Dr Junshi Chen was graduated from the Beijing Medical College in 1956 and engaged in nutrition and food safety resea rch for more than 50 years at the Institute of Nutrition and Food Safety, Chinese Center for Disease Control and Preventi on (the former Chinese Academy of Preventive Medicine), Beijing, People Republic of China.
Because of his outstanding research in the selenium and Keshan disease during period 1968-1976, he received the Schwartz International Award in 1984. He has also conducted large epidemiologic studies on diet, nutrition and chronic diseases, in collaboration with Dr T Colin Campbell, Cornell University and Prof Richard Peto, University of Oxford since 1983. From late 1980's, he conducted a series of studies on the protective effects of tea on cancer, including laboratory study and human intervention trials. He is the member of the expert panel who wrote the WCRF/AICR report “Food, Nutrition and the Prevention of Cancer: a Global Perspective” (1997). Recently, he was appointed as the Chair of the Chinese National Expert Committee for Food Safety Risk Assessment and the Vice-Chair of the National Food Safety Standard Reviewing Committee. Internationally, he serves as the chairperson of the Codex Committee on Food Additives (CCFA) , member of the WHO Food Safety Expert Panel and Director of ILSI (International Life Sciences Institute) Focal Point in China.
Dr Chen's research interests focus on nutrition epidemiology as well as food safety surveillance and risk assessment in the following areas:
(1) Relationship between diet, nutrition and non-communicable diseases in different geographical areas and population
groups in China.
(2) Food fortification.
(3) Studies on the protective effect of edible plant (tea, vegetables, fruits, etc.) components on cancer formation with
special emphasis on biomarkers and human intervention trial.
(4) Total Diet Study in China.
His commitment to nutrition scholarship and capacity building in the Asia Pacific region make him a most worthy
recipient of the Asia Pacific Clinical Nutrition Society Award for 2011.
Although hip fracture is considered to be associated with hypovitaminosis D and K, few reports have previously studied both of them. We have studied the vitamin D- and K-status as well as the general nutritional status in ni- nety-nine patients with hip fracture. Mean serum concentration of 25hydroxy-vitamin D (25OH-D) in female fractured patients was only approximately 9 ng/mL, suggesting severe vitamin D deficiency. There was no sig- nificant difference between the two groups in serum concentration of intact parathyroid hormone in both genders and serum 25OH-D levels in the male subjects. Plasma concentrations of phylloquinone (vitamin K1; PK) and menaquinone-7 (MK-7) were significantly lower in the fractured group than in the control group in both genders. Logistic regression analysis indicated that circulating concentrations of albumin, PK and 25OH-D were the sig- nificant and independent determinants of fracture risk, with their higher concentrations associated with decreased fracture risk. Finally, principal component analysis (PCA) was performed to summarize the clinical parameters into smaller numbers of independent components. Three components were obtained, each representing the over- all nutritional status, the vitamin D status, and the vitamin K status. In conclusion, our study has shown that pa- tients with hip fracture have vitamin D and K deficiency independent of general malnutrition.
Background: to report anthropometry and morbidity among term low birth weight infants and anthropometry of their first time mothers during the first six months in relation to breastfeeding practice. Methods: we examined data from a randomized controlled trial in Manila, the Philippines. Of the 204 mothers randomized, 68 mothers received eight postpartum breastfeeding counseling sessions, the rest did not. Maternal and infant anthropomet- ric data at birth, 2, 4 and 6 months were taken. During seven follow-up hospital visits, an independent inter- viewer recorded feeding data. Results: the 24 infants exclusively breastfed from birth to six months did not have diarrhea compared to 134 partially breastfed (mean 2.3 days) and 21 non-breastfed infants (mean 2.5 days). Par- tially breastfed and non-breastfed infants compared to exclusively breastfed infants had more frequent, as well as more severe episodes of respiratory infections. At six months, neither overall gain in infant weight, length and head circumferences nor mean maternal weight and body mass index differed significantly between the feeding groups. Conclusions: exclusive breastfeeding for 6 months can be recommended in term low birth weight in- fants, who were protected from diarrhea, had fewer respiratory infections, required no hospitalization and had catch up growth. Exclusively breastfeeding mothers did not differ from mothers who breastfed partially or those who did not breastfeed with regard to weight changes at six months.
Bifidobacterium longum (BL999), Lactobacillus rhamonosus (LPR), prebiotics (inulin and fructo-oligosaccharides), and long-chain polyunsaturated fatty acids (LCPUFA) are believed to have health benefits. In a randomized, double-blind, controlled trial we compared growth and development of toddlers fed milk containing synbiotics (BL999, LPR, and prebiotics) and LCPUFA or a control milk. Three hundred and ninety three healthy, 12 month-old toddlers were fed approximately 400 mL/day for 12 months. Anthropometric measurements were tak- en at 12, 14, and 16 months. Toddlers’ response to measles and hepatitis A vaccine was measured at 16 months, and Bayley scale for motor, cognitive, and behavioral functions made at 24 months. The primary outcome was weight gain between 12 and 16 months. Secondary outcomes were gain in length, head circumference, and body mass index, gastrointestinal tolerance (stool characteristics), stool bacterial counts, safety, anti-vaccine IgG, and neurodevelopment. Weight gain was greater in the synbiotics group (mean±SD, 7.57±4.13 g/day) compared with the control group (6.64±4.08 g/day). The difference of 0.93 g/day (with a 95% confidence interval of 0.12 to 1.75) is significant (p=0.025). The gain in the synbiotics group resulted in a change in z-score weight-for-age closer to WHO Child Growth Standard. There was a significant increase in lactobacilli and enterococci counts between 12 months and 16 months in the synbiotic group. We conclude that in healthy toddlers milk containing synbiotics and LCPUFA provides better growth and promotes favorable gut colonization, as shown by higher Lactobacillus counts.
Objective: The objective of this study was to test whether “Dietary Guidelines for Chinese Residents” have beneficial effects on anthropometric and metabolic variables, adipokines and inflammatory markers in metabolic syndrome patients. Methods & Procedures: A multi-stage sampling method was applied to select metabolic syn- drome patients in two districts of Shanghai. Two hundred and seventy-two metabolic syndrome patients were di- vided into control and intervention groups according to their district. Nutrition education guided by “Dietary Guidelines for Chinese Residents” was performed in the intervention group for one year. Results: Nutrition- related knowledge, attitudes and behavior were improved in the intervention group. Potassium intake and food to total energy ratio for grain, vegetable and fruit increased while sodium intake as well as fat to total energy ratio decreased in the intervention group compared to the control group (p<0.05). Correspondently, the intervention group significantly improved its waist circumference, waist to hip ratio, high-density lipoprotein cholesterol, adiponectin, leptin and tumor necrosis factor-α compared to the control group (p<0.05). Waist circumference changes from baseline to end of the study in the intervention and the control groups were -3.9±0.3 and -2.3±0.4 cm respectively. There was a significant difference between the two groups (p=0.004). Means of waist circum- ference, waist to hip ratio, leptin and tumor necrosis factor-α were lower, and high density lipoprotein- cholesterol was higher in the intervention group than the control group (p<0.05). Conclusion: This study con- firmed “Dietary Guidelines for Chinese Residents” had beneficial effects on anthropometric, lipids, adipokines and inflammatory markers in metabolic syndrome patients.
This study aimed to examine school principals’ perceptions of the school environment in Hong Kong as a con- text for the dissemination of food knowledge and inculcation of healthy eating habits. A questionnaire survey was administered in secondary schools in Hong Kong to survey Principals’ views of students’ food choices, op- eration of the school tuck shop, and promotion of healthy eating at school. Questionnaires were disseminated to all the secondary schools offering Home Economics (300 out of 466), and 188 schools responded, making up a response rate of 63%. Collected data were analyzed using SPSS. Most of the schools (82%) claimed to have a food policy to monitor the operation of the school canteen, and about half (52%) asserted there were insufficient resources to promote healthy eating at school. Principals (88%) generally considered it not acceptable for the school tuck shop to sell junk food; however, 45% thought that banning junk food at school would not help stu- dents develop good eating habits. Only 4% of the principals believed nutrition education influenced eating hab- its; whereas the majority (94%) felt that even with acquisition of food knowledge, students may not be able to put theory into practice. Cooking skills were considered important but principals (92%) considered transmission of cooking skills the responsibility of the students’ families. Most of the principals (94%) believed that school- family collaboration is important in promoting healthy eating. Further efforts should be made to enhance the ef- fectiveness of school food policies and to construct healthy school environments in secondary schools.
The purpose of the present study was to investigate the influence of awareness of the Japanese Food Guide Spin- ning Top on eating behavior and obesity in Japan. Participants were 1,558 Japanese male and female adults (40.2±12.2 years) who had been registered with a social research company. The cross-sectional questionnaire survey was conducted via the Internet in November 2007. Potential respondents were invited to complete the survey via e-mail, which contained a link to the survey Uniform Resource Locator (URL). The measures were awareness of the Japanese Food Guide Spinning Top, eating knowledge scores, eating attitude scores, and eating behaviors scores, according to the recommendations of the Health Japan 21 and the Food Balance Guide Spin- ning Top. Obesity was assessed by self-reported body mass index (BMI) and waist circumference. The relation- ships between awareness of the Japanese Food Guide Spinning Top, eating knowledge scores, eating attitude scores, eating behavior scores, and obesity were analyzed using path analysis. Path analysis revealed that aware- ness of the Japanese Food Guide Spinning Top was associated with BMI and waist circumference via eating be- havior scores. In addition, eating knowledge scores and eating attitude scores were mediators of the association between awareness of the Japanese Food Guide Spinning Top and eating behavior scores. These results suggest that promotion of the Japanese Food Guide Spinning Top would be a useful strategy to encourage healthy eating and prevent obesity in the Japanese population.
The purpose of this study was to examine the nutrition transition in four countries with respect to body dissatis- faction and eating styles. The target population for this study was college students in China (n=207), Japan (n=865), Jordan (n=322), and the United States (n=432). A cross-sectional survey was used to assess eating styles, disordered eating attitudes and behaviors, body esteem and dissatisfaction, and media influence. Results indicated that the Chinese sample was in an earlier stage of the nutrition transition, followed by Japan, Jordan, and the US. Interestingly, Jordanian and Chinese students exhibited the lowest level of body dissatisfaction. However, Jordanian students exhibited high levels of restrained eating similar to those seen in the Japanese and American students. The Japanese sample demonstrated a complex relationship between the culture of thinness, body dissatisfaction and eating styles. However the US sample reflected the expected levels of body dissatisfac- tion, high levels of restrained eating, emotional eating, and disordered eating attitudes and behaviors. Implica- tions and suggestions for further research are discussed.
The risk of cardiovascular disease is substantially high in hemodialysis patients. The risk factors for cardiovascular disease in dialysis patients include age, malnutrition, duration of dialysis, diabetes mellitus and hyperphos- phatemia. However, it is not clear whether cardiovascular disease is associated with abdominal obesity in dialysis patients. The aim of the present study was to clarify the relationship among visceral fat area and cardiovascular complications in chronic dialysis patients. Area of visceral fat was measured using computed tomography scan in 94 patients. The abdominal aortic calcification index (ACI), blood lipid profile and complication of cardiovas- cular disease were evaluated in these patients. Compared to patients with smaller visceral fat area (<100 cm2), those with larger visceral fat area (≥100 cm2) showed significantly higher cardiovascular complication and high- er serum levels of triglyceride and significantly lower serum levels of HDL-cholesterol. Patients with larger vis- ceral fat area and longer duration of dialysis showed severer calcification by ACI analysis, and showed higher incidences of ischemic heart disease. This study suggested that chronic dialysis patients with higher visceral fat area have a higher risk for vascular events, especially ischemic heart disease.
This research was designed to evaluate the effectiveness of fortified flour on micronutrient status in poor rural adult women. A total of 4,700 farmers as the intervention group were supplied with multi-nutrient fortified wheat flour for three years, while 2750 farmers as the control group were supplied with unfortified wheat flour. Wheat flour was fortified with vitamins A, B-1, B-2, niacin, folic acid, iron and zinc in mg/kg at 2, 3.5, 3.5, 35, 1, 20 and 25, respectively. Blood samples were taken at baseline and annually from about 300 volunteer adult fe- males aged 20-60 years in each group. Hemoglobin (Hb), serum retinol, serum iron, free erythrocyte protopor- phyrin, serum zinc were measured annually and a dietary survey conducted every 6 months. Average intakes of fortified micronutrients increased to adequate levels with average consumption of fortified flour at 117 g per per- son per day. Intervention groups showed a significant increase in terms of Hb levels from 24 m to 36 m and anemia rate decreased from 15.1% at baseline to 10.8% at 36 m. Serum iron levels of the intervention group sig- nificantly increased from 12 m to 36 m and erythrocyte protoporphyrin decreased from 24 m to 36 m respec- tively. Serum retinol and serum zinc of intervention group improved significantly from 12 m to 36 m compared with baseline and control group. The results showed that the fortified flour could improve micronutrient status of adult females in poor rural region.
Epidemiologic findings are inconsistent concerning the association of endometrial cancer risk with alcohol con- sumption. Therefore, we conduct a meta-analysis of studies that assessed the association of alcohol consumption and the risk of endometrial cancer. A systematic literature search up to April 2010 was performed in MEDLINE and EMBASE, and study-specific risk estimates were pooled using a random-effects model. In the present study, six prospective and 14 case-control studies were included. Alcohol intake was not significantly associated with the risk of endometrial cancer among prospective studies (relative risk (RR): 1.04; 95% confidence interval (CI): 0.91-1.18) or among case-control studies (odds ratio (OR): 0.89; 95% CI: 0.76-1.05). However evidence from the results of our stratified analyses revealed that increased risk of endometrial cancer was associated with liquor consumption (RR: 1.22; 95% CI: 1.03-1.45) but null association with wine and beer consumption. In conclusion, alcohol consumption is not associated with the risk of endometrial cancer. Future studies should also examine whether the relation varies according to different type of alcoholic beverages.
In the globalised world of the 21st century, issues of food and nutrition labelling are of pre-eminent importance. Several international bodies, including the World Health Organisation and World Trade Organisation, are en- couraging countries to harmonise their food and nutrition regulations with international standards, guidelines and recommendations such as those for Codex Alimentarius. Through harmonisation, these organisations envisage fewer barriers to trade and freer movement of food products between countries, which would open doors to new markets and opportunities for the food industry. In turn, increased food trade would enhance economic develop- ment and allow consumers a greater choice of products. Inevitably, however, embracing harmonisation brings along cost implications and challenges that have to be overcome. Moreover, the harmonisation process is complex and sporadic in light of the tasks that countries have to undertake; for example, updating legislation, strengthening administrative capabilities and establishing analytical laboratories. This review discusses the legislation and regulations that govern food and nutrition labelling in Southeast Asia, and highlights the discrepancies that exist in this regard, their origin and consequences. It also gives an account of the current status of harmonising labelling of pre-packaged foodstuffs in the region and explains the subsequent benefits, challenges and implications for governments, the food industry and consumers.
A 28-item simplified food frequency questionnaire (SFFQ) combined with 9 open questions about staples was designed for the Elderly Nutrient and Health Survey in Taiwan (NAHSIT) to collect information on participants’ usual food intake of the previous month. We have examined the validity of this SFFQ via comparison with data on multiple 24-hour dietary recall (n=81) and biomarkers (n=1473). All questionnaires were completed by face- to-face interview and fasting blood samples were taken. Thirty seven males and 44 females were randomly se- lected from NAHSIT participants. Of these, 31 and 50 subjects completed 2 or 3 24-hour dietary recalls within one month, respectively. Mean daily intake frequencies for each food group were calculated from the SFFQ and 24-hr recalls, respectively. Spearman rank correlation coefficients between frequencies of food group obtained from the FFQ and from dietary recalls ranged from 0.132 to 0.678 for men; 0.052 to 0.759 for women. Correla- tion coefficients between frequency and food weight were similar. When validated by nutrient status, the most correlated was dairy intake frequency judged by 24-hour vitamin B-2 and calcium intakes and by erythrocyte glutathione reductase (EGRAC) for B-2 functionality, where the correlation coefficients were, respectively, 0.533, 0.518 and -0.205 for men; 0.494, 0.475 and -0.174 for women; fish and fruit frequency followed in over- all validity. The SFFQ measured the food patterns of NAHSIT elders with validity high for dairy and good for fish and fruit intakes in both genders.
The Seminar on Young Child Nutrition: Improving Nutrition and Health Status of Young Children in Indonesia held in Jakarta on November 2009 reviewed the current nutritional and health status of young children in Indo- nesia and identified key nutrient deficiencies affecting their optimal growth. The continuation of child growth from fetal stage is of paramount importance; and maternal and child health should be a central consideration in policy and strategy development. Clinical management of nutrient deficiency and malnutrition, as well as strate- gies and education to improve feeding practices of young Indonesian children were discussed in the seminar. Relevant experiences, approaches and strategies from France, New Zealand and Malaysia were also shared and followed with discussion on how regulatory systems can support the development of health policy for young children. This report highlights important information presented at the seminar.
Involuntary weight loss is a symptom of protein energy malnutrition often reported among elderly people, espe- cially those with dementia. In this study, we examined whether dementia-related eating difficulties increase the probability of weight loss in the elderly. This cross-sectional observation study was conducted in 60 community- dwelling elderly people with dementia (84.1±6.7 yr of age). Over 6 months, 26.7% of the subjects lost at least 5% of body weight. Impaired mental status and eating difficulties were closely associated with weight loss as de- termined by Spearman’s rank correlation coefficient. Assessment of eating difficulties combined with mental states in the subjects by discriminant analysis enabled us to differentiate subjects with ≥5% weight loss from those with less than 5% weight loss at a probability of 76.4%. This result suggests that eating difficulties and impaired mental status among elderly people with dementia are closely associated with weight loss.
The purpose of this study was to investigate associations between combinations of body mass index (BMI) cate- gories plus non-alcoholic fatty liver disease (NAFLD) and diabetes mellitus (DM) among Korean adults. We prepared the data of 5665 subjects aged 20 years and over who had visited a health promotion center. We ex- cluded 582 subjects as they had a viral or alcoholic liver disease. According to BMI-NAFLD status, the subjects were categorized as non-obese (BMI<25 kg/m2) without NAFLD (n=2568), obese (BMI≥25 kg/m2) without NAFLD (n=572), non-obese with NAFLD (n=748), or obese with NAFLD (n=1195). The prevalence of NAFLD was highest in the obese subjects with DM (87.9%). In non-obese and non-DM subjects, the prevalence of NAFLD was lowest (18.4%). After adjustment of age, gender, waist circumference, smoking status, alcohol drinking, regular exercise, the odd ratios for DM or DM plus impaired fasting glucose (IFG) of subjects with mild NAFLD regardless of obesity were almost 2-fold compared to non-obese subjects without NAFLD. More- over, those of subjects with moderate or severe NAFLD regardless of obesity were about 4- fold. Clinicians and investigators need to pay attention to non-obese patients with fatty liver.
Dieting is becoming a popular phenomenon among university students to achieve or maintain a healthy weight. The purpose of this study is to obtain a preliminary understanding of what dieting practices university students use in order to achieve their desirable body weight and to determine the magnitude of body dissatisfaction in re- lation to weight status among a sample of students (n=252) from the Lebanese American University in Beirut, Lebanon. Students filled out a self-reported questionnaire that included questions on their dieting and physical activity practices in addition to the body shape questionnaire (BSQ). Weight and height were measured to calcu- late body mass index. Percentage body fat was measured using Tanita scale body fat analyzer 300A. The out- come of this study showed that smoking and unhealthy dieting practices were not common among students (only 26% reported smoking, 8% reported taking laxatives and 4% taking diet pills). Half of the students reported practicing regular physical activity. Multivitamin intake was also not popular among students. BSQ scores indi- cate that the majority of students were not worried about their body image perception (64% reported not being worried, 19% were slightly worried, 12% were moderately worried and 5% were extremely worried). A gender difference was observed in the BSQ scores, as 89% of the “extremely worried” students were females. Collec- tively, results indicate that unhealthy dieting practices are uncommon among students. However, developing health promotion awareness’ programs to promote good self image within the concept of a realistic healthy weight will be beneficial, especially among females.
Obesity is an important risk factor for lifestyle diseases. There has been much interest in the role of eating be- havior in the development of obesity, but findings from population-based epidemiologic studies are limited and inconsistent. The objective of our cross-sectional study was to examine the association between eating behavior and prevalence of overweight. Subjects were 290 men of two municipal offices in northeastern Kyusyu, Japan. A positive association was found between overweight and some eating behaviors; multivariate-adjusted odds ratios (95% confidence intervals) for overweight were 4.33 (2.46-7.64), 2.29 (1.22-4.32), and 2.01 (1.06-3.80) for the behaviors of eating quickly, eating until full and eating fatty foods, respectively. Moreover, the prevalence of overweight was further increased when these eating behaviors were combined; multivariate odds ratios (95% confidence intervals) of overweight for men with 1, 2 and ≥3 versus no high-risk eating behaviors were 2.66 (1.27-5.56), 4.32 (1.87-9.97) and 7.32 (3.01-17.84), respectively (p<0.0001 for trend). Our findings suggest that eating quickly, eating until full and eating fatty foods are related to overweight in Japanese men.
A total of 4428 adults (>18 years old) from 5 different selected regions in Peninsular and East Malaysia partici- pated in this health survey. Using World Health Organization recommendations for body mass index (BMI), the prevalence of overweight and obesity were found to be 33.6% (95% CI= 32.2, 35.0) and 19.5% (95% CI= 18.3, 20.7) respectively. There were more females who were obese (22.5%, 95% CI=20.9, 24.0) compared to males (14.1%, 95% CI=12.3, 15.9). Highest prevalence of obesity were among the Indians (24.6%, 95% CI=20.3, 29.3), followed closely by the Malays (23.2%, 95% CI=21.6, 24.8%) and lowest prevalence was among the Chinese subjects (8.2%, 95% CI=6.2, 10.6). More than 43% of the 531 younger subjects (<30 years old) were either overweight (20%, 95% CI=16.6, 23.6) or obese (13.9%, 95% CI=11.1, 17.2%). All subjects who claimed to be non-diabetes were required to undergo 75 g glucose tolerance test. Compared to subjects with normal BMI (18.5-24.9 kg/m2), there was a 3- and 2-folds increase in the prevalence of newly diagnosed diabetes and im- paired glucose tolerance respectively, among obese subjects (BMI >30 kg/m2) who initially claimed to have no diabetes. This study highlights a need for more active, inter-sectoral participation advocating a health-promoting environment in order to combat obesity in this country.
Nutritional status of iron, folate, and vitamin B-12 in vegetarians were assessed and compared with those of non- vegetarians in Korea. The vegetarian subjects were 54 Buddhist nuns who ate no animal source food except for dairy products. The non-vegetarians were divided into two groups: 31 Catholic nuns and 31 female college stu- dents. Three-day dietary records were completed, and the blood samples were collected for analyzing a complete blood count, and serum levels of ferritin, folate, and vitamin B-12. There was no difference in hemoglobin among the diet groups. The serum ferritin and hematocrit levels of vegetarians did not differ from that of non- vegetarian students with a high intake of animal source food but low intake of vitamin C, and the levels were lower than that of non-vegetarian Catholic nuns with a modest consumption of animal source food and a high in- take of vitamin C. The serum vitamin B-12 levels of all subjects except one vegetarian and the serum folate lev- els of all subjects except one non-vegetarian student fell within a normal range. In vegetarians, there was a posi- tive correlation between the vitamin C intake and serum ferritin levels as well as between the laver intake and se- rum vitamin B-12 levels. In order to achieve an optimal iron status, both an adequate amount of iron intake and its bioavailability should be considered. Sufficient intake of vegetables and fruits was reflected in adequate se- rum folate status. Korean laver can be a good source of vitamin B-12 for vegetarians.
In Japan, γ-carboxylation of blood coagulation factors is the basis for determining adequate intake (AI) for vita- min K in Dietary Reference Intakes (DRIs) issued in 2010. Recently, vitamin K is also known to be essential for preventing fracture. In this study, relative susceptibility of liver and bone to vitamin K deficiency was studied. Thirty-seven elderly institutionalized subjects were evaluated for vitamin K status by measuring serum PIVKA (protein induced by vitamin K absence) –II and ucOC (undercarboxylated osteocalcin) levels, as sensitive markers for hepatic and skeletal vitamin K deficiency, respectively. Serum PIVKA-II and ucOC levels, with their cut-off values in the parentheses, were 20.2±8.9 mAUmL (28 mAU/mL) and 4.7±3.0 ng/mL (4.5 ng/mL), respectively. Median vitamin K intake was approximately 200 μg/day, which is more than 3 times higher than the current Japanese AI. Vitamin K intake was significantly correlated with serum PIVKA-II and ucOC/OC lev- els, but not with serum ucOC level. Although serum ucOC level is generally a good indicator for vitamin K status, multiple regression analysis revealed that elevated bone turnover marker significantly contributed to se- rum ucOC level. All subjects had vitamin K intake exceeding AI for vitamin K. Nevertheless, serum PIVKA-II and ucOC concentrations exceeded the cut-off value in 14% and 43% of subjects, respectively. The present find- ings suggest that vitamin K intake greater than the current AI is required for the skeletal health in the institution- alized elderly.