For most of its history, China has supported a growing population through food systems which have been mutually inclusive of people and their locality. This trajectory has required adequate ecosystem maintenance or human- ised reformulation and a high degree of recyclable nutrient flow. The ‘tipping point’ in habitat sustainability has come with the size and demographic structure of China’s population to one that is ageing, with modernisation of its infrastructure and increased expectations of better livelihoods, standards of living and health. In order to meet these expectations, China has embarked on rapid urbanisation for upwards of 300 million people over the next 15-20 years and to do so taking account of the environmental limitations. The process will radically change rural as well as urban China and the systems which connect them. Chief among these will be ecosystems in number and type along with the food and health systems integral to them. To minimise ecological damage and optimise the benefits to people and place, describing, monitoring and managing the process will be paramount. The present paper is a situational analysis of health as it may be ecologically favoured or disordered (Ecosystem Health Disorders) and of the food systems on which the environment and health depend. An effort is made to enumerate the current situation in China in a way that might enable the optimisation of humanised ecosystems.
Background and Objectives: Overweight and obesity increase the risk of hypertension, type 2 diabetes, and other metabolic disorders and are increasing in Japan, particularly among men. Several prospective studies have suggested that high vegetable intake is inversely associated with weight gain. Here, the association between vege- table consumption and weight gain in a group of food manufacturing workers over the course of one year was in- vestigated. Methods and Study Design: The study was a one-year cohort study of the nutrition and lifestyle sur- vey. The study population consisted of 900 and 910 Japanese employees (aged 19-60 years) from a manufactur- ing company located in Musashino City, Tokyo, Japan, that were administered the same validated brief self- administered diet history and dietary lifestyle questionnaire in 2006 and 2007, respectively. Clinical examinations of body weight were also performed to assess changes in weight. We analyzed participants who responded in both 2006 and 2007 (n=478). Results: Risk of weight gain of more than 3 kg was significantly lower in the group consuming the most vegetables than in the group consuming the least, and this difference remained significant af- ter adjustment for baseline age, sex, and consumption of other foods (p for trend=0.028). Conclusions: Weight gain was inversely associated with high consumption of vegetables. Encouraging Japanese employees to consume more vegetables may be an important strategy in controlling weight gain and preventing metabolic syndrome.
Background and Objectives: The objective was to compare the dietary intakes of individuals with type 1 diabe- tes (T1D) to individuals without diabetes in China. Methods and Study Design: Data are from 1) the 3C Nutri- tion Ancillary Study, a cross-sectional study of individuals with T1D in China, and 2) the China Health and Nu- trition Survey. Dietary intake in both samples was assessed using three 24-hour recalls. ANCOVA and multivari- able logistic regression, adjusted for sex, age, and urban-rural residence, were used to assess differences in nutri- ent and food group intake between participants without diabetes (n=1059) and participants with T1D (n=97), who were stratified by insulin regimen (basal-bolus, n=49, versus fixed, n=48). Results: Participants with T1D had a lower percentage of energy from carbohydrates, higher vegetable intake, and were more likely to consume low- fat cakes and fungi/sea weed compared to participants without diabetes (all p<0.05). Distinguishing characteris- tics of insulin regimen groups also emerged. Participants on fixed regimens had higher intakes of wheat and were less likely to consume fruit and more likely to consume high-fat cakes and dairy compared to participants without diabetes (all p<0.05). Participants on basal-bolus regimens were less likely to consume fried foods and more like- ly to consume fish/shellfish compared to participants without diabetes (all p<0.05). Conclusions: Differences in dietary intake between participants with and without T1D in China suggest that dietary modifications are com- mon and reflect carbohydrate-conscious nutrition recommendations for individuals with T1D. Future research should focus on the health effects of these modifications.
To evaluate how prenatal exposure to antioxidant vitamins and heavy metals affects subsequent development. Maternal serum and cord serum levels of antioxidant vitamins (A, E, and C) were determined. Full-state, perfor- mance, and verbal intelligence quotients (FSIQ, PIQ, and VIQ, respectively) of 97 children were assessed at 5 years of age. The placental transport ratio (PTR: cord level relative to maternal serum level) of vitamin A (VA) was associated positively with FSIQ score (p=0.041), vitamin E (VE)-PTR was associated positively with PIQ (p=0.002) and FSIQ (p=0.025) scores, and cord serum cadmium (Cd) level was correlated negatively with VIQ score (p=0.025) at 5 years of age. High VE-PTR protected against low PIQ (OR=0.025; p=0.021) and FSIQ (OR<0.001; p=0.004). High maternal age was a protective factor against low VIQ (OR=0.661; 95% CI, 0.500- 0.875; p=0.004) and FSIQ (OR=0.700; 95% CI, 0.512-0.957; p=0.025). A higher maternal education (OR=0.038; 95% CI, 0.003-0.458; p=0.010) and economic level (OR=0.047; 95% CI, 0.004-0.579; p=0.017) were protective against a low FSIQ score. VA-PTR predicted physical growth. VA-PTR and VE-PTR predicted intelligence test performance at 5 years old. High Cd in cord blood may negatively affect subsequent intelligence.
Background and Objectives: To explore the diet characteristics of anaemic infants and young children of China, blood tests and diets surveys were conducted in five cities. Methods and Study Design: About 150 children aged 6-36 mo were selected in a typical community health center of each city, and the total sample was 750. Nutrition- al status was measured through 24h dietary recall method and HEMO Cue was used for Haemoglobin concentra- tion testing. Results: The average prevalence of anaemia was 17.2% in 6-12 mo children, which was higher than in other age groups. Median intakes of 8 nutrients (protein, vitamin A, B-1 and C, calcium, iron, zinc and copper) in anaemic children were less than non-anaemic children (p<0.05) in 6-12 mo olds; at age 12-24 mo the intake of vitamin A in anaemic children was less than in non-anaemic children (p<0.05). Market complementary food was the main source of iron in both anaemic and non-anaemic children (6-12 mo olds: 2.28 and 3.69 mg; 12-24 mo olds: 2.06 and 2.09 mg, respectively). Iron intake from formula was lower in anaemic children than in non- anaemic children (6-12 mo olds: 0.88 vs 2.54 mg; 12-24 mo olds: 1.59 vs 2.87 mg). The proportion of children obtaining continued breastfeeding in anaemic children was significantly higher than in non-anaemic children aged 6-12 mo (65% vs 37%, p<0.05). Conclusions: Appropriate practices around continuing breastfeeding and complementary feeding particularly targeted to breast fed older infants and young children are needed to reduce anaemia in infants and young children.
Background and Objectives:More than 30 years of socioeconomic development in China has improved living conditions which contributed to a steep decline in malnutrition prevalence of children under 5 years. To elucidate the role of socioeconomic development in improving nutritional status and to identify appropriate policy priorities for intervention in nutrition improvement for younger children. Methods and Study Design: We collected data on socioeconomic development, education, cultural and recreational services, food consumption, average family size and malnutrition prevalence from national surveys. Results: From 1990 to 2010, Gross Domestic Product (GDP) per capita increased from 1644 Chinese Yuan (CNY) to 30,015 CNY; average disposable income and food expenditure per capita significantly increased in urban and rural areas; per capita consumption for education increased from 112 CNY to 1628 CNY and from 15.3 CNY to 367 CNY for other cultural services; illiteracy rate decreased from 15.9% to 4.1%; average family size from 3.97 to 3.10; and prevalence of stunting and under- weight decreased from 33.1% to 9.9% and 13.7% to 3.6%, respectively. However, anaemia prevalence did not obviously decline between 1992 and 2000. After adjusting confounding effects of variables, negative relation- ships were observed between GDP per capita, average family size and stunting or underweight prevalence. How- ever, no association was observed between illiteracy rate and prevalence of stunting and underweight, and there was no correlation between GDP per capita, illiteracy rate, average family size and anaemia prevalence. Conclu- sions: Our results indicated that economic development cannot solve all nutritional problems and comprehensive national developmental strategies should be considered to combat malnutrition.
Background and Objectives: To quantify whole grain intake in pregnant women in Singapore in order to pro- vide the first detailed analysis of whole grain intake in an Asian country and in pregnant women. Methods and Study Design: Analysis of 24-h diet recalls in a cross-sectional cohort study and analysis of a biomarker of whole grain intake (plasma alkylresorcinols) in a subset of subjects. The Growing Up in Singapore Towards healthy Outcomes-mother offspring cohort study based in Singapore. 998 pregnant mothers with complete 24-h recalls taken during their 26-28th week of gestation. Plasma samples from a randomly select subset of 100 sub- jects were analysed for plasma alkylresorcinols. Results: Median (IQR) whole grain intake for the cohort and the 30% who reported eating whole grains were 0 (IQR 0, 9) and 23.6 (IQR 14.6, 44.2) g/day respectively. Plasma alkylresorcinol concentrations were very low [median (IQR)=9 (3, 15) nmol/L], suggesting low intake of whole grain wheat in this population. Plasma alkylresorcinols were correlated with whole grain wheat intake (Spear- man’s r=0.35; p<0.01). Conclusions: Whole grain intake among pregnant mothers in Singapore was well below the 2-3 (60-95 g) servings of whole grains per day recommended by the Singapore Health Promotion Board. Ef- forts to increase whole grain intake should be supported to encourage people to choose whole grains over refined grains in their diet.
Background and Objectives: There is only limited available evidence of a relationship between total plasma homocysteine (tHcy) levels and type 2 diabetes in hypertensive subjects. Methods and Study Design: A total of 5,935 Chinese essentially hypertensive subjects were recruited by cluster sampling from 60 communities. The cases had diabetes, whereas the controls did not. Anthropometric indices and biochemical parameters were as- sessed using standard procedures. A multivariable analysis was performed to analyze the association of tHcy and type 2 diabetes susceptibility in hypertensive subjects. Results: The 5,241 controls (women/men: 2,716/2,625) and 594 cases (women/men: 291/303) were recruited consecutively. The level of tHcy was dose- dependently as- sociated with type 2 diabetes in the hypertensive women subjects. After controlling for corresponding confound- ing factors, a significant trend was only noted in the women subjects, with odds ratios per 5 μmol/L tHcy of 1.11 (95% confidence interval (CI), 1.07-1.16) in the crude model, 1.05 (95% CI, 1.01-1.11) in model 1, and 1.07 (95% CI, 1.02-1.13) in model 2. However, no significant result was found for levels of tHcy ≥15 μmol/L vs <15 μmol/L in the men, women and all hypertensive subjects. Conclusions: When the level of tHcy was divided into quartiles, tHcy was positively associated with type 2 diabetes in hypertensive women subjects. However, when the level of tHcy was separated into hyperhomocysteinemic (≥15 μmol/L) and normal (<15 μmol/L), no signifi- cant results were observed.
Background and Objective: Over the past three decades, the prevalence of overweight and obesity in China has increased greatly. Chinese body mass index (BMI) dynamics have shown much greater rates of changes among men, aged 18-45 years, than among women. This study examined the gender difference in the BMI trends and re- lated factors. Methods and Study Design: We used longitudinal data from the China Health and Nutrition Sur- vey collected in 1997, 2000, 2004, 2006, 2009 and 2011. A total of 10,982 participants (N=5339 men and 5643 women) aged 18-45 years were included in the final analysis. Lambda mu sigma method (LMS) was used to de- scribe changes of BMI distribution. Separate sex-stratified multilevel random intercept-slope growth models were applied to examine effects of individual and community variables on BMI trends of Chinese adults. Results: Male BMI increased by 0.21 kg/m2 overtime, which was larger than female BMI at 0.16 kg/m2. Higher income, drinking and away-from-home food consumption were associated with higher BMI, and these variables were only significant among men. Physical activity (PA) had a negative association for both genders. Conclusions: Since different variables resulted in gender disparity in BMI trends among Chinese adults, separate health policies should be developed for men and for women.
Background and Objectives: Cross-sectional studies indicate that adaptation to Western norms, especially at a younger age, might explain the higher average body mass index (BMI) among Asians living in the United States (US) compared to Asians living in Asia. However, migrants differ from non-migrants in sociocultural factors that are difficult to measure and, thus, longitudinal studies on the same individuals prior to and after immigration are needed. The objective of this study was to determine differences in changes in BMI across age by residence (US or Asia) and age at immigration using longitudinal data on BMI prior to and after immigration. Methods and Study Design: The California Men’s Health Study includes 1,549 foreign-born Asian men who were aged 44-71 at baseline in 2002-03. BMI at ages 30, 40, 50 and 60 was calculated using self-reported weight history and cur- rent height. Residence at each age decade and age at immigration were determined. Data were analyzed using generalized estimating equations. Results: Ten-year BMI increases were smaller among Asians who lived in Asia prior to migrating to the US compared to those who already lived in the US. This effect was most evident be- tween ages 30-40 when Asians in Asia had a 0.69 kg/m2 (95% CI: -1.08, -0.30) smaller increase in BMI. Immi- grants who moved to the US before age 40 experienced greater increases in BMI than immigrants who moved to the US at an older age. Conclusion: This study is the first to support the hypothesis that living in the US and younger age at immigration results in larger BMI increases in Asian men.
Hypertension is one of the most common chronic diseases affecting more than 25% of adults worldwide. In Paki- stan, 33% of the adult population suffers from hypertension. Numerous epidemiological studies have demonstrat- ed the critical role of dietary patterns in the causation, prevention and management of hypertension. There’s a dearth of evidence from South Asia in this regard. The present study aimed to identify the association between dietary patterns and hypertension among 4304 low income urban adults who participated in the Control of Blood Pressure and Risk Attenuation (COBRA) study in Karachi, Pakistan. Dietary information was collected by a 33- item food frequency questionnaire and 3 unique dietary patterns namely; fat and sweet, fruit and vegetable, and seafood and yogurt patterns were derived using principal component factor analyses. We used univariate and multivariable logistic regression to examine the association between dietary patterns and hypertension. Men were more likely to have hypertension, while increase in age, and body mass index were also associated with hyperten- sion (p<0.001). After adjusting for age, gender, education, marital status, body mass index, and tobacco use; the seafood and yogurt pattern was less likely (OR=0.78: 95% CI: 0.63, 0.98; p-value 0.03) to be associated with hy- pertension, whereas no significant associations were seen for other two dietary patterns. These findings suggest that certain dietary patterns may be associated with hypertension among Pakistani low income urban adults.
Garlic is a common spicy flavouring agent also used for certain therapeutic purposes. Garlic’s effects on blood glucose have been the subject of many clinical and animal studies, however, studies reporting hypoglycemic ef- fects of garlic in humans are conflicting. A comprehensive literature search was conducted to identify relevant trials of garlic or garlic extracts on markers of glycemic control [fasting blood glucose (FBG), postprandial glu- cose (PPG), glycosylated haemoglobin (HbA1c)]. A meta-analysis of the effect of garlic intake on human was done to assess garlic’s effectiveness in lowering glucose levels. Two reviewers extracted data from each of the identified studies. Seven eligible randomized controlled trials with 513 subjects were identified. Pooled analyses showed that garlic intake results in a statistically significant lowering in FBG [SMD=-1.67; 95% CI (-2.80, -0.55), p=0.004]. Our pooled analyses did not include PPG control and HbA1c outcomes. Because only 1 study included in the meta-analysis reported PPG variables and only 2 studies reported HbA1c variables. In conclusion, the cur- rent meta-analysis showed that the administration of garlic resulted in a significant reduction in FBG concentra- tions. More trials are needed to investigate the effectiveness of garlic on HbA1c and PPG.
The objective of this study was to identify correlates of household food insecurity and poor dietary diversity in rural Cambodia. Trained interviewers administered a survey to 900 households in four rural districts of Prey Veng Province, Cambodia. The Household Food Insecurity Access Scale (HFIAS) and Household Dietary Diver- sity Score (HDDS) were used to assess household food insecurity and dietary diversity. Multivariate logistic re- gression models were constructed to identify independent correlates of household food insecurity and poor die- tary diversity (HDDS 3). The meanSD HFIAS and HDDS scores were 5.33.9 and 4.71.6, respectively. The respective prevalence of mild, moderate, and severe food insecurity were 33%, 37%, and 12%; and 23% of households had an HDDS 3. In multivariate analyses, several indicators of socioeconomic status, and ownership of agricultural land were associated with household food security status, although the latter association lost its significance in models that adjusted for household income. Similarly, although ownership of agricultural and homestead land was initially associated with poorer dietary diversity, income mitigated these associations. The presence of electricity and vegetable production were the only other variables that were significantly associated with both outcomes. In this rural area of Cambodia, the prevalence of any degree of household food insecurity was very high and dietary diversity was generally low. Interventions to improve food security and dietary diversi- ty should encompass income-generating activities and be targeted toward the poorest households.
Background and Objectives: Health outcomes such as survival, minimal disability and well-being are presump- tively dependent on food and ecosystems. An integral measure of the critical urban food system linkages to health problems is needed. Much of the current health change in cities could be attributed to short-comings in food sys- tems which can pose threats to food security and food safety. Health problems have needed a reconceptualisation of present medical and nutritional constructs. Methods and Study Design: The present study is based on a situa- tional analysis of food and the related ecosystems presumptively affected by rapid urbanisation in China. With an ecological information matrix, an Urban Food System Index with ten indicators which could influence food sys- tem outcomes and promote health and well-being has been developed. It uses sixteen data sets from the National Bureau of Statistics for all 31 provinces in China. The indicators were Locality, Climate, Biodiversity, Infrastruc- ture, Transport, Population structure, Livelihood, Recreation and Socialisation, Personal security and Communi- cation. The indicators for each province, scored between 1 (severe) and 5 (best), were used to predict life expec- tancy for China as a whole by multivariable regression analysis. Results: The best model explained 70% of the variance and had significant beta coefficients for population structure (proportion of juveniles) (-0.52, p<0.0001) and livelihood (food expenditure) (0.31, p<0.05). Conclusions: Population characteristics and livelihoods related to food systems can account for much of life expectancy as a health outcome. An index which captured this in- formation is provided and could evaluate concurrently as well as prospectively food system-related health with urbanisation.
The aim of this study was to assess the prevalence of six healthy dietary behaviours and associated factors in uni- versity students from 26 low, middle and high income countries. In a cross-sectional survey, we used a self- administered questionnaire (largely based on the European Health and Behaviour Survey) among 19503 under- graduate university students (mean age 20.8, Standard deviation=2.8, age range of 16-30 years) from 27 universi- ties in 26 countries. Results indicated that for a total of six healthy dietary behaviours, overall, students scored a mean of 2.8 healthy dietary behaviours. More female than male students indicated healthy dietary behaviours. In multivariate linear regression among men and women, living in an upper middle income or high income country, dieting to lose weight, the high importance of dietary health benefits, high non-organized religious activity, high physical activity and currently a non-tobacco user were associated with the healthy dietary behaviour index. The study found a high prevalence of relatively poor dietary healthy behaviours.
Background: The possible pathophysiology of the relationship between gastro-esophageal reflux disease and ap- nea of prematurity has been widely investigated. Various physiological protective reflex responses provide a plausible biological link between gastro-esophageal reflux and apnea of prematurity. It is uncertain whether or not there is a causal relationship between the two diseases. Patient’s Findings: Twins were admitted to the neo- natal intensive care unit due to feeding problems. Physical examination was normal except for reticulated, blue- violet skin changes. Short apneic attacks occurred on the first day in twin 1 and on the second day in twin 2, and these were initially treated by stimulation and increased ambient O2 concentration. Then, we conducted methylxanthine and continuous positive airway pressure treatment. Laboratory and radiological analysis were normal. As gastro-esophageal reflux disease was thought to be the causes of the treatment-refractory apnea, ther- apy with gaviscon and domperidon was begun for both cases. Apneic attacks did not recur after gaviscon and domperidon therapy. Conclusion: Pharmacological therapy for gastro-esophageal reflux disease has not defini- tively been shown to be effective in improving symptoms and hence, should be reserved especially for infants with treatment refractory apnea episodes suspected as being gastro-esophageal reflux in premature infants.
For infants with high arched palate, feeding is one of the most immediate challenges faced by parents and care- takers. General suggestions for feeding in infants with cleft palate may be adapted to infants with high arched palate. These include oral feeding facilitation techniques and special feeding tools. Here we present a newborn with a high arched palate and serious feeding problems who was fed easily by a large size and a large hole nipple, ordinarily used for infants older than 6 months, instead of specialized feeding equipment.
The Seminar on Adolescent Pregnancy and the First 1000 Days (the Philippine Situation) was held in Metro Ma- nila on September 2013. The objectives were to: 1) describe the current nutrition and health status of Filipino ad- olescent females, including those pregnant and lactating; 2) discuss existing programs that address their concerns; and 3) identify gaps in existing knowledge and programs, and ways to address these gaps. Adolescent pregnancy rates had increased from 8% in 2003 to 10% in 2008. In 2008, more than 35 percent of pregnant women below 20 years old were considered nutritionally-at-risk. Iodine deficiency and anaemia were major health problems in both pregnant and lactating women of all ages. While government programs exist to address the needs of preg- nant women, none were geared towards meeting the specific needs of pregnant adolescents. Conclusions: Studies are needed to find ways to improve adolescent health and to effectively prevent and deal with unwanted pregnan- cies among adolescents. Recommendations include 1) developing adolescent-friendly health centers, information and education materials to increase reproductive and health awareness among youth and health workers, 2) exam- ining the psychosocial and nutritional factors that determine birth outcomes and nutritional status of preg- nant/non-pregnant adolescents, 3) examining adolescent growth patterns following delivery, 4) evaluating the im- pact of current programs and interventions geared towards improving adolescent and maternal health, and more importantly, 5) identifying the underlying reasons for the continued rise in adolescent pregnancy in the country.
Background and Objectives: No consensus has been reached concerning the effects of peri-operative im- munonutrition in patients undergoing liver transplantation. We conducted a meta-analysis to evaluate the effects of peri-operative immunonutrition on clinical outcomes and liver function in patients undergoing liver transplan- tation. Methods and Study Design: The Pubmed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and google scholar were searched to identify all available randomized controlled studies which com- pared peri-operative immunonutrition support (glutamine, ω-3 polyunsaturated fatty acids, arginine and ribonu- cleic acids) with standard nutrition. The data analysis was performed using Revman 5.2 software. Results: A to- tal of 7 randomized controlled trials (RCTs) involving 501 patients were included. Peri-operative immunonutri- tion significantly reduced the risk of infectious complications (RR: 0.51; 95% CI: 0.27 to 0.98, p=0.04) and shortened the postoperative hospital stay [weighted mean difference (WMD): -3.89; 95% CI: -7.42 to -0.36; p=0.03]. Furthermore, peri-operative immunonutrition improved liver function by decreasing the levels of aspar- tate aminotransferase (AST) in the blood (WMD: -25.4; 95% CI: -39.9 to -10.9, p=0.0006). However, we did not find statistically significant differences in serum alanine aminotransferase (ALT), total bilirubin (TB) and direct bilirubin (DB) levels. There were no statistically significant differences in mortality and rejection reaction. Con- clusions: Peri-operative nutrition support adding immunonutrients like glutamine, ω-3 polyunsaturated fatty acids, arginine and ribonucleic acids may improve outcomes in patients undergoing liver transplantation. Due to the limited sample size of the included trials, further large-scale and rigorously designed RCTs are needed.
Background and Objectives: We designed this study to determine the predictive value of Nutritional Risk Index (NRI) for postoperative survival time of patients who had undergone hepatectomy for primary liver cancer. Methods and Study Design: The 620 patients who underwent hepatectomy for primary liver cancer (PLC) in the Department of Hepatobiliary Surgery, Cancer Hospital of Henan Province, Zhengzhou, China from December 1, 2008 to December 1, 2012 were followed up. A nutritional risk index (NRI) was used to screen the patients with malnutrition (NRI 100). At the same time, the prognosis and survival of the patients were recorded. Kaplan- Meier curve with log-rank test was used to analyze the relationship between malnutrition and prognosis of the subjects. Also the postoperative survival time and its influencing factors were analyzed by Cox proportional haz- ards model. Results: The cumulative survival probability at 1, 3, and 5 years of the 620 subjects was 49%, 33% and 29% respectively. Kaplan-Meier analysis with log-rank test showed that non-malnourished (NRI values >100) patients had longer postoperative survival time compared with malnourished patients. NRI values >100 was sig- nificantly associated with longer postoperative survival time. Cox proportional hazards model showed that NRI was an independent predictor of postoperative survival time and that NRI varied inversely with the risk of death. Conclusion: The patients with NRI values >100 survived longer than those with NRI values 100.
Background and Objectives: To examine the relationship between malnutrition criteria, serum glutamine and arginine concentrations, and clinicopathological features in Taiwan colorectal cancer patients. Methods and Study Design: Three malnutrition criteria (body weight loss >5% over past 6 months, body mass index (BMI) <18.5 kg/m2, and hypoalbuminemia) and serum levels of glutamine and arginine were measured in 164 colorectal patients. Malnutrition status and serum glutamine and arginine concentrations were tested for their association with each other, as well as with the clinicopathological variables. Results: Of the 164 patients, 38 (23.5%) had body weight loss, 19 (11.9%) had low BMI, and 57 (35.8%) had hypoalbuminemia. The univariate analysis showed hypoalbuminemia was correlated with advanced tumour stage, lower concentrations of glutamine, higher C-reactive protein level, and progression-free survival rate. Univariate analysis also showed glutamine levels were lower in advanced tumour stage, but arginine levels were not associated with any clinicopathologic varia- bles. Neither the nutrition criteria used in this study nor glutamine and arginine levels were correlated with hospi- tal stay or progression-free survival rate in multivariate analysis. Conclusions: Different nutrition assessment cri- teria produced different malnutrition rates in colorectal cancer patients; however, pre-treatment malnourished sta- tus and low serum glutamine and arginine concentrations were not correlated with hospital stay and progression- free survival rate.
No nutrition assessment tools specifically tailored for intensive care unit (ICU) patients have been developed and validated in Singapore. Studies conducted in Brazilian populations suggest that the thickness of the adductor pol- licis muscle (TAPM) may be used to assess nutritional status and predict mortality of critically ill patients. The aim of this study was to determine if TAPM can be used as a predictive indicator of mortality in Singapore ICU patients. TAPM values were obtained using skinfold calipers in 229 patients admitted to the medical ICU. TAPM measured in both hands showed no significant correlation with either the primary outcome (28-day mortality) or secondary outcomes (hospital outcome and hospital length of stay). This study demonstrated that TAPM does not predict 28-day mortality and hospital outcome, and is not correlated to length of stay in Singapore ICU patients. More studies are necessary to validate the use of TAPM as an anthropometric indicator of ICU outcome in other regions of the world.
This was a cross-sectional study that investigated the relationship between nutrient intake and psychosocial fac- tors with the overall rate of weight loss after bariatric surgery among patients who had undergone sleeve gastrec- tomy in University Kebangsaan Malaysia Medical Centre (UKMMC). Forty-three subjects (15 men and 28 wom- en) were recruited for this study. Subjects completed assessment questionnaires including the Binge Eating Scale (BES), Beck Depression Inventory (BECK), Family Support Questionnaires, and the Index of Peer Relation (IPR). Results showed that the median overall rate of weight loss was 4.3±5.5 kg/month, which was lower when compared to the rate of weight loss at three months which was 5.0±5.6 kg/month. Pre-operative weight was the predictor of overall rate of weight loss (p<0.05, R2=0.52). Binge eating disorder (BED) and depression were also closely associated with each other after bariatric surgery (p<0.001, R2=0.46). Subjects with good compliance to dietary advice had lower scores on the binge eating scale. The mean caloric and protein intake was very low, only 562±310 kcal/day and 29.6±16.1 g/day. The intake of vitamin A, B-1, B-2, B-3, B-12, C, folate, and iron met the Malaysian Recommended Nutrient Intake (RNI). However, the RNI for calcium, zinc, selenium, vitamin D, and vitamin E was not met. In conclusion, although bariatric surgery had many health benefits, several factors hin- dered weight loss after bariatric surgery. Health care professionals should closely monitor patients after bariatric surgery.
Cooling of cooked starch is known to cause starch retrogradation which increases resistant starch content. This study aimed to determine the effect of cooling of cooked white rice on resistant starch content and glycemic re- sponse in healthy subjects. Resistant starch contents were analyzed on freshly cooked white rice (control rice), cooked white rice cooled for 10 hours at room temperature (test rice I), and cooked white rice cooled for 24 hours at 4°C then reheated (test rice II). The results showed that resistant starch contents in control rice, test rice I, and test rice II were 0.64 g/100 g, 1.30 g/100 g, and 1.65 g/100 g, respectively. Test rice II had higher resistant starch content than test rice I, hence used in the clinical study along with control rice to characterize glycemic response in 15 healthy adults. The clinical study was a randomized, single-blind crossover study. In the clinical study, test rice II significantly lowered glycemic response compared with control rice (125±50.1 vs 152±48.3 mmol.min/L, respectively; p=0.047). In conclusion, cooling of cooked white rice increased resistant starch content. Cooked white rice cooled for 24 hours at 4°C then reheated lowered glycemic response compared with freshly cooked white rice.
Background and Objectives: Determinants of cystatin C, a novel marker of mortality in the elderly, have not been extensively studied in Asian elderly population. Methods and Study Design: Associations of cystatin C with anthropometric, cardiometabolic, hematological, nutritional variables and inflammatory markers were exam- ined in 159 community-living elderly Japanese women whose BMI averaged 22.6±2.9 (SD) kg/m2. Results: Se- rum creatinine and cystatin C averaged 0.73±0.16 mg/dL and 0.85±0.20 mg/L, respectively. Creatinine-based es- timated glomerular filtration rate (standardized β, -0.538, p<0.001), age (standardized β, 0.274, p<0.001), serum leptin (standardized β, 0.218, p<0.001) and tumour necrosis factor-α (TNF-α, standardized β, 0.165, p=0.002) emerged as significant predictors of serum cystatin C independent of percentage body fat, homeostasis model as- sessment of insulin resistance, high-sensitivity C-reactive protein, systolic blood pressure and HDL cholesterol (cumulative R2=0.674). Conclusions: Elevated serum levels of leptin and TNF-α contributed to elevated cystatin C independent of kidney function, fat mass, insulin resistance and inflammation in community-living elderly women and may represent confounders of associations between cystatin C and mortality in this population.