Background and Objectives: The double burden of malnutrition (DBM) – a combination of undernutrition and overnutrition – is a problem faced by many countries. This study aimed to comprehensively review the DBM in ASEAN (Association of South East Asian Nations) countries, including levels (population [including country, city, or any community], household, or individual), types (the type of undernutrition and overweight), and preva- lence. Methods and Study Design: Data were sourced from four electronic databases, Medline via OvidSP, Scopus, Global Health via OvidSP and Web of Science, from January 1990 until May 2017. We only included studies that reported prevalence of DBM, were published in English language peer-reviewed journals and were available in full text. Studies were formally assessed against a published critical appraisal tool to produce a robust narrative review. Results: We included 48 studies in the review from eight countries. No study was found from Singapore or Brunei Darussalam. Most studies were from Indonesia and there was only one study from Lao PDR. There were a range of criteria for anthropometry used in these studies, hence comparison is impossible. DBM happened at community, household, and individual levels, with different types of undernutrition (stunt- ing/underweight/wasting/thinness) in combination with overweight/obesity. At the household level, DBM ranged from 5.0% in Vietnam to 30.6% in Indonesia. Conclusions: ASEAN countries may need to strengthen surveil- lance using WHO standards to improve the comparability of data, further develop strategies to address under- or overweight issues and investigate potential “double-duty actions” as suggested by the World Health Organization.
Background and Objectives: To compare the effectiveness, safety, and costs of commercial standardized multi- chamber bag and customized compounded total parenteral nutrition (TPN) among gastric cancer patients after gastrectomy. Methods and Study Design: A retrospective cohort study was conducted among 64 gastric cancer patients who underwent gastrectomy from 2014 to 2016 in a tertiary teaching hospital in Beijing, China. Patients were categorized into standardized (s-TPN) and customized TPN (c-TPN) groups based on their TPN order after gastrectomy. Patients were followed up until discharge. The effectiveness measures (body mass index (BMI) and albumin) and safety measures (liver and renal functions and electrolytes) were compared before TPN started and after TPN finished within and between the two groups. The length of hospital stay and costs were compared be- tween the two groups. Results: There were no significant differences between the two groups in BMI preserva- tion, metabolic complications, the length of hospital stay and costs, except that both total bilirubin (Tbil) and di- rect bilirubin (Dbil) were significantly higher in the s-TPN group than c-TPN (p<0.05). Conclusions: There were no significant differences in effectiveness and safety measures, the length of hospital stay and costs between s- TPN and c-TPN groups, except that s-TPN group was more likely to lead to parenteral nutrition-associated liver disease (PNALD). More studies are needed to confirm the findings of this study in other healthcare settings and study populations.
Background and Objectives: To determine how frequently diabetic diets are recommended to individuals with diabetes in South Asia, whether they are followed, and if they are associated with healthier dietary choices and clinical benefits. Methods and Study Design: Data are from the Centre for cArdiometabolic Risk Reduction in South-Asia Cohort Study. Participants with self-reported physician-diagnosed diabetes (n=1849) were divided in- to four groups based on whether they reported being prescribed and/or were following a diabetic diet. Linear re- gression was used to estimate associations between these groups and outcomes. Results: 53% of participants with self-reported diabetes reported not being prescribed or following a diabetic diet. Among those prescribed and fol- lowing a diet, mean whole grain consumption was 1.18 times/day and refined grain consumption was 0.75 times/day compared to 0.88 times/day and 1.74 times/day, respectively, among those neither prescribed nor fol- lowing a diet (both p<0.0001). Following a diet despite not being prescribed a diet was not associated with gly- cemic control, blood pressure, or body mass index, but was associated with a -8.54 mg/dL (95% confidence inter- val: -15.5, -1.58) lower low-density lipoprotein cholesterol compared to not following and not being prescribed a diet after adjustment for confounders. Conclusion: Though participants who were prescribed diabetic diets and followed them exhibited healthier dietary choices, the majority of participants with diabetes in urban South Asia was neither prescribed nor followed such diets. Moreover, there was no statistically significant clinical benefit, thus indicating that current dietary modifications may not be large enough or consistent enough to produce mean- ingful changes in health outcomes in this population.
Background and Objectives: This analytical cross-sectional study investigated the prevalence of vitamin D de- ficiency and its association with metabolic risk factors in the adult population of Gansu Province, China. Meth- ods and Study Design: In total, 11,157 healthy participants (4,740 men and 6,417 women) were enrolled. A questionnaire was used to assess general characteristics and personal habits. We detected 25-hydroxyvitamin D and associated metabolic parameters through electrochemiluminescence immunoassays. Results: The prevalence of severe deficiency (<10 ng/mL), deficiency (10-20 ng/mL), insufficiency (20–30 ng/mL), and sufficiency (≥30 ng/mL) among the participants was 17.3%, 64.6%, 11.8%, and 6.3%, respectively. Vitamin D deficiency was more prevalent in women than in men (82.5% vs 81.1%, p<0.001). The significant predictors of vitamin D defi- ciency included younger age and female sex (p<0.05), whereas sun exposure, physical activity, and calcium (Ca) supplementation were associated with less vitamin D deficiency (p<0.05). Serum 25(OH)D3 was inversely asso- ciated with parathyroid hormone (r=−0.279, p<0.001) and positively associated with serum Ca (r=0.239, p<0.001), serum P (r=0.090, p=0.018), LDL cholesterol (r=0.100, p=0.008), and BMI (r=0.093, p=0.014). No significant association was observed between serum 25(OH)D3 and metabolic disorders. Conclusions: Vitamin D deficiency is highly prevalent among the adult population of Gansu Province, northwest China, especially young physically inactive and overweight women with limited sunlight exposure, whose biomarkers put them at greater risk of osteoporosis and cardiovascular disease.
Background and Objectives: Dietary patterns are undergoing a major shift worldwide. This study analysed the consumption of processed and ultraprocessed foods in Jakarta and its contribution to the energy and nutrient in- take based on the Individual Food Consumption Survey 2014. Methods and Study Design: Food consumption data were based on 24-hour dietary recall. Foods were grouped into four food groups: nonprocessed foods, pro- cessed ingredients, processed foods, and ultraprocessed foods and subsequently categorised according to the In- donesian Food Category System. Energy and nutrient intake were calculated using Nutrisurvey 2007 software. Results: Nonprocessed food, processed ingredient, processed food, and ultraprocessed food consumption con- tributed to 57.2%, 21.6%, 1.7%, and 19.5% of total weight consumption, respectively. Ultraprocessed foods con- tributed to 15.7%, 16.7%, 14.2%, 12.6%, 18.4%, and 31.3% of daily energy, carbohydrate, protein, fat, sodium, and sucrose intake, respectively, and the respective contributions of nonprocessed foods were 52.2%, 58.7%, 65.8%, 32.6%, 7.9%, and 11.1%; of processed ingredients were 30.0%, 22.7%, 16.4%, 53.6%, 68.9%, and 57.6%; and of processed foods were 2.1%, 2.0%, 3.6%, 1.2%, 4.8%, and 0%. Linear regression analysis between the amount of food consumption and nutrient intake showed that at the same weight consumption, processed ingredi- ents provided a higher intake of energy, fat, sodium, and sucrose than the other food groups. Conclusions: Pro- cessed and ultraprocessed foods still have a lower contribution to energy and nutrient intake in Jakarta than nonprocessed foods and processed ingredients.
Background and Objectives: Pregnant women are at particular risk of iodine deficiency due to their higher io- dine requirements. Iodine is known to be essential for normal growth and brain development, therefore neonatal outcomes in mildly iodine deficient areas, such as Gippsland, are a critical consideration. This study aimed to in- vestigate whether iodine supplementation prevented iodine insufficiency as determined by neonatal thyroid stimulating hormone (TSH) screening criteria. Methods and Study Design: Gippsland-based women aged 18 years, in their third trimester of pregnancy, provided self-reported information regarding their iodine supplement use and consent to access their offspring’s neonatal TSH screening data. 126 women consented to participate, with 111 women completing all components of this study. Results: Only 18.9% of participants followed the Na- tional Health and Medical Research Council (NHMRC) recommendation of 150 μg/day iodine supplement, with 42.3% of participants not taking any supplements, or taking supplements with no iodine or insufficient iodine. The remaining women (38.7%) were taking supplements with doses of iodine much higher (200-300 μg) than the NHMRC recommended dose or were taking multiple supplements containing iodine. When correlating iodine in- take to their neonates’ TSH, no correlation was found. When iodine supplementation usage was categorised as below, equal to, or above NHMRC recommendations there was no significant difference in neonatal TSH. Con- clusion: This study found that iodine supplementation appeared to prevent maternal iodine insufficiency when measured against neonatal TSH screening criteria.
Background and Objectives: Iodine deficiency remains a public health concern, particularly in pregnant women and those planning pregnancy because of the risk of impaired fetal neurological development. Following imple- mentation of strategies to improve iodine intake in Australia, there has been minimal investigation into current iodine status. We aimed to characterise iodine status in a population of women of childbearing-age in Australia. Methods and Study Design: A cross-sectional study was performed in 97 women of childbearing-age attending outpatient clinics at a tertiary hospital in Sydney. Pregnant and postmenopausal women were excluded. Iodine in- take was surveyed via questionnaire. Spot urinary iodine (UI) was concurrently measured. The relationships be- tween UI, dietary intake and use of iodine-containing multivitamins/medications were examined. Results: Medi- an UI was 117 ug/L. Forty women (41%) were iodine deficient (UI <100 ug/L). The most commonly consumed source of dietary iodine was bread (29/97, 30% daily). Forty-three women took iodine-containing multivitamins but 18/43 (41.2%) remained deficient. There were no significant associations between UI and diet. There was a smaller proportion of deficient people than in our previous study (125/180 non-pregnant subjects, 69%, vs 41% in this study, p<0.001). Conclusion: The overall population median is now sufficient, however, a significant pro- portion of this multicultural group are iodine deficient. There are similar proportions of deficiency in those using iodine supplements versus not. Contributors may include ethnicity-related dietary practices, limited awareness or poor adherence to iodine supplements. Despite public health strategies, a significant proportion of women of child-bearing age remained iodine deficient. Further research involving a larger population and contributors to io- dine deficiency is warranted.
Background and Objectives: Excessive gestational weight gain has been associated with higher risk for large for gestational age newborns. This systematic review and meta-analysis aims to assess whether an intensive diet and exercise intervention has an effect in reducing gestational weight gain and large for gestational age newborns. Methods and Study Design: The search was conducted on PubMed and Cochrane database. Through PRISMA flow diagram, clinical trials which met the inclusion criteria were selected. Risk of bias, sensitivity analysis, and quality of evidence assessment were conducted using adequate statistical tests, and the quality of evidence was performed by GRADE method. A random-effect model was used to estimate the statistical significance of the me- ta-analysis. Results: Ten clinical trials met the inclusion criteria. Using the random-effect model and a sensitivity analysis, it was found that an intensive patient-centered intervention reduced gestational weight gain when com- pared with standard prenatal care (Z=6.21 (p<0.00001); Tau2=0.00; Chi2=3.90, df=4 (p=0.42); I2=0%), and the quality of evidence was moderate. An intensive diet and exercise intervention decreased the number of large for gestational age newborns (Z=2.20 (p=0.03); Tau2=0.14; Chi2=7.84, df=4 (p=0.10); I2=49%), and the quality of evidence using the GRADE approach was moderate. Conclusion: The present review and meta-analysis indicates that an intensive diet and exercise intervention reduced gestational weight gain and large for gestational age new- borns.
Background and Objectives: Childhood obesity is increasing in urban India. This study aimed to examine the associations of younger siblings abdominal adiposity with individual, familial and environmental factors, in urban school aged siblings. Methods and Study Design: Weight, height and waist circumference of 2906 siblings aged 3-16 years were measured along with details on demographics, diet, lifestyle, behavior and reported parental an- thropometrics. Abdominal adiposity was classified as waist circumference above the age and sex specific 75th percentile value. The associations of various factors with abdominal adiposity in the younger siblings were exam- ined through logistic regression analyses. Results: Sibling, familial factors and environmental factors had signifi- cant associations with abdominal adiposity. The odds of a younger sibling having abdominal adiposity was great- est (OR=3.16, 95% confidence interval (95% CI): 2.27 to 4.42), when the older sibling had abdominal adiposity, followed by the odds ratio of both parents being overweight (OR=1.63, 95% CI: 1.33 to 1.99) compared to nei- ther being overweight. The influence of abdominal adiposity of the older sibling was greater when the siblings were of the same sex (OR=3.55, 95% CI: 2.24 to 5.65) than when they were of different sex (OR=2.73, 95% CI: 1.67 to 4.46); the odds ratio being highest when both siblings were males. Conclusions: The younger sibling’s abdominal adiposity is associated with that of his/her sibling and parental obesity, in addition to other known risk factors in urban south Indian families. Interventions to prevent childhood obesity need to also consider the sibling effect along with the other known factors.
Background and Objectives: The results of prenatal nutrient supplementation on birth weight are inconsistent in different areas. This study aimed to investigate whether the effects of prenatal iron plus folic acid and folic acid supplementation on neonatal birth weights differed between urban and rural areas of Northwest China. Methods and Study Design: A stratified multistage random sampling method was used to recruit women between the ages of 15 and 49 and their offspring born between 2010 and 2013 from 10 urban areas and 20 rural areas of the Shaanxi Province of Northwest China. Information regarding socio-demographics and prenatal nutrient supple- mentation status was collected using a standardized questionnaire, and the neonatal birth weights were obtained from the birth certificates. Multilevel models were established separately for the urban and rural areas to assess the effects of prenatal nutrient supplementation on neonatal birth weights. Results: The association between pre- natal nutrient supplementation and neonatal birth weight was not statistically significant in urban areas. However, in rural areas, prenatal iron plus folic acid and folic acid supplementation increased the mean birth weights by 45.3 g (9.4 to 81.1 g, p=0.014) and 30.9 g (15.6 to 46.1 g, p<0.001), respectively. Conclusions: The effects of prenatal nutrient supplementation on neonatal birth weights differ between urban and rural areas of Northwest China. The different effects may be due to the different nutritional status of the urban and rural pregnant women. Prenatal nutrient supplementation may be a helpful way for improving neonatal birth weight in rural areas.
Background and Objectives: Information on the growth status of indigenous children is useful for developing intervention strategies, but the data are limited. This study determined the prevalence of undernutrition among under-five indigenous children (Orang Asli) and tracked the growth status of Orang Asli children aged 0–3 years. Methods and Study Design: This study had two phases: a cross-sectional growth study of under-five Orang Asli children (N=304; Phase 1) and a 2-year prospective cohort growth study of Orang Asli children aged 0–3 years (N=214; Phase 2) in the Temerloh district of Pahang, Malaysia. Weight-for-age, length/height-for-age, weight- for-length/height, and body mass index-for-age were determined. Results: The prevalence rates of stunting, un- derweight, wasting, and thinness in under-five Orang Asli children (Phase 1) were 64%, 49%, 14%, and 12%, re- spectively. In the cohort of 214 children (Phase 2), weight-for-age was initially documented and maintained closely at −1.50 standard deviations (SD) in the first 6 months, but it declined to approximately −2.00 SD at 15 months and remained close to −2.00 SD thereafter. Length/height-for-age declined rapidly to approximately −2.50 SD at 18 months and fluctuated between −2.30 and −2.50 SD thereafter. Weight-for-length/height in- creased sharply to −0.40 SD at 2–3 months, declined gradually to less than −1.00 SD at 12 months, and plateaued between −1.00 and −1.30 SD thereafter. Conclusions: Undernutrition is prevalent among Orang Asli children, with length rather than weight faltering being more pronounced in the first 2 years of life. Identifying the causes of early growth retardation in this population is required to inform future preventive strategies.
Background and Objectives: Malnutrition is a known complication of Inflammatory Bowel Disease (IBD). We assessed a known screening tool, as well as developed and validated a novel screening tool, to detect nutrition risk in outpatients with IBD. Methods and Study Design: The Saskatchewan IBD–Nutrition Risk (SaskIBD-NR Tool) was developed and administered alongside the Malnutrition Universal Screening Tool (MUST). Nutrition risk was confirmed by the IBD dietitian (RD) and gastroenterologist (GI). Agreement between screening tools and RD/GI assessment was computed using Cohen’s kappa. Results: Of the 110 patients screened, 75 (68.2%) patients had Crohn’s Disease and 35 (31.8%) ulcerative colitis. Mean BMI was 26.4 kg/m2 (SD=5.8). RD/GI as- sessment identified 23 patients (20.9%) at nutrition risk. The SaskIBD-NR tool classified 21 (19.1%) at some nu- trition risk, while MUST classified 17 (15.5%). The SaskIBD-NR tool had significant agreement with the RD/GI assessment (k 0.83, p<0.001), while MUST showed a lack of agreement (k 0.15, p=0.12). The SaskIBD-NR had better sensitivity (82.6% vs 26.1%), specificity (97.7% vs 87.4%), positive predictive value (90.5% vs 35.3%), and negative predictive value (95.5% vs 81.7%) than the MUST. Conclusion: The SaskIBD-NR, which assesses GI symptoms, food restriction, and weight loss, adequately detects nutrition risk in IBD patients. Broader valida- tion is required.
Background and Objectives: Children age 6 to 72 months, living in refugee camps are at increased risk of de- veloping vitamin A deficiency (VAD), resulting in increased morbidity and mortality. Due to poverty, often this population group has limited access to foods containing vitamin A from animal-based food sources and do not commonly consume available foods containing beta-carotene. To date, there is a paucity of data on vitamin A in- take in young refugee children. To determine vitamin A intake in children ages 6 to 72 months at refugee camps in East Timor. Methods and Study Design: A cross sectional study was carried out among children ages 6 to 72 months at refugee camps near Dili, East Timor. A detailed vitamin A intake questionnaire was ascertained from the primary caretaker, and the criteria and indicator cut off values suggested by World Health Organization (WHO) were used to classify the populations’ vitamin A risk. Results: Although animal sources of vitamin A were limited due to costs, all 89 children commonly consumed fruit containing vitamin A sources more than 3 times a week. Most children (69.7%) had been breast fed regularly, while 30.3% combined with bottle milk. 80.9% of children received vitamin A supplementation. Conclusion: Children in East Timor refugee camps have adequate vitamin A intake.
Background and Objectives: The food frequency questionnaire (FFQ) is a dietary tool used to assess the habitu- al intake of the population. The goal of this study is to examine the reproducibility and validity of the FFQ that was developed for a multi-ethnic population in Malaysia. Methods and study design: Collective food data from MyHeARTs 2012 database were used to construct the MyUM Adolescent FFQ. Seventy-eight participants be- tween 13 and 15 years old in 2014 were selected through convenient sampling for test – retest study. They com- pleted the MyUM Adolescent FFQ twice, with an interval period of one week. One hundred and fifty-six MyHeARTs study participants who were 15 years old in 2014 were randomly selected for this comparative valid- ity study. They completed a 7-day diet history (7DDH) and subsequently completed the self-administered MyUM Adolescent FFQ. Results: Pearson’s correlations between the FFQ and 7DDH for all macronutrients were statis- tically significant. Energy-adjusted correlations for protein, carbohydrate, and fat were 0.54, 0.63 and 0.49 re- spectively. Most of the micronutrients and minerals, were statistically correlated ranging from 0.31 to 0.49 after energy adjustment. Cross-classification analyses revealed that more than 70 percent of adolescents were classified into either the same or adjacent quartile of nutrient intake when comparing data of 7DDH and FFQ. No serious systematic bias was evident in the Bland-Altman plots. Conclusion: The 200-item FFQ developed for Malaysian adolescents has moderate to good comparative validity for assessment of macronutrient and micronutrient intake.
Background and Objectives: The Chinese Dietary Guidelines (CDGs) were first released to the public in 1989 by the Chinese Nutrition Society (CNS). In 2016, the Ministry of Health commissioned the CNS to revise and publish new CDGs. Methods and Study Design: The CNS convened an expert committee of leaders in the fields of nutrition, epidemiology, public health, preventive medicine, and food science. The CDGs were revised accord- ing to the World Health Organization Handbook for Guideline Development procedures. The expert committee recommended key inclusions for the CDGs on the basis of the current status of public health and priority health challenges affecting the Chinese population, as well as the quality of scientific evidence. Results: The CDGs (2016) provide six key dietary recommendations for the general Chinese population aged 2 years and above. In addition to a newly revised Chinese Food Guide Pagoda, both the Chinese Food Guide Plate and Chinese Food Guide Abacus are newly created pictorial models in the CDGs (2016); the Chinese Food Guide Abacus is specifi- cally designed for children. Seven additional dietary guidelines targeting specific populations are included; these guidelines emphasize the different physiological and nutritional requirements of particular populations, including dietary guidelines for vegetarians for the first time. Conclusions: The CDGs (2016) is an official document pub- lished by the National Health Commission of China. Its content highlights the current status of public health and offers advice to address health concerns faced by the Chinese population. The CDGs (2016) have been widely disseminated and accepted in the Chinese population; the National Nutrition Week is a major national event in which the CDG are used as its core to increase public awareness towards a healthy diet and lifestyle.
Background and Objectives: Poor adherence to dietary guidelines is related to physical and mental disorders, as reflected in self-reported health statuses. This study evaluates the association between diet quality and self- reported health within the Shanghai Diet and Health Study. Methods and Study Design: We used Chinese Die- tary Guidelines Adherence scores to assess diet quality in a cross-sectional study of 4487 subjects above 15 years of age, who completed three-day 24h diet recalls and responded to self-reported health questionnaires. A compo- site health score was calculated based on Item Response Theory, using the Rasch model. Multiple linear- regression models were evaluated to assess the relationship between self-reported health status and diet quality. Results: Based on the various adherence scores, we divided our sample into fifths. Based on these divisions and with the exception of a single instance, our results show a significant trend: self-reported health declines with de- clining adherence to official dietary guidelines. This trend was even significant when controlling for a large num- ber of potential confounders. Conclusions: This study shows that consumption of a healthy and balanced diet, as reflected in adherence to the Chinese Dietary Guidelines, is related to increased levels of overall health among Shanghai residents.
Background and Objectives: The quality of meta-analyses (MAs) on nutrition intervention in mainland China remains uninvestigated. To assess the quality of the evidence regarding nutrition intervention in mainland China, we used vitamin intervention as an example to assess the overall methodological and reporting qualities of MAs on nutrition interventions published in Chinese journals. Methods and Study Design: A cross-sectional study on MAs of vitamin interventions was performed. Four Chinese databases were searched from inception through Sep- tember 2016 for all MAs of vitamin intervention. A Measurement Tool to Assess Systematic Reviews (AMSTAR) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements were used to assess methodological and reporting qualities, respectively. Results: A total of 43 MAs of vitamin interventions were included, but none of the studies had been updated. These reviews mainly focused on the effects of interven- tions involving vitamin D, B vitamins and vitamin E, and the most studied condition was “Endocrine, Nutritional and Metabolic diseases,” such as diabetes, obesity, and nutritional rickets. The median AMSTAR score was 6 (0- 7), and median PRISMA score was 18 (3-24). No study provided an ‘a priori’ design, a list of excluded studies, or a statement on conflict of interest, and less than 50.0% of included MAs stated the publication status and per- formed an adequate structure summary. Conclusions: The quality of the included MAs was disappointing regard- ing some items, and some lower quality reviews should be updated. Future MAs should improve on reporting conflicts of interest, harm, and publication bias.
Background and Objectives: The genetic variations of vitamin D receptor (VDR) have revealed its association with the risk of metabolic syndrome (MetS). In Thailand, evidence of this association has not been obtained. Thus, this study aimed to investigate the association of VDR gene polymorphism with MetS and related diseases as well as the possible linkage disequilibrium (LD) and haplotypes of VDR in Thai adults. Methods and Study De- sign: Four single nucleotide polymorphisms (SNPs) of VDR gene, rs2228570, rs1544410, rs7975232 and rs731236, were genotyped using PCR-RFLP method in 259 MetS and 261 control groups. Results: Genotypes AA of rs1544410, TG of rs7975232 and TG+TT of rs7975232 were significantly associated with an increased risk of MetS [OR 10.8 (2.07–56.1), p=0.005], [OR 1.83 (1.16–2.87), p=0.009] and [OR 1.78 (1.17–2.72), p=0.007], respectively, using GG as a reference. Moreover, genotype AA of rs1544410 showed a strong associa- tion compared with GG+AG [OR 11.4 (2.20–59.2), p=0.004]. Diseases related to MetS also had significant asso- ciations with two SNPs of the VDR gene (rs1544410 and rs7975232). In addition, LD among rs1544410, rs7975232 and rs731236 was detected. Haplotype CATT significantly increased the risk of MetS [OR 4.32 (1.32– 14.1), p=0.016], although haplotype TGGT reduced the risk [OR 0.68 (0.48–0.98), p=0.042]. Conclusions: The SNPs rs1544410 and rs7975232 were mainly implicated in the increased risk of MetS in the Thai population. LD and haplotypes of VDR gene related to MetS were also discovered. These SNPs of VDR gene are remarkable ge- netic factors involved in the development of MetS.
Background and Objectives: Estimation of energy demand using basal metabolic rate (BMR) is a rational ap- proach for optimizing glycemic control and weight management in patients with type 2 diabetes mellitus (T2DM). Here, we assessed the accuracy of predictive equations in estimating BMR in Japanese patients with T2DM. Methods and Study Design: BMR was measured indirectly (BMRm) with a portable gas analyzer in the fasting state in 69 Japanese patients with T2DM. BMR was estimated using the Harris-Benedict equation (BMRhb) and Ganpule equation (BMRg). An original predictive equation (BMRdm) was formulated by stepwise multiple regres- sion analysis using subject age, lean soft tissue mass, fat mass and bone mineral content. Mean differences and 95% limits of agreement between measured and three estimated BMRs were evaluated by Bland-Altman plots. In addition, subjects were divided into three BMI groups (normal, BMI <25; overweight, BMI ≥25; obese, BMI ≥30), and the influence of BMI on the error size between measured and estimated BMRs was assessed. Results: Between BMRm and the three estimated BMRs (BMRhb, BMRg, and BMRdm), there were small systematic errors with large random errors (mean difference±2SD ; −32±365 kcal，26±405 kcal, and −1.6±349 kcal, respectively) and significant proportional errors (r=0.42, 0.44, and 0.30, respectively). BMI subgroup analysis revealed that the obese group showed larger random errors and significant proportional errors compared to the overweight and normal weight groups. Conclusion: Predictive equations provide unacceptably inaccurate estimates of BMR in Japanese patients with T2DM, particularly in obese individuals.
Background and Objectives: Short bowel syndrome (SBS) is a rare and life-threatening disease. Few studies have investigated risk factors for parenteral nutrition (PN)-dependence and death in SBS. Accordingly, the aim of this study was to investigate the risk factors for PN-dependence and long-term mortality in SBS. Methods and Study Design: This retrospective study reviewed and evaluated children and adults who were diagnosed with SBS at King Chulalongkorn Memorial Hospital from October 2005 to January 2015. Age, causes of SBS, length of remnant bowel, type of anastomosis, types of nutrition support, SBS-associated complications, PN-dependence rate, duration of PN-dependence, mortality rate, and causes of death were evaluated. Results: Twenty-two adults and 19 children were reviewed. The median follow-up time was 48 months. At the end of follow-up, PN- dependence rate was 51.2%. The residual colon ≥50% group had a significantly lower PN-dependence rate, with a hazard ratio of 0.36 (95% CI: 0.14-0.93; p=0.03). The most frequent cause of death was infection, with the highest percentage of mortality occurring within the first 2 years after surgery. The mortality rate was 53.8% and the residual colon ≥50% group had a significantly lower mortality rate, with a hazard ratio of 0.36 (95% CI: 0.14- 0.88; p=0.03). Conclusions: PN-dependence and death occurred in about half of all patients. Residual colon ≥50% was significantly associated with lower death rate and PN-dependence. The crucial role of colon in conti- nuity as a protective factor should be investigated further in prospective studies.
Background and Objectives: Hand grip strength (HGS) has emerged as a predictor of the nutritional status. However, many factors may modify the malnutrition–HGS association. This study explored the nutritional as- sessment value and determinants of HGS in patients hospitalized with cancer. Methods and Study Design: In this multicenter, retrospective, observational study (11,314 patients), the Receiver operator characteristic curve was used to observe HGS and nutritional status sensitivity/specificity. Sex; age; height; weight; mid-upper arm circumference (MAMC); Patient-Generated Subjective Global Assessment (PG-SGA) score; Karnofsky score; physical function (PF) domain; cognitive function (CF) domain; global health and quality of life (QL) domain of EORTC QLQ-C30 (a quality of life instrument designed by the European Organization for Research and Treat- ment of Cancer); and albumin, prealbumin, and hemoglobin levels were included in a Stepwise analysis model to identify the factors influencing HGS. Results: HGS showed a very low diagnostic value and accuracy for identi- fying severe malnourishment (area under the curve, 0.615–0.640; p˂0.01). HGS positively correlated with sex; height; weight; MAMC; Karnofsky score; QL, PF, and CF domains; and hemoglobin and prealbumin levels (Be- ta=0.02–0.42, p≤0.05), and negatively with age (Beta=−0.19, p˂0.01). However, the PG-SGA score was excluded because of its very limited contribution to HGS variability. Conclusions: HGS is a mutifactorial index. The use of HGS cutoff values to identify malnutrition is markedly challenging. Thus, HGS may be of limited use as a predictor of nutritional status.
Background and Objectives: Coronary artery disease (CAD) is a major cause of death worldwide. Chronic sta- ble angina (CSA) is the primary sign of CAD. Oxidative stress and inflammation play a substantial role in patho- genesis and progression of CAD. The aim of this study was to investigate the effects of oral administration of powdered Melissa officinalis (MO) on biomarkers of oxidative stress, inflammation, and lipid profile in patients with CSA. Methods and Study Design: A randomized, double-blind, placebo-controlled clinical trial was per- formed in 80 patients with CSA. The subjects were randomly assigned to obtaineither oral MO 3 g/d (n=40) or placebo (n=40) for eight weeks. Anthropometric indices, biomarkers of oxidative stress, inflammation, and lipid profile were evaluated at baseline and post-intervention. Results: The mean serum concentrations of triglycerides, total-cholesterol, LDL-cholesterol, and malondialdehyde (MDA), and high sensitive C-Reactive Protein (hs-CRP) were lower in the intervention group compared with placebo (p<0.01) post intervention. Moreover, the mean se- rum concentration of paraxonase 1 (PNO1) and HDL-c were higher (p<0.001) in the intervention group compared with the control group. Conclusion: Oral MO supplementation improves the lipid profile, MDA, hs-CRP, and PNO1 in patients with CSA.
Background and Objectives: Nutritional anemia is a significant public health issue with 50-80% prevalence in Indian children. Fortification of food, specifically milk, with iron is a potential approach to increase dietary iron intake. Ferric pyrophosphate [Fe4(P2O7)3] is organoleptically neutral and is less soluble in acid medium and, fur- ther, has low bioavailability in milk. However, since ascorbic acid is a potent enhancer of iron absorption, the co- administration of ascorbic acid with Fe4(P2O7)3 might enhance the absorption of iron. We evaluated the effect of ascorbic acid on iron absorption from a Fe4(P2O7)3 and an ascorbic acid fortified milk beverage with respect to milk fortified with Fe4(P2O7)3 alone. Methods and Study Design: A double-blind, two-way crossover, random- ized study was conducted in 25 mildly anemic children. The test group received milk fortified with beverage powder containing 7 mg isotopically labeled iron (57Fe/58Fe) as Fe4(P2O7)3, equimolar proportions of ascorbic ac- id and 200 mg of calcium whereas control group received milk fortified with energy, calcium and iron equivalent beverage powder. Fractional iron absorption was measured by erythrocyte incorporation of stable isotopes of iron (57Fe/58Fe) in both the groups. Results: The fractional iron absorption from the control drink was 0.80% (95% CI: 0.57, 1.12). Fortifying the milk with an equimolar amount of ascorbic acid increased the fractional iron absorp- tion almost 2-fold to 1.58% (95% CI: 1.13, 2.22). Conclusions: The presence of ascorbic acid in an equimolar ra- tio with that of iron from Fe4(P2O7)3 salt in milk as a fortificant enhanced iron absorption when compared to milk fortified with only Fe4(P2O7)3.
Background and Objectives: The excessive intake of trans fatty acids increases serum low-density lipoprotein- cholesterol and reduces high-density lipoprotein-cholesterol. We studied the effects of 1% energy trans fatty acid supplementation on serum lipid concentrations in healthy adult Japanese with different obesity-related gene pol- ymorphisms. Methods and Study Design: A randomized, double-blind, parallel trial was conducted in 53 healthy adults. The volunteers consumed one cookie containing either 1% energy or <0.01% energy (control) of trans fatty acids every day for 4 weeks, and a blood sample was then obtained after overnight fasting. The single nucleotide polymorphisms of the fat mass- and obesity-associated gene rs9939609 and beta-3 adrenergic receptor rs4994 were genotyped. Results: The mean trans fatty acid intake of the control and trans fatty acid groups cor- responded to 0.28% and 1.31 % energy, respectively. There were no significant differences in serum cholesterol (total, low-density lipoprotein and high-density lipoprotein) or triacylglycerol between the control and trans fatty acid groups. The responses of serum cholesterol, triacylglycerol, glucose, insulin and hemoglobinA1c were also independent of the fat mass- and obesity-associated gene and beta-3 adrenergic receptor gene variants. Conclu- sions: Our findings indicate that supplementation with 1% energy trans fatty acids has little effect on serum cho- lesterol in healthy adult Japanese, regardless of genotype of fat mass- and obesity-associated gene or beta-3 ad- renergic receptor. More systematic studies, with respect to dietary trans fatty acid intakes above those used here, may be warranted to determine the tolerable upper level of dietary trans fatty acid.
Background and Objectives: There are few data on the fatty acid status of non-pregnant Indian women. Our ob- jective was to investigate the effect of a snack containing green leafy vegetables (GLVs) on women’s erythrocyte long chain polyunsaturated fatty acid status (LCPUFA). Methods and Study Design: Non-pregnant women (n=222) aged 14-35 years from Mumbai slums were randomized to consume a snack containing GLVs, fruit and milk (treatment) or a control snack containing foods of low micronutrient content such as potato and onion, daily under observation. One treatment snack contained a mean (SD) of 54.1 (33.7) mg alpha-linolenic acid (ALA) and one control snack contained 4.1 (3.4) mg ALA. Blood was collected at baseline (0 weeks) and after 12 weeks of supplementation. Erythrocyte fatty acids were analyzed using gas chromatography and expressed as g/100g fatty acids. Plasma malondialdehyde, homocysteine, and erythrocyte superoxide dismutase and glutathione peroxidase were measured. The effect of the treatment on 12 week LCPUFA was assessed using ANCOVA models. Results: Median (IQR) erythrocyte DHA in the treatment group increased from 1.50 (1.11, 2.03) at baseline to 1.86 (1.50, 2.43) (p<0.001) at 12 weeks, and fell in controls from 1.78 (1.37, 2.32) to 1.60 (1.32, 2.04) (p<0.001). The total n-3 fatty acids increased in the treatment group. There was no effect on malondialdehyde and antioxidant enzyme levels. Plasma homocysteine at 0 and 12 weeks was inversely associated with erythrocyte DHA at 12 weeks. Conclusion: Daily consumption of a snack containing GLV improved women’s erythrocyte DHA levels without increasing oxidative stress.