We reviewed the literature that examines the association between the built environment and diet. The MEDLINE electronic database was searched. Eligible articles must have been published between 2000 and 2013, in the Eng- lish language, and must have been conducted among a population-based sample of adults older than 18 years of age. Twenty-four articles met the inclusion criteria. The majority of studies (over 70%) focused on fruit and vege- table consumption. Most studies (88%) found a statistically significant relationship between diet and some aspect of the built environment. However, the results across studies were not consistent. These inconsistencies may be attributable to methodological challenges, including differing definitions of neighbourhood, and inconsistent ap- proaches to measuring built environment features and diet. In order to explore the complex relationship between built environment and people’s dietary behaviour, research design needs to be improved, and the items people ac- tually buy need to be examined. In addition, more research is needed to investigate the causal pathways linking environmental factors and dietary intake.
Serum undercarboxylated osteocalcin (ucOC) is an index of vitamin K nutritional status in treatment-naive post- menopausal osteoporotic women. The purpose of the present study was to reveal the association between vitamin K nutritional status and serum ucOC concentrations in postmenopausal osteoporotic women taking bisphospho- nates. Eighty-six postmenopausal women with osteoporosis (age range: 47-90 years) initiated bisphosphonate treatment. Vitamin K nutritional status was evaluated using a simple vitamin K-intake questionnaire and serum ucOC concentrations were measured after 6 months of treatment. The patients were divided into two groups ac- cording to the simple vitamin K-intake questionnaire score: a low vitamin K-intake (score <40) group (n=67) and a normal vitamin K-intake (score ≥40) group (n=19). There were no significant differences between the groups in baseline parameters including age, height, body weight, body mass index, serum alkaline phosphatase (ALP), urinary cross-linked N-terminal telopeptides of type I collagen (NTX), and changes in serum ALP and urinary NTX concentrations during the 6-month treatment period. However, the mean serum ucOC concentration after 6 months of treatment was significantly higher in the low vitamin K-intake group (2.79 ng/mL) than in the normal vitamin K-intake group (2.20 ng/mL). These results suggest that 78% of postmenopausal osteoporotic women treated with bisphosphonates may have vitamin K deficiency as indicated by low vitamin K-intake and high se- rum ucOC concentrations, despite having a similar reduction in bone turnover to women who have normal vita- min K-intake.
In Cambodia, both anaemia and vitamin A deficiency are serious health problems. Despite this, few comprehensive nutritional surveys have been completed to date. This study evaluates the adequacy of iron and vitamin A intakes, as well as women’s nutritional knowledge in rural Kandal province. Twenty-four hour recalls, pile sort activities, socioeconomic surveys, focus groups, and market surveys were carried out with 67 women from 5 villages in rural Kandal Province. Ninety seven percent of women did not meet their daily-recommended intake of iron, while 70% did not meet their daily-recommended intake of vitamin A. Although many women consume vitamin A-rich and iron rich-foods daily, they do not consume large enough quantities of these foods. Results suggest that both the cost of foods as well as the extent of health knowledge is linked to nutritional practice. Most animal-source iron and vitamin A-rich foods are considered expensive; however, small fish, and several plant-source vitamin A-rich foods are inexpensive and easy to access. Despite health education, food restrictions lead some healthy foods to be considered to be harmful to women. Ultimately, this study demonstrates the importance of developing comprehensive nutritional interventions in Cambodia. Health programming must provide women with not only suggestions to include low-cost nutrient-rich foods, but also ad- vise them about the quantities that are likely to have an impact on nutritional status. Programs should take a community-based, inter-sectoral approach that simultaneously combines culturally informed health education with initiatives that combat poverty and increase access to nutrient rich foods.
Feeding practices during early childhood play an important aetiological role in early childhood caries (ECC). The role of feeding practices in causation of ECC is debated. The objective of this study was to assess the aetiological role of feeding practices on ECC. A descriptive cross sectional study was conducted at a paediatric unit in Sri Lanka. Two hundred and eighty-five children between 36 to 60 months, admitted to the unit were randomly se- lected for the study. An interviewer administered questionnaire asked about socio-demographic characteristics and feeding practices. The mouths of children were examined for dental caries. Out of 285 children, 61% had ex- clusive breast feeding up to six months, 69% continued breast feeding beyond two years and 82% had overnight feeding after two years of age. One hundred and thirty-six children (47.7%) had dental caries with a mean deft score of 1.81. Overnight feeding with any type of milk beyond two years significantly increased dental caries in- cidence and severity. Children exclusively breast fed for six months or had breast feeding beyond two years had a higher prevalence of caries than children not exclusively breast fed or who were not breast feed beyond two years, but the difference was not significant. Overnight feeding with any type of milk beyond two years should be dis- couraged.
Iodine deficiency disorder (IDD) is a major public health problem in Uttarakhand. The present study was conducted in district Nainital, Uttarakhand state with an objective to assess the prevalence of IDD in school age children. A total of 2269 children in the age group of 6-12 years were included. Clinical examination of thyroid of all children was undertaken. “On the spot” urine samples were collected from 611 children. Salt samples were collected from the family kitchen for 642 children. The Total Goitre Rate (TGR) was 15.9%. The proportion of children with urinary iodine excretion levels <20, 20-49, 50-99, 100-199 and 200 μg/L and above, was nil, 11.8, 24.9, 38.3 and 25.0 percent, respectively. The median Urinary Iodine Excretion level was 125μg/L. About 57.7% of the children were consuming salt with iodine content of 15 ppm and more. Findings of the present study indicates that the population is possibly in transition phase from iodine deficient as revealed by Total Goitre Rate of 15.9% to iodine sufficient as revealed by median urinary iodine excretion level of 125 μg/L. There is a need to further strengthen the existing monitoring system for the quality of iodized salt in the district in order to achieve the elimination of IDD.
This study aimed to assess the nutritional status of infants aged 0 to 5 months by different feeding approaches. A cross-sectional study on infant nutrition was performed in eight cities in China. A total of 622 infants from birth to 2 months of age and 456 infants from 3 months to 5 months of age were included in this study. Mix-fed infants received breast milk and complementary foods from birth to 2 months of age. Approximately 38.2% of mix-fed infants received excessive vitamin A, and 15.6% of infants exceeded the tolerable upper intake levels (ULs) of zinc. For artificially fed infants who received only complementary foods, approximately 20% and 12.5% infants received inadequate dietary vitamin A and zinc intakes, respectively. The vitamin A and zinc intakes of half of the infants exceeded the ULs. Results showed that the usual intake distribution of the infants from 3 months to 5 months of age were similar to that of the infants from birth to 2 months of age. The common vitamin A and zinc intakes were also severely imbalanced. In addition, higher disease prevalence and lower Z scores of length-for- age, weight-for-age, and weight-for-length were found in artificially fed infants and mix-fed infants compared with those in breast-fed infants. In conclusion, the usual nutrient intakes were adequate for the majority of Chi- nese infants, except for an important number of infants at risk for imbalance of vitamin A and zinc intakes.
Overweight and obesity prevalence among children is increasing globally. Health promoting school policy has been initiated in Thailand to tackle this problem. The schools that best conduct obesity management programs are rated as diamond level health promoting schools (DLHPS). However, the methods used by these schools and their efficacies have not been well-documented. This qualitative study aims to analyze the processes and activities used by four DLHPSs in obesity management programs. In-depth interviews were used to obtain information from school directors, teachers, and cooks, whereas focus group discussions were used for students. School-based obe- sity management programs have resulted from health promoting school policy and the increasing prevalence of overweight students. Teamwork has been a key strategy in program implementation. Policy diffusion and division of labor have been effected by school directors. A monitoring process is put in place to ensure program delivery. The most evident success factor in the present study has been intersectoral cooperation. Challenges have included confusion about the criteria in obtaining the DLHPS status, parental involvement, and students’ resistance to con- sume vegetables and other healthy foods. From the student focus groups discussions, three activities were most valued: class health and nutrition learning; provision of healthy foods and drinks, together with removal of soft drinks and seasoning from the cafeteria; and exercise for health. Intersectoral cooperation is the key success fac- tor for the operationality of DLHPS, especially in making healthy foods available and physical activity the norm, at school and home.
Background: Few studies have examined the risk of type 2 diabetes in various occupational groups. Farmers in Sweden have a low risk of coronary heart disease, but less is known about diabetes. Objective: To analyze the cumulative incidence and relative risk of type 2 diabetes among farmers and referents taking lifestyle factors and components of the metabolic syndrome into account. Methods: In a longitudinal observational cohort study we followed 1,220 farmers, 1,130 rural non-farmer referents and 1,219 urban referents over 20 years. Outcomes were generated from national registers and from two surveys 12 years apart. Baseline data were assessed at the first survey conducted in 1990-91. Results: Farmers had a significantly lower risk of all diabetes compared with urban and rural referents (p<0.05). A total of 91 farmers (8.4%) and 102 non-farming rural referents (11.5%) were iden- tified with type 2 diabetes over the 20 year study period (OR=0.70; 95% CI 0.52-0.95). Fractional analyses of lifestyle factors and components of the metabolic syndrome showed that the low risk of type 2 diabetes among farmers was explained in terms of physical activity and meal quality. Farmers had significantly higher physical capacity (p<0.001) and scored higher in a meal quality index than rural referents (p<0.001). Conclusions: The prevalence of type 2 diabetes was significantly lower among farmers. The low relative risk was explained by high physical activity and better meal quality, indicating that farmers’ lifestyles and their work environment are health- promoting.
Objective: This study aims to describe the lifestyle of Chinese centenarians and to identify the beneficial factors that are correlated to their longevity. Methods: A census-based survey was conducted among centenarians in Chongqing, Southwest China, to identify the lifestyle factors affecting their health. From screening identification cards, 878 centenarians (age range 100-117, mean 102) were identified and interviewed. Results: The survey in- dicated that 64% centenarians were able to take care of themselves. The majority of centenarians were non- smokers (92%) and non-drinkers (83%). No significant difference was observed between urban and rural distribu- tions (χ2=0.939, p=0.625). Moreover, 43% centenarians maintained a regular diet, and only 33% had a sedentary lifestyle. Conclusions: A nutritious diet, adequate physical exercise, and a harmonious family environment may be the key lifestyle factors for their longevity of centenarians in Chongqing. These observations might be helpful in designing health promotion and welfare strategies for the elderly.
Objective: To evaluate a 3-week program comprising cooking demonstrations with free food samples in motivat- ing elderly adults to cook more and improve their nutritional status. Design: An experimental pre-post study. Set- ting: Three districts in Hong Kong. Participants: Sixty aged 59-95 home-living adults. Intervention: Group A (one 1-day food sample given free weekly) and Group B (three 1-day food samples given free weekly). Main Outcome Measure: Satisfaction questionnaires were conducted every week. Mini Nutritional Assessment (MNA) scores were assessed at baseline and 6 months after the program’s completion. Analysis: Nutritional status was assessed before and after intervention. Repeated analysis of variance measures of compliance, appetite, easiness of pro- gram at 3-week time-points were calculated to differentiate a more frequent (Group B) and a less frequent (Group A) provision of food sample reinforced their cooking skills to a greater extent. Results: The compliance rate of Group B was higher than that of Group A. More than 60% of the participants intended to continue cooking and a third of the participants expressed satisfaction with the program. The MNA scores had improved 6 months later (combined data from both groups). Conclusions: Nutrition education through cooking demonstrations and the community-based distribution of food ingredients can improve the nutrition status of the elderly population.
Food stockpiles and methods of ensuring food availability after the Great East Japan Earthquake of March 11, 2011 have been studied. Questionnaires were sent to 1911 registered dietitians and general dietitians who were members of the Japan Dietetic Association in August 2012. Four hundred thirty-five dietitians (22.8%) completed the questionnaire about work involved in feeding facilities, types and administration of meals, and food stockpiles. Methods of ensuring food availability, preparation, and accommodating food for special dietary uses were rec- orded for the three-day period immediately following the earthquake, and the period from 4 days to one month af- ter the earthquake. Three days after the earthquake, differences in administration of meals at feeding facilities providing three meals daily, food stockpiles, organization, contactable facilities, and how to contact them for food items were assessed. Sixty-nine percent of all feeding facilities in this study had stockpiles of food before the Great East Japan Earthquake. Administration of meals in feeding facilities and the possibility of contact with co- operative feeding facilities were found to correlate positively with ensuring the availability of food groups. Food scores were higher in facilities providing three meals daily by direct administration of meals and with accessible public administrators, cooperative facilities and suppliers, and facilities that were contactable by landline tele- phone, mobile phone, fax or email. The necessity for natural disaster-readiness through continuous stockpiling food at feeding facilities is confirmed. Each prospective feeding facility must be required to plan its stockpiles, their turnover and replaceability to maximise food security in the face of disaster.
Obesity is a risk factor for the onset of liver cancer in patients with cirrhosis. To prevent overfeeding and obesity, estimation of energy requirement is important, but energy expenditure in patients with liver cirrhosis has not been fully elucidated. This study aimed to investigate resting energy expenditure (REE) and energy intake in patients with cirrhosis and determine adequate energy intake criteria. In this cross-sectional study, indirect calorimetry measurement was conducted in 488 Japanese inpatients with cirrhosis. We compared REE measured by indirect calorimetry (M-REE) with basal energy expenditure (BEE) predicted by the Harris-Benedict equation (H-BEE) and Dietary Reference Intakes (DRI) for Japanese (D-BEE). Mean M-REE (1256 kcal) was significantly lower than H-BEE (1279 kcal); however, it was not significantly different from D-BEE (1254 kcal). Mean M-REE ex- pressed in relation to body weight (BW; REE/kg BW) was 21.7 kcal/kg BW. H-BEE was significantly higher than M-REE in patients in the first and second quartiles of BMI, and D-BEE was significantly different from M- REE in patients in the highest and lowest quartiles of BMI. Average energy intake was 30.5 kcal/kg BW, which was 1.4 times greater than REE/kg BW. Although DRI is a useful tool for the estimation of REE in patients in the second and third quartiles of BMI, M-REE is recommended to ensure the provision of adequate nutritional care to patients with cirrhosis, including those in the highest and lowest quartiles of BMI.
Background: Micro (mi) RNAs have been found to play an important role in the regulation of adipogenesis and insulin sensitivity. However, associations between miRNA and insulin signalling-related gene expressions in ab- dominal adipose tissues in obese subjects remain unclear. Methods: We used a microarray platform to screen miRNA expressions in abdominal adipose tissues between genders in severely obese subjects and found that the top-ranking miRNA in abdominal omental adipose tissues was miRNA-125a-3p. MicroR-125a-3p and insulin signalling-related gene expressions in abdominal omental adipose tissues of all subjects (11 men and 10 women) were subsequently quantified by a real-time PCR. Also, associations of miR-125a-3p with insulin signalling- related gene expression and biochemical markers in obese subjects were analyzed by a linear regression analysis. Results: miR-125a-3p expressed by abdominal omental adipose tissues was much higher in obese men than women. No gender difference was observed in abdominal subcutaneous adipose tissues. Concomitant with high miR-125a-3p, c-Jun N-terminal kinase gene expression was also higher, whereas insulin receptor was lower in men than women. There were negative associations of miR-125a-3p with the insulin receptor and phosphatidyl- inositol 3-kinase expressions. Fasting plasma glucose and cholesterol levels were positively associated with miR- 125a-3p expression. These associations were obvious in obese men but not women. Conclusion: Our results sup- port the involvement of miR-125a-3p in regulating the insulin signalling pathway and imply that increased miR- 125a-3p expression in omental adipose tissues may be a characteristic feature of insulin resistance in obese men.
We evaluated urinary isoflavonoid excretion as a biomarker of dietary isoflavone intake during two randomized soy trials (13-24 months) among 256 premenopausal women with a total of 1,385 repeated urine samples. Participants consumed a high-soy diet (2 servings/day) and a low-soy diet (<3 servings/week), completed 7 unannounced 24-hour dietary recalls, and donated repeated urine samples, which were analyzed for isoflavonoid excretion by liquid chromatography methods. We computed Spearman correlation coefficients and applied lo- gistic regression to estimate the area under the curve. Median overall daily dietary isoflavone intakes at baseline, during low- and high-soy diet were 2.3, 0.2, and 60.4 mg aglycone equivalents, respectively. The corresponding urinary isoflavonoid excretion values were 0.4, 1.0, and 32.4 nmol/mg creatinine. Across diets, urinary isoflavo- noid excretion was significantly associated with dietary isoflavone intake (rs=0.51, AUC=0.85; p<0.0001) but not within diet periods (rs=0.05-0.06, AUC=0.565-0.573). Urinary isoflavonoid excretion is an excellent biomarker to discriminate between low- and high-soy diets across populations, but the association with dietary isoflavone in- take is weak when the range of soy intake is small.
Dietary fibre plays an important role in controlling postprandial glycemic and insulin response in diabetic patients. The intake of dietary fibre has been shown to delay the gastric emptying in healthy subjects. The relationship between gastric emptying and postprandial blood glucose in diabetic patients with fibre-load liquids needs to be investigated. To investigate the impact of soluble dietary fibre (SDF) on gastric emptying, postprandial glycemic and insulin response in patients with type 2 diabetes. 30 patients with type 2 diabetes (DM) and 10 healthy subjects (HS) matched for gender and age were randomized to receive SDF-free liquid (500 mL, 500 Kcal) and isoenergetic SDF liquid (oat β-glucan 7.5 g, 500 mL, 500 Kcal) on two separate days based on a cross-over with 6-day wash-out period. Gastric emptying was monitored by ultrasonography at intervals of 30 min for 2 hours. Fasting and postprandial blood was collected at intervals of 30-60 min for 180 min to determine plasma glucose and insulin. Proximal gastric emptying was delayed by SDF-treatment both in DM (p=0.001) and HS (p=0.037). SDF resulted in less output volume in the distal stomach in DM (p<0.05). SDF decreased postprandial glucose (p=0.001) and insulin (p=0.001) in DM subjects. Postprandial glucose (r=-0.547, p=0.047) and insulin (r=-0.566, p=0.004) were negatively correlated with distal emptying of SDF in DM subjects. Distal gastric emptying was de- layed significantly in DM subjects with HbA1c levels ≥6.5% (p=0.021) or with complications (p=0.011) by SDF, respectively. SDF improved postprandial glycaemia which was related to slowing of gastric emptying.
This survey was initiated to examine possible coastal-inland differences in cadmium (Cd) burden in general Korean populations. In total, 268 healthy non-smoking middle-aged women (30 to 49 years; 88 residents in 8 coastal areas and 180 residents in 15 inland areas) participated in the study. They offered peripheral blood and spot urine samples so that cadmium in blood (Cd-B) and urine (Cd-U) were taken as exposure markers. Determination of Cd-B and Cd-U was carried out by graphite furnace atomic absorption spectrophotometry. With regard to Cd burden, geometric means for the coastal and inland residents were 1.70 and 1.72 μg/L for Cd-B, 1.54 and 1.00 μg/L for Cd-U as observed (Cd-U), 2.59 and 1.81 μg/g creatinine for Cd-U as correct- ed for creatinine (Cd-Ucr), respectively. Cd-U and Cd-Ucr were higher in the coastal areas than in inland ar- eas. Reasons for higher Cd-U in the coastal areas than in the inland areas were are discussed in relation to major sources of Cd in daily life of the residents. Attention was paid to consumption of fish and shellfish in the coastal areas as major sources of dietary Cd intake. This study shows that Cd burdens were higher in coastal areas than in inland areas in Korea.
Objective: This cross-sectional study was carried out to determine the prevalence of overweight and obesity among secondary school children aged 12 to 14 years in the city of Mashhad, Iran and its association with paren- tal body mass index. Methods: A total of 1189 secondary school children (579 males and 610 females) aged 12- 14 years old were selected through a stratified multistage random sampling. All adolescents were measured for weight and height. Household socio-demographic information and parental weight and height were self-reported by parents. Adolescents were classified as overweight or obese based on BMI-for age Z-score. Multivariable lo- gistic Regression (MLR) determined the relationship between parental BMI and adolescent overweight and obesi- ty. Results: The overall prevalence of overweight and obesity among secondary school children in Mashhad was 17.2% and 11.9%, respectively. A higher proportion of male (30.7%) than female (27.4%) children were over- weight or obese. BMI of the children was significantly related to parental BMI (p<0.001), gender (p= 0.02), birth order (p<0.01), parents’ education level (p<0.001), father’s employment status (p<0.001), and family income (p<0.001). MLR showed that the father’s BMI was significantly associated with male BMI (OR: 2.02) and female BMI (OR: 1.59), whereas the mother’s BMI was significantly associated with female BMI only (OR: 0.514). Conclusion: The high prevalence of overweight/obesity among the research population compared with previous studies in Iran could be related to the changing lifestyle of the population. The strong relationship with parental BMI was probably related to a combination of genetic and lifestyle factors. Strategies to address childhood obe- sity should consider the interaction of these factors.
This study investigated the influence of two different intensities of acute interval exercise on food preferences and appetite sensations in overweight and obese men. Twelve overweight/obese males (age=29.0±4.1 years; BMI =29.1±2.4 kg/m2) completed three exercise sessions: an initial graded exercise test, and two interval cycling ses- sions: moderate-(MIIT) and high-intensity (HIIT) interval exercise sessions on separate days in a counterbalanced order. The MIIT session involved cycling for 5-minute repetitions of alternate workloads 20% below and 20% above maximal fat oxidation. The HIIT session consisted of cycling for alternate bouts of 15 seconds at 85% VO2max and 15 seconds unloaded recovery. Appetite sensations and food preferences were measured immediately before and after the exercise sessions using the Visual Analogue Scale and the Liking & Wanting experimental procedure. Results indicated that liking significantly increased and wanting significantly decreased in all food categories after both MIIT and HIIT. There were no differences between MIIT and HIIT on the effect on appetite sensations and Liking & Wanting. In conclusion, manipulating the intensity of acute interval exercise did not af- fect appetite and nutrient preferences.
Background: Associations of copper (Cu) and zinc (Zn) serum levels with risk factors for cardiovascular disease (CVD) have not been extensively studied in elderly Asian people. Methods: Relationships to CVD risk factors were examined in 202 freely-living elderly Japanese women. Results: By univariate analysis, log high-sensitivity C-reactive protein (hsCRP) and non-HDL cholesterol were associated with serum Cu concentrations. An inde- pendent predictor of Cu was log hsCRP. Serum Zn concentrations decreased with age. After adjustment for age, serum albumin, HDL cholesterol and red blood cell (RBC) were positively and serum insulin and log hsCRP were inversely associated with serum Zn. In stepwise multiple regression analysis (model 1), serum albumin and HDL cholesterol were associated with serum Zn. In analysis excluding albumin from model 1 (model 2), inde- pendent determinants were log hsCRP (inverse) and the total number of RBC. In analysis including serum creati- nine in model 2, creatinine has emerged as a determinant in addition to log hsCRP and RBC number. In analysis including estimated glomerular filtration rate (eGFR) instead of creatinine and excluding age in model 2, eGFR has emerged as a determinant of serum Zn in addition to log hsCRP and RBC number. Conclusions: Systemic low-grade inflammation may contribute to elevated serum Cu and decreased serum Zn concentrations in the el- derly, and may represent an important confounder of the relationship between the serum trace elements and mor- tality in this population.
Osteoporosis and atherosclerosis often present atypically in postmenopausal women, making clinical recognition difficult. Prospective studies suggest independent associations between bone mass and vascular calcification through vitamin D deficiency as an established predictor of both conditions. We aimed to examine the relation- ship between serum osteocalcin and vitamin D status in postmenopausal women with and without angiographic evidence of coronary artery disease (CAD). One hundred and eighty postmenopausal women undergoing coro- nary angiography were selected sequentially from the Catheterization unit of King Abdulaziz University Hospital. Socio-demographic, anthropometric parameters and dietary habits were measured. Biochemical variables were estimated in blood samples. Half of the postmenopausal women did not have significant CAD, 24% had signifi- cant CAD in a single and/or double coronary vessels, 26% had significant CAD in three coronary vessels. Mean serum vitamin D concentrations showed that vitamin D deficiency was a common finding in the whole population. Vitamin D and calcium intakes were uniformly low in the study cohort. Serum osteocalcin was significantly cor- related with dietary vitamin D in all subgroups (r=-0.172, p<0.05) and positively correlated among the patients (r=0.269, p=0.01). Serum magnesium, alkaline phosphatase, dietary vitamin D, and body weight were independ- ent variables of serum osteocalcin level. In conclusion, elevated levels of serum C reactive protein and vitamin D were associated with low serum osteocalcin levels. Therefore, osteocalcin may be a potential cardiovascular risk marker. However, further studies are needed to clarify the pathophysiological processes underlying the relation- ship between serum osteocalcin level and atherosclerosis parameters.