APJCN

Diabetes mellitus (DM) is a complex and chronic disease with multiple complications leading to increased mor- tality and poor quality of life. Current studies have shown that lowering glycosylated haemoglobin (HbA1c) con- fers protection against microvascular complications. However, with more intensive glucose control to achieve HbA1c of less than 6.5%, there seems to be a significant increased risk of mortality and cardiovascular events. The current recommendation worldwide is for “tailoring” of DM management to risk and also quality of Life (QOL) which is a crucial component in determining the success or failure of DM management. In Asia, DM has become a health crisis but there is a lack of QOL assessment tool that is specific for Asians with wide spectrum of ethnicity, languages, religions and socio-economic differences. In this review, we discuss the evolution of DM management over the decade and the issues pertaining to QOL among people living with diabetes in Asia.

Objective: Weighing scales are often lacking at home birth in developing countries. Therefore, simple, reliable, and inexpensive methods for detecting low birth weight especially before birth would be useful. This study was performed to evaluate the diagnostic value of maternal anthropometric measurements for predicting low birth weight. Methods: Bivariate diagnostic meta-analysis was conducted to construct hierarchical summary receiver operating characteristic curves. All English language studies included in the meta-analysis enrolled apparently healthy pregnant women and provided the data necessary to construct two-by-two tables (i.e., true positive, false positive, false negative, and true negative values). Ten data bases, including PubMed, were searched to identify these studies. Results: A sufficient number of studies involving 309,419 women paired with their newborns in Africa, Asia, Europe, Latin America, the Middle East, and Oceania, included data on maternal height, weight, arm circumference, body mass index, and weight gain during pregnancy (n=85, 80, 23, 51, and 16, respectively) to provide generalizable findings. However, sensitivity of 0.46 (95% confidence interval (CI)=0.35-0.56) to 0.63 (95% CI=0.54-0.71), specificity of 0.55 (95% CI=0.42-0.67) to 0.71 (95% CI=0.61-0.80), and diagnostic odds ra- tios of 2 (95% CI=2-2) to 4 (95% CI=3-5) were not sufficiently high for primary screening. The generalizability of abdominal circumference data could not be guaranteed due to the limited sample (one article). Conclusions: Maternal anthropometric measurements are unsuitable for predicting low birth weight.

Breast milk provides adequate nutrients during the first 6 months of life. However, there are some reports of zinc deficiency in breastfed infants. This study was conducted to determine the prevalence of zinc deficiency in infants aged 4-6 months and the associated factors. Healthy infants aged 4-6 months and their mothers were enrolled. They were classified by feeding types as breastfed (BF), formula-fed (FF), and mixed groups (MF). Data collection included demographic data, perinatal data, given diets, and anthropometric measurement. Blood from infants and lactating mothers, and breast milk samples were collected to assess plasma and breast milk zinc concentrations. From 158 infants, the prevalence of zinc deficiency (plasma level below 10.7 mol/L) was 7.6%, and according to feeding groups 14.9%, 5.3%, and 2.9% in the BF, the FF, and the MF groups, respectively. Breastfed infants with zinc deficiency had significantly lower maternal zinc concentrations compared with those without zinc deficiency. There was a higher proportion of maternal zinc deficiency in zinc-deficient infants than those without zinc deficiency (66.7% vs 16.2%, p=0.02). There was a positive correlation between zinc concentrations in breast milk and plasma zinc concentrations of infants (r=0.62, p=0.01) and plasma zinc concentrations of lactating mothers (r=0.56, p=0.016). Using the regression analysis, infant zinc status was associated with maternal plasma zinc concentrations among breastfed infants. The results of this study suggest that breastfed infants aged 4-6 months may have a risk of zinc deficiency and that risk is associated with maternal zinc status and breast milk zinc concentrations.

Purpose: To determine the prevalence of nonalcoholic fatty liver disease (NAFLD) and explore the relationship of NAFLD with anthropometric parameters among school children from the Yangtze River delta region. Meth- ods: A cross sectional study on childhood NAFLD was conducted using the stratified cluster sampling method in four regions of the Yangtze River delta in September 2009 to October 2011. In all, 7,229 students, aged 7-18 years, from 12 primary, middle and high schools participated in the study. Height, weight, and waist circumfer- ence were measured; body mass index (BMI) and waist to height ratio (WHtR) were calculated and liver ultraso- nography was performed. Results: The overall NAFLD prevalence was 5.0%; 7.5% in boys, 2.5% in girls, 5.6% in subjects with peripheral obesity, 12.9% in those with abdominal obesity and 44.8% in those with mixed obesity. The prevalence was also increased with regional difference. Binary logistic regression analysis showed that WHtR was the major independent risk factor for childhood NAFLD, causing a 14.4-fold increase in NAFLD risk. Receiver operating characteristic curve analysis also showed that WHtR was the best obesity index to evaluate the presence of NAFLD in Chinese schoolchildren with the optimal cutoff of 0.47. Conclusions: Mixed obesity had the strongest association with NAFLD. Male gender and regional urbanization also influenced NAFLD prev- alence among schoolchildren. WHtR may be an effective indicator to predict NAFLD.

Objective: To study the dietary intake and level of physical activity (PA) of patients with diabetes mellitus and the association with non-alcoholic fatty liver disease (NAFLD). Methods: Consecutive adult patients with type 2 diabetes mellitus seen in our hospital diabetes clinic were enrolled. The Global Physical Activity Questionnaire and a semi-quantitative food-frequency questionnaire were used to assess PA and dietary intake, respectively. Di- agnosis of NAFLD was ultrasound-based and following exclusion of significant alcohol intake and other causes of chronic liver disease. Results: Data for 299 patients were analyzed (mean age 63.3±10.5 years old, 41.1% male). Prevalence of NAFLD was 49.2%. Patients with low PA were more likely to have NAFLD (OR=1.75, 95% CI=1.03-2.99, p=0.029). There was no significant difference in energy intake, intake of macronutrients and percentage energy intake from each macronutrient, high sugar food, high cholesterol food and high SFA food be- tween patients with and without NAFLD. Among centrally obese patients, patients with low PA and in the high- est quartile of percentage energy intake from fat (OR=4.03, 95% CI=1.12-15.0, p=0.015), high cholesterol food (OR=3.61, 95% CI=1.37-9.72, p=0.004) and high SFA food (OR=2.67, 95% CI=1.08-6.67, p=0.019) were most likely to have NAFLD. Among those who were not centrally obese, PA and percentage energy intake from fat, high cholesterol food and high SFA food was not associated with NAFLD. Conclusion: Low PA and high per- centage energy intake from fat, high cholesterol food and high SFA food is associated with NAFLD in centrally obese but not in non-centrally obese patients with diabetes mellitus.

Objectives: This study investigated the distribution density of fast food outlets around schools, and the relation- ship between dietary health of children and adolescents and the density of fast food outlets in Korea. Methods: A distribution map of fast food outlets was drawn by collecting information on 401 locations of 16 brands within a 15-minute walk (800 meter) of 342 elementary and secondary schools in Suwon, Hwaseong and Osan. A ques- tionnaire was used to gather data on the dietary life of 243 sixth and eighth grade students at eight schools. Schools in the upper 20% and lower 20% of the fast food outlet distribution were classified as high-density and low-density groups, respectively. The practice rate of dietary guidelines published by the Health and Welfare Ministry and the fast food consumption pattern of children and adolescents from low and high density groups were determined. Results: The number of schools with a fast food outlet within 200 meters or in the Green Food Zone around its location was 48 of 189 (25.4%) in Suwon and 14 of 153 (9.2%) in Hwaseong and Osan. Students in the low-density group visited fast food outlets less often than those in the high-density group (p<0.01). Dietary guideline practice scores for children did not show a significant difference between the two groups. Conclusion: The distribution map of fast food outlets within 200 meters of schools was useful for identifying the effectiveness of the Green Food Zone Act and nutrition education programs.

The feasibility of a dietary survey tool is crucial for successful nutritional assessment via a community survey and for nutritional epidemiology. In 2012, we identified a newly developed computerized dietary survey system, the Diet Evaluation System (DES), which could be successfully applied to a community survey delivered during home visits using notebook computers when the internet environment was adequate, using either a WiBro modem or a smartphone as a tethered modem. In 2013, we retested DES feasibility using various mobile devices and in a larger number of subjects. We conducted a total of 430 interviews, representing two for each of 215 subjects of various ages, using tablet personal computers (PCs) and laptops. In addition, a group discussion with the inter- viewers was conducted. The interview success rate was improved to 84% (compared to 67% in 2012). Complet- ing each interview took 14 min 1 s, and data processing was conducted automatically. The subjects’ age, gender, and the type of mobile device used influenced the DES interview time. This study implies that the DES is an ef- fective one-stop dietary survey system for use in a local setting. The interviewers’ group discussion revealed that a one-stop system using the DES is convenient and that DES optimization for tablet PCs and continued database updating is needed.

Objectives: Maternal docosahexaenoic acid (DHA) intakes is important for brain development in fetuses. Accu- rate assessment of EPA and DHA intakes is required in clinical settings to identify women with deficiency of these nutrients and provide an appropriate intervention for them. We examined the validity and reproducibility of a brief-type self-administered diet history questionnaire (BDHQ) for evaluating EPA and DHA intakes of preg- nant Japanese women, to establish an easily administered dietary assessment tool. Methods: A total of 105 wom- en in the second trimester and 102 women in the third trimester were studied at a university hospital in Tokyo, between November 2010 and February 2012. The reference values for the validation study were plasma concen- trations of EPA and DHA. For the reproducibility study, 54 women completed the BDHQ twice, within a 4-week period in the second trimester. Results: Energy-adjusted intakes of EPA, DHA, and EPA+DHA were significant- ly associated with the corresponding plasma concentrations (rs=0.354, rs=0.305, and rs=0.327 in the second tri- mester; rs=0.391, rs=0.316, and rs=0.358 in the third trimester, respectively). Intraclass correlation coefficients for the two-time BDHQ were 0.543 (EPA), 0.611 (DHA), and 0.581 (EPA+DHA). In the Bland-Altman plots, the in- takes of EPA, DHA, and EPA+DHA in the two-time BDHQ showed that the values for most participants were in the accepted range of agreement. Conclusions: BDHQ has an acceptable validity level for assessing EPA and DHA intakes among Japanese women in the second and third trimesters.

Background/Aims: Long-chain polyunsaturated fatty acids (LC-PUFA) are regarded as essential for child cognition. Genetic variation in fatty acid (FA) desaturase enzyme (FADS) has been recognized as an important effect modifier in the relation between LC-PUFA and child cognitive function. This study aimed to identify the distribution of genetic variant (genotype) SNP rs174468 and to assess plasma FA and developmental outcome by the genotype among under-2 year old Sasaknese Indonesian children. Methods: Data was collected at baseline of a randomized trial (NUPICO, clinicaltrials.gov NCT01504633) in East Lombok district, Indonesia. Breastfed, 12- 17 month old children were recruited and 240 subjects were included in the study. Child cognition was assessed as Bayley Mental Developmental Index (MDI). Results: From 206 subjects whose blood samples can be collected, only two genotypes were found (90.3% GG homozygotes, 9.7% AG heterozygotes), and minor allele AG was significantly associated with higher level of arachidonic acid (20:4 n-6), n-6 LC-PUFA and FADS1 index. MDI score was associated with a FADS2 index (DHA:EPA ratio) but not genotype (Adjusted R-square= 0.043). Conclusions: FADS2 index was associated with cognitive function. No difference was found between children with GG and AG genotypes who were all breastfed and not low birth weight.

Several genes have been implicated as genetic determinants of osteoporosis. Vitamin D receptor (VDR) is an in- tracellular hormone receptor that specifically binds to the biologically active form of vitamin D, 1-alpha, 25- dihydroxyvitamin D3 [1, 25(OH)2D], and mediates its effects. One of the most frequently studied single nucleo- tide polymorphisms is the restriction fragment length polymorphism (RFLP) Fok-I (rs2228570). The presence of a Fok-I site, designated f, allows protein translation to initiate from the first ATG. An allele lacking the site (ATG>ACG: designated F), initiates from a second ATG site. In the present study, we explored the effect of the VDR Fok-I genotype on associations among serum bone-specific alkaline phosphatase (ALP), 25- hydroxyvitamin D3 [25(OH)D], 1, 25(OH)2D, and the dietary nutrient intake in healthy young Japanese subjects (n=193). Dietary nutrient intakes were calculated based on 3-day food records before the day of blood examina- tions. Quantitative ultrasound (QUS) parameters at the right calcaneus (heel bone) were measured. The allele fre- quencies were 0.622 for the F allele and 0.378 for the f allele in all subjects. Grouped by the VDR genotype, a significant positive correlation between the levels of serum bone-specific ALP and 25(OH)D was observed in the FF-type (p=0.005), but not in the ff-type. In addition, there was a significant positive correlation between the lev- el of serum 25(OH)D and osteo-sono assessment index (OSI) in the FF-type (p=0.008), but not in the ff-type. These results suggest that the level of circulating 25(OH)D is an important factor when assessing the VDR Fok-I polymorphism to prevent osteoporosis.

The mortality and morbidity of geriatric patients is much higher than for younger patients, especially when criti- cally ill. This may be attributed to a lower reserve capacity in most organs and systems, reduced ability to deal with physical stress and the presence of acute or chronic co-mobidities. Parenteral and enteral nutrition support can improve the clinical condition of the elderly patient and result in better outcomes, such as lower mortality, re- duced hospital stay and reduced medical costs. There is a need to standardize nutrition screening and assessment, and the implementation of appropriate evidence based nutritional support of geriatric patients in China. The Chi- nese Medical Association’s Group of Geriatric Nutrition Support has developed guidelines by researching the present situation in Chinese hospitals and by referring to the guidelines from both American Society for Parenter- al and Enteral Nutrition (ASPEN) and the European Society for Clinical Nutrition and Metabolism (ESPEN).

Mantou, a traditional Chinese food, is widely consumed in the North China due to its nutritional value and good mouth-feel. However, its current family-style production is impeded due to short shelf-life caused by mold and starch retrogradation. The current packaging and storage methods are not efficient enough for mantou preserva- tion. Recently, a novel, hot online package technology has attracted attention due to its high processing efficiency and low cost. Most importantly, by using this methodology, secondary contamination by microbes can be avoided and starch retrogradation can be markedly delayed, with mantou shelf-life under room temperature extended from a few to at least 90 days without any additives. In this review, the mechanisms of mantou quality deterioration are explained and the advantages of hot package technology addressed and compared with other packaging methods, such as frozen chain storage. In this way, not only wheat, but also other grains (including whole-grains) and in- gredients may be mantou constituents, to enhance nutrition of traditional mantou. There is now a technological opportunity for mantou to become a more nutritious, sustainable and affordable foodstuff in local communities.

Nutrition therapy is essential for the management of critically ill patients. Some guidelines have been published to standardize and optimize the nutrition therapy. However, there are still many controversies in nutrition practice and there is a gap between guidelines and clinical nutrition therapy for patients in intensive care units (ICUs). This study aimed to assess attitudes and beliefs toward nutrition therapy of Chinese intensive care physicians by using the American guidelines as a surrogate. A questionnaire was sent to 45 adult ICUs in China, in which sur- veyed physicians were asked to rate their attitudes toward the American guidelines. A total of 162 physicians from 45 ICUs returned the questionnaires. Physicians were categorized into groups according to their profession- al seniority, hospital levels and whether they were members of Chinese Society for Parenteral and Enteral Nutri- tion (CSPEN). Overall, 94% of the respondents thought that nutrition therapy for critically ill patients was very important, and 80% mentioned that they used the American guidelines. There was diversity of opinion on the recommendations pertaining to nutrition assessment, supplemental parenteral nutrition and cutoff values for gas- tric residual volume, negative or neutral attitudes about these recommendations were 43%, 59% and 41%, respec- tively. Members of CSPEN were more likely to select a greater strength of recommendation than non-members. In conclusion, the overall attitudes of Chinese intensive care physicians toward the American guidelines were positive. Nevertheless, given the great guideline-practice gap, nutrition-focused education is warranted for many intensive care physicians in China.

Objectives: To investigate the clinical application of the fast track surgery (FTS) model based on preoperative nutritional risk screening (NRS) in patients with esophageal cancer. Methods: 180 patients with esophageal can- cer who underwent surgery between January 2008 and April 2014 were randomly divided into study and control groups based on matched-pairs. The study group underwent assessment using the NRS 2002 and received treat- ment before surgery and the control group was treated by the conventional method. Postoperative indicators in- cluding time to first exsufflation, time to defecation, time to chest tube removal, hospitalization duration, and postoperative complications were examined after surgery. Results: Compared with the control group, the postop- erative indicators including time to first exsufflation (88.4±2.76 vs 57.83±2.68 hours), time to first defecation (4.68±1.71 vs 3.28±1.34 days), time to chest tube removal (4.30±0.25 vs 2.70±0.33 days), postoperative hospital- ization durations (11.71±1.39 vs 9.00±0.78 days), and total complication rate (18.9% [17/90] vs 6.67% [6/90]) were all significantly reduced in the study group (p<0.05). Conclusions: The FTS model based on NRS can ef- fectively promote postoperative rehabilitation of patients, reduce the incidence of postoperative complications, and shorten hospital stay.

Background: Patients with stroke suffer from nutrition impairments and often rely on enteral nutrition (EN), which is associated with respiratory complications such as regurgitation and aspiration. Objective: To evaluate the incidence of regurgitation and aspiration in patients with severe stroke infused with different volumes of EN. Methods: A randomized controlled trial was conducted on 210 patients with severe stroke undergoing EN thera- py. Patients were randomly assigned into two groups. Subjects in the treatment group received EN with an initial rate defined according to the total volume and the infusion rate was adjusted based on gastric residual volume (GRV) assessed every 4 hours. Subjects of the control group received EN without monitoring the GRV and reached the target infusion volume within 72 hours. The incidence of reflux and aspiration was recorded. Results: The incidences of regurgitation and aspiration were significantly lower in treatment group (6.3% and 7.9%, re- spectively) than control group (18.8% and 17.5%, respectively). In the treatment group, 1 patient developed re- gurgitation while 2 developed aspiration when EN was 500 mL. When EN increased to 1000 mL, 2 patients de- veloped regurgitation and 2 developed aspiration, and 5 patients developed regurgitation and 6 had aspiration when EN was 1500 mL. There was no significant difference in the risk of reflux and aspiration when total volume of EN increased from 500 to 1500 mL. Conclusions: During EN therapy for patients with stroke, using feeding pump with a continuous infusion for 20 hours and adjusting infusion rate based on GRV could reduce the inci- dence of respiratory complications.

Objective: To identify the optimal time for introducing enteral nutrition to critically ill neonates. Methods: This prospective cohort study included all eligible critically ill neonates who were admitted to a multidisciplinary ter- tiary neonatal intensive care unit (NICU) between 1st June and 30th November 2013. Nutrient intake and clinical outcomes during NICU stay were recorded. The effect of early (<24 hours after NICU admission) and delayed (≥24 hours) enteral nutrition introduction on clinical outcomes was assessed. Results: Energy deficit in critically ill neonates was frequent: 84.7% could not achieve the caloric goal during the NICU stay. Growth retardation was common especially among the preterm: the frequency of neonates whose weight was below the 10th percentile in- creased significantly from 21.6% on admission to 67.6% at discharge. Compared with delayed enteral nutrition, early enteral nutrition was associated with better median time to starting weight gain (0 vs 6 days, p=0.0002), a lower chance of receiving parenteral nutrition (41.7% vs 95.9%, p<0.0001), shorter NICU stays (196 vs 288 hours, p=0.0001), fewer hours on mechanical ventilation and a lower chance of developing pulmonary infection (37.5% vs 56.0%, p=0.005). The accumulated energy deficit to the subjects who were exposed to delayed nutri- tion could not be compensated by subsequent nutrition. Neonates who underwent mechanical ventilation had suboptimal nutrient delivery: they took longer to gain weight and were more likely to develop respiratory distress and receive parenteral nutrition. Conclusions: Early enteral nutrition initiation (<24 hours) is recommended. Ne- onates with mechanical ventilation should be monitored with particular attention.

Background: Although several large-scale clinical trials shave examined the relationship between early parenter- al nutrition (ePN) and critically ill patients, a consensus has not been reached. In addition, no meta-analysis in this area has yet been published. The objective of this meta-analysis was to examine the effect of ePN, alone or accompanying enteral nutrition, in critically ill patients. Methods: A meta-analysis was performed to evaluate risk ratios (RR) and mean differences with 95% confidence intervals (CIs) between the ePN and control groups. Subgroup analyses were conducted to evaluate combinations of early enteral nutrition (eEN). Results: Five ran- domized control trials (RCTs) were included. Compared with controls, ePN had no effect on mortality (RR: 1.05, 95% CI: 0.96, 1.16). Secondary outcomes were variable: compared with the control group, the ePN group re- quired fewer days of ventilation (p=0.007, RR: -0.95, 95% CI: -1.64, -0.27), but a longer hospital stay (p<0.001, RR: 3.76, 95% CI: 2.25, 5.28). Conclusion: Overall, this meta-analysis from RCTs indicates that provision of ePN within 24-48 hours has no benefit on the survival rate in critically ill patients. Thus, provision of ePN in pa- tients is not needed in those who have contraindications to enteral nutrition or can tolerate a low volume of enter- al nutrition.

Background: Universal salt iodization (USI) was introduced in China in 1995, but whether the iodine status is optimal is questionable. This study was conducted to assess the iodine nutrition among Zhejiang population in coastal regions in China. Methods: A cross-sectional survey for iodine nutritional status was conducted with general population (n=10,350), including pregnant and lactating women (n=450 each) selected by stratified multi- stage sampling. Iodine content in drinking water, table salt and urine, were determined using arsenic-cerium cata- lytic spectrophotometry, the direct titration and the arsenic-cerium catalytic spectrophotometry, respectively, and daily iodine intake was estimated by 3 days of 24-hour recall method. Results: The median iodine content in drinking water was 2.46 μg/L, Zhejiang belonged to the region of iodine deficiency in outer environment accord- ing to China standard. The median iodine content in table salt was 27.9 mg/kg, conforming to the standard re- quirements; the household coverage rate of qualified iodized salt reached 76.8%, which does not reach the stand- ard requirement of WHO >90%. The dietary iodine intake of a reference individual averaged 379 μg/d, which in- dicated that the current iodine intake in diet was appropriate. In addition, the median urinary iodine concentration (UIC) was 162 μg/L in general population, and 130 μg/L in pregnant women, which didn’t reach the standard re- quirements. Conclusion: The current dietary iodine intake in Zhejiang was generally sufficient and safe, but there is a risk of iodine deficiency among pregnant women and the population who do not consume iodized salt.

Background and Purpose: Calcium intake has been associated with stroke risk in a prior meta-analysis, howev- er, newly published results are inconsistent. Dairy food benefits on stroke incidence may involve a calcium- related mechanism. We have therefore updated this meta-analysis with particular references to any possibility of a calcium-mediated dairy food risk reduction of stroke risk. Methods: We searched multiple databases and bibliog- raphies for prospective cohort studies. Reports with multivariate-adjusted relative risk (RR) and corresponding 95% confidence intervals (CI) for the association of calcium intake with stroke incidence were considered. Re- sults: Ten studies with 371,495 participants and 10,408 stroke events were analyzed. The pooled analysis showed no statistically significant association of the risk of total stroke (RR=0.96; 95% CI: 0.89-1.04) and stroke sub- types with the highest and lowest calcium intake quantiles. Nevertheless, high dairy calcium intake was signifi- cantly associated with an approximately 24% reduction of stroke risk. (RR=0.76; 95% CI: 0.66-0.86). Further- more, a long-term follow-up (≥14 years) was helpful to reduce the risk of stroke (RR=0.67; 95% CI: 0.51-0.88). Additionally, a non-linear dose-response relationship was predicted between calcium intake and stroke risk. Con- clusions: Dairy calcium intake is inversely associated with stroke incidence. There is a non-linear dose-response relationship between calcium intake and stroke risk. However, when the follow-up time is long enough, the in- verse relationship is independent of dose. Additional large cohort studies are required to illustrate this relationship in detail.

Iron deficiency and associated anemia are severe public health problems, which are prevalent in the developing world. We conducted a cross-sectional survey, comprised of written interview questions and laboratory analysis of blood biomarkers, in Kandal Province, Cambodia. The objective of this study is to examine possible factors that are associated with anemia in rural Cambodia. Data on socioeconomic status, water source/treatment practic- es, and meat consumption was also collected. Of the 297 women surveyed, 51.2% were anemic. Of those women found to be anemic, iron deficiency was implicated in 9.7% of cases (SF <15 ng/L), with an additional 18.5% re- ported to be borderline iron deficient (serum ferritin=15-30 ng/L). Meat consumption was very low, with nearly one-half of the women consuming meat one time per month or less. This study highlights the multi-faceted etiol- ogy of anemia in Cambodia and emphasizes the need for comprehensive nutrition surveying in order to better in- form prevention and treatment programming and policy development.