Background and Objectives: Undernutrition remains a significant cause of childhood illness, poor growth, de- velopment, and death in Papua New Guinea (PNG). Studies on child nutritional outcomes in PNG vary by design, measurement protocols and quality. We conducted a systematic review to assess the evidence for the prevalence of child undernutrition across different study populations, geographical locations and time periods. Methods and Study Design: Six electronic databases and additional grey literature were searched for articles describing the nutritional status by wasting, stunting and underweight, of PNG children under five years of age, published be- tween 1990 and April 2015. Prevalence data using different scales of measurement and reference populations were standardized according to WHO protocols. Results: The search yielded 566 articles, of which, 31 studies met the inclusion criteria. The prevalence of child undernutrition varied from 1% to 76% for wasting (median 11%), 5% to 92% for stunting (median 51%), and 14% to 59% for underweight (median 32%). Wide variations exist according to the index used for measurement, the population characteristics and the geographical region in which they live. Prevalence estimates increase significantly when data using different scales of measurement and population references are standardized to the WHO protocols. Conclusions: Child undernutrition in PNG is re- gionally variable due to a complex interplay of poverty, disease, food-security, cultural, environmental and socio- political issues requiring a complex mix of solutions by governments, health systems and local communities. Ar- ea-specific surveys using multiple measures are necessary to inform local solutions for this important problem.
Background and Objectives: The counts of cariogenic bacteria lactobacilli and mutans streptococci have been studied and correlated with sugar intake. This study was to investigate the association between salivary lactoba- cilli and mutans streptococci counts with sweet food eating behavior and sweet sensitivity among 120 Malaysian women (101 ethnic Chinese, 19 ethnic Indians), while taking into account anthropometric and menstruation vari- ables. Methods and Study Design: Demographics, anthropometric measurements and menstrual history were taken. Hedonic preference, intake frequency of a list of sweet foods, intensity perception and pleasantness ratings of sweet stimuli were assessed. Saliva was collected for lactobacilli and mutans streptococci culture. Results: We found that centrally obese subjects (high waist circumference and waist-hip ratio) had significantly higher sali- vary lactobacilli and mutans streptococci counts (all p<0.05), while overweight and high total body fat subjects had significantly higher salivary mutans streptococci counts (p<0.001). The sweetness intensity perception of chocolate malt drinks was significantly lower in women who were in their pre-menstrual (post-ovulation) phase. However, menstruation variables (menstrual phases, regularity and pre-menstrual syndromes) did not play a role in determining compulsive eating, sweets/chocolate craving and salivary lactobacilli and mutans streptococci counts. Conclusions: Taken together, salivary lactobacilli and mutans streptococci counts of the Malaysian women are associated with central obesity, but not sweet food eating behaviour, sweet sensitivity and menstrua- tion variables. Salivary microbiome analysis could be useful as a potential diagnostic indicator of diseases such as obesity.
Background and Objectives: Although there are many studies on the umami receptor and its signaling pathway, literature on the effect of umami taste acuity on dietary choices in healthy subjects is limited. The current study aims to clarify the relationship between umami taste acuity with sweet or bitter taste acuity, food preference and intake. Methods and Study Design: Forty-two healthy Japanese female university students were enrolled. The acuity for umami, sweet, and bitter tastes was evaluated using the filter-paper disc method. The study population was divided into 32 umami normal tasters and 10 hypo-tasters based on the taste acuity at the posterior part of the tongue using monosodium glutamate. Results: Umami hypo-tasters exhibited a significantly lower sensitivity to sweet tastes than normal tasters. However, the sensitivity to bitter taste was comparable between the two groups. Food preference was examined by the food preference checklist consisted of 81 food items. Among them, umami tasters preferred shellfish, tomato, carrot, milk, low fat milk, cheese, dried shiitake, and kombu significantly more than umami hypo-tasters did. A self-reported food frequency questionnaire revealed no significant differences in the intake of calories and three macronutrients between the two groups; however, umami tasters were found to eat more seaweeds and less sugar than umami hypo-tasters. Conclusions: These data together may indicate the pos- sibility that umami taste acuity has an effect on a dietary life. Therefore, training umami taste acuity from early childhood is important for a healthy diet later in life.
Background and Objectives: The prevalence and potential health effects of common food antimicrobials in pro- cessed foods and beverages are relatively unknown in Singapore. The occurrence of chemical antimicrobials in processed foods and beverages and their effects on inflammation and oxidative stress in vitro were examined. Methods and Study Design: The occurrence of antimicrobials in 1605 processed food and 359 beverage items were examined by surveying the ingredients on the product labels. Human neutrophils were exposed to physio- logically relevant concentrations of common antimicrobials. Established markers of inflammation, l Leukotriene B4 and oxidative stress, F2-isoprostanes were measured using stable-isotope dilution gas chromatography-mass spectrometry. Results: Antimicrobials were added to 23.2% of the processed foods and beverages. Sorbic, benzoic, lactic, propionic and acetic acids accounted for 84.8% of the added antimicrobials in the processed foods and beverages. 92.5% of the bread contained propionic acid. Lactic acid was the most common antimicrobial (44.4%) in cheeses. Sorbic acid was added to 63.2% of the margarines selected. Sauces (31.5%), energy drinks (50.0%), soft drinks (70.7%) and fruit cordials (66.6%) contained added benzoic acid. Benzoic and propionic acids at physiologically relevant concentrations augmented leukotriene B4formation (benzoicacid, EC50 = ~100 μg L-1and propionic acid, >200 μg L-1). Lactic and sorbic acids dose-dependently inhibited the F2-isoprostanes production (IC50 values ~100 μg L-1) and myeloperoxidase activity (IC50values ~100 μg L-1). Conclusions: Our results demon- strate that Singapore consumers are significantly exposed to food antimicrobials, and these molecules, in physiologically relevant concentrations, exert significant and differential effects in vitro.
Background and Objectives: Omega-3 fatty acids are widely used in nutritional support. However, whether par- enteral supplementation with ω-3 fatty acids is effective for gastrointestinal cancer patients remains uncertain. This study assessed the effects of this form of parenteral nutrition on immune function and clinical outcomes in postoperative gastrointestinal cancer patients. Methods and Study Design: We searched Medline, Embase, Sco- pus, and the reference lists of selected studies to identify randomized controlled trials that compared ω-3 fatty ac- ids with a control, and that included immune indices, infectious complications, or length of hospital stay in the fi- nal outcomes. The odds ratio and weighted mean difference with 95% confidence intervals were calculated and the I2 statistic was used to assess heterogeneity. Results: Seven trials with a total of 457 participants were includ- ed in the meta-analysis. Five pooled trials with 373 participants indicated that the incidence of infectious compli- cations was significantly different between the intervention and control groups (odds ratio: 0.36; 95% confidence interval: 0.18, 0.74, p<0.05). Five trials involving 385 participants indicated that parenteral ω-3 fatty acid sup- plementation significantly shortened the length of hospital stay (weighted mean difference: −2.29, 95% confi- dence interval: −3.64, −0.93; p<0.05). Meta-analysis also indicated that ω-3 fatty acids increased the level of CD4+ and CD4+/CD8+ ratio. Conclusions: The results of this study suggest that parenteral ω-3 fatty acid supple- mentation is beneficial for gastrointestinal cancer patients, and is accompanied by improved postoperative im- mune function and satisfactory clinical outcomes.
Background and Objectives: The potential benefits of home enteral nutrition (HEN) and the effects of HEN on quality of life (QOL) after esophagectomy remain unclear. The aim was to investigate the effect of 3 months HEN on health related QOL and nutritional status of esophageal cancer patients who were preoperatively malnourished. Methods and Study Design: 142 malnourished (PG-SGA stage B or C) patients with esophageal cancer were assigned to receive Ivor Lewis minimally invasive esophagectomy (MIE group) with laparoscopic jejunal feeding tube placement or open esophagectomy (OE group) with nasojejunal feeding tube placement. After discharge, patients in the MIE group received HEN with 500-1000 kcal/d for 3 months, while the OE group patients did not receive HEN, as nasojejunal feeding tubes had been removed. QLQ-C30 and PG-SGA questionnaires were used to evaluate the QOL and the risk of malnutrition. Results: 67 patients were enrolled in the MIE group and 75 patients were enrolled in the OE group. Symptoms related to fatigue, nausea, vomiting, pain, and appetite loss were significantly decreased in the patients treated with 3 months HEN. Similarly, patients treated with 3 months HEN had a lower risk of malnutrition than patients did not receive HEN (PG-SGA score, 5.7 vs 7.9, p<0.01). More patients in the MIE group (received 3 months HEN) were able to complete postoperative chemoradiotherapy than patients in the OE group (p<0.01). Conclusions: MIE and subsequent treatment with 3 months HEN can improve the QOL and reduce the risk of malnutrition in preoperatively malnourished patients.
Background and Objectives: Preoperative oral carbohydrate therapy has been suggested to attenuate postoperative insulin resistance. The purpose of this study was to investigate the effect of a carbohydrate-rich beverage given preoperatively on intraoperative glucose metabolism. Methods and Study Design: This study was a randomised, open-label, placebo-controlled trial. Patients undergoing oral–maxillofacial surgery were divided into two groups. In the glucose group, patients took glucose (50 g/278 mL, p.o.) 2 h before anaesthesia induction after overnight fasting; control-group patients took mineral water. Primary outcome was blood concentrations of ketone bodies (KBs); secondary outcomes were blood concentrations of free fatty acids, insulin and glucose. Concentrations were measured 2 h before anaesthesia (T0), induction of anaesthesia (T1), and 1 h (T2), 3 h (T3), and 5h after anaesthesia start (T4). Results: In the control group (n=11), KBs increased continuously from anaesthesia induction. In the glucose group (n=12), KBs were maintained at low concentrations for 3h after beverage consumption but increased remarkably at T3. At T1 and T2, concentrations of KBs in the glucose group were significantly lower than those in the control group (T1, p=0.010; T2, p=0.028). In the glucose group, glucose concentrations decreased significantly at T2 temporarily, but in the control group, glucose concentrations were stable during this study (T2, p<0.001: glucose vs control). Conclusions: Preoperative intake of glucose (50 g, p.o.) can alleviate ketogenesis for 3 h after consumption but can cause temporary hypoglycaemia after anaesthesia induction.
Background and Objectives: To determine the effect of oral nutritional supplements (ONS) on children with acute lymphoblastic leukaemia undergoing remission-induction chemotherapy. Methods and Study Design: We included 127 paediatric patients who were diagnosed with acute lymphoblastic leukaemia and undergoing remission–induction chemotherapy in the First Affiliated Hospital of Zhengzhou University. Children from two paediatric wards who met the inclusion criteria were enrolled. One ward was randomly chosen as the intervention group and the other ward as the control group. Children in the two groups were matched for age and sex. The ONS group was administered Peptamen® (n=60) and the control group was administered a low-fat diet (n=67). Results: The baseline information before treatment was not significantly different between groups (p>0.05). In the control group, weight loss at the end of chemotherapy was significantly higher than that of ONS group (p<0.05). The hemoglobin level and the concentrations of total protein, albumin, and pre-albumin were significantly higher in the ONS group than in the control group (p<0.05 and p<0.01, respectively). The incidences of hypoalbuminaemia, gastrointestinal complications, and infection were lower in the ONS group than in the control group (p<0.05). The ONS group also used lower amount of albumin infusion, fewer blood-product infusion, and had lower hospital costs than the control group. Conclusions: During remission-induction chemotherapy, oral nutritional supplements can improve the nutritional status of children, reduce the incidence of complications, and decrease the costs of hospitalization.
Background and Objectives: Krill oil (KO) and fish oil (FO) are good sources of health-benefiting long chain n3 polyunsaturated fatty acids (LC n-3 PUFA), EPA and DHA. There are conflicting outcomes on the bioavailability of LC n-3 PUFA from KO compared with FO. This study investigated the postprandial incorporation of LC n3 PUFA into plasma lipids following consumption of 5 capsules of KO or FO in comparison with olive oil (OO) control in healthy women. Methods and Study Design: 10 women (aged 18-45 years) consumed a high-fat (15 g) breakfast, supplemented with 5 g of KO, FO, or OO in a random order with a minimum seven-day washout period between the supplementations. The LC n-3 PUFA content in KO was 907 mg compared with 1441 mg in FO. Blood samples were collected in the fasting state and for the next 5 hours after test meal consumption on an hourly basis. Results: Significant increases in plasma EPA concentrations were observed starting at 2 h after KO and FO consumption (p<0.05). There were no significant changes in either DHA or DPA between the three groups. The increases in plasma EPA concentrations were similar between the KO and FO groups (p>0.05). Conclusions: The lower dose (31%) of EPA from KO led to a similar plasma EPA concentration as in the FO group, suggesting that EPA from KO may be more efficiently incorporated into plasma. This may be related to the high content of phospholipids and free fatty acids in KO.
Background and Objectives: Beginning in 2007, 29 hospitals in South Korea have received accreditation from Joint Commission International (JCI). The present study aimed to identify differences in clinical nutrition service provisions between JCI accredited acute care hospitals and non-accredited acute care hospitals. A survey questionnaire was sent to all 43 acute care hospitals in South Korea. Methods: A total of 35 sets of clinical nutrition service surveys, 234 sets of clinical dietitian job satisfaction surveys, and five-day daily work logs from 129 clinical dietitians were received. We used Fisher’s exact test and independent t-test to analyze differences between acute care hospitals based on JCI accreditation. Study Design: Nationwide cross-sectional survey. Results: JCI accredited acute care hospitals (N=8) showed a higher, but not significantly higher, nutritional intervention rate of 12.7% among malnourished patients, compared with 7.0% in non-JCI accredited acute care hospitals (N=27). Analysis of work hours of clinical dietitians indicated time spent on direct care was higher (p<0.05), while time spent on outpatient care was lower (p<0.05) among JCI accredited acute care hospitals relative to non-JCI accredited acute care hospitals. Conclusions: Accreditation from JCI has a positive influence in the advancement of not only the hospital services, but also clinical nutrition services.
Background and Objectives: The rates of sarcopenia and cachexia evaluations by different occupational groups at different settings are unclear. The objectives are to evaluate and compare the relative use of sarcopenia and cachexia evaluations among dietitians and associated healthcare professionals in a diverse range of settings. Methods and Study Design: Participants were 4,621 members from the Japanese Association of Rehabilitation Nutrition. Settings included acute general wards, convalescent rehabilitation wards, long-term care wards, homecare service, and other settings. A questionnaire-based cross-sectional study was performed to evaluate assessments for sarcopenia and cachexia among dietitians and other professionals. Multiple comparisons based on Bonferroni method and logistic regression analysis were used. Results: 718 (15.5%) answered the questionnaire. Data from 683 valid questionnaires were analyzed. Muscle strength, muscle mass, physical function, and cachexia were assessed by 53.4%, 51.1%, 53.4%, and 17.4% of dietitians. At convalescent rehabilitation wards, these rates were 81.8%, 62.0%, 82.5%, and 14.0%. The use of muscle strength and physical function evaluations was significantly lower among dietitians than among physical therapists and occupational therapists. The use of muscle mass and cachexia evaluations was not significantly different among the occupations. The use of muscle mass and strength evaluations was significantly higher in convalescent rehabilitation wards than in acute general wards, long-term care wards and facilities, and other settings, but not in homecare services. Cachexia evaluations were not significantly different between all settings. Conclusions: Raising the awareness of cachexia and sarcopenia among dietitians is a key issue, which should be addressed.
Background and Objectives: This review manuscript examines the burden and national response to non- communicable diseases (NCDs), food and nutrition security in Vietnam from 1975 to 2015. Methods and Study Design: We extracted data from peer-reviewed manuscripts and reports of nationally representative surveys and related policies in Vietnam. Results: In 2010, NCDs accounted for 318,000 deaths (72% of total deaths), 6.7 mil- lion years of life lost, and 14 million disability-adjusted life years in Vietnam. Cardiovascular diseases, cancers, chronic obstructive pulmonary disease, and diabetes mellitus were major contributors to the NCD burden. Adults had an increased prevalence of overweight and obesity (2.3% in 1993 to 15% in 2015) and hypertension (15% in 2002 to 20% in 2015). Among 25-64 years old in 2015, the prevalence of diabetes mellitus was 4.1% and the ele- vated blood cholesterol was 32%. Vietnamese had a low physical activity level, a high consumption of salt, in- stant noodles and sweetened non-alcoholic beverages as well as low consumption of fruit and vegetables and sea- food. The alcohol consumption and smoking prevalence were high in men. Exposure to second-hand tobacco smoke was high in men, women and youths at home, work, and public places. In Vietnam, policies for NCD pre- vention and control need to be combined with strengthened law enforcement and increased program coverage. There were increased food production and improved dietary intake (e.g., energy intake and protein-rich foods thanked to appropriate economic, agriculture, and nutrition strategies. Conclusions: NCDs and their risk factors are emerging problems in Vietnam, which need both disease-specific and sensitive strategies in health and related sectors.
Background and Objectives: This review manuscript examines the burden and national response to non-communicable diseases (NCDs), food and nutrition in Vietnam from 1975 to 2015. Methods and Study Design: We extracted data from peer-reviewed manuscripts and reports of nationally representative surveys and related policies in Vietnam. Results: In 2010, NCDs accounted for 318,000 deaths (72% of total deaths), 6.7 million years of life lost, and 14 million disability-adjusted life years in Vietnam. Cardiovascular diseases, cancers, chronic obstructive pulmonary disease, and diabetes mellitus were major contributors to the NCD burden. Adults had an increased prevalence of overweight and obesity (2.3% in 1993 to 15% in 2015) and hypertension (15% in 2002 to 20% in 2015). Among 25-64 years old in 2015, the prevalence of diabetes mellitus was 4.1% and the elevated blood cholesterol was 32%. Vietnamese had a low physical activity level, a high consumption of salt, instant noodles and sweetened non-alcoholic beverages as well as low consumption of fruit and vegetables and seafood. The alcohol consumption and smoking prevalence were high in men. Exposure to second-hand tobacco smoke was high in men, women and youths at home, work, and public places. In Vietnam, policies for NCD prevention and control need to be combined with strengthened law enforcement and increased program coverage. There were increased food production and improved dietary intake (e.g., energy intake and protein-rich foods thanked to appropriate economic, agriculture, and nutrition strategies. Conclusions: NCDs and their risk factors are emerging problems in Vietnam, which need both disease-specific strategies and a strengthened health system response.
Background and Objectives: The present study aims to determine the serum vitamin B-12 in children presenting with vasovagal syncope. Methods and Study Design: This is a prospective review of 160 children presenting with vasovagal syncope. Subgroup analysis was done based on the results of head up tilt test. Results: Head up tilt test gave positive results in 80 children and yielded negative results in the remaining 80 children. The tilt test positive children had significantly lower thyroid stimulating hormone concentrations (p=0.06), total iron binding capacity (p=0.04) and serum vitamin B-12 (p=0.01). The prevalence of vitamin B-12 deficiency was significantly higher in the tilt positive group (80% vs 52.5%, p=0.001). Out of 80 children with positive tilt test, 8 children (10%) showed cardioinhibitory response, 22 children (27.5%) demonstrated a vasodepressor response, 24 children (30%) displayed mixed response and 26 children (32.5%) had the postural orthostatic tachycardia syndrome. Erythrocyte sedimentation rate was significantly lower in the mixed response group than in the vasodepressor group (6.2±0.8 mm/h vs 14.3±2.5 mm/h, p=0.001). Serum vitamin B-12 was significantly lower in the postural orthostatic tachycardia syndrome (POTS) group than in the vasodepressor group (240.8±38.2 pg/mL vs 392.7±27.1 pg/mL, p=0.001). The prevalence of vitamin B-12 deficiency was significantly higher in the POTS group than in the vasodepressor group (92.3% vs 45.5%, p=0.001). Conclusions: Vitamin B-12 deficiency causes reduction in myelinization, deceleration in nerve conduction and elevation in serum concentrations of noradrenaline. These factors may contribute to the impairment of autonomic functions which are involved in the pathogenesis of vasovagal syncope.
Background and Objectives: Recent studies have reported that obesity is associated with platelet activation and systemic inflammation. Malaysia has the highest prevalence of obesity, hence, this research is performed to eval- uate the development of low-grade inflammation and platelet activation, measured using soluble CD40 ligand (sCD40L) and soluble P-selectin (sP-sel), and to determine their association with obesity. In addition, we as- sessed the mean platelet volume (MPV) and platelet count (PLT), which are novel parameters consistently asso- ciated with obesity. Methods and Study Design: A cross-sectional study was conducted on 112 healthy men and women from 3 main ethnic group (Malay, Chinese, and Indian) who were aged 18–60 years. The participants were categorized into normal body mass index (BMI), overweight and obese groups according to WHO criteria for BMI in Asian populations (18.5 kg/m2<BMI<35 kg/m2). Waist circumference (WC) was also measured and included in the analysis. Results: MPV, sCD40L, and sP-sel differed significantly among the normal BMI, over- weight, and obese groups (p<0.05). Contrastingly, the PLT did not vary significantly among the 3 groups. In ad- dition, sP-sel levels correlated significantly with BMI (r=0.36, p=0.001) and WC (r=0.25, p=0.007) and MPV correlated significantly with BMI (r=0.2, p=0.001) and WC (r=0.2, p=0.003). Conclusions: Higher MPV and sP- sel levels in the obese participants than in the overweight and normal BMI participants indicated potentially high- er activation of platelets in people with obesity. Moreover, we observed higher sCD40L levels in obese partici- pants than in the overweight and normal BMI participants, suggesting a proinflammatory state in obese individu- als.
Background and Objectives: Skinfold thickness assessment is a widely recognized technique for the estimation of body adiposity and fat free mass. This method assumes that skinfolds’ compressibility is constant but there are some factors that could influence its compressibility. This study aims to evaluate whether the skinfolds’ com- pressibility is influenced by hydration status. Methods and Study Design: An intervention study was conducted in a sample of 22 adult male amateur soccer players, who took part in a 90min simulated soccer match. Before and after the intervention skinfolds thicknesses were measured in eight anatomical sites. An electronic caliper, Lipotool, was used to collect and record 120 values during 2s of evaluation. To analyze skinfolds’ compressibility, two methods were used: identification of lowest skinfold thickness measurement (SL) and SH = 110% x SL, and the parameter TAU (τ) determination. Baseline hydration status was evaluated by total body water (TBW) through multifrequency bioimpedance analysis. Dehydration was assessed by the difference of body weight be- fore and after the intervention. Results: The intervention resulted in a loss of 2.11% of participants’ baseline weight. The skinfolds thicknesses, assessed by SL and SH, were significantly higher after exercise for all skinfolds except for skinfolds at iliac crest and abdominal. This intervention did not affect skinfolds’ compressibility when assessed by τ. However, an association between dehydration and medial-calf skinfold’ compressibility was found (r=0.48, p=0.042). Conclusions: Although an increase in the skinfolds thickness after the intervention was found, skinfolds’ compressibility did not change.
Background and Objectives: Iron deficiency Anemia (IDA) in women of reproductive age is a recognized pub- lic health concern that impairs health and well-being in women and is associated with adverse reproductive out- comes. In Pakistan there is a dearth of up-to-date information on the prevalence and predictors of IDA. This study sought to investigate IDA in Pakistani women. Methods and Study Design: Secondary analysis was performed using the National Nutrition Survey in Pakistan 2011- 2012. We used a pre-structured instrument to collect socio demographic, reproductive and nutritional data on women. We also collected anthropometric measurements and blood samples for micronutrient deficiencies. Univariate and multivariate logistic regression were used to analyse the data. Results: A total of 7491 non-pregnant women aged between 15-49 years were included in the analysis. The prevalence of IDA was 18.1%. In the multivariate regression analysis; not using iron folic acid supplementa- tion during the last pregnancy adjusted odds ratio (AOR) (95% CI) 1.31 (1.05, 1.64), a history of four or more pregnancies AOR (95% CI) 1.30 (1.04, 1.60), birth interval of <24 months AOR (95% CI) 1.27 (1.06, 1.71), household food insecurity AOR (95% CI) 1.42 (1.23, 1.63) and presence of clinical anemia AOR (95% CI) 5.82 (4.82, 7.02) were significantly associated with increased odds of IDA while with obesity AOR (95% CI) 0.60 (0.4, 0.88) showed a protective effect on IDA. Conclusion: To reduce IDA in Pakistani women, the country needs a multifaceted approach that incorporates iron supplementation, food fortification, improved family planning ser- vices and efforts to reduce food insecurity.
Background and Objectives: Human milk has nutritional, protective, and developmental advantages for prema- ture infants. However, proteomic information of low abundant protein of donor milk is insufficient. The purpose of this study is to analyze and compare the proteome of low abundant protein of donor milk obtained at different postpartum ages other than the colostrum. Methods and Study Design: Donor breast milk from 12 healthy mothers was collected 15 days, 2 months and 6 months after delivery and stored by medically approved methods. The whey milk proteomes were analyzed by mass spectrometry and classified using bioinformatics analysis. Re- sults: Human milk obtained 15 days and 2 months after delivery showed more abundant expression of whey pro- teins related to the generation of precursor metabolites and energy, metabolism, and catalytic activity, compared with milk collected at 3 months. Immune and transport-related proteins were abundant at all time points. Proteins involved in cellular movement, immune cell trafficking, and the carbohydrate metabolism network was more abundant in whey milk collected at 15 day and 2 months using a network analysis. Conclusions: We report pro- teomic information for human donor whey protein. As significant changes were found in whey proteome collect- ed earlier than 2 months and 6 months after delivery, selecting human donor milk earlier than 2 months might be more helpful for early postnatal recipients.
Background and Objectives: Indonesia is currently facing double burden malnutrition in children. As over- weight and obesity are due to a disturbed energy balance, this study aimed to assess the association of total ener- gy intake and physical activity with the prevalence of overweight among Indonesian children. Methods and Study Design: The data used for this analysis were from 1143 children, 6-12 years old, that participated in the South East Asian Nutrition Survey (SEANUTS). Physical activity (PA) was measured using pedometers for 2 consecutive days and was categorized low, moderate and high. Child nutritional status was categorized based on body mass index for age z-scores (BAZ) into normal weight (-2 SD ≤BAZ≤1 SD) or overweight (BAZ >1 SD). Energy intake was calculated from a one day 24 hour recall and compared to the Indonesian recommended die- tary allowance (RDA) for energy. Results: Children with low PA had higher risk (ODDs 3.4, 95% CI: 2.0, 6.0) of being overweight compared to children who had high PA. Children with moderate PA and energy take >100% RDA had higher risk (ODDs 4.2, 95% CI 1.9, 9.3) of being overweight than children with high PA and energy intakes ≤100% RDA. Conclusions: Low physical activity independently or moderate physical activi- ty and high energy intake are risk factors for Indonesian children to get overweight. Program intervention such as increasing physical activity at school and home is needed to reduce overweight among children.
Background and Objectives: This study analyzed the intake of fruits and vegetables by cooking location and daily meals for Korean children and adolescents. Methods and Study Design: For this study, 2,538 Korean chil- dren and adolescents aged 7–18 years, who participated in the 2010 and 2011 Korea National Health and Nutri- tion Examination Survey dietary intake survey (24-hour recall methods), were sampled. Results: The total un- salted vegetable and fruit intake for all subjects was 300 g (aged 7–12 years, 280 g; aged 13–18 years, 316 g). Regarding cooking location, the combined unsalted vegetable and fruit intake was 159 g at home, 206 g at com- mercial locations, and 104 g at institutions. The combined unsalted vegetable and fruit intake in snack form was 128 g, which was higher than that during daily meals. In total, 24.9% of subjects satisfied the recommended fruit and vegetable intake (400 g), according to the guidelines created by the World Health Organization/World Can- cer Research Fund. Logistic regression analysis results revealed that the fruit and vegetable intake of girls was 1.4 times higher than that of boys, and the number of people who ate more than 400 g of fruits and vegetables was 1.7 times higher in the group with higher education. Conclusions: Based on the above results, in-depth measures to continuously increase intake of fruits and vegetables in children and adolescents are needed. This study can be used as basic data for the development of educational programs for dietary improvements.
Background and Objectives: Vitamin D deficiency is reportedly common, but we lack data from young adults. Such data are of interest because epidemiological data support vitamin D as a possible risk modulator for diabetes and cardiovascular (‘cardiometabolic’) disease. Our objectives were to assess vitamin D status (as plasma 25(OH)D concentration) and investigate associations between this and biomarkers of cardiometabolic disease risk in a group of still-healthy young adults in Hong Kong. Methods and Study Design: In this observational study, fasting venous blood was collected from 196 (63 males, 133 females), young (18-26 years) non-smoking, non- obese, consenting adults in good general health. Plasma 25(OH)D was measured by LC-MS/MS. A panel of es- tablished cardiometabolic risk factors (HbA1c, plasma glucose, lipid profile, hsCRP) and blood pressure were al- so measured. Results: Mean (SD) plasma 25(OH)D concentration was 42.1 (13.0), with range 15.7-86.8 nmol/L; 141/196 subjects (72%) had vitamin D deficiency (25(OH)D <50 nmol/L); 13/184 (6.6%) were severely deficient (<25 nmol/L). Inverse association was seen between 25(OH)D and fasting glucose (r=-0.18; p<0.05). Higher HbA1c and TC:HDL-C ratio and lower HDL-C were seen in those with plasma 25(OH)D <25 nmol/L (p<0.05). Conclusions: Vitamin D deficiency was highly prevalent and associated with poorer cardiometabolic risk profile in these young adults. Public health strategies for addressing vitamin D deficiency are needed urgently. These new data provide support for further study on vitamin D deficiency as a modifiable risk factor for cardiometabol- ic disease and the ameliorative effects of increased vitamin D intake on cardiometabolic disease risk profile of vitamin D-deficient young adults.
Background and Objectives: In investigating diet-disease relationships, examination of dietary patterns allows for conclusions to be drawn based on overall intake. This study characterized dietary patterns of early adolescent girls over a two-year period and examined the relationship between dietary patterns and body mass index (BMI). Methods and Study Design: Cross-sectional analyses were performed using longitudinal data from food records of early adolescent girls (n=148) 9 to 14 years in Hawai‘i from the Female Adolescent Maturation (FAM) study. Dietary patterns were identified using principal component analysis (PCA). Pearson’s correlations between BMI percentile and z-score and dietary pattern factor scores at Times 1 (2001-2002) and 2 (2002-2003) were calculat- ed. For each dietary pattern, participants were divided into low, intermediate, and high scorers. Mean BMI per- centiles and z-scores were compared between groups using analysis of covariance. Results: At Time 1, three pat- terns were identified, characterized by: (1) whole grains, nuts and seeds, added sugar; (2) non-whole grain, toma- toes, discretionary fat; and (3) deep yellow vegetables, other starchy vegetables, cooked dry beans/peas. At Time 2, three different dietary patterns emerged: (1) non-whole grains, meat, discretionary fat; (2) other vegetables, fish, eggs; and (3) whole grain, tomatoes, other vegetables. BMI percentile and z-score differed between high and low scorers on Time 1-Pattern 1 and Time 2-Pattern 3. Conclusion: Results revealed changes in dietary patterns over time and an association between intake and BMI. Findings demonstrate the importance of frequent nutrition as- sessment to monitor changes in intake that may be improved to prevent obesity.
Background and Objectives: Dietary protein intake has been associated with reduced risk of stroke. This study aimed to examine the relationship between premorbid dietary intake of protein and both stroke severity and neu- rological outcomes in patients with acute ischemic stroke. Methods and Study Design: Consecutive patients with first-ever ischemic stroke in Jinling Hospital were screened for eligibility of participation. A validated food- frequency questionnaire (FFQ) was performed to collect necessary data for calculating pre-stroke dietary intakes. Stroke severity was assessed by the National Institutes of Health Stroke Scale (NIHSS) at baseline. Neurological outcomes were assessed by the modified Rankin scale (mRS) 90 days after stroke onset. Multivariable logistical regression was applied to analyze the impacts of dietary protein intake on stroke severity or neurological out- comes. Results: Of the 201 enrolled patients, 110 (54.7%) were classified as minor (NIHSS ≤5) and 91 (45.3%) as major stroke (NIHSS ≥6). After adjusting for potential confounders, multivariable logistic regression did not detect significant association between total (odds ratio (OR)=0.98, p=0.15), animal (OR=1.01, p=0.87) or plant protein intake (OR=0.96, p=0.07) and stroke severity. According to the 90-day mRS, 127 patients (63.2%) were determined with good (mRS ≤2), and 74 (36.8%) with poor outcomes (mR 3-6). Multivariable logistic regression detected that premorbid dietary intake of total protein was positively associated with good neurological outcomes (OR=1.05, p=0.04). Conclusions: Higher level of premorbid protein intake may be associated with favorable neurological outcomes independent of stroke severity.
Background and Objectives: To assess the prevalence, etiology, diagnosis of primary and secondary lactose in- tolerance (LI), including age of onset, among children 1-5 years of age. Suspected/perceived lactose intolerance can lead to dietary restrictions which may increase risk of future health issues. Methods and Study Design: MEDLINE, CAB Abstract, and Embase were searched for articles published from January 1995-June 2015 relat- ed to lactose intolerance in young children. Authors independently screened titles/abstracts, full text articles, for eligibility against a priori inclusion/exclusion criteria. Two reviewers extracted data and assessed quality of the included studies. Results: The search identified 579 articles; 20 studies, the majority of which were cross- sectional, were included in the qualitative synthesis. Few studies reported prevalence of primary LI in children aged 1-5 years; those that did reported a range between 0-17.9%. Prevalence of secondary LI was 0-19%. Hydro- gen breath test was the most common method used to diagnose LI. None of the included studies reported age of onset of primary LI. Conclusions: There is limited recent evidence on the prevalence of LI in this age group. The low number of studies and wide range of methodologies used to diagnose LI means that comparison and interpre- tation, particularly of geographical trends, is compromised. Current understanding appears to rely on data gener- ated in the 1960/70s, with varied qualities of evidence. New, high quality studies are necessary to understand the true prevalence of LI. This review is registered with the International Prospective Register for Systematic Re- views (PROSPERO).
Background and Objectives: There is considerable evidence that periconceptional maternal folate deficiency and coding variants in maternal genes coding for critical enzymes in the folate pathway are associated with neural tube defects (NTDs) in offspring. In a case-control study we investigated C677T polymorphism in the 5,10- methylenetetrahydrofolate reductase (MTHFR) gene in case and control mothers of Pakistani origin, and com- pared these with the respective maternal folate concentrations measured at the time of delivery. Methods and Study Design: A case-control study was conducted among 109 case and 100 control mothers identified through the Holy Family Hospital Rawalpindi, Quaid-i-Azam University, Islamabad, Pakistan. Red blood cell (RBC) and serum folate concentrations and MTHFRC677T polymorphism were compared between case and control mothers. Results: Mean RBC folate and serum folate concentrations were significantly lower in cases compared with con- trol mothers (p<0.0001). Maternal MTHFR 677CT and 677TT genotypes were more common among cases com- pared with control mothers (CC vs TT p<0.0393 and CC/CT vs TT p<0.021). T-allele frequency was higher in cases compared with control mothers (C vs T p<0.017). Case mothers with 677CT or 677TT genotypes had sig- nificantly lower serum (p<0.0001) and RBC folate concentrations (p<0.0001) compared with control mothers. Conclusions: The present study provides further evidence that maternal folate deficiency and MTHFRC677T polymorphism might be associated with an increased risk for NTDs in offspring. Our results are limited by the fact that maternal folate concentrations were not obtained during the periconceptional period, but at delivery. Fur- ther analyses, including maternal folate levels during the periconceptional period, are warranted.
Background and Objectives: The present report summarized the best available evidence regarding consumption level and sources of free or added sugars in Indonesia. Methods and Study Design: Information was extracted from food balance sheets, household expenditure surveys, nutrition surveys, published studies, unpublished the- ses/dissertations, and government reports. Results: A total of 18 references were obtained, showing varying re- sults. Indonesia’s national surveys suggested intakes of sugar below 50 grams per day or below 10% of energy intake. Published studies suggested higher levels of intake. Studies used expenditure surveys or a single day of recall to determine dietary intake. None made use of biomarkers to determine the level of sugar intake. The 2014 Total Diet Study estimated that 11.8% of the population consumed >50 grams sugar per day. Common food sources were table sugar, wheat products, milk products, sweetened drinks, condiments, candies and chocolate products. Conclusions: Insufficient evidence exists regarding the levels and sources of added sugar intake of dif- ferent population groups in Indonesia. A nationwide survey using multiple (at least two) 24-hour recalls to allow estimation of usual intake and to identify food sources, and the use of biomarkers to validate intake will provide more accurate information on which to base policy decisions
Background and Objectives: There is no evidence on the most effective nutritional screening tool for hospital- ized children. The objective of this study was to develop and validate a pediatric nutritional screening tool to as- sess undernutrition risk upon hospital admission. Methods and Study Design: The study had a two-phase pro- spective observational design. A novel pediatric nutritional screening score (PNSS) was developed and sensitivity, specificity, and reliability were evaluated by comparing with a complete dietetic assessment. Length of hospital stay, weight loss, disease complications, and nutritional support were recorded. Results: PNSS consisted of three elements: disease with malnutrition risks, changes in food intake, and anthropometric measurements, with a score of 0–2 for each element. The optimal cut-off score to identify patients (n=96) at risk of undernutrition was two. The agreement between PNSS and the complete dietetic assessment was moderate (κ=0.435, 95% CI=0.373– 0.498). Sensitivity and specificity values of PNSS were 82% (95% CI=76%–87%) and 71% (95% CI=67%–74%), respectively. Inter-rater agreement had a κ value of 0.596 (95% CI=0.529–0.664, p<0.001). The percentage of children with undernutrition risk was 44.9%. Children with oncologic, gastrointestinal, and cardiac diseases were most likely to be at risk of undernutrition. The at-risk group was associated significantly with longer length of hospital stay and higher percentage of weight loss compared with the not-at-risk group. Conclusion: PNSS is the first nutritional screening tool developed for hospitalized children and validated in a large population of patients in China.
Background and Objectives: Resting energy expenditure (REE) and respiratory quotient (RQ) are important for optimal nutritional care. The purpose of this study was to assess the accuracy and repeatability of an indirect calo- rimetry device (IIM-IC-100) in the measurement of REE and RQ in healthy Chinese adults. Methods and Study Design: A total of 38 healthy adults (19 male and 19 female) aged 18-52 years (25±6 years) were enrolled in this study. REE and RQ were measured by IIM-IC-100 and by VO2000, alternately and in duplicate. Results: There was a highly significant correlation between IIM-IC-100 REE and VO2000 REE (r=0.906, p<0.001), with mean IIM-IC-100 REE significantly higher than that of VO2000 (1475±269 vs 1394±313 kcal/d, p=0.002). Bland- Altman analysis revealed that the mean difference between IIM-IC-100 REE and VO2000 REE was 81.3 kcal/d, with limits of agreement of -185 to +347 kcal/d. There was no significant difference in RQ between the two de- vices. No significant differences were observed between the repeated measurements for both devices. Intra- subject coefficients of variation (CVs) of REE were smaller for IIM-IC-100 (5.8%) than for VO2000 (10.5%), while CVs of RQ were similar for IIM-IC-100 (7.2%) and VO2000 (6.9%). Conclusions: These preliminary data indicated that the IIM-IC-100 showed promise as an accurate and precise tool in the assessment of REE and RQ in healthy Chinese adults.
Background and Objectives: The increasing prevalence of malnutrition in old people is related to the risk of ill- ness and death. A number of screening tools to detect malnutrition have been used in the elderly to assess nutri- tional status and predict prognosis. The aim of the present study was to investigate the ability of the Geriatric Nu- tritional Risk Index (GNRI) to assess nutritional status and predict mortality in very old home-care people by us- ing a cross-sectional study of Chinese older people aged 90–105 years. Methods and Study Design: The present study was based on a 4-year follow-up of mortality data from a previous cross-sectional study. The study was conducted with a very elderly population with a mean age of 93.5±3.2 years (n=716; 230 men and 486 women). In 2005, trained researchers performed face-to-face interviews and physical and geriatric assessments to obtain information on sociodemographic factors, self-reported medical diseases, geriatric-specific conditions, anthropo- metric factors, biochemical data, and the GNRI score. In 2009, vital status were requested from the local govern- ment. Results: After 4 years of follow-up, 371 participants died (125 men and 246 women, 51.8%). The median follow-up time was significantly worse in the nutritional risk group (GNRI 98) (30.26±15.80 vs 42.27±11.82 months, p<0.001). Activities of daily living (ADL) impairment (hazard ratio [HR]=1.414, 95% CI=1.121–1.783), and GNRI score (HR=0.92, 95% CI=0.908–0.932) were associated with all-cause mortality according to a Cox regression analysis. Conclusions: The GNRI, a nutrition-related risk index, can predict mortality in very old Chi- nese home-care people.
Background and Objectives: Finger millet (Eleusine coracana L.) (FM) is rich in dietary fibre and is therefore expected to elicit a lower glycemic response compared to other grains. However, there is little data on the glyce- mic properties of FM-based products. We evaluated the nutritional, sensory and glycemic properties of decorti- cated millet with lower polish (DFM-LDP), flakes (FMF), vermicelli (FMV) and extruded snack (FMES) (both FMV and FMES with 7-8% added soluble fibre). Methods and Study Design: The nutrient contents of the FM products were evaluated by standard AOAC (Association of Official Analytical Chemists) and AACC (American Association of Cereal Chemists) methods. Sensory evaluation was conducted monadically using a 9-point hedon- ic scale using untrained panel members. GI testing was conducted using a standardized validated protocol. The study was conducted according to the guidelines laid down by the Declaration of Helsinki, and was approved by the Ethics Committee of the Madras Diabetes Research Foundation. Results: The products had dietary fibre (DF) content between 5.8-15.6 g%. FMES was unique in having a very low fat content (0.17%). Evaluation of sensory perception revealed moderate acceptance of millet based products. The glycemic indices (GI) (mean±SEM) of the products were 84.7±7.7%, 82.3±6.4%, 65.5±5.1% and 65.0±6.6% for DFM-LDP, FMF, FMV and FMES respec- tively. Conclusions: DFM-LDP and FMF (purely finger millet based products) elicited higher glycemic respons- es. Comparatively, FMV and FMES (with added functional ingredients) exhibited medium GI values and, are healthier dietary options. It is possible to prepare FM products with lower GI by utilizing functional ingredients.
Background and Objectives: This study was aimed to investigate the association between obesity and chronic low grade inflammation (CLGI) measured by Dietary Inflammatory Index (DII) as a proxy indicator of CLGI among obese and non-obese teachers. Methods and Study Design: We conducted a cross sectional study among 128 non-obese (BMI <25) and 116 obese (BMI 25) female teachers aged 25-60 years from six urban schools in Yangon, Myanmar between January and March 2015. Usual dietary intake was collected by 3-day non- consecutive estimated 24 hour’s dietary records and semi-quantitative Food Frequency Questionnaires. Adapted DII was calculated by standardized methods using literature-derived population-based dietary inflammatory weights of 31 food parameters. C-reactive protein (CRP) was analysed by a sandwich Enzyme-Linked Immuno- sorbent Assay (ELISA) technique. Mean DII between obese and non-obese was compared by independent t test. The association between obesity indices and high DII (DII 1.1) and high CRP (>3 mg/L) were investigated by logistic regression. Results: Obese teachers had lower intakes of anti-inflammatory nutrients (vitamin B-6, vita- min A and zinc)/food (onion) compared with non-obese teachers (p<0.05) and obesity was significantly associat- ed with CRP (Odd ratio (OR)=5.5, 95% Confidence interval (CI) 1.2-24.1, p=0.02). However, there was no sig- nificant association between obesity and DII (OR=1.4, 95% CI -0.8-2.3, p=0.23). Conclusions: Role of anti- inflammatory foods should be promoted for prevention of obesity and related diseases. Further use of DII among Myanmar general population for prevention of obesity and its related diseases should be explored with longitudi- nal studies.