Prasong Tienboon was born and raised in Sukhothai province Thailand. He undertook his medical training (Doctor of Medicine - MD) at Chiang Mai University in 1976. He received his Board of Pediatrics Certificate of Proficiency from the Thailand Medical Council in 1981 and his Master’s Degree in Community Nutrition (MCN) from the University of Queensland, Australia in 1984. He then pursued his PhD at Deakin University in the Section of Human Nutrition, Australia (1991) in conjunction with an Internal Medicine specialist training in Clinical Nutrition and Metabolism at the Monash Medical Centre, Melbourne, Australia. He also trained in Pediatrics and Gastroenterology at the Royal Children Hospital, in Melbourne. Through assiduous continuing education, he added clinical strengths in pursuit of a combined career in clinical nutrition and paediatrics.
After his studies in Australia, he returned to Thailand and became an Associate Professor at the Chiang Mai University, his former alma mater, in 1993 and was certified as a Specialist in Pediatric Nutrition from the Royal College of Pediatricians of Thailand in 2010. He became Head of the Division of Nutrition and Nutrition Research Center, Department of Pediatrics, Faculty of Medicine at Chiang Mai University where he practised as a Pediatrician and Medical nutritionist until his untimely death. In addition he was an Adjunct Professor of Pediatrics in the Department of Pediatrics, Faculty of Medicine, and Louisiana State University, USA from 1997 to 2011.
He held several positions of note for clinical nutrition and paediatrics. These included Presidency of the Asia Pacific Clinical Nutrition Society (APCNS), 2005-2011; Presidency of Thai Clinical Nutrition Society (TCNS), 2005-2011; Editor-in-Chief of the Thai Journal of Clinical Nutrition (TJCN), 2007-2011; membership of the Editorial Board of the Asia Pacific Journal of Clinical Nutrition, 1995-2011;Chairman, Scientific Program of the Parenteral and Enteral Nutrition Society of Asia (PENSA), 1995-2011and Executive Committee Member: Pediatric Nutrition Society of Thailand (PNST), 1998-2011. He was a co-founder of the Asia Pacific Public Health Nutrition Association (APPHNA). His publications in his professional field have been extensive, as books, reviews, and original scientific papers.
He received the prestigious Knight Grand Cordon (first class) of the Most Noble Order of the Crown of Thailand from His Majesty King Bhumibol Adulyadej in 2009 in recognition for his outstanding and long public service.
With great enthusiasm and commitment he organised the 7th APCNS Conference on Clinical Nutrition in Bangkok, June 5-8th 2011. Remarkably, he was an active participant in the very first APCNS conference, jointly with its Australasian counterpart, in Singapore in 1991, some 20 years before. Sadly, he died unexpectedly of ischaemic heart disease a matter of days before the conference he had so professionally planned. That conference and its impact on nutritional paediatrics in the Asia Pacific region and beyond stand as a vital testimony to his exceptional career and life.
OBJECTIVE: The purpose of this study was to investigate body weight satisfaction, eating attitudes and dietary intake related to eating disorders of female junior high school students in Taiwan. METHODS: In a cross- sectional survey, 835 female junior high school students participated in this study. The questionnaire items in- cluded respondents’ demographic information as well as weight and body image concerns. Developmental and attitudinal scales such as the body shape-related teasing scale, Pubertal Development Scale, Eating Attitudes Test-26 (EAT-26) and 24-hour dietary recall were also used to collect data. Data were analyzed using a Stu- dent’s t test, chi-square test and logistic regression. RESULTS: Disturbed eating attitudes and behaviors were found in 10.4 % of participants (measured by EAT-26≥20). The multivariate logistic regressions showed that disturbed eating attitudes and behaviors were associated with weight/shape-related teasing experiences and dis- satisfaction with body weight. The reported intakes of energy, protein, fat, carbohydrate, cholesterol, zinc and vi- tamins B-6, B-12, were significantly lower in participants with disturbed eating patterns than in participants without disturbed eating. Conversely, participants with disturbed eating patterns had higher dietary and crude fi- ber intake than participates without disturbed eating. CONCLUSION: Disturbed eating behaviors exist among female adolescents in Taiwan, and these behaviors jeopardize their necessary dietary intake requirements. More research using the EAT-26 as a measure to predict the quality and quantity of food intake among female adoles- cents warrants further study.
Aim: Energy restricted meal plans may compromise nutrient intake. This study used diet modelling to assess the nutritional adequacy of energy restricted meal plans designed for weight management in young obese women. Methods: Diet modelling of 6000 kJ/d animal protein based meal plans was performed using Australian nutrient databases with adequacy compared to the Australian Nutrient Reference Values (NRVs) for women (19-30 years). One diet plan was based on the higher carbohydrate (HC) version of the Australian Guide to Healthy Eat- ing for women 19-60 years. An alternative higher protein (HP) plan was adapted from the CSIRO Total Wellbe- ing Diet. Vegan and lacto-ovo versions of these plans were also modelled and compared to the appropriate vege- tarian NRVs. Results: Both animal protein diets met the estimated average requirement (EAR) or adequate in- take (AI) for all nutrients analysed. The recommended dietary intake (RDI) was also satisfied, except for iron. HC met 75±30% and HP 81±31% of the iron RDI when red meat and iron fortified cereal were both included three days a week, and remained below the RDI even when red meat was increased to seven days. Iron for the modified vegan (57±5% HC; 66±4% HP) and lacto-ovo (48±6% HC; 59±7% HP) plans was below the RDI and zinc below the EAR for the vegan (76±8% HC; 84±9% HP) plans. Conclusion: The 6000 kJ/d animal protein meal plans met the RDI for all nutrients except iron. Iron and zinc failed to meet the vegetarian RDI and EAR respectively for the vegan plans.
Adequate weight gain in pregnancy is essential for the health of the mother and developing fetus. However, a woman’s self-beliefs regarding body shape and weight gain may become a driving force toward unnecessary die- tary restriction during pregnancy. In order to assess the current status of self-beliefs, attitudes toward pregnancy related changes, and dieting behavior in pregnant women, a questionnaire survey was conducted at a prenatal clinic in Tokyo. A self-administered questionnaire was distributed to 500 women and 248 women responded with eligible data. Nearly all respondents (91.5%) stated that they knew their own weight gain targets. Thirty- four women (13.7%) reported dieting before being pregnant, and 88 women (35.5%) reported current dieting. Seventy-eight of the current dieters were doing so based on self-judgment, and only fifteen were following a di- etician’s advice. The majority of the respondents (69.0%) believed that smaller babies would help a smooth de- livery. From multivariable logistic regression analysis, the odds ratio (OR) for current self-judged dieting was significant in women who had dieted before pregnancy (OR: 4.67, 95% confidence intervals (CI): 2.10-10.4), and those who desired smaller babies for a smooth delivery (OR: 2.73, 95% CI: 1.35-5.52). Obstetricians, mid- wives, and dieticians should be aware of previous dieting history and self-beliefs in pregnant women, in order to give professional advice about the importance of adequate weight gains.
Somatostatin (SST) may protect organism from overnutrition-induced insulin resistance and oxidative stress by inhibiting pancreatic endocrine and exocrine secretion, gastrointestinal digestion and absorption. Many studies clearly show its release becomes perturbed in diabetes and obesity. Therefore, in the present study we first aimed to investigate whether or not plasma somatostatin level was different in patients with hyperlipidemia and nor- molipidemic controls. We also assessed the relationship between plasma somatostatin levels with atherosclerotic index (AI) and malondialdehyde (MDA) in non-diabetic dyslipidemic patients. Subjects with hyperlipidemia have insulin resistance and high levels of oxidative stress. Median somatostatin (57.2±19.2 vs 68.0±21.9 pg/mL; p<0.05) levels were lower in hyperlipidemic than in normolipidemic subjects. Significant inverse relationships between SST level and AI (r=–0.21, p< 0.05), or MDA (r=–0.31, p<0.01) were observed. These results suggest a possible protective role of endogenous SST, at least on hyperlipidemia and atherosclerosis that are attributed to excess energy intake and physical inactivity. Of course these preliminary results should be supported by prospec- tive studies.
The Nutrition and Health Survey in Taiwan (NAHSIT) 2005-2008 was funded by the Department of Health to provide continued assessment of health and nutrition of the people in Taiwan. This household survey collected data from children aged less than 6 years and adults aged 19 years and above, and adopted a three-stage stratified, clustered sampling scheme similar to that used in the NAHSIT 1993-1996. Four samples were produced. One sample with five geographical strata was selected for inference to the whole of Taiwan, while the other three samples, including Hakka, Penghu and mountainous areas were produced for inference to each cultural stratum. A total of 6,189 household interviews and 3,670 health examinations were completed. Interview data included household information, socio-demographics, 24-hour dietary recall, food frequency and habits, dietary and nutri- tional knowledge, attitudes and behaviors, physical activity, medical history and bone health. Health exam data included anthropometry, blood pressure, physical fitness, bone density, as well as blood and urine collection. Re- sponse rate for the household interview was 65%. Of these household interviews, 59% participated in the health exam. Only in a few age subgroups were there significant differences in sex, age, education, or ethnicity distri- bution between respondents and non-respondents. For the health exam, certain significant differences between participants and non-participants were mostly observed in those aged 19-64 years. The results of this survey will be of benefit to researchers, policy makers and the public to understand and improve the nutrition and health status of pre-school children and adults in Taiwan.
The availability of new food choices has increased dramatically in recent times, whilst increasingly sedentary lifestyles have reduced calorie intake requirements. The present study uses 24 hour dietary recall data, and bio- chemical and anthropometric measurements from the 1993-1996 and 2005-2008 Nutrition and Health Surveys in Taiwan (NAHSIT) to investigate trends in dietary habits, and cardiovascular and metabolic disease markers in Taiwanese persons aged 19 years and above. We found that dietary habits in Taiwan are changing, particularly in regards to intakes of cakes and sweets, and sugary drinks. Energy intakes in young people have increased, and combined with an increasingly sedentary lifestyle, this may have led to the increase in obesity and associated metabolic diseases. Large increases in the prevalence of the metabolic syndrome, diabetes, hypertriglyceridemia and gout have been observed. Fortunately, some positive dietary and behavioral changes have also been ob- served; including an increased avoidance of products made from animal fats and oils’ and a concomitant increase in the use of vegetable oil. Intakes of fruit and vegetables, soy products, fish, whole grains, nuts and seeds have also increased; and intakes of red meat, carbohydrates and sodium containing foods have decreased. These posi- tive dietary changes could explain the lack of large changes in the prevalence of hypertension and hypercholes- terolemia, and the decrease in prevalence of hyperuricemia. Intake of dairy products remains low, and continues to be an important dietary issue in Taiwan.
The aim of this study was to investigate trends in nutrients and sources of dietary intake for Taiwanese people from the Nutrition and Health Survey in Taiwan (NAHSIT) 1993-1996 to 2005-2008. Twenty-four hour dietary recall data were obtained from the 2005-2008 NAHSIT. The results showed that intake of cereals and grains, and dietary fiber has decreased, whereas intake of carbohydrate rich convenience foods has increased. As a result, 10-20 g of dietary fat is now obtained from carbohydrate rich foods. A greater proportion of Taiwanese are choosing low-fat meat products, however, excessive intake of meat by men and women aged 19 to 64 years is resulting in excessive intakes of protein, cholesterol and saturated fat. Men and women aged 19 to 30 years had insufficient intakes of fruit and vegetables. Consumption of fruit, dairy/products, and nuts was low in all age groups. We recommend strengthening public nutrition education and changing diet related environment to im- prove dietary quality and food group distributions. Issues of concern include excessive intakes of energy and the soybean/fish/meat/eggs food group in all subjects, high amount of processed foods and refined-carbohydrate rich foods in men aged 19 to 64 years and women aged 19-30 years, as well as intakes below the DRI for a variety of nutrients in elderly persons.
Data from nationwide population-based nutrition surveys in Taiwan were used to investigate trends and nutri- tional status for magnesium from 1993 to 2008. Dietary magnesium intake was estimated from 24-hour dietary recalls. Serum and urinary magnesium were also measured. In Nutrition and Health Survey in Taiwan (NAHSIT) 2005-2008, average magnesium intake was 305 mg and 259 mg for adult males and females, respectively, which is equivalent to 82-85% of relevant Taiwanese Dietary Reference Intakes (DRIs). After correcting intra- individual variation, 74-81% of adult subjects’ dietary magnesium was estimated as sub-optimal. Mean serum magnesium concentration was 0.866 mmol/L and 0.861 mmol/L for the males and females, respectively. The prevalence of low serum magnesium (<0.8 mmol/L) was 12.3% and 23.7% for the males and females, respec- tively. There was positive association among dietary magnesium, blood magnesium, and urinary magne- sium/creatinine ratio. From NAHSIT 1993-1996 to NAHSIT 2005-2008, dietary magnesium significantly in- creased (p<0.05), the blood magnesium and urinary magnesium/creatinine ratio decreased (p<0.05). The findings suggest that the relationships between dietary magnesium and biochemical markers among different nutrition and health surveys are not straightforward and need to be further clarified.
To investigate ten year trends in folate status in Taiwanese aged ≥19 yrs by three Nutrition and Health Survey in Taiwan (NAHSIT) in 1993-1996, 1999-2000 and 2005-2008. Women had higher blood folate levels than men in all three surveys. The prevalence of folate deficiency (5.2% <3 ng/mL) and insufficiency (34.1% ≤6 ng/mL) in men was highest in 2005-2008. Adults aged 19-30 yrs had the lowest blood levels and the highest prevalence of deficiency (8.1% in men; 3.5% in women) and insufficiency (48.6% in men; 25% in women) as compared to other age groups in 2005-2008. Folate insufficiency rate in those aged 31-44 yrs was twice as high in men and three times as high in women in 2005-2008 compared to 1993-1996. In the elderly, folate insufficiency rate (28%) in 2005-2008 was not higher than that of 1993-1996, although it was higher than that found in 1999-2000 (18.4%). Men aged ≥ 80 yrs had the poorest folate status in 2005-2008, and men were twice as likely to have in- adequate status as women. Plasma homocysteine (Hcy) levels were higher in older men than older women in both surveys. The elderly had significantly higher plasma tHcy in 2005-2008 compared to the 1999-2000 survey. Dark green vegetables and fruit intake frequency in young adults (19-30 yrs) was the lowest among all age groups. This study suggests that folate status in Taiwan has not improved during the past fifteen years, and has worsened in the young population.
Osteoporosis is one of the most prevalent global health problems in the elderly. A nationwide representative sample of 1121 adult subjects, aged 19 years and older, were scanned by a dual-energy X-ray absorptiometry in the third survey year of Nutrition and Health Survey in Taiwan 2005-2008. There was an apparent gender differ- ence in the trend of bone mineral density (BMD) with age. In males, the decrease in BMD with age at lumbar spine and at femoral neck were statistically significant in those younger than 50 years, whereas the decrease in BMD at forearm was significant only in those aged 50 years and older (β= -0.005, p<0.0001). In females there was a significant negative correlation between BMD at femoral neck and age (β= -0.004, p<0.0001). In the 236 subjects aged 50 years and older, the prevalence rates of osteoporosis were 4.3% at lumbar spine, 12.0% at femoral neck, and 11.6% at forearm in males, and 12.6% at lumbar spine, 18.1% at femoral neck, and 25.0% at forearm in females, respectively. The prevalence rates of osteoporosis at any site were 23.9% in males and 38.3% in females, respectively. The prevalence rates of low bone mass at lumbar spine, femoral neck, and fore- arm were 28.8%, 57.5%, and 22.7% in males and 34.7%, 45.9%, and 26.1% in females, respectively. Effective measures to maintain bone health and/or to reduce excessive bone loss may be important in the prevention of os- teoporotic fractures in Taiwanese adults.
Food security has emerged as one of the most pressing socio-economic and health issues of our time. While the formal processes of international and national governance are short-changing the need for action, an increasing number of professional science-based organisations are rallying to reduce the presence and risks of food insecurity. Examples are the Food in Health Security Network (FIHS) for the Asia Pacific region and the ‘Healthy Agriculture, Healthy Nutrition, Healthy People’ initiative of the World Council on Genetics, Nutrition and Fitness for Health. The common denominator is the threat to ecosytems which are intrinsic to food and health systems. To increase their prospects for sustainability and health promotion, coordinated partnerships between agriculture and health as well as other sectors are imperative
Obesity and the metabolic syndrome (MetS) are challenging public health issues as globesity popularizes. The present study illustrates the trend of obesity and MetS for the last 12 years in Taiwan based on the analysis of Nutrition and Health Survey in Taiwan. Between the two surveys, a large growth on MetS prevalence was ob- served, from 13.6% to 25.5%. In NAHSIT 2005-2008, the prevalence of MetS in females exceeded that of males in people older than the age of 45. With regard to regional differences, the growing prevalence of obesity and the metabolic syndromes alleviated in the northern area level one, the most urbanized and dense area. Prevalence of obesity and MetS in Hakka, central, and southern areas increased rapidly. Aboriginal areas had the highest prevalence, which increased modestly. Prevalence of MetS rose fast among males, but much slower among fe- males. Comparing the Taiwanese data with other countries, obesity prevalence in Taiwan was higher than in many of Asian countries, but less than in the West. The prevalence of MetS in Taiwanese females reached levels close to that of the West. Reduced rank regression analysis was used to extract a risk reducing dietary pattern in women, featured by not only more vegetables, fruit, lean meat, and fish, but also some specific Taiwanese die- tary items including mushrooms, seaweed, and soybean. No apparent increase in intake of certain healthy foods including lean meat, milk, dark-green vegetables, and fruit in the last 12 years, challenges future strategies to promote health.
Hyperuricemia is a recognized risk factor for cardiovascular disease. This study investigated trends in uric acid levels, hyperuricemia and gout among adults in Taiwan from 1993-1996 to 2005-2008, using data collection from, Nutrition and health surveys in Taiwan (NAHSIT) conducted in 1993-1996 and 2005-2008. Information on food frequency, medical history, physical measures and fasting blood parameters were analyzed. Mean uric acid levels decreased between 1993-1996 and 2005-2008 in both genders (6.77 vs 6.59 mg/dL in men and 5.33 vs 4.97 mg/dL in women) and the prevalence of hyperuricemia declined from 25.3% to 22.0% in men (p<0.0001) and from 16.7% to 9.7% in women (p<0.0001). However, the prevalence of gout (self-reported) increased (4.74% vs 8.21% in men and 2.19% vs 2.33% in women, p<0.0001). Reduced rank regression was used to iden- tify dietary patterns that explained significant amounts of variance in uric acid. Frequency of consumption of lean meat, soy products and soymilk, milk, eggs, vegetables, carrots, mushrooms, fruit and coffee were nega- tively associated with hyperuricemia, whereas consumption of organ meats, bamboo shoots, and soft drinks were positively associated with hyperuricemia. The dietary factor score (DFS) composed of the frequency of above food items decreased from -5.40 to -6.00 between the two surveys (p<0.0001). In conclusion, uric acid levels and prevalence of hyperuricemia both declined, whilst self-reported gout increased between 1993-1996 and 2005- 2008. Changes in dietary patterns may in part explain the decrease in uric acid levels between the two national surveys.
The purpose of this study is to understand nutrition knowledge, attitude, and behavior in Taiwanese adults. Re- sults indicated that adults’ knowledge on “relationship between diet and disease” and “comparison of foods in terms of specific nutrients” is acceptable. However, they lack knowledge on “daily serving requirements” and “weight and weight loss”. Although they recognize the importance of nutrition, nutrition was not the major con- cern of food selection. Significant differences were found among gender and age groups. Females of most age groups are better than males in many aspects of nutrition knowledge, attitude and behavior except emotional and external eating behavior. Young (age 19–30) and prime (age 31–44) adults have better knowledge than that of middle adults (age 45–64), while prime adults hold a more positive attitude than young adults. As for nutrition behavior, prime and middle adults are better than young adults. Nutrition knowledge and attitude of adults in ur- ban areas is generally better than those in suburban and remote areas. However, adults in urban areas perform “emotional and external cued eating” more frequently than those in suburban and remote areas. There are sig- nificantly positive correlations among nutrition knowledge, attitude and behavior; and attitude has stronger cor- relation (r=0.42) with behavior than knowledge does (r=0.27). Therefore, to achieve desirable eating behaviors, the adult nutrition education program should include knowledge of what constitutes a balanced diet and what constitutes being overweight. Proper strategies to enhance the behavioral motivation of healthy food selection must also not be neglected.
The aim of the study was to understand the use of supplements in Taiwan. Data used in this study came from the 2005-2008 Nutrition and Health Survey in Taiwan. The total sample available for analysis of supplement use in- cluded 973 adults (485 men and 488 women), aged 19-44 years. Survey data were weighted to adjust for the sur- vey design effect and to make the sample nationally representative. Our results showed that 33.2% of Taiwanese adults aged 19-44 took supplements (26.6% of men and 40.0% of women). Gender was the only demographic factor found to be associated with the total number of supplement types taken. Men were more likely to take on- ly one supplement. In contrast, women were 2.6 times more likely than men to take two or more supplements. The most commonly taken supplements by adults were multivitamins and minerals (35.8%), followed by vitamin B group (20.6%) and calcium (9.3%). We found that in both men and women, nutrient intakes from supplements exceeded DRIs for vitamins A, D, E, B-1, B-2, B-6, B-12, pantothenic acid and biotin. Men were more likely than women to take excess iron. Women were more likely than men to take excess vitamin C and niacin. Our study results may be used by government agencies to develop policies regarding supplement use in Taiwan.
This study describes dietary supplement consumption practices among the Taiwanese population over the age of 65. Data for the analyses were derived from the 2005-2008 Nutrition and Health Survey in Taiwan. Data from a total of 914 participants (456 men and 458 women) was collected in the study to delineate patterns of supple- ment usage. The results indicated that the percentage of individuals taking supplements was 45.7% for men and 52.2% for women. There were no significant differences in supplement use by gender, age group, geographic stratum, current employment status, household monthly income, self-reported health status or marital status, ex- cept for higher education and adequate perceived financial resources. Half of both men and women chose to take only one supplement. In addition, as the number of supplements taken increased, the number of people decreased. The elderly with higher education levels were more likely to take two kinds of supplements. The top five sup- plements consumed from highest to lowest were: glucosamine, multivitamins and minerals, calcium, fish oil and vitamin B complex. The major reason for supplements use for men was to supplement an unbalanced diet, and that for women was to prevent joint degeneration. The main factor influencing choice of supplements in the eld- erly was receiving the supplement as a gift from another person. Note that mean intakes of vitamins A, C, E, B-1, B-2, B-6, B-12, biotin, niacin, and pantothenic acid from supplements over-exceeded DRIs in Taiwan.
The purpose of the study was to understand present infant complementary foods eating and compare trends over the past 10 years in Taiwan. We investigated the methods used to introduce infants to complementary foods, dif- ficulties encountered, sources of information and the principle caregiver’s knowledge about infant feeding. This study focused on findings from the 2005-2008 Nutrition and Health Survey in Taiwan (NAHSIT) and compared with those from the 1997-1999 Child NAHSIT. Interviews in both surveys were carried out by trained inter- viewers. In 2005-2008 survey, 50% of infants aged 7-12 months had started eating baby cereals or juice at age 4- 6 months as recommended. The proportions of infants aged 10-12 months who were introduced to particular complementary foods at recommended periods varied from biscuits (51.1%) to tofu (1.1%). The proportions were higher in 2005-2008 than in 1997-1999 for only 3 items. In both survey, more than 80% of mothers were the one who made the decision to introduce their children to complementary foods. More than 75% of caregivers fed baby cereals to their babies from milk bottles. In 2005-2008, the most commonly encountered problem was that the child wouldn’t eat. Nutrition knowledge of the caregivers have improved since 1999, but still needs fos- tering. The timing to introduce complementary foods become later than ten years ago. Whether the delay will af- fect the normal dietary intakes of children after one year of age needs attention. The government should not only promote breastfeeding, but also reevaluate current evidence-based recommendation on complementary food in- troduction time.
The Inaugural Conference on ‘Healthy Agriculture, Healthy Nutrition, Healthy People’ of the World Council on Genetics, Nutrition and Fitness for Health was held at Ancient Olympia, Greece on October 5-8, 2010. The focus of the Conference was on the evolutionary aspects of diet throughout the life cycle in terms of genetic predisposi- tion, health, disease prevention and sedentary lifestyles; the dietary changes brought about by modern agriculture, agribusiness, food production systems, changes in climate and the need for urban agriculture and architecture, all of which are influenced by governments, national and inter- national policies. Therefore the role of governments and international organizations was extensively discussed during the last session of the Conference by the partici- pants from 20 countries representing six continents.
GENERAL CONCLUSIONS AND RECOMMEN- DATIONS
Today we live in a nutritional environment that is very different from the environments to which we are geneti- cally adapted. Major changes in our food supply accom- panied the domestication of animals and the agricultural revolution about 10,000 years ago. Later, the industrial revolution and developments in food technology brought about further major changes in the composition of foods, one of the most important of which was a change in the quantity and quality of the various fatty acids. The con- tent of saturated fat and omega-6 essential fatty acids in- creased, whereas the content of omega-3 fatty acids de- creased. A development related directly to industrialisa- tion was the intentional increase in the content of trans- fatty acids produced by the hydrogenation of polyunsatu- rated and monounsatured fatty acids. Furthermore, a 30% decrease in the content of essential vitamins and minerals in fruits and vegetables has accompanied the use of chem- ical fertilizers, which are produced by processes requiring large amounts of energy and, perhaps most serious of all, resulting in dangerous disruption of the phosphorus cycle. In spite of these and many other close relationships be- tween agriculture and food production on the one hand and nutritional and ecological problems on the other, pol- icies for agriculture, for the environment and for human nutrition and health are largely disconnected. In our ana- lyses, priorities and policies, we quite obviously need to
take a broader view, one that at the very least recognizes the complex relationships between farming, human health, and the ecological systems on which life on earth depends.
The presentations at the conference noted that the hu- man genome has not changed very much during the rela- tively short period (10,000 years) of these major changes in diet. It is likely, therefore, that chronic diseases such as certain forms of cardiovascular disease, obesity, diabetes, cancer, arthritis, mental illness and neurodegenerative diseases are due, at least in part, to an environment of food and other elements of modern life to which we are genetically not well adapted. An analysis of epidemiolog- ical studies of dietary fatty acids and coronary heart dis- ease (CHD) indicated that, in contrast to almost all cur- rent recommendations, high amounts of dietary linoleic acid (the major omega-6 fatty acid) from vegetable oils actually increase the risk of CHD. The production of vegetable oils such as corn oil and soybean oil are a major element of modern food production systems. It may therefore be very unfortunate that foods with a high ratio of linoleic acid (omega-6) to alpha-linolenic acid (omega- 3) of about 15/1, common in developed countries, are now spreading to developing countries adopting the agri- cultural and dietary practices of the so-called developed world. Studies of transgenic animals (the F A T -1 mouse) provided further support for the concept that the effects of high linoleic acid and arachidonic acid are detrimental and that the effects of alphalinolenic aicd, eicosapentae- noic acid and docosahexaenoic acid are beneficial.
Decreasing omega-6 fatty acids and increasing omega- 3 fatty acids in the diet, so that the ratio of omega-6 to omega-3 is reduced from typically 15:1 or more to ideally 2:1 or less is a nutritional policy that should be consi- dered by national and international organizations, agricul- tural and health associations and food industry. It is con- sistent with results of basic research, current epidemiolo- gy and studies of evolution. In contrast, the introduction of trans-fatty acids was not supported by any kind of re- search into possible health effects, and recent research indicates that trans-fatty acids confer risk of coronary heart disease at least as great as that of saturated fat. Si- milarly, the introduction of high amounts of omega-6 fatty acids into the diet was supported by research that would not have met current research standards. The health effects of “novel foods” and any dietary (quantitative and
qualitative) changes contemplated by agriculturists and food technologists must therefore be carefully considered, and pilot studies should be carried out before these foods become widely available to the whole population.
Phenylketonuria illustrates how interaction of nutrient intake with a strong but rare genetic variation determines the difference between health and disease. In contrast, much more common but weaker genetic variations, inte- racting with nutrients, can moderately affect health in substantial proportions of populations. As an example, metabolism of the essential nutrients, linoleic acid and alpha-linolenic acid, to essential longer chain fatty acids is under the control of genes. Common variations in such genes affect the efficiency of these metabolic conversions, so that dietary requirements for linoleic and alpha- linolenic acid can vary significantly between individuals. As a corollary, since the absolute and relative amounts of dietary linoleic acid and alpha-linolenic acid are asso- ciated with risk of coronary heart disease and cancers such as breast cancer, risk could vary between individuals with similar intakes of fatty acids as a function of varia- tions in these control genes. In affluent countries, and for the rich, it is becoming possible to consider individual genetic variation in making dietary recommendations (personalized nutrition).
Obesity, type 2 diabetes, and certain kinds of cardi- ovascular disease and cancer are commonly called diseas- es of “life-style.” The term emphasizes individual rather than institutional responsibilities for avoiding disease, but in all cases the responsibility for promoting health is ob- viously dual. As an example, physical activity is, within wide limits, linearly related to good health, and the re- sponsibility for adequate physical activity rests on gov- ernment as well as the individual. Government must en- sure the safety of physical environments so that its citi- zens are safe to walk and bicycle for local transportation, and government must formulate policies for education that ensure physical activity breaks for all primary and secondary education students. Urban environments must be free of pollutants, and urban architecture should en- courage the involvement of citizens in activities such as local gardening of fruits and vegetables. Benefits include better citizenship, better diets, more physical activity and lower emissions of greenhouse gases.
The enormous population of humans depends on agri- culture for most of its food. Agriculture is also the most ecologically destructive of human activities, and it is an important contributor to our emissions of greenhouse gas- es. How destructive it is to farm depends critically on what and how we choose to farm. Producing livestock destroys ecosystems more effectively than producing fruits and vegetables, but whether we farm destructively or sustainably also depends on how intelligently we pro- duce edible animals and plants. Allowing cows to graze rather than feeding them grains decreases emission of methane, for example. At the same time, health depends on what and how much we eat. To continue the example, the ratio of omega-6 to omega-3 fatty acids is lower in milk from cows that graze than cows fed grains. Eating large amounts of red meat (from cows, hogs, sheep and goats), moreover, increases the risk of common forms of cardiovascular disease and cancer. Moderate amounts of
meat and dairy, however, can be valuable sources of pro- tein. Such complex relationships indicate that we must align our policies for producing food and for preventing disease, and future dietary recommendations must be based on what we know about ecology and climate change as well as what we know about nutrition.
Most of the effects of global warming and climate change will make farming more difficult and food sup- plies more precarious. At the same time, agriculture con- tributes importantly to global warming and climate change, in part because contemporary agriculture, not least indus- trial agriculture, depends on burning fossil fuels for cheap energy. Energy in whatever form is expected to become much more expensive in the near future, however, and for this and other reasons, including environmental protection, food security, and public health, we need far more intelli- gent forms of agriculture. An example is the concept of agroecology as described in Olivier de Schutter’s report on the right to food to the Human Rights Council of the UN in late 2010. Of equal importance, we need to inte- grate the results of the sciences of agriculture, nutrition and medicine. Agriculture must produce foods that we know are healthy to eat,
Large business interests partially finance and substan- tially affect the relevant science. The relationship of in- dustrial agricultural interests to agricultural universities is a case in point. Food and agriculture scientists, moreover, have traditionally driven nutrition research and the devel- opment of products that were not proven beneficial to health (i.e. high amounts of omega-6 fatty acids in the food supply by changing animal feeds high in grains, trans fatty acids, and high fructose syrup, etc.). Instead nutrition research and knowledge should define first what products are needed, and the food scientists and technolo- gists grow and develop the products which should be pilot tested for safety and health before they are made available to the public. Nutrition departments should be leading in research and product development and Agriculture and Food Sciences and Technology departments should play a secondary role instead of leading product development before nutritional benefit to humans, animals and the en- vironment is established. If this were to happen then the names of the various organizations should be changed from i.e. “The Food and Nutrition Board” to “The Nutri- tion, Food and Agriculture Board” indicating that Nutri- tion Research drives Food and Agriculture Sciences Re- search and Technology. Similarly the Food and Agricul- ture Organization (FAO) should change to “Nutrition Food and Agriculture Organization.” It would serve us better if nutritional research instead were to drive food sciences.
The complex problems of agriculture, food distribution, nutrition and human health in a setting of possibly dis- astrous ecosystem degradation and climate change can be addressed intelligently only by public and private policies based on science that is unbiased, critical and independent of special interests.. We must therefore recognize the dangers inherent in the increasingly close ties between industry, government and university.
To be successful the following actions are needed: 1) Agronomic, nutritional and medical science should be independent of business interests, 2) Need for new forms
of agriculture such as agroecology, 3) Future dietary guidelines to be based on ecological (including climato- logical) as well as nutritional science. 4) Healthy oriented agriculture is needed to tailor the food chain to eradicate critical deficiencies and imbalances (e.g. change animal feeds to balance the omega-6/omega-3 fatty acid ratio). 5) A wide range of initiatives, particularly the ones that promote active being, such as sustainable neighborhoods, smart growth, public transport, oriented developments, networks of pedestrian and bicycle friendly paths. 6) Food sources and food pathways and how they interact or not with the built environment of cities is critical. 7) Re- duce “food deserts” within urban environment by increas- ing the availability of fresh fruits and vegetables by en- couraging retail outlets in such neighborhoods.
In the fifth Century B.C. Hippocrates articulated the Concept of Positive Health as follows: 'Positive health requires a knowledge of man's primary constitution (which today we call genetics) and of the powers of various foods, both those natural to them and those resulting from hu- man skill (today's processed food). But eating alone is not enough for health. There must also be exercise, of which the effects must likewise be known. The combination of
these two things makes regimen, when proper attention is given to the season of the year, the changes of the winds, the age of the individual and the situation of his home. If there is any deficiency in food or exercise the body will fall sick.'
Today by focusing on Healthy Agriculture, Healthy Nutrition, Healthy People we seem to develop an inte- grated concept contributing to a Healthy World. We must now consider how the participants of the Conference – concerned scientists, medical doctors, academics, health promoters, agriculturists, government policy makers and industry representatives – can actually promote the goal of Healthy Agriculture, Healthy Nutrition, Healthy People in their own countries around the world – in order that altogether could work to accelerate progress in achieving a Healthy world and reflect on the role of science in the process. Ultimately in promoting “Healthy Agriculture, Healthy Nutrition, Healthy People” we in fact are promoting a single integrated model or perception of a Healthy Society. Therefore these are not three inde- pendent concepts or goals, but rather integral parts of the whole that support and sustain a healthy society and envi- ronment.
Objective: To determine the effects of total parenteral nutrition (TPN) and enteral nutrition (EN) on biochemical and clinical outcomes in pancreatic cancer patients who underwent pancreaticoduodenectomy. Methods: From the year 2006 to 2008, 60 patients who underwent pancreaticoduodenectomy in Tianjin Third Central Hospital were enrolled in this study. They were randomly divided into the EN group and the TPN group. The biochemical and clinical parameters were recorded and analyzed between the two groups. Results: There was no significant difference in the nutritional status, liver and kidney function, and blood glucose levels between the TPN and EN groups on the preoperative day, the 1st and 3 rd postoperative days. However, on the 7th postoperative day, there was significant difference between the two groups in 24 h urinary nitrogen, serum levels of, total protein (TP), transferrin (TF), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and γ-glutamyl transpeptadase (GGT), blood urea nitrogen (BUN) and creatinine (Cr). On the 14th postoperative day, there was a significant difference between the two groups in terms of urinary levels of 24 h nitrogen, TP, TF, retinol binding protein, ALT, AST, ALP, GGT, total bilirubin, direct bilirubin, BUN, Cr, and glucose. The inci- dence of delayed gastric emptying in the EN and TPN groups was 0% and 20%, respectively. Moreover, the in- cidence of pancreatic fistulas and hemorrhages in the EN group were 3.6% and 3.6%, versus 26.7% and 30% in the TPN group, respectively. Conclusions: EN is better than TPN for pancreatic cancer patients who received pancreaticoduodenectomy.
This study aimed to determine whether educating diabetic patients to ‘eat vegetables before carbohydrate’ was as effective on long-term glycemic control as a traditional exchange-based meal plan. To test this hypothesis, we carried out a randomized, controlled trial in patients with type 2 diabetes that compared changes in HbA1c as the primary outcome. A total of 101 patients were stratified according to sex, age, BMI, duration of diabetes, and HbA1c, and then randomized to receive instructions to eat either vegetables before carbohydrate (VBC, n=69) or an exchange-based meal plan (EXB, n=32). The impact of the two plans on glycemic control was compared over 24 months of follow-up. Significant improvements in HbA1c over 24 months were observed in both groups (VBC, 8.3 to 6.8% vs EXB, 8.2 to 7.3%). HbA1c levels were significantly lower in the VBC group than in the EXB group after 6, 9, 12 and 24 months of the study. Both groups exhibited similar improvements in dietary practices with respect to intake of carbohydrate, fats and sweets, while the VBC group had a significant increase in consumption of green vegetables and a significant decrease in fruit consumption. A simple meal plan of ‘eat- ing vegetables before carbohydrate’ achieved better glycemic control than an exchange-based meal plan in Japa- nese patients with type 2 diabetes over a 24-month period.
Numerous studies have revealed that kiwifruit contains many medicinally useful compounds, among which anti- oxidants and serotonin may be beneficial in the treatment of the sleep disorders. The aim of this study was to evaluate the effects of kiwifruit on sleep patterns, including sleep onset, duration, and quality. In this study, we applied a free-living, self-controlled diet design. Twenty-four subjects (2 males, 22 females) 20 to 55 years of age consumed 2 kiwifruits 1 hour before bedtime nightly for 4 weeks. The Chinese version of the Pittsburgh Sleep Quality Index (CPSQI), a 3-day sleep diary, and the Actigraph sleep/activity logger watch were used to as- sess the subjective and objective parameters of sleep quality, including time to bed, time of sleep onset, waking time after sleep onset, time of getting up, total sleep time, and self-reported sleep quality and sleep onset latency, waking time after sleep onset, total sleep time, and sleep efficiency before and after the intervention. After 4 weeks of kiwifruit consumption, the subjective CPSQI score, waking time after sleep onset, and sleep onset la- tency were significantly decreased (42.4%, 28.9%, and 35.4%, respectively). Total sleep time and sleep effi- ciency were significantly increased (13.4% and 5.41%, respectively). Kiwifruit consumption may improve sleep onset, duration, and efficiency in adults with self-reported sleep disturbances. Further investigation of the sleep- promoting properties of kiwifruit may be warranted.
Inflammatory conditions likely to benefit from fish oil therapy are prevalent in older adults however acceptability in this group is uncertain. This study aimed to assess the palatability of a range of liquid fish oil concentrations, the frequency and extent of side effects, and to summarise any effects on adherence to fish oil therapy in older adults. One hundred patients (≥60 years) completed a randomised, single-blind palatability study, conducted in two parts. In part one, 50 subjects, blinded to random sample order, consumed multiple liquid fish oil samples (2x10%, 40% and 100%). In part two, 50 subjects tasted one concentration, or 100% extra light olive oil (con- trol). Pleasantness of taste was scored on a 5-point Likert scale. Side effects were recorded 24-hr post-tasting. Results of part one showed that 9/50 participants reported increasingly unpleasant taste with increasing fish oil concentration. 14/50 reported unpleasant taste for 100% fish oil vs 7/50 for 10%. 14/50 reported side effects which would not affect compliance with therapy. For part two, 1/12 reported unpleasant taste for 100% vs 0/13 for 10% fish oil or control. 4/50 reported side effects and 2/4 indicated these would prevent ongoing fish oil therapy. The authors conclude that taste itself is not a deterrent to fish oil therapy. Furthermore, reported adverse effects may not be a true reaction to fish oil, or dissuade patients from compliance. Liquid fish oil supplements are acceptable to older adults, therefore should be investigated as a therapy for geriatric conditions.
Human growth is associated with complex interactions between genetic and environmental factors. While re- search has reported increased body size and body mass index (BMI) of Japanese children, few studies have com- pared the magnitude of increments in growth before and after World War II (WW II) and also considered other social and economical events that may have influenced the growth of children. The current study assessed the secular change in growth in Japanese children and adolescents aged between 6 and 17 years using data from the School Health Statistics Survey conducted between 1900 and 2000 with consideration of key social changes dur- ing the 20th Century. Over the 100-year period, Japanese boys had height and weight increments of 1.0-2.0 cm per decade and 0.4-1.7 kg per decade whereas girls had rates of 1.1-1.9 cm and 0.4-1.5 kg per decade, respec- tively. The rates of height increment were significantly (p<0.05) different between pre-, during and post-WW II periods. While Japanese children were considerably larger in 2000 compared to 1900, increments between 1950 and 1960 reflected catch-up growth to restore physical size seen in children prior to WW II. The increments in body size continued after 1960 with greatest changes seen across the pubertal years. While increments in BMI were evident in most age groups, the BMI of 17-year-old girls was consistent over the 100 years. Results clari- fied secular changes in growth in Japanese school children across the 20th Century and possible factors contrib- uting to these changes.
Coconut oil is a common edible oil in many countries, and there is mixed evidence for its effects on lipid profiles and cardiovascular disease risk. Here we examine the association between coconut oil consumption and lipid profiles in a cohort of 1,839 Filipino women (age 35-69 years) participating in the Cebu Longitudinal Health and Nutrition Survey, a community based study in Metropolitan Cebu. Coconut oil intake was estimated using the mean of two 24-hour dietary recalls (9.5±8.9 grams). Lipid profiles were measured in morning plasma samples collected after an overnight fast. Linear regression models were used to estimate the association between coconut oil intake and each plasma lipid outcome after adjusting for total energy intake, age, body mass index (BMI), number of pregnancies, education, menopausal status, household assets and urban residency. Dietary coconut oil intake was positively associated with high density lipoprotein cholesterol especially among pre-menopausal women, suggesting that coconut oil intake is associated with beneficial lipid profiles. Coconut oil consumption was not significantly associated with low density lipoprotein cholesterol or triglyceride values. The relationship of coconut oil to cholesterol profiles needs further study in populations in which coconut oil consumption is common.