Some reflections from work in the Asia Pacific Region, mostly with WHO, in the past 25 years, and the changes in nutrition seen in this time are shared. In 1988-89 I helped to start a Centre for Child Nutrition in Chengdu, Si- chuan, through the Italian Development Cooperation. The nutritional problems in urban and rural China, 25 yearsago,weresimilartothoseelsewhereintheRegion. LikeChina,thesecountriesunderwentrapideconomic development and changes in health patterns, within two decades. The main problems for child nutrition had to do with infant feeding practices and less breastfeeding: anaemia, protein energy malnutrition and rickets were fre- quent. How did China and other countries tackle these and other nutrition problems? In the 1990s the global nu- trition community started working on a problem-solving framework. In 1992, at the 1st FAO/WHO International Conference on Nutrition, 159 countries agreed to develop national nutrition plans. In 2014, 22 years later, FAO and WHO invited countries to review their national nutrition situation and plans. The epidemiological picture to- day is profoundly different. Many Asia-Pacific countries have achieved remarkable progress in socio-economic development, including malnutrition reduction. To reach the MDGs and the post-MDG goals being formulated, the remaining under-nutrition problems need to be alleviated, inequalities between sectors of society reduced, and also the growing threat of overweight/obesity and NCDs prevented and controlled. Assessing, monitoring and evaluating programmes to improve progress, now requires focusing not only on biological outcomes, but al- so on food security, programme process, and the policy environment.
Introduction: Diet plays a crucial role for maintaining normal growth and development while optimizing glyce- mic control in children with diabetes. Dietary restrictions, in a diabetic child’s diet may lead to micronutrient de- ficiencies. Objectives: To examine dietary nutritional deficiencies of Asian Indian children with Type 1 diabetes mellitus and develop micronutrient-rich recipes suitable for them. Methods: Anthropometry, diet (3-day recall) of 70 children with diabetes (24 boys) was recorded. Daily nutrient intakes and nutrient content of recipes were estimated using CDIET version 2.0. Results: Mean intake amongst children for energy was 79% of Indian Rec- ommended Dietary Allowance (RDA), protein was 105% RDA, but fat intakes were high (143% RDA). Mean in- takes of riboflavin, β carotene, zinc, iron were less than 50%, and thiamin and calcium were around 60% RDA suggesting a possible multiple micronutrient deficiency. Based on popularly consumed snacks, 20 healthy recipes were devised that can be incorporated in children’s diet. Mean energy content of new recipes was similar to rou- tine snacks (281±28 kcal/100 g vs 306±27 kcal/100 g cooked weight). However, the mean vitamin and mineral content of new recipes was significantly higher (p<0.01). There was a five-fold increase in total mineral content (zinc, calcium and iron) and twofold increase in total vitamin content (β carotene, vitamin C, vitamin B-1, B-2, and B-3) in new recipes compared with the routine snacks. Conclusion: Multiple dietary micronutrient deficien- cies are observed in diabetic children. Addition of newly developed recipes in their everyday diet may help to en- hance micronutrient intakes without increasing their energy load.
Background: Transthyretin (TTR), a sensitive indicator of malnutrition and inflammation, has been shown to be associated with mortality in elderly population. Methods: We examined relationships between serum TTR and a range of risk factors for mortality in 185 free-living elderly women. Blood was drawn between breakfast and lunch. Results: TTR was correlated negatively with age (r= -0.30, p<0.001). After controlling for age, TTR was negatively associated with log high-sensitivity CRP (hsCRP) and serum copper. It was positively associated with albumin, serum iron and hemoglobin. In addition, TTR was positively correlated with systolic and diastolic blood pressure and postprandial triglyceride (TG). In multiple regression analysis for TTR as a dependent variable, he- moglobin (standardized β, 0.244), serum copper (standardized β, -0.134), postprandial TG (standardized β, 0.223) and log hsCRP (standardized β, -0.190) emerged as determinants of TTR independently of age, albumin, serum iron, systolic and diastolic blood pressure, and explained 22.8% of TTR variability. Conclusions: Subclinical low-grade inflammation, elevated serum copper and decreased hemoglobin were associated with decreased serum TTR in community-living elderly Japanese women and may represent important confounders of the relationship between low TTR and mortality in the elderly. The positive association of TTR with postprandial TG warrants further investigation.
Background: Epidemiological studies to-date provided inconsistent findings on the effects of dairy consumption on the risk of cardiovascular disease (CVD). We aimed to examine the association of dairy consumption and its specific subtypes with CVD risk, including the risk of stroke and coronary heart disease (CHD) by a meta- analysis. Methods: PubMed, EMBASE, and Cochrane Library databases were searched for articles published up to February 2014 to identify prospective cohort studies. Random-effects model or fix-effects model was used to compute the summary risk estimates. Results: A total of 22 studies were eligible for analysis. An inverse associa- tion was found between dairy consumption and overall risk of CVD [9 studies; relative risk (RR)=0.88, 95% con- fidence interval (CI): 0.81, 0.96] and stroke (12 studies; RR=0.87, 95% CI: 0.77, 0.99). However, no association was established between dairy consumption and CHD risk (12 studies; RR=0.94, 95% CI: 0.82, 1.07). Stroke risk was significantly reduced by consumption of low-fat dairy (6 studies; RR=0.93, 95% CI: 0.88, 0.99) and cheese (4 studies; RR=0.91, 95% CI: 0.84, 0.98), and CHD risk was significantly lowered by cheese consumption (7 studies; RR=0.84, 95% CI: 0.71, 1.00). Restricting studies according to various inclusion criteria yielded similar results for CVD and CHD analyses, but showed attenuated results for stroke analysis. Heterogeneity across stud- ies was found for stroke and CHD analyses, and publication bias was found for stroke analysis. Conclusion: This meta-analysis provided further evidence supporting the beneficial effect of dairy consumption on CVD. Low-fat dairy products and cheese may protect against stroke or CHD incidence.
Background: Epidemiological studies on the association between cruciferous vegetable (CV) consumption and the risk of ovarian cancer have demonstrated inconsistent results. We conducted a meta-analysis on CV consump- tion and ovarian cancer risk. Methods: The relevant studies were identified by searching the Medline (Pubmed), Embase and Web of Science databases. The references of related articles and reviews up to October 2013 were also screened. The pooled relative risks (RRs) with 95% confidence intervals (CIs) for the highest versus the low- est CV consumption levels were calculated using a random-effects model. The heterogeneity and publication bias were also evaluated. Results: Eight studies (4 case-control studies and 4 cohort studies) were identified and in- cluded in this meta-analysis. When all studies were pooled together, there was a significantly inverse association between CV consumption and the risk of ovarian cancer (RR: 0.89; 95% CI: 0.81-0.99). No significant heteroge- neity or publication bias was found. Conclusions: The findings from this study suggest that the consumption of CVs may reduce the risk of ovarian cancer. Further investigations are needed to confirm the clinical effect of CVs on ovarian cancer.
Introduction: This study examines how the changes in weight status across the spectrum of a senior high school study are associated with academic performance measured by the university entrance exam scores. Materials and Methods: A unique dataset which compiles a national health examination profile and the General Scholastic Ability Test data bank in Taiwan was constructed. The final sample comprised 149,240 senior high school stu- dents of which 70,662 were males and 78,578 were female students. The school-level fixed effect models were estimated. Results: Students who were either (a) not overweight in the first year but overweight in the third year of senior high school, (b) overweight in both the first and third year, or (c) overweight in the first year but not overweight in the third year, were more likely to score lower on the university entrance exam, compared with their never-overweight counterparts. The findings differ by gender and test subjects. Discussions: The change in weight status during senior high school period is associated with subsequent university entrance exam outcome. Students who start senior high school being overweight should be paid attention. School-based programs and practices need to be implemented to reduce the prevalence of overweight among students.
Objective: The purpose of this study was to investigate the association between the level of weight-related stig- matizing experiences and binge eating in overweight adults in southern Taiwan. Methods: This study design was a cross-sectional questionnaire survey with convenience sample. A total of 141 questionnaires were analyzed. Results: The study showed that 97.9% participants had at least one weight-related stigmatizing experience in their lifetime. The main sources of weight-related stigmatizing experiences were from either parents, relatives or doctors. BMI and age were significantly correlated with weight-related stigmatizing experiences. Furthermore, about 19.9% of participants experienced binge eating. The scores of the weight-related stigmatizing experiences and binge eating were positively correlated (r=0.33, p<0.01). The scores of the weight-related stigmatizing expe- riences and monthly income significantly explained factors of binge eating. Conclusions: The findings showed that there is a need to develop interventions to assist overweight people cope with weight-related stigmatization and prevent binge eating in the future.
Pregnancy exacerbates vitamin A (VA) deficiency and anaemia among women in developing countries. Improv- ing circulating haemoglobin (Hb) requires erythrocyte production and availability of iron. Insulin-like growth fac- tor-1 (IGF-1) functions in erythropoiesis, but its association with VA status and pregnancy-associated anaemia has not been studied. The aim of this study was to examine the relationship between serum retinol, IGF-1, and Hb among pregnant women in extant samples collected during a placebo-controlled trial of VA and beta-carotene (BC) supplementation in rural Nepal conducted from 1994 to 1997. Mid-pregnancy serum IGF-1 was measured in serum from n=589 randomly selected women of n=1186 in whom anthropometric, VA (retinol) and iron (Hb, erythrocyte zinc protoporphyrin (ZP), and ferritin) status data were available. Associations of IGF-1 with retinol, Hb or anaemia, and iron status were determined using multiple linear and logistic regression. Path analysis was used to explore the role of IGF-1 as a mediator between retinol and Hb, accounting for iron status. A 2.6 g/L in- crease in IGF-1 was observed per 0.1 mol/L increment in retinol (p<0.0001). Hb increased with each quartile of IGF-1, and odds of anaemia declined 68.8% from the 1st to 4th quartile. Improved iron status indicators ex- plained only 29.1% of the association between IGF-1 and Hb, while IGF-1 explained 25.6% of the association be- tween retinol and Hb. Increasing IGF-1 was likely one mechanism by which retinol improved circulating Hb in pregnant women of rural Nepal, although IGF-1 worked primarily through pathways independent of improved iron status indicators, perhaps by stimulating erythrocyte production.
Objective: The aim of this study was to determine the predictive value of maternal serum lipid levels during late pregnancy for neonatal body size. Methods: This study was conducted from January 1, 2011 to July 31, 2012 at a Maternal and Child Health Hospital. Fasting blood glucose, serum triglyceride, total cholesterol, HDL and LDL were estimated in maternal collected before delivery. Detailed anthropometry of the neonates was performed. Re- sults: Women who delivered a large for gestational age baby were older, taller, had a higher pre-pregnancy weight, higher pre-pregnancy BMI, and higher weight gain during pregnancy than women who delivered an ap- propriate for gestational age infant. After adjusting for maternal age, pre-pregnancy BMI, weight gain during pregnancy, parity, neonatal sex and gestational age at delivery, we found that only maternal HDL level was in- verse associated with birth weight, length and head circumference (p<0.05). On logistic regression analysis, the significant metabolic predictors of large for gestational age was HDL (OR 0.57, 95%CI: 0.38-0.84, per 1 mmol/L increase) after adjusting for the confounders. Conclusions: Maternal serum HDL level determined in maternal blood taken close to delivery was independently associated with neonatal size and was the independent predictor for large for gestational age.
Objective: To assess the micronutrient status and its relationship with nutritional status in preschool children. Methods: In a cross sectional study, anthropometric data and fasting blood samples were obtained from 340 chil- dren attending preschool in urban Sri Lanka. Serum concentrations of vitamin D, parathyroid hormone, vitamin A, zinc and haemoglobin were measured. Z-scores of anthropometric indices of height-for-age, weight-for-age and weight-for-height were computed to evaluate the nutritional status. Results: Prevalence of stunting, underweight, wasting and anaemia among children were 7.1%, 16.9%, 21.2% and 7.4%, respectively. Deficiencies of zinc and vitamin A occurred among 67% and 38% of children, respectively. Vitamin D deficiency (<10 ng/mL) and insuf- ficiency (10-20 ng/mL) occurred in 5.0% and 29.1% of children, respectively, and12% had parathyroid hormone levels indicative of hypocalcaemia. Nutritional status was significantly correlated (p<0.05) with vitamin D status [height-for-age (r=0.10), weight-for-age (r=-0.18), weight-for-height (r=-0.12)], and with haemoglobin status [weight-for-age (r=0.11)]. Zinc and vitamin A levels were lower in severe stunting compared with normal height (p<0.05). Significant correlations (p<0.05) were observed between vitamin D and parathyroid hormone (r=-0.12) and between haemoglobin and vitamin A (r=0.01), zinc (r=0.02) and vitamin D (r=0.02) levels. Conclusions: In the surveyed population, zinc deficiency was high and to a lesser degree vitamin A deficiency and vitamin D in- sufficiency prevailed. The nutritional status of the children was related to vitamin D status and with haemoglobin status. Zinc and vitamin A levels were low in children with severe stunting. Vitamins A, D and zinc levels were associated with haemoglobin status.
Background: Treatment effects of fortified ready-to-use foods for moderately to mildly wasted children are largely unknown. Methods: Two nutritionally comparable forms of locally produced ready-to-use foods for daily feeding programmes of moderately to mildly wasted children (weight-for-height Z-score/WHZ-3 to <-1.5SD) were assessed on Nias, Indonesia. The frequencies of reaching target WHZ-1.5SD, compliance to the ready-to- use food programme, and weight gain until recovery or programme closure among children treated with pea- nut/milk-based spreads (n=29) were compared among children receiving cereal/nut/legume-based biscuits (n=44) and a second group treated with cereal/nut/legume-based biscuits whose mothers received intensive nutrition ed- ucation (n=38). Results: Children in the cereal/nut/legume-based biscuits groups were younger (31 and 33 vs 39 months, p=0.004) and more likely to be moderately wasted (45 and 39 vs 21% with WHZ<-2, p=0.114) at admis- sion, but had a higher rate in recovery (84 and 79 vs 62%, p=0.086) and showed more frequently a high compli- ance (>80%) to the ready-to-use (86 and 84 vs 45%, p<0.001) than those children in the peanut/milk-based spreads programme. Multivariable logistic regression revealed high compliance followed by weight gain and a lower degree of wasting at admission as independent and significant predictors of reaching target WHZ-1.5SD (all p<0.01). Weight gain was positively associated with the consumption of the biscuits (vs peanut//milk-based spreads: r=0.188, p=0.051) and was highest in the cereal/nut/legume-based biscuits plus intensive education com- pared with the cereal/nut/legume-based biscuits and peanut/milk-based spreads groups. Conclusions: Locally produced ready-to-use foods as biscuits or spreads were similarly effective for rehabilitation of moderately to mildly wasted children.
The aim of this updated systematic review is to summarize the evidence of the effect of omega-3 polyunsaturated fatty acids (n-3 PUFA) on non-communicable diseases (NCDs). Publications of meta-analysis up to August 2014 were systematically searched from PubMed, the Cochrane and EMBASE databases. N-3 PUFAs have the follow- ing beneficial effects; cardio-protective effects, reduce ischemic stroke risk in both men and women and total stroke risk in women, increase insulin sensitivity in Asians, decrease risk of breast cancer and colorectal cancer in men. However, n-3 PUFAs may have unfavourable effects on type 2 diabetes in Caucasians. In conclusion, n-3 PUFA plays a crucial role in the prevention of NCDs, however, unfavourable effects should be considered in sub- jects with certain clinical conditions. Cross-cultural studies on the effect of n-3 PUFA on type 2 diabetes are needed to verify why diabetic patients with different ancestries have a different response to n-3 PUFA.
Background: This analysis examined factors associated with non-use of antenatal iron/folic acid supplements in Indonesia. Methods: Data from the 2002/2003 and 2007 Indonesia Demographic and Health Surveys (IDHS) were used, providing survival information for 26,591 most recent deliveries over the five-year period prior to each survey. The main outcome variable was non-use of iron/folic acid supplements. Using logistic regression, we examined the role of external environment, predisposing, enabling, need factors, and previous utilization of other maternal care services in non-use of antenatal iron/folic acid supplements. Results: Mothers from outer Ja- va-Bali Region and rural areas (OR=1.73, 95% CI: 1.48-2.03) had increased odds for not using antenatal iron/folic acid supplements. The likelihood for not using the supplements increased with the reduction of house- hold wealth index and parental education. The odds increased amongst mothers with low autonomy on her own health care (OR=1.24, 95% CI: 1.04-1.49), high birth-rank infants, mothers with low knowledge of obstetric complications and low exposure to mass media. Enabling factors associated with increased odds for non-use of iron/folic acid supplements included mothers reporting money to pay health services (OR=1.28, 95% CI: 1.13- 1.44) and distance to health services (OR=1.20, 95% CI: 1.02-1.40) were major problems. Our study demonstrat- ed the importance of antenatal care as a distribution channel of the supplements. Conclusions: Increasing com- munity awareness, coverage and access to health services along with strengthening counselling sessions during antenatal care and community participation in health programs are necessary to improve the uptake of iron/folic acid supplements, to increase infant survival in Indonesia.
The aim of this study was to assess the prevalence of trying to lose weight among non-overweight in university students and its sociodemographic and behavioural factors from 22 low and middle income and emerging econo- my countries. In a cross-sectional survey we took anthropometric measurements and used a self-administered questionnaire among 15997 undergraduate university students (mean age 20.8, Standard deviation=2.8, age range of 16-30 years) from 22 universities in 22 countries. Body mass index (BMI) was used for weight status. Results indicate that 27.1% non-overweight students were trying to lose weight, 34.6% among women and 16.5% among men. Among underweight or normal weight students, 19.0% perceived themselves to be overweight, 11.3% were dieting to lose weight, and 53.5% considered to lose weight of high importance. Multivariate logistic regression found that being female, coming from a low income country, the perception of being overweight, high im- portance of losing weight, dieting to lose weight, trying to eat fibre, and avoiding foods with fat and cholesterol were associated with trying to lose weight in non-overweight university students. The study found a high preva- lence of weight control practices and several specific risk factors were identified that can be utilized in interven- tions to target unhealthy weight control measures.
In this case study, we demonstrate the effects of different lipid emulsions on liver function in a 52-year-old wom- an with short bowel syndrome who was totally dependent on parenteral nutrition. Over a 13-month period after small bowel resection and jejunostomy, we followed the patient’s plasma triglycerides and liver enzyme levels as well as body weight and discomfort levels. During the first 3 months when parenteral nutrition including a lipid emulsion containing 50% soybean oil/50% medium-chain triglyerides was administered daily, the patient report- ed feeling unwell (experiencing dizziness and palpitations) and her triglycerides and liver enzyme levels rose to 366 mg/dL and 145 U/L (alanine aminotransferase [ALT]), respectively; these levels recovered when this emul- sion was discontinued. For the following 9 months, an emulsion containing 80% olive oil and 20% soybean oil was administered, and the patient’s triglycerides (182 mg/dL) did not increase to abnormal levels and liver en- zyme levels were only mildly elevated (109 U/L). The patient felt well and her body weight increased from 51 kg to 55 kg during this period. These results suggest that parenteral nutrition with a reduced soybean oil content may better preserve liver function in patients with short bowel syndrome.
Two of the most pressing issues of our time, climate change and health, are addressed with exceptional schol- arship and clarity in this new volume edited by Prof Colin D Butler of the Faculty of Health at the University of Canberra, Australia. Unusual for a multi-author book where disciplinary diversity is required is its coherence and evidential thoroughness. This is no small tribute to the broad grasp of the complex science tackled and mar- shalled by the editor and his advisors.
The legacy that the late Prof AJ (Tony) McMichael, pioneer of climate change and health epidemiology, pro- vides the book in one of its chapters and through the con- tributions of his successors is plainly evident. He pro- gressed the notion that the present geological epoch as Anthropocene, one where human enterprise began to match the forces of nature (Crutzen in 2004 and Steffen in 2007), is of major health relevance. Indeed, as Steffen asserts in the present volume, it is now possible that, on this account, the earth may enter an irreversible warmer era, with all if its dire consequences.
In the meantime, the authors adduce the primary, sec- ondary and tertiary health effects already underway in various regions. The biomedical, psychosocial and envi- ronmental health threats we face are cogently elaborated.
What of food and health? Throughout the publication we are caused to think how closely food and health secu- rity move together. The ecological basis of health is un- dergoing a momentous natural experiment which must be recognised and acted upon through population , resource ad conflict management in order to survive long enough for sufficient planetary recovery to occur.
This is a book with content for all food, nutritional and health professionals to assimilate.
Dr Luca Tommaso CAVALLI-SFORZA was born in Milan, Italy on 26th May 1951, and graduated in Medicine in 1976 followed by specialist training in psychiatry and dietetics in Italy and nutrition in London. He further undertook training in epidemiology and public health with particular relevance to the changing patterns of disease. He was well- prepared for the career journey he would take in both community and clinical nutrition and in international health. After appointments in Italy as a Schools Physician and as a Nutrition and Chronic Disease Researcher, he began to work as a Nutrition Advisor to the, Directorate for Development Cooperation in Rome. This provided an opportunity to work in the field in Chengdu, China, where, as a consequence, a Child Nutrition Centre was opened in 1989. By 1991 he had joined WHO (the World Health Organisation) as its Medical Officer/Clinical Nutritionist at the WHO Regional Centre for Research and Training in Tropical Diseases and Nutrition, Kuala Lumpur, Malaysia. In this post he successfully fostered the discipline of Clinical Nutrition, working with the newly formed Asia Pacific Clinical Nutrition Society (APCNS). In its Asia Pacific Journal of Clinical Nutrition’s inaugural issue, he co-authored a paper on clinical nutrition in East Asia and the Pacific.1 A notable success in the encouragement of clinical nutrition training was the First National Symposium on Clinical Nutrition in Malaysia which he organised in 1994.2 From the Malaysian position, he reached out across Asia and the Pacific to stimulate a wide range of nutritional programs in maternal and child health with a focus on breast-feeding, nutritional anaemia, iodine deficiency disorders (IDD), along with food culture and consumption of dairy products in lactose fermenters as opposed to digesters. The emerging burden of obesity, diabetes and cardiovascular disease in the Asia Pacific region also captured his attention.
From 1996-2013, he was able to develop his understanding of the food-health nexus and support programs to prevent and manage nutritionally-related disorder and disease(NDD) as the Regional Director of Nutrition for WHO in the Western Pacific(WPRO). Added to his earlier spectrum of interests were those of food safety and security, intestinal parasitosis and other zoonoses, and capacity-building throughout the region. In the latter respect, he worked closely with IUNS (International union of Nutrition Sciences) especially in the Philippines, Indochina and South East Asia. Another landmark during this period was the adaptation and promotion of the Food-Based Dietary Guidelines approach of WHO and FAO (Food and Agricultural Organisation), developed in Cyprus in 1995, for the Western Pacific3 through the strong support of Dr Cavalli-Sforza.
It has been said that the mark of success is how much of what one has done endures into the future. It is already clear that the tenure of Dr Luca Tommaso Cavalli-Sforza in the Asia Pacific Region has advanced for time-to-come the nutrition well-being of its peoples. It is, therefore, fitting that he receive the APCNS Award for 2015.
Citation By Prof Duo Li MD PhD President Asia Pacific Clinical Nutrition Society
Background: In Indonesia, 37% of children under-five are stunted, 12% wasted and 12% overweight. Adequate feeding practices among children above 6 months of age are critical to tackle malnutrition. National surveys have been conducted to assess feeding practices but these aggregates hide geographic disparities. While several studies have been conducted in specific country locations to address this gap, no attempt has been made to reconcile available information. This paper aims to provide a comprehensive review of the literature on feeding practices among Indonesian children above six months of age. Methods: A literature search was conducted in several da- tabases using combinations of different search terms: feeding, child, Indonesia, MPASI/complementary feeding, gizi/nutrition, factor, determinant, praktek/practices. All documents were reviewed using a three-step procedure to assess content appropriateness and research quality. Available information was analyzed using current recom- mendations on feeding practices. Results: Dietary diversity, consumption of iron-rich foods, active feeding and hygiene practices were among the non-optimal feeding practices. Consequently dietary intakes are not fulfilled for several micronutrients. Some feeding practices are worst in younger children. Differences between data from national and site-specific surveys are noted. Overall quality of the surveys needs to be strengthened. Conclu- sions: Generally, child feeding practices are not optimal. Indicators used to assess components of child feeding vary and make inter-survey comparisons challenging. The results also stress the need to investigate the underly- ing factors to optimal child feeding practices. The results may be used for advocacy of additional resource alloca- tion for effective child feeding promotion programs.
Background: Feeding practices among young children are not optimal in Indonesia. Improving these practices is crucial to prevent and reduce malnutrition among young children. A better understanding of the underlying fac- tors to appropriate practices is essential to address barriers and identify opportunities to optimal practices. This paper aims to shed light on potential determinants of feeding practices among children above 6 months of age. Methods: A systematic research of several databases using combinations of different search terms: feeding, child, Indonesia, MPASI/complementary food, gizi/nutrition, factor, determinant, praktek/practices was conducted. All documents were reviewed using a three-step procedure to assess content appropriateness and research quality. Data were analyzed using the Hector’s framework on behaviour change. Results: Available data on individual factors influencing feeding practices related mainly to mother’s attributes, namely knowledge, perceptions, atti- tudes, beliefs and skills. Some of them are positively linked to good practices. Some environmental-related fac- tors such as health services, home and peer environment were conducive to improved practices. Studies on socie- tal factors were mostly restricted to food systems which do not favour optimal feeding practices. Conclusions: The review provides insights on underlying factors conducive to optimal feeding practices. Yet, relevant and quality research is required to get a better understanding on factors related to the environment and society as well as on how they are related with each other and operate in different contexts. Indonesia has already experimented successful programs which can be used as a reference to strengthen young child feeding practices.
Background: Early enteral nutrition (EEN) is better than total parenteral nutrition (TPN) for many reasons. Our aim was to determine the safety and feasibility of EEN using a jejunum feeding tube in the duodenum or jejunum for congenital obstruction in neonates post-operatively. Methods: This was a retrospective review of 120 patients who had duodenal and jejunal congenital obstructions in our hospital. The patients were categorized into two groups (EEN group [n=70 patients] and control group [n=50 patients]). Differences in operative time, post- operative time to tolerate oral feeding (40 mL/3 h), post-operative hospital stay, and complications, such as cathe- ter obstruction, diarrhea, and nutrition index, were reviewed. Results: The operative time and time to first defeca- tion post-operatively was not significantly different between the two groups. The time to tolerate oral feeding (40 mL/3 h) and the hospital length of stay post-operatively for the EEN group were significantly shorter than the control group. Total protein, pre-albumin, and retinol binding protein were significantly higher in the EEN group than the control group 14 days post-operatively. The incidence of cholestasis and obstruction in the EEN group was significantly lower than the control group, and the incidence of diarrhea was lower than the control group, but not significantly lower. Conclusion: EEN using a jejunal feeding tube in an upper digestive tract malfor- mation in newborns post-operatively is safe, easy, and has fewer complications.
Background: The aim of this study was to compare clinical aspects of the application of three-in-one total nutri- ent mixture (TNA) for peripheral parenteral nutrition (PPN) with those of the conventional PPN (cPPN) method of providing short-term parenteral nutrition for pediatric inpatients. Methods: We conducted a retrospective study in children from 2 to 18 years old who were hospitalized and underwent PPN administration. We compared clinical aspects of two methods of PPN, cPPN (n=39) and TNA (n=57). Results: The mean age was 6.5±3.1 years in the cPPN group and 8.2±3.4years in the TNA group (p=0.015). In the TNA group, there was a signifi- cantly shorter period between the day of admission and the first day of PPN or oral feeding (p<0.0001 & p<0.0001, respectively).The TNA group also fasted for a shorter period before PN after admission, and the total duration of fasting was also shorter (p<0.0001 & p<0.0001, respectively). The TNA group showed a lower glu- cose infusion rate and fewer daily administered total calories per weight (p<0.0001 & p=0.001, respectively). However, there was no significant difference in the amount of administered amino acids and lipids (p=0.584 & p=0.650, respectively) and PPN-related complications. Conclusions: When providing nutrients to hospitalized children who cannot take in enough nutrients via the enteral route, TNA formula may be an easier and faster method than cPPN.
Background and Objective: Unguided nasojejunal feeding tube insertion success rates are low. Controversy persists about how to safely and efficiently perform enteral nutrition (EN) in critically ill patients. This study ex- plores an innovative blind nasointestinal tube (NIT) insertion method and compares nasogastric and nasointestinal feeding. Methods: Seventy critically ill patients admitted to the intensive care unit (ICU) were divided randomly into a nasogastric tube group (NGT; n=35) and an NIT group (NIT; n=35). After bedside NGT and blind-type NIT insertion, tube position was assessed and EN was started on day 1. Patients’ nutritional status parameters, mechanical ventilation duration, average ICU stay, nutritional support costs, and feeding complications were compared. Results: Pre-albumin and transferrin levels on days 7 and 14 were significantly higher in the NIT group than in the NGT group (p<0.01, p<0.05). Bloating, diarrhea, upper gastrointestinal bleeding, and liver damage did not differ significantly between groups (p>0.05). Interleukin-6 and tumor necrosis factor-α levels and APACHE II score were significantly lower in the NIT group than in the NGT group (p<0.01, p<0.05). Reflux and pneumonia incidences, mechanical ventilation duration, average ICU stay length, and nutritional support costs were significantly lower in the NIT group than in the NGT group (p<0.01). Conclusion: Blind bedside NIT inser- tion is convenient and its use can effectively improve nutritional status, reduce feeding complications, and de- crease nutritional support costs of critically ill patients.
Objective: This study aims to determine the impact of increasing polyunsaturated fatty acid intake on blood glu- cose, lipid metabolism, and pregnancy outcomes of pregnant women with gestational diabetes mellitus. Methods: Under constant total energy and protein intake, 84 pregnant women with gestational diabetes mellitus were ran- domly divided into the experimental and control groups, which were given oil-rich and conventional low-oil meals, respectively. Results: After the dietary intervention, the intake and energy supply of fat and the three fatty acids were significantly higher in the experimental group than the control group (p<0.001). The intake and energy supply of polyunsaturated fatty acids increased significantly post-intervention in the experimental group but did not change in the control group. In both the intervention and the control group, fasting blood glucose, 2 h post- prandial plasma glucose, and the insulin resistance index decreased significantly post-intervention (p<0.05); the lipid changes were consistent between groups. Pregnancy outcomes did not differ significantly between the two groups (p>0.05). Conclusions: An appropriate increase in polyunsaturated fatty acid intake benefits pregnant women with gestational diabetes mellitus as well as fetuses, as long as the diet therapy follows basic recommen- dations and total energy intake is strictly controlled.
Present study was a post-hoc analysis and aimed to examine the influence of adiposity status on the response of insulin sensitivity to diacylglycerol (DAG) oil in type 2 diabetic patients. A total of 127 type 2 diabetic patients were recruited into a randomized double-blind controlled parallel trial in Hangzhou, China. Subjects were allo- cated to consume the same amount (25 mL/d) of DAG (n=66) or triacylglycerol (TAG) oil (n=61) with similar fatty acid compositions for 120 days. Marginally significant interaction was observed between BMI status (over- weight versus normal weight) and test oils for fasting insulin (p-interaction=0.046) and Homeostasis Model As- sessment of Insulin Resistance (HOMA-IR) (p-interaction=0.059). For normal weight subjects (BMI25), DAG group showed significant decrease of fasting insulin (-2.0, 95% CI: -3.90, -0.10; p=0.036) and HOMA-IR (-0.69, 95% CI: -1.36, -0.03; p=0.015), but not in the TAG group. No significant change of either trait in DAG or TAG group was observed for overweight subjects (BMI>25). In summary, the effect of DAG oil on insulin sensitivity in type 2 diabetic patients is influenced by the baseline BMI status. Type 2 diabetic patients may benefit from DAG oil in terms of insulin sensitivity improvement, however only when they are in normal body weight range.