management of several forms of kidney disease. Using soy protein instead of animal protein reduces development of kidney disease in animals. Reducing protein intake preserves kidney function in persons with early diabetic kidney disease. Our clinical ob- servations led us to the soy-protein hypothesis that “substitution of soy protein for animal protein results in less hyperfiltration and glomerular hypertension with resulting protection from diabetic nephropathy.” These compo- nents of soy protein may lead to the benefits: specific peptides, amino acids, and isoflavones. Substituting soy protein for animal protein usually decreases hyperfiltration in diabetic subjects and may reduce urine albumin excretion. Limited data are available on effects of soy peptides, isoflavones, and other soy components on renal function on renal function in diabetes. Further studies are required to discern the specific benefits of soy protein and its components on renal function in diabetic subjects.

Observational studies suggest nut consumption is inversely associated with the incidence of cardiovascular dis- ease and cancer. In addition to being rich in several vitamins and minerals, unsaturated fatty acids, and fiber, tree nuts and peanuts contain numerous phytochemicals that may contribute to promoting health and reducing the risk of chronic disease. While many of these bioactive constituents remain to be fully identified and character- ized, broad classes include carotenoids, phenols, and phytosterols. Phytosterols in nuts range from 95-280 mg/100 g. α- and β-Carotene, β-cryptoxanthin, lutein, and zeaxanthin are found in μg/100 g amounts in some nuts but at 1-3 mg/100 g in pistachios and none at all in Brazils, macadamias, and peanuts. Phenols, including phenolic acids, flavonoids, and stilbenes, are present in nuts. Walnuts are particularly rich in total phenols with 1625 mg gallic acid equivalents/100 g. The stilbene resveratrol is found in peanuts and pistachios at 84 and 115 μg/100 g, respectively. The flavonoid content of nuts as provided in USDA Database for the Flavonoid Content of Selected Foods, lists totals in pecans at 34, almonds at 15, and pistachios and hazelnuts at 12 mg/100 g. Proanthocyanidins are found in almonds, cashews, hazelnuts, pecans, pistachios, peanuts, and walnuts, with con- centrations varying from 9-494 mg/100 g. Nut phytochemicals have been associated with numerous bioactivities known to affect the initiation and progression of several pathogenic processes. However, as complete phyto- chemical profiles are lacking for most nuts, information is limited regarding their bioavailability and metabolism, so further research on this topic is warranted.

Inflammation is one of the recognised mechanisms involved in the development of atherosclerotic plaque and in- sulin resistance. Inflammatory or endothelial markers such as C-Reactive Protein (CRP), Interleukin-6 (IL-6), fi- brinogen, Vascular Cell Adhesion Molecule-1 (VCAM-1) and Intracellular Adhesion Molecule-1 (ICAM-1) have been identified as independent predictors of cardiovascular disease (CVD) or diabetes in human prospec- tive studies. Epidemiological and clinical studies suggest that some dietary factors, such as n–3 polyunsaturated fatty acids, antioxidant vitamins, dietary fiber, L-arginine and magnesium may play an important role in modu- lating inflammation. The relationship observed between frequent nut consumption and the reduced risk of car- diovascular mortality and type 2 diabetes in some prospective studies could be explained by the fact that nuts are rich in all of these modulator nutrients. In fact, frequent nut consumption has been associated with lower concen- trations of some peripheral inflammation markers in cross-sectional studies. Nut consumption has also been shown to decrease the plasma concentration of CRP, IL-6 and some endothelial markers in recent clinical trials.

Nuts are a nutrient-rich food group. Depending on the type, they may provide substantive concentrations of Vi- tamin E, magnesium, folate, essential fatty acids, fiber and protein to the diet. They also contain potentially im- portant phytochemicals. By mechanisms yet to be identified, they are reported to improve postprandial lipid pro- files and may hold other health benefits. However, they are also energy dense so a theoretical contributor to positive energy balance and weight gain. However, epidemiological studies have consistently revealed an in- verse association between the frequency of nut consumption and BMI. Further, intervention trials demonstrate less than predicted weight gain following inclusion of nuts in the diet. The mechanisms for these observations are currently under study. Candidates include strong satiety effects, promotion of energy expenditure and/or in- efficient energy utilization. Recent trials have revealed support for each. Inclusion of nuts in the diet results in strong satiety effects as revealed by robust compensatory dietary responses that offset approximately 65-75% of the energy they provide. Several trials note increased energy expenditure that may account for an additional 10% of their energy yield. Limited bioaccessibility results in a loss of 5-15% of energy. Taken together, these findings largely account for the energy provided by nuts and explain the epidemiological and clinical observa- tions. Thus, current knowledge suggests moderate nut consumption does not pose a threat for weight gain.

The world of nutrition has changed dramatically over the past 100 years. This presentation provides an analysis of how the lessons learned from prior nutrition interventions and public policies can be translated to address the current nutrition issues of populations globally. The formulation and implementation of nutrition policies is complex. Prior emphasis in US nutrition policies was in addressing problems of nutrient deficiencies and under consumption. While these problems still exist, worldwide problems related to dietary patterns and chronic dis- eases are emerging as more common. There are few “success” stories for interventions aimed at the prevention of diet related chronic diseases, particularly in urban areas. Newer paradigms for nutrition interventions, includ- ing public- private sector collaborations are presented. In addition, examples of effective, enabling policies are discussed.

Since 1970s, the economic and social development in South Korea, as well as dietary pattern, has undergone various changes. Concerns for the decreased nutrition quality and physical activities among Koreans, especially young population, call for a need of a holistic approach in national food and nutrition policy. The National Health Promotion Act of 1995 included national interventions and programs to deal with nutrition-related chronic diseases and obesity prevention. A nation-wide monitoring system, which includes nutrition and health examination survey, is being built and run by the Ministry of Health and Welfare and its affiliated organizations every three years. The Korea Food and Drug Administration (KFDA) is another key agency undertaking national food and nutrition policies. The KFDA recently promulgated the national strategic plans for improving food safety and nutrition, focusing on children. Nutrition labelling policy for processed food is managed by KFDA and various education programs are developed and disseminated to enhance the awareness of nutrition labelling. The agency also makes standards and regulates foods for special dietary uses and health functional food. The Rural Development Administration (RDA) is responsible for maintaining the food composition database. Finally, the National School Lunch Program is mainly governed by the Ministry of Education and Human Resources De- velopment. The above central government agencies along with regional health centers are making efforts to promote the healthy eating habits in addition to constructing healthy environment by making laws and programs and by research and social marketing.

Micronutrients (MN) share common metabolic pathways, or work in complementarity. Missing or having too much of one micronutrient may tip the balance, resulting in manifested deficiencies of one or more micronutri- ents. Coexistence of micronutrient deficiencies have been reported from developing countries. This raises the concern of the commonly implemented single micronutrient supplementation. Efficacy of high dose of multiple micronutrient supplementation has been tested but results are mixed. This may be dependent on which outcomes were measured. It is possible that interaction is more likely with high dose of MN supplementation. Shifting from single to multiple micronutrient supplementation will still encounter the same challenges to program effec- tiveness. Food-based strategy is a promising public nutrition measure. However, it requires a holistic environ- ment to be effective. More evidence on efficacy and/or effectiveness of food-based interventions is urgently needed, to establish policy and program options to deal with coexistence of multiple micronutrient deficiencies. Interactions among micronutrients are recognized, and should be taken into account for designing appropriate in- tervention program.

After World War II, Japan has imported food from other countries to solve malnutrition, and then dietitians pro- vided nutrition education to people for effective food utilization. Flour and skimmed milk imported from the United State were distributed to the school lunch program. Dietitians were trained to encourage the people to adapt western style dietary habits. The western style dietary habit issues have been brought since in 1980’s as overeating and obesity have been considered as nation’s health problems. In the 1990’s, the prevention and treatment of lifestyle-related diseases became key objects for the nation. Government settled on "Healthy Japan 21" as a preventive policy of the lifestyle-related disease in 2000. In 2006, the middle survey for the effective- ness of the campaign was conducted, but it did not bring a good result as expected. The Ministry of Health, La- bor and Welfare made the “Japanese Food Guide Spinning Top” for practical and easy mean to improve eating habits. Dietitians are in the process of developing new nutrition education using this tool. In 2005, the nine spe- cific targets’ Basic Law on Dietary Education “Shoku-Iku” was enacted to promote childhood dietary education. The Ministry of Education and Science started the new education to become a teacher called “diet and nutrition teacher” on the professional education programs of registered dietitian in university. “Diet and nutrition teach- ers” have already started teaching in some schools. From now, the roles of dietitians are not only supervising food preparation and planning meals but also nutrition education as teachers.

More than 21,000 practicing dietitians are working in the various fields of institutional foodservice settings in Korea. For the effective placement and practice of dietitians in their special areas, proper enactment and imple- mentation of required legislations shall be imperative. Following legislations are few of those: regulations for dietitians enacted in 1963 in accordance with decree of the Ministry of Health and Social Affair; the School Meals Act in 1981; placement regulation for dietitians in childcare and nursery facilities with over 100 children under the enforcement of Infant Care Act of 1991; regulation for nutrition improvement program stated in the National Health Promotion Act of 1995; enforcement regulation for the placement of dietitians in public health centers under the Regional Public Health Act of 1997; amendment of School Meal Act and Primary and Secon- dary Education Act in 2003 stating that school shall have the nutrition education teacher who is dietitian quali- fied and passed national teacher qualifying examination; amendment of the Ministry of Health and Welfare Noti- fication in 2003 enabled clinical dietitians at hospitals to bill a medical nutrition therapy service fee officially to patients with the following diseases: diabetes, hypertension, cardiac disease, and cancer; and amendment of the Justice Department and its Affiliates Notification in 2006 stating dietitians are placed at correction facilities. Newly introduced nutrition teachers who have tasks of nutrition education and meal service management were arranged at 4,134 schools of public or national primary and secondary as well as special schools for the handi- capped in September, 2007.

Metabolic syndrome (MS) is a rising disease entity characterized by a clustering of metabolic conditions. Al- though prevalence of obesity as defined by the World Health Organization (WHO) is relatively low in Asia compared to western countries, metabolic syndrome is growing into a significant public health problem. Com- parative studies indicate that metabolic responses to obesity may be greater in South and East Asians than their western counterparts at given Body Mass Indexes (BMIs). Higher percentage body fat in Asians at given BMIs and over-responsiveness to obesity may in part explain the phenomenon for which the underlying causes are not clear. Furthermore, aborigines may be at an even greater MS risk. The metabolic syndrome definition itself as well as whether it should be defined are controversial. The National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) gives equal weight to each component disorder, while the International Diabetes Federation (IDF) takes central obesity as a pre-requisite. Both criteria adopt ethnic-specific cut-off points for waist circumference. Asian data favour the new NCEP-ATP III definition, as individuals that were selected through the NCEP criteria but disregarded by the IDF criteria had similar Framingham cardiovascular disease risk scores to those picked by both definitions. Prospective data show that the metabolic syndrome not only increases the risk of coronary artery disease but also cerebrovascular disease in Asians. Macronutrient composition and the quality of the diet are associated with the risk of metabolic syndrome. More research is needed to relate diet and metabolic syndrome in Asians.

Tawana Pakistan Project, a multifaceted pilot project (Sept. 2002 to June 2005) was funded by the Government of Pakistan to address poor nutritional status and school enrolment of primary school age girls. The core strategy was to create safe environment empowering village women to take collective decisions. Through reflective learning process women learnt to plan balanced menus, purchase food, prepare and serve a noon meal at school from locally available foods at nominal costs (USD 0.12/child). Aga Khan University partnered the government for the design, management, monitoring and evaluation of the project, 11 NGO’s facilitated implementation in 4035 rural government girls’ schools. Training was provided to 663 field workers, 4383 community organizers, 4336 school teachers and around 95 thousand rural women. Height and weight were recorded at baseline and every 6 months thereafter. Wasting, underweight and stunting decreased by 45%, 22% and 6% respectively. En- rolment increased by 40%. Women’s’ ability to plan balanced meals improved and >76% of all meals provided the basic three food groups by end of project. Government bureaucracy issues, especially at the district level proved to be the most challenging bottlenecks. Success can be attributed to synergies gained by dealing with nu- trition, education and empowerment issues simultaneously.

Dietetic practice in Singapore is mainly applied at the clinical settings, such as hospitals. The main scope of practice is in providing medical nutrition therapy to patients in a multidisciplinary team approach at both inpa- tient and outpatient clinics. This is delivered in the form of nutrition counseling and nutrition support. Dietitians are also involved in other areas such as conducting nutrition workshops and talks and provide consultation to the hospital’s food service department. They set dietary guidelines for inpatient meal services and equip the food service personnel with the knowledge to plan and prepare healthier menus and therapeutic diets. In the schools, all the students are taught the basic principles of nutrition in the school curriculum. Healthy eating messages are reinforced through various interesting activities in schools. Nutrition guidelines on creating healthy and nutri- tious menus in the school tuckshops are available for schools to implement the Model School Tuckshop Pro- gramme. This programme is aimed at cultivating healthy eating habits among school children. For overweight students, they are referred to the students health centre for medical screening, assessment and for regular nutri- tion counseling at the Nutrition Clinic.

A healthful diet can reduce major risk factors for chronic diseases. To assess the dietary status of Thais and monitor changes in food consumption patterns, the Healthy Eating Index for Thais (THEI) is developed, an im- portant tool for meeting the nutrition goals and determining people’s overall diet quality. This index measures how well the diets of Thai people conform to the recommendations of the Food Guide Thailand Nutrition Flag. The THEI consists of 11 components, each representing different aspects of a healthful diet: Components 1-5 measure the degree to which a person’s diet conforms to serving recommendations for the five major food groups of Thailand Nutrition Flag; Components 6, 7 and 8 measure total fat, saturated fat and added sugar con- sumption, respectively; Components 9 and 10 measure total cholesterol and sodium intake; and Component 11 examines variety in a person’s diet. Each of the 11 components has a score ranging from 0 to 10, for a total score of 110. The dietary intake data from selected working adults were collected to derive the THEI scores. The aver- age THEI score indicated that the diets of most people needed improvement and some individuals were more likely than others to consume a poor diet. This suggests a continued role for nutrition education and promotion efforts should result in a significant improvement of people’s overall diet quality. In conclusion, the THEI is an useful index for describing overall diet quality for Thais and serves as a basic tool for providing nutrition educa- tion and promotion.

Glutamate is a major constituent of dietary protein and is also consumed in many prepared foods as a flavour ad- ditive in the form of monosodium glutamate (MSG). Evidence from human and animal studies indicates that glutamate is the major oxidative fuel for the gut and that dietary glutamate is extensively metabolized in first- pass by the intestinal enterocytes. Glutamate also is an important precursor for bioactive molecules, including glutathione, and functions as a key neurotransmitter. The central importance of glutamate as an oxidative fuel may have therapeutic potential for improving function of the infant gut, which exhibits a high rate of epithelial cell turnover. Our recent studies in infant pigs show that when MSG is fed at higher (4-fold) than normal dietary quantities, the majority (~70%) of glutamate molecule is either oxidized as energy or metabolized by the mucosa into other nonessential amino acids. Our results also showed that at high dietary intakes the rate of MSG absorp- tion is higher when given via the intragastric compared to intraduodenal route. This intriguing finding implies that gastric glutamate transport may be physiologically significant and warrants further research into the role of MSG in gastric development and function during infancy.

Gustatory and anticipatory cephalic stimuli during a meal yield nutritional information and aid efficient food di- gestion. Mammals, including humans, can detect the amount of dietary protein and its quality via cephalic relay to initiate proper digestion in the upper gastrointestinal (GI) tract. In addition to gustatory stimuli, visceral sens- ing by the abdominal vagus conveys primary afferent nutritional information from the digestive system to the brain. Electrophysiological studies indicated that abdominal vagal afferents, which were innervated into the stomach and intestine sending information to the brain, were activated by luminal glutamate. Histochemical analysis also revealed the existence of a glutamate signalling system (metabotrophic glutamate receptors) in the GI tract. Luminal glutamate in the stomach and intestine provides the efferent reflection of the abdominal vagus, supporting the modulation of exocrine and endocrine excretion during digestion. These results strongly indicate that glutamate has regulatory effects on the food digestive processes through the gut nutrient-sensing system. It plays physiological and nutritional roles and initiates digestion in the stomach as well as anticipates subsequent processes in the small intestine and the liver. We reviewed recent studies on glutamate physiology in the gut in- cluding our research, and discussed the physiological significance of dietary free glutamate in the regulation of gut function, focusing on the visceral sensation from the stomach.

In the Western world, consumers have only recently learned to discriminate the Umami taste, although they have enjoyed its contribution to the palatability of traditional dishes for centuries. The flavor enhancing properties of MSG have been scientifically investigated in European subjects. By adding MSG to such foods as soups, their content in sodium can be decreased without altering palatability, thus favoring a net decrease in sodium intake. Consumers presented with a novel food often have to get accustomed to the new taste before they acquire a pref- erence for the food. A study showed that when such novel foods are added with some appropriate amount of MSG, consumers acquire a preference for them more rapidly. In elderly persons, the addition of MSG to nutri- tionally valuable foods (soups, vegetables, starches) did induce an increase of intake of MSG-added foods. Total meal size, however, was not affected, since the increased intake of MSG-containing foods was followed by a de- creased consumption of foods served later in the meal, such as desserts. The same observations were repeated in hospitalized diabetic patients. Again, the patients ingested more healthy MSG-containing foods and less of other foods, with the same total meal energy intake. These two studies suggested that MSG could be used to stimulate appropriate food choices in certain populations.

Plant-based foods and food ingredients provide a wide range of phytochemicals and antioxidants that render their beneficial health effects through a number of mechanisms. The presence of phenolics in different plant materials and beverages depends on the source material which dictates the type and quantity present. In addition, processing of raw materials, including fermentation, may alter the chemical nature and efficacy of their phenolic constituents. While vinegar has traditionally been used for food preservation and as a seasoning, more recently, fruit vinegars with different sensory characteristics have appeared in the marketplace. In addition to acetic acid, fruit vinegars often contain citric, malic, lactic, and tartaric acids and may also include phenolics, some of which are produced as a result of fermentaion. The beneficial health effects of fruit vinegars may in part be related to the process-induced changes in their phenolics and generation of new antioxidative phenolics during fermentation.

Some food products fit better within a healthy diet than others, but how can consumers tell? The Choices pro- gramme is a simple and internationally-applicable programme to help consumers make a healthy choice on food and beverages and to stimulate industry towards healthy product innovation in all food groups. The essence of the programme is a front-of-pack stamp on products that pass an evaluation against scientific criteria. To that end generic criteria have been established for levels of saturated fat, trans fat, sugars and sodium, which are based on international dietary guidelines (FAO/WHO). For some food categories there are specific criteria for these nutri- ents as well as for dietary fibre and calories. In this way the criteria are challenging without being impossible to meet. The programme has been initiated by food industry and is open to all companies in food industry, retail and catering. The approach is also supported by nutritional scientists, governments and NGOs. An independent scientific committee is responsible for designing and periodically reviewing the qualifying criteria. The current qualifying criteria were developed by scientific committees in the Netherlands and Belgium. These criteria will now be reviewed by an International Scientific Committee, consisting of internationally-recognised food and nu- trition experts. To accommodate the developments in nutrition science and food technology, this review will take place every two years.

Cancer has always a negative impact on nutritional status, weight loss being a common feature in patients with neoplastic diseases. If left untreated, weight loss may evolve into cancer cachexia, a complex syndrome charac- terized by marked depletion of body weight, associated with profound alterations of both nutritional status and metabolic homeostasis. Progressive wasting of skeletal muscle mass and adipose tissue is a typical feature of cancer cachexia. Cachexia has a large impact on morbidity and mortality, and significantly affects patients’ re- sponse and tolerance to treatments and quality of life. On this line, understanding the pathogenic mechanisms of cachexia is of crucial importance to define targeted therapeutic strategies. Well structured, systematic and timely appropriate nutritional intervention in cancer patients is of pivotal importance. Indeed, it has been shown that malnutrition in cancer patients can be delayed when nutritional supplementation is adopted early in the course of the disease. The preservation of a good nutritional status, in particular when it is achieved concurrently with spe- cific antineoplastic treatments, will prevent or at least delay the onset of overt cachexia, allowing the use of more aggressive therapeutic regimens. The inclusion of specific, metabolically active nutritional substrates, such as branched chain amino acids or eicosapentaenoic acid may be helpful in interfering with the mechanisms respon- sible for the metabolic alterations and the perturbations of molecular pathways ultimately leading to the clinical picture of cancer cachexia.