For thousands of years, humans have consumed tea made from leaves of Camellia sinensis, first as a medicinal herb and then as a widely popular beverage. In the past 10 years, theanine, a tea-derived, unique, nonproteinic amino acid, has been extensively studied for its health benefits. Recently, multiple lines of evidence have proven its beneficial effects on hepatic and immune functions. One possible mechanism for its biological activity in- volves the downregulation of the inflammatory response through the induction of nitric oxide production and glu- tathione synthesis. In this review, we summarize published results describing the potential mechanisms for these beneficial health effects and provide new insight into how theanine can be therapeutic for liver injury and chronic liver disease.
Background and Objectives: Animal studies have demonstrated poor cognitive outcomes in offspring in rela- tion to maternal vitamin D deficiency before and/or during pregnancy. Human studies linking maternal vitamin D status during pregnancy with offspring cognitive function are limited. We aimed to test the hypothesis that lower maternal vitamin D status during pregnancy is associated with poor offspring cognitive ability in an Indian popu- lation. Methods and Study Design: Cognitive function was assessed in children from the Mysore Parthenon birth cohort during childhood (age 9-10 years; n=468) and adolescence (age 13-14 years; n=472) using 3 core tests from the Kaufman Assessment Battery for children and additional tests measuring learning, long-term re- trieval/storage, short-term memory, reasoning, verbal fluency, visuo-spatial ability, and attention and concentra- tion. Maternal serum 25-hydroxyvitamin D concentration was measured at 30±2 weeks of gestation. Results: During pregnancy 320 (68%) women had ‘vitamin D deficiency’ (serum 25-hydroxyvitamin D concentration <50 nmol/L). Girls scored better than boys in tests of short-term memory, reasoning, verbal fluency, and attention (p<0.05 for all). Maternal vitamin D status (low as well as across the entire range) was unrelated to offspring cognitive function at both ages, either unadjusted or after adjustment for the child’s current age, sex, maternal age, parity, season at the time of blood sampling, gestational age, the child’s birth and current size, socio-economic status, parents’ education, maternal intelligence and home environment. Conclusions: In this population, despite a high prevalence of vitamin D deficiency during pregnancy, there was no evidence of an association between maternal vitamin D status and offspring cognitive function.
Background and Objectives: There is very limited published data on Tibetan dietary patterns and its association with nutrient intakes and socioeconomic factors. The aim of this study was to identify and describe the dietary patterns and the associations with nutrient intakes in rural Tibetan pregnant, lactating mothers. Methods and Study Design: Dietary patterns and nutrient intakes were identified via a food frequency questionnaire (FFQ). We identified dietary patterns using principle component analysis (PCA) of intakes of 17 food groups and specif- ic Tibetan foods. Quartile categories of each dietary pattern were used, and non-dietary lifestyle factors and total energy intake were adjusted for the analysis. We identified two dietary patterns: “Varied pattern” and “Staple pat- tern”. Result: The “Varied pattern” was characterized by a high intake of vegetables, fruits and soy foods which showed significant positive associations with vitamins. Vitamin C (Ptrend<0.01) and vitamin E (Ptrend<0.01) were strongly associated with “Varied pattern” among mothers with children younger or older than 12 months. The “Staple pattern” was characterized by Tibetan staple foods, Tibetan beverages and Tibetan snacks and showed significant negative associations with protein (Ptrend<0.01) among mothers with children younger than 12 months or older than 12 months. Carbohydrate intakes significantly increased with “Staple pattern” among mother with children younger than 12 months only. Conclusions: The results presented here suggested our dietary patterns to great extent characterize the dietary behavior of Tibetan lactating mothers. There is, therefore, potential for die- tary patterns to be used as a valid tool in assessing Tibetan diet.
Background and Objectives: As tackling socioeconomic inequality in child malnutrition still remains one of the greatest challenges in developing countries, we examined maternal educational differences in malnutrition and the magnitude of its inequality among 4,198 children from the Prospective Cohort study of Thai Children (PCTC). Methods and Study Design: Prevalence of stunting, underweight, and wasting from birth to 24 months was cal- culated using the new WHO growth chart. The Relative Index of Inequality (RII) was used to examine the magni- tude and trend of inequality in malnutrition between maternal educational levels. Results: The low education group had lower weight and height in most ages than the high education group. Faltering in height was observed in all education levels, but was most remarkable in the low education group. On the other hand, while upward trends for weight-for-age and weight-for-height across ages were observed in the high education group, a marked decline between 6 to 12 months was observed in the low education group. An increasing trend in inequality in The RII revealed an increasing trend in inequality in stunting, underweight, and wasting by maternal education levels was observed during infancy with an almost monotonic increase until 24 months, although the inequality in wasting decreased after 18 months of age. Conclusion: Inequality in malnutrition remarkably increased during infancy, and for stunting and underweight it remained until 24 months. These findings shed light on the extent of malnutrition inequality during the first 2 years of life and they suggest sustainable efforts must be established at the national level to tackle the malnutrition inequality in infancy.
Background and Objectives: To compare growth characteristics of Aboriginal and Caucasian formula-fed in- fants in the first 12 months of life. Methods and Study Design: We conducted post-hoc data analysis of infants who were part of a previous randomised controlled trial comparing infants randomly assigned to cow or goat milk-based infant formulae. Weight, height, and body composition were assessed at serial time points between study entry (~1-2 weeks of age) and 12 months. There was no growth difference between the randomised groups so the two groups were combined and the data were used to conduct a non-randomised comparison of the growth between Aboriginal (n=11) and Caucasian formula-fed (n=169) infants. Results: Aboriginal formula-fed infants had significantly higher mean z-scores for weight (0.65 difference, [95% CI 0.11, 1.18], p=0.018) and weight-for- length (0.82 difference [95% CI 0.20, 1.44], p=0.010) at 2 months, and all time points onward compared with Caucasian formula-fed infants. Mean length z-scores and the overall growth trajectory across time did not differ between Aboriginal and Caucasian formula-fed infants. Concordant with the weight and weight-for-length z- scores, Aboriginal infants had increased fat mass at 2 months (292 g difference [95% CI 56, 528], p=0.015), and all time points onward compared to Caucasian infants. There was no difference in fat free mass. Conclusions: Though there was only a small number of Aboriginal infants for comparison, our data indicate Aboriginal formu- la-fed infants were heavier and had a larger increase in fat mass over time compared with Caucasian formula-fed infants. Further studies using a larger cohort are needed to substantiate these findings.
Background and Objectives: Constipation, a common complaint in children, considerably affects the quality of life. This systematic review assessed the treatment effects of glucomannan on children with constipation by summarising evidence from previous randomised controlled trials (RCTs). Methods and Study Design: A com- prehensive electronic literature search was conducted for identifying eligible RCTs that evaluated the effective- ness of glucomannan. The results were reported as mean differences (MDs), standardised mean differences (SMDs), and risk ratios (RRs) with 95% confidence intervals (CIs). The primary outcome was the defecation fre- quency per week; the secondary outcomes were stool consistency and the rate of successful treatment. A meta- analysis was conducted using the random effects model. Results: Three RCTs evaluating 122 participants were identified. Glucomannan use was associated with an increased frequency of defecation (3 trials; MD=1.40; 95% CI: 0.36–2.44, p=0.008); however, there were no significant differences in the outcomes of stool consistency (3 trials; SMD=0.48; 95% CI: −0.44 to 1.40, p=0.300) or the rate of successful treatment (2 trials; RR=1.36; 95% CI: 0.48–3.81, p=0.110). Conclusions: Glucomannan moderately increases the defecation frequency of children with constipation but is not associated with a reduction in stool consistency or overall improvement in the rate of successful treatment. However, these results should be cautiously interpreted because of the small sample size and the risk of products containing glucomannan need to be considered. Additional large-scale and well-designed RCTs are necessary to evaluate the efficacy and long-term safety of glucomannan.
Background and Objectives: The Chinese government officially enacted the Regulation on the Management of Food Nutrition Labelling in 2007 and the General Rules for Nutrition Labelling of Pre-packaged Foods in 2011. Our investigation examined the presence and accuracy of nutrition labelling of pre-packaged foods in Shanghai and provides baseline data for future studies. Methods and Study Design: Nutrition labels on pre-packaged foods were recorded by photograph, transcription, or purchase in four supermarkets in Shanghai. We compared the observed labelling rate with results from a survey conducted in 2008. To assess labelling accuracy, we sent randomly selected foods to an analytical laboratory to test food energy and nutrient content. Results: The overall labelling rate was 54.8%, representing a great improvement over the rate measured prior to implementation of the Regulation (35.4%). The labelling rate for energy content and core nutrients were all above 98%, whereas the rates for saturated fat, trans-fatty acids, and iron were 11.5%, 7.0%, and 10.7%, respectively. Pre-packaged foods manufactured by domestic Chinese companies were labelled less frequently (45.8%) than foods manufactured by companies from Taiwan/Hong Kong (67.0%) or overseas (65.7%). The accuracy of carbohydrate content on la- bels was as high as 100%, while the accuracy of protein and fat content were 94.4% and 96.0%, respectively. Conclusion: Pre-packaged food manufacturers and government agencies should collaborate to improve the man- agement of nutrition labelling. Mandatory regulations may be the best way to ensure that nutrition labelling facili- tates informed consumer decision-making.
Background and Objectives: Adolescence is a critical life-stage that sets the foundation for health in adulthood. Adolescent women are a unique population and should be targeted as such for nutrition promotion activities. Us- ing Indonesia as a case study, this qualitative study aimed to identify existing nutrition promotion programs aimed at adolescent girls, how best to target this population and effective recommendations to inform nutrition education program design for this important group. Methods and Study Design: Semi-structured interviews and questionnaires were conducted with ten key informants working in public health in Indonesia. Interview tran- scripts were analysed and coded to identify key themes. Results: No existing nutrition education programs target- ing adolescent women in Indonesia were identified. Several strategies apply to nutrition programs for adolescent girls: 1) nutrition promotion messages that are relevant to the lifestyles and interests of adolescent women; 2) technology-based interventions show promise, however, they need to be appropriately targeted to sub-groups; 3) school remains an important setting; and 4) early marriage is an important issue affecting nutritional status and engagement of adolescent girls. The informants recommended that: 1) more research is needed about the underly- ing motivations for behaviour change among adolescent women and ways to effectively implement the identified engagement strategies; 2) adolescent girls should be included in program design to improve its suitability and up- take; and 3) government budget and policy support is crucial to success. Conclusions: Adolescent women are an important population group and more research is required to identify the optimal forms of engagement to improve nutrition programs for them.
Background and Objectives: A core challenge for low- and middle-income countries (LMICs) in combating the negative effects of the nutrition transition is to implement appropriate prevention strategies to halt the increasing prevalence of obesity and non-communicable diseases (NCDs), against a background of prevailing under nutri- tion. There have been several proposals for the enhancement of university nutrition education for future health and related professionals who are expected to communicate knowledge of health risks to the broad community. However, little is known about university nutrition education in LMICs. The present study aimed to investigate professional development opportunities and barriers for university nutrition lecturers to teach public health nutri- tion (PHN). Methods and Study Design: An online survey was conducted among 242 Vietnamese health and education professionals and university nutrition lecturers across Vietnam. Purposive sampling was used to recruit participants. Comparisons of between the groups’ responses were examined via SPSS Crosstabs. The structures of the perceived barriers and desired PHN training topics were examined via factor analyses. Multiple linear re- gression examined the influences on lecturers’ learning interests in nutrition areas. Results: The lecturers’ learn- ing interests spanned four areas: basic nutrition, basic food, food policy and ‘new’ trends (e.g. food policy, mar- keting). Major impediments to nutrition teaching in universities divided into two groups: resource limitations and professional constraints (e.g. lack of relevant training opportunities). The lecturers’ perceptions of professional constraints influenced their interest in learning about ‘new’ trends. Conclusions: The results highlighted the need and opportunities to enhance PHN professional development for nutrition lecturers in Vietnam.
Background and Objectives: Research on how urbanization has influenced the food environment in China is limited. The study aimed to examine the impact of urbanization on the food environment in China. Methods and Study Design: Longitudinal data collected during 1989-2009 from the China Health and Nutrition Survey were used, which covered 9 provinces in China. Urbanicity index (0-10) was assessed using an urbanicity scale. Final analyses included 216 communities. Random-effect models were used in analyses. Results: Urbanization (higher urbanicity index) increased the odds of having fast food restaurants (OR=2.78, 95% CI: 2.18-3.54) and other in- door restaurants (OR=2.93, 95% CI: 2.28-3.76) within the community, the odds of having supermarkets (OR=2.43, 95% CI: 2.04-2.89) and free markets (OR=2.56, 95% CI: 1.77-3.70) within 30 minutes’ bus ride from the community. Food prices for apples (β=0.06, 95% CI: 0.04-0.08) and lean pork (β =0.02, 95% CI: 0.01-0.03) increased with urbanicity, while prices for other food did not. Urbanicity was positively associated with commu- nity norms for fast food consumption (RR=1.28, 95% CI: 1.22-1.33), fast food preferences (RR=1.09, 95% CI: 1.06-1.12) and nutrition knowledge (RR=1.02, 95% CI: 1.01-1.03). Conclusions: Urbanization is associated with food environment in China. The findings provide insight for future economic development and public health ef- forts related to urbanization.
Background and Objectives: The association between fruit and vegetable (FV) intake and risk of the metabolic syndrome (MetS) has not been elucidated fully, particularly by menopausal status. Method and Study Design: The study population was 2,999 women aged 40-64 years participating in the 4th Korea National Health and Nu- trition Examination Survey. The definition of MetS and its components was based on the modified National Cho- lesterol Education Program Adult Treatment Panel III (NCEP ATP III) for Koreans. Dietary data were assessed by a 24-hour recall. Results: Fruit intake was inversely related only to the risk of high blood pressure (BP), but not MetS. Total vegetable consumption was inversely associated with the MetS risk, and when combined with fruits, the inverse association was observed even in its features of high triglycerides (TG) and low HDL- cholesterol as well as MetS. Assessing women by menopausal status revealed that the inverse association with the MetS risk was found only in postmenopausal women having greater total vegetables and total FV intake (aOR=0.47, 95% CI=0.29-0.75, p-trend=0.003 and aOR=0.54, 95% CI=0.35-0.85, p-trend=0.007, respectively). Analysis regarding MetS features showed that while the inverse association of total vegetables or total FV intake was observed with high TG risk in postmenopausal women, fruits intake was inversely associated with high BP risk in premenopausal women (aOR=0.54, 95% CI=0.37-0.79, p-trend=0.004). Conclusion: Results suggest that while fruit intake was inversely associated with high BP in premenopausal women, greater dietary intake of vege- tables and total FV may protect against the risk of MetS, particularly in postmenopausal women.
Background and Objectives: The Japanese Maternal Breastfeeding Evaluation Scale (JMBFES) was developed in 2013 based on the original Maternal Breastfeeding Evaluation Scale (MBFES). Mothers’ abilities to incorpo- rate breastfeeding into their daily life may influence their decision to continue or discontinue to breastfeed, but that version of the JMBFES had no questions to measure this important aspect of breastfeeding. Therefore, we sought to improve the JMBFES by incorporating questions measuring “lifestyle compatibility-incompatibility,” and we conducted psychometric testing of the improved version. Methods and Study Design: In this longitudi- nal study, the revised JMBFES was developed, and its reliability and validity was tested among 215 Japanese mothers. In the first survey, which was done three months after delivery, infant-feeding status and the prenatal in- tention regarding breastfeeding were measured. In the second survey, which was done two months later, the JMBFES questions were asked along with questions regarding infant-feeding status. We identified items that could be deleted while maintaining high reliability. Using regression models, we examined associations of JMB- FES scores with breastfeeding intention and breastfeeding outcomes. Results: All three subscales in the revised JMBFES had acceptable reliability (alpha ≥0.78). The two “lifestyle compatibility-incompatibility” items (one new item and the one that had been deleted previously) belonged to the “potentially negative aspects” subscale. Scores on that subscale were not associated with breastfeeding intention. However, in both surveys, the mothers who were using formula reported more potential difficulties (p≤0.01). Conclusion: Results of validation testing and reliability testing indicate that the revised JBFEES can be used to measure breastfeeding satisfaction among Japanese mothers.
Background and Objectives: The home food environment is known to influence children’s diet and selected health outcomes. However, similar research in adults is scarce. The home is arguably the most important food environment for New Zealand adults as the majority of food consumed is stored and prepared in the home. There- fore we investigated relationships between home food availability and nutrient intake in 50 year olds from Can- terbury, New Zealand. Methods and Study Design: A cross-sectional study where participants completed a home food inventory and a four-day estimated food diary. Regression analysis was used to investigate relation- ships between home availability of ‘Fruit and Vegetables’ and ‘Obesogenic Foods’ and intake of selected nutri- ents, adjusting for Body Mass Index and demographic factors. Men and women (n=216) aged 50 were randomly selected from Canterbury District Health Board area electoral rolls. Results: Women with a high ‘Obesogenic Foods’ score were significantly more likely to have a high intake of saturated fat (OR 5.8, CI: 1.67, 19.6) and high sugar intake (OR 3.1, CI: 1.23, 7.58). Men with a high ‘Obesogenic Foods’ score were less likely to have high folate (OR 0.14, CI: 0.05, 0.40) and fibre intake (OR 0.21, CI: 0.07, 0.60). Men and women with a higher ‘Fruit and Vegetables’ score were more likely to have high vitamin C intake (OR 5.6 and 4.5 respectively). Con- clusions: Home Food Inventory scores are associated with selected nutrient intakes, particularly in women, sug- gesting that they are useful for identifying those groups with less favourable nutrient intakes. Future research should investigate whether these scores can predict health outcomes.
Background and Objectives: The aim of this study was to investigate the relationship between major dietary patterns and the risk of insulin resistance (IR) among an urban Iranian population. Methods and Study design: In this longitudinal study, 802 adult men and women were studied within the framework of Tehran Lipid and Glucose Study. Fasting serum insulin and glucose were measured at baseline and again after a 3-year of follow- up. The usual dietary intakes were assessed using a validated 168 item semi-quantitative food frequency ques- tionnaire and major dietary patterns were obtained using principal component analysis. Logistic regression mod- els were used to estimate the occurrence of IR across tertiles of dietary patterns with adjustment for potential con- founding variables. Results: Mean age of participants was 39.0±11.2 years and 45.5% were men. Three major di- etary patterns including the Western, traditional and healthy were extracted, which explained 25.3% of total vari- ance in food intake. The healthy dietary pattern, loaded heavily on intake of vegetable oils, fresh and dried fruits, low-fat dairy, nuts and seeds,was accompanied with a reduced risk of insulin resistance by 51% (OR=0.49, 95% CI=0.30-0.81), and 81% (OR=0.19, 95% CI=0.10-0.36), in the second and third tertile, respectively (p trend=0.001). In the presence of all dietary pattern scores in the logistic regression model, a 45% reduced risk of IR was observed per 1 unit increase in healthy dietary pattern score. Conclusion: These findings confirmed the protective effect of a plant-based, low-fat dietary pattern against the development of insulin resistance as a main risk factor of type 2 diabetes and metabolic disorders.
Background and Objectives: Arterial stiffness is a leading cause of cardiovascular disease (CVD), and it is considered to be affected by dietary intake. However, few studies have examined the relationship between major dietary patterns and brachial-ankle pulse wave velocity (baPWV) among Japanese middle-aged subjects. We studied whether major dietary patterns were associated with baPWV in this population. Methods and Study Design: Between 2009 and 2012, 70 Japanese middle-aged subjects (39 men and 31 women) with no history of stroke, coronary heart disease, or cancer were studied. Dietary intake was documented using a validated food-frequency questionnaire, and dietary patterns were generated using factor analysis. Correlational analyses were performed between baPWV and identified dietary patterns and between baPWV and individual risk factors (total cholesterol, triglyceride, low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], nonHDL-C, LDL/HDL ratio, and augmentation index). Results: Two dietary patterns were identified: a rice-rich pattern (high in rice, breads, oils and fats, meats, and confectionery) and a vegetable-rich pattern (high in vegetables, fruit, fish, and seaweed). The rice-rich pattern was not associated with baPWVor other risk factors. A significant inverse correlation was found between baPWV and the vegetable-rich dietary pattern (p<0.05). Conclusions: Our findings suggest that a dietary pattern characterized by high consumption of vegetables, seafood, seaweed, fruit, and pulse is inversely associated with arterial stiffness measured by baPWV. This diet offers an additional nutritional approach to the prevention and treatment of arterial stiffness.
Background and Objectives: Recent observational studies have suggested a positive association of white rice and protective associations of green tea and coffee with the risk of diabetes. However, none have examined the interaction between these dietary factors on the risk of diabetes. We prospectively investigated the effect modification of green tea and coffee on the association between rice and incident diabetes in elderly Japanese men and women. Methods and Study Design: Among subjects who participated in the baseline survey (2004–2007), 11717 (91 %) subjects responded to the follow-up survey (2010–2012). By using multiple logistic regression analysis, ORs of incident diabetes were calculated according to categories of cereal food, green tea, and coffee intakes, examining also the effect modification of green tea and coffee. Results: 464 new cases of diabetes were identified. Women, but not men, showed a positive association of rice intake (trend p=0.008) and an inverse association of green tea intake (trend p=0.02) with incident diabetes. Coffee showed no association with incident diabetes either in men or women. In the analysis stratified by green tea intake, the association between rice and diabetes disappeared among women with an intake of ≥7 cups/d of green tea (interaction p=0.08). Conclusions: Rice intake was associated with an increased risk of diabetes only in women, and women with a higher intake of green tea had a lower risk of diabetes. A high intake of green tea may be protective against increased risk of diabetes with a higher intake of rice in women.
Background and Objectives: Each of the effects of physical activity and dietary intake on health is well known, but combined associations of physical activity and dietary intake on health has not been reported yet. Physical activity and dietary intake are key factors for maintaining health of survivors of the Great East Japan Earthquake in 2011. This study aimed to examine combined associations of physical activity and dietary intake with survivors’ health status. Methods and Study Design: We used data from 6668 participants of a cross-sectional survey taken 3 years (2013) after the disaster. To evaluate combined associations of physical activity and dietary intake, answers to questions regarding these two variables were categorized into four groups: poor physical activity and poor dietary intake (Group 1), poor physical activity and good dietary intake (Group 2), good physical activity and poor dietary intake (Group 3), and good physical activity and good dietary intake (Group 4). Multiple logistic regression analyses were performed by sex, with good self-rated health and good mental health as dependent variables, and age, place of residence, living conditions and physical activity/dietary intake group (with Group 1 as the reference category) as independent variables. Results: Good self-rated health was associated with age in both sexes, and Groups 3 (male: odds ratios (ORs) 1.84 (95% confidence intervals (95% CIs) 1.32-2.57), female: OR 1.82 (95% CI 1.32-2.51)) and 4 (male: OR 1.96 (95% CI 1.39-2.76), female: OR 1.94 (95% CI 1.42-2.64)). Good mental health was associated with Groups 3 (OR 1.48 (95% CI 1.10-1.97)) and 4 (OR 1.86 (95% CI 1.37-1.97)) for male respondents; and living place (other than temporary housing) (OR 1.45 (95% CI 1.26-1.68)) was associated with Group 4 (OR 1.42 (95% CI 1.09-1.85)) for female respondents. Conclusions: Good physical activity alone or combined with good dietary intake was associated with good self-rated health and good mental health. Further interventions regarding physical activity and dietary intake are needed to improve the health status of survivors.
Background and Objectives: Urbanization in China has increased the prevalence of high-fat and low-fiber diets, and of adverse health behaviors associated with an increased risk of diet-related, non-communicable diseases (DR-NCDs) in eastern Chinese women. This study aimed to characterize the dietary intake and health behaviors in eastern Chinese women. Methods and Study Design: Retrospective data of 122,058 women aged 25 to 70 who completed a multi-staged, stratified, cluster sampling epidemiological survey in eastern China in 2008, including self-report of diet and lifestyle information (sleep, physical activity, work, etc.). The survey included food groups (on a 4-point scale from daily to rarely) and health behaviors. Results: Of 122,058 surveyed women, 2008 (1.6%) smoked tobacco, 4326 (3.5%) consumed alcohol, 10,274 (8.4%) reported insomnia, and 38,305 (31.4%) exercised regularly. Consumption was most commonly reported as daily for vegetables/fruits (68.1%); 3-4/week for garlic (31.7%); 1-2/week for bean products (39.4%), red meat (40.8%), corn (36.6%), and carrots (41.9%); and rarely for milk products (46.4%), fried food (42.1%) and charcuterie (55.8%). Conclusions: This study suggests some overall positive lower rates of tobacco use, alcohol consumption and insomnia than reported previously, but physical exercise was also decreased. Dietary habits were relatively healthy.
Background and Objectives: Image-assisted dietary assessment methods are frequently used to record individu- al eating habits. This study tested the validity of a smartphone-based photographic food recording approach by comparing the results obtained with those of a weighed food record. We also assessed the practicality of the method by using it to measure the energy and nutrient intake of college students. Methods and Study Design: The experiment was implemented in two phases, each lasting 2 weeks. In the first phase, a labelled menu and a photograph database were constructed. The energy and nutrient content of 31 randomly selected dishes in three different portion sizes were then estimated by the photograph-based method and compared with a weighed food record. In the second phase, we combined the smartphone-based photographic method with the WeChat smartphone application and applied this to 120 randomly selected participants to record their energy and nutrient intake. Results: The Pearson correlation coefficients for energy, protein, fat, and carbohydrate content between the weighed and the photographic food record were 0.997, 0.936, 0.996, and 0.999, respectively. Bland-Altman plots showed good agreement between the two methods. The estimated protein, fat, and carbohydrate intake by participants was in accordance with values in the Chinese Residents’ Nutrition and Chronic Disease report (2015). Participants expressed satisfaction with the new approach and the compliance rate was 97.5%. Conclusions: The smartphone-based photographic dietary assessment method combined with the WeChat instant messaging appli- cation was effective and practical for use by young people.
Background and Objectives: Perioperative nutritional support has become a hot topic in the clinical manage- ment of congenital heart disease (CHD). Postoperative enteral nutrition (EN) offers many benefits, such as pro- tection of the intestinal mucosa, reduced risk of infection, and low clinical costs. Interruptions in EN frequently influence nutritional support and clinical outcomes. We, therefore, aimed to determine the causes of interruptions in postoperative EN in CHD patients and discuss clinical counter measures. Methods and Study Design: We an- alyzed the data of 360 CHD patients to determine the causes of interruptions in postoperative EN and develop possible clinical strategies to prevent such interruptions. Results: Of the 360 patients (aged from 1 month to 6 years), 198 patients had at least one EN interruption. The total number of interruptions was 498 (average, 2.52 in- terruptions/patient). Non-gastrointestinal factors (airway management, fluid overload, invasive procedure, in- creased intracranial pressure, feeding tube block, and clinical deterioration) accounted for 67.8% (338/498) of all interruptions and gastrointestinal factors (vomiting, gastrointestinal bleeding, diarrhea, constipation, and large gastric residual volume) accounted for 32.2% (160/498). The total number of interruptions and the number of in- terruptions due to gastrointestinal factors were significantly higher in younger patients (aged from 1–12 months) than in older patients (aged from 1–6 years). Conclusions: Non-gastrointestinal factors were the main causes of interruptions in postoperative EN in CHD patients. Younger patients had a greater number of interruptions as a whole, and more interruptions caused by gastrointestinal factors. Gastrointestinal factors can be reduced by tube feeding and use of gastrointestinal motility drugs.
Background and Objectives: The purpose of this study was to determine whether supplementation with lutein improved visual function in patients with nonproliferative diabetic retinopathy (NPDR). Methods and Study De- sign: In this randomized, double-blind, placebo-controlled trial, 31 patients with NPDR were assigned randomly to 10 mg/d of lutein or identical placebo for 36 weeks. Visual performance indices, including visual acuity (VA), contrast sensitivity (CS) and glare sensitivity (GS) at four different spatial frequencies, were measured at baseline, week 18 and 36. Results: At 36 weeks, a slight improvement in VA was found in the lutein group. A significant association was observed between the changes in VA and the corresponding baseline values in treatment group (r=-0.53; p=0.04). At 36 weeks, the lutein treatment group increased CS at four spatial frequencies, and the im- provement achieved statistical significance at 3 cycles/degree (p=0.02). The changes in CS at 3 cycles/degree for the lutein group was marginally significantly greater than those for the placebo group (p=0.09). There was also a slight increase in GS in the lutein group up to week 36, however, no significant changes were found over time in any cycles/degree. Conclusions: In patients with NPDR, supplementation with lutein resulted in potential im- provements in CS at low spatial frequency. Further studies are required to determine the possibility that such in- tervention could be used as an adjunct therapy to prevent vision loss in diabetic patients.
Background and Objectives: Vitamin D3 (cholecalciferol) dose required to maintain sufficiency in non- Caucasian women with postmenopausal osteoporosis (PMO) inthe tropics has not been well studied. Some guidelines mandate 800-1000 IU vitamin D/day but the Endocrine Society (US) advocates 1500-2000 IU/day to maintain 25-hydroxyvitamin-D (25(OH)D) concentration at >75 nmol/L. We aimed to establish oral cholecalciferol dose required to maintain 25(OH)D concentration at >75 nmol/L in PMO Chinese Malaysian women, postulating lower dose requirements amongst light-skinned subjects in the tropics. Methods and Study Design: 90 Chinese Malaysian PMO women in Kuala Lumpur, Malaysia (2°30’N) with baseline serum 25(OH)D levels ≥50 nmol/L were recruited. Prior vitamin D supplements were discontinued and subjects randomized to oral cholecalciferol 25,000 IU/4-weekly (Group-A) or 50,000 IU/4-weekly (Group- B) for 16 weeks, administered under direct observation. Serum 25(OH)D, PTH, serum/urinary calcium were measured at baseline, 8 and 16 weeks. Results: Baseline characteristics, including osteoporosis severity, sun exposure (~3 hours/week), and serum 25(OH)D did not differ between treatment arms. After 16 weeks, 91% of women sufficient at baseline, remained sufficient on 25,000 IU/4-weekly compared with 97% on 50,000 IU/4-weekly with mean serum 25(OH)D 108.1±20.4 and 114.7±18.4 SD nmol/L respectively (p=0.273). At trial’s end, 39% and 80% of insuffi- cient women at baseline attained sufficiency in Group A and Group B (p=0.057). Neither dose was associated with hyperparathyroidism or toxicity. Conclusions: Despite pretrial vitamin D supplementation and adequate sun exposure, 25.6% Chinese Malaysian PMO women were vitamin D insufficient indicating sunshine alone cannot ensure sufficiency in the tropics. Both ~900 IU/day and ~1800 IU/day cholecalciferol can safely maintain vitamin D sufficiency in >90% of Chinese Malaysian PMO women. Higher doses are required with baseline concentration <75 nmol/L.
Background and Objectives: We investigated whether intake of non-glutinous brown rice (BR) or glutinous brown rice (GBR) for 1 day had an influence on the daily glucose profile measured by continuous glucose moni- toring (CGM) when compared with intake of non-glutinous white rice (WR). Methods and Study Design: A to- tal of 37 inpatients with type 2 diabetes mellitus (T2DM) were recruited for a 3-day randomized triple cross-over trial in which they ate WR, BR, or GBR for 1 day each. One of the three types of rice was eaten at breakfast, lunch, and dinner on the first day, before switching to the other types on the second and third days. Each meal had the same energy content and the same side dishes. The main outcome measures were the blood glucose profile de- termined by continuous glucose monitoring (CGM) and the profile of serum C-peptide (CPR) for 3 hours after breakfast. A self-administered questionnaire was used to assess the palatability of each type of rice. Results: Ac- cording to the CGM data, the mean 24-hour glucose concentration was lowest with GBR (p<0.01). Serum C- peptide showed no significant differences among the three diets. Regarding palatability, BR was assigned signifi- cantly lower scores than WR and GBR (p<0.05), while there was no difference between WR and GBR. Conclu- sions: GBR intake suppressed the whole-day glucose profile of patients with T2DM, mainly by reducing post- prandial glucose excursion, and GBR was preferred over BR with respect to palatability. GBR may be worth add- ing to the diet of patients with T2DM.
Background and Objectives: This study aimed to evaluate the relationship between serum 25-hydroxy-vitamin D and bone metabolism in healthy women of reproductive age. Methods and Study Design: This study included 100 healthy female residents of Beijing (23-30 years old), who underwent bone ultrasonography as well as testing to evaluate serum25-hydroxy-vitamin D, parathyroid hormone, bone alkaline phosphatase, calcium, sodium, phosphorus, and alkaline phosphatase. Results: Mean 25-hydroxy-vitamin D in the winter (22.3±3.55 nmol/L) was significantly lower than that in the summer (46.2±16.3 nmol/L). In the winter, a negative correlation was ob- served between 25-hydroxy-vitamin D and parathyroid hormone(r=0.300, p=0.002) and bone alkaline phospha- tase (r=0.274, p=0.016). In the summer, a negative correlation was observed between 25-hydroxy-vitamin D and parathyroid hormone (r=0.386, p<0.001) and bone alkaline phosphatase (r=0.523, p<0.001). Serum calcium, so- dium, phosphorus, and alkaline phosphatase were within the normal ranges for both winter and summer, and ex- hibited no significant correlations with serum 25-hydroxy-vitamin D. The mean speed of sound during bone ul- trasonography was 4,125±365 m/s, and a linear correlation was observed between 25-hydroxy-vitamin D and the speed of sound(r=0.215, p=0.031). Serum alkaline phosphatise was not correlated with bone alkaline phosphatase. Conclusion: Serum vitamin D deficiency was common among healthy women of childbearing age in Beijing during both winter and summer. Furthermore, bone ultrasonography findings and serum vitamin D, parathyroid hormone, and bone alkaline phosphatase accurately reflected these women’s bone metabolism status.
Background and Objectives: The prevalence of low birth weight (LBW) infants in Japan has doubled in the last several decades. The objective of this study was to examine the effects of pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) on LBW infants of Japanese women. Methods and Study Design: This ret- rospective study was conducted using data on 1,336 mothers (mean age, 34.0 years) whose pre-pregnancy BMI was less than 23 kg/m2 and their singleton infants were born at full term between January and December in 2011. The outcome of interest was LBW infants (less than 2,500 g). The main exposure variables were pre-pregnancy BMI and GWG. The effects of these two variables on LBW were determined after adjusting for confounder vari- ables such as maternal age, smoking, drinking, parity, gestational week at birth and infant gender. Results: The proportion of LBW infants was 4.2% in total, 6.1% among underweight mothers (<18.5 kg/m2) and 3.5% among normal weight mothers (18.5-22.9 kg/m2). A stepwise multivariable logistic regression model showed that un- derweight mother were more likely [odds ratio (OR) 1.86, 95% confidence interval (CI), 1.04-3.31] than normal weight mother to deliver a LBW infant. Mothers with inadequate GWG <8.5 kg were more likely to deliver a LBW infant (OR 1.66, 95% CI: 0.80-3.45) compared with mothers who gained 10.5-12.4 kg (the third lowest quartile) but this did not reach statistical significance. Conclusions: This study demonstrated that mothers who were underweight before pregnancy were independently associated with the delivery of LBW infants.