Asia Pacific Journal of Clinical Nutrition
Volume 15, issue 2
(March 2006)


Papers

Contents	Abstract	Papers
Review Articles Body mass index and risk of diabetes mellitus in the Asia-Pacific region ASIA PACIFIC COHORT STUDIES COLLABORATION   Dietary patterns and metabolic syndrome - a review of epidemiologic evidence AMANDA J BAXTER, TERRY COYNE AND CHRISTINE McCLINTOCK Asia Pac J Clin Nutr. 2006;15(2):134-142.   Natural products and anti-inflammatory activity GAOFENG YUAN, MARK L WAHLQVIST, GUOQING HE, MIN YANG AND DUO LI Asia Pac J Clin Nutr. 2006;15(2):143-152.	html   html   html	pdf   pdf   pdf
Original Articles
The KOJACH food frequency questionnaire for Chaoshan, China: development and description LI KE, TOSHIRO TAKEZAKI, SONG FENG-YAN, YU PING, LIN XU-KAI, YANG HE-LIN, DENG XIAO-LING, ZHANG YU-QI, LV LAI-WEN, HUANG XIN-EN AND KAZUO TAJIMA Asia Pac J Clin Nutr. 2006;15(2):153-160.	html	pdf
Reproducibility and validity of a Chinese food frequency questionnaire used in Taiwan MEEI-SHYUAN LEE, WEN-HARN PAN, KAI-LI LIU AND MEI-SHU YU Asia Pac J Clin Nutr. 2006;15(2):161-169.	html	pdf
Item non-responses in mailed food frequency questionnaires in a Korean male cancer cohort study YOUNJHIN AHN, HEE YOUNG PAIK AND YOON-OK AHN Asia Pac J Clin Nutr. 2006;15(2):170-177.	html	pdf
An Aboriginal-driven program to prevent, control and manage nutrition-related "lifestyle" diseases including diabetes MICHAEL GRACEY, ERNIE BRIDGE, DAVID MARTIN, TIMOTHY JONES, RANDOLPH M SPARGO, MARK SHEPHARD, AND ELIZABETH A DAVIS Asia Pac J Clin Nutr. 2006;15(2):178-188.	html	pdf
Anthropometric, metabolic and dietary fatty acids profiles in lean and obese diabetic Asian Indian subjects ARNAB GHOSH Asia Pac J Clin Nutr. 2006;15(2):189-195.	html	pdf
Parental overweight as an indicator of childhood overweight: how sensitive? KAYOUNG LEE, EUN-RYOUNG KWON, TAE-JIN PARK, MIN-SEON PARK AND CARINE M LENDERS Asia Pac J Clin Nutr. 2006;15(2):196-200.	html	pdf
Body image differences among Malay, Samoan, and Australian women ANDREW J MCDOWELL AND MALCOLM J BOND Asia Pac J Clin Nutr. 2006;15(2):201-207.	html	pdf
Differences in nutrient intakes and physical activity levels of Japanese and Australian Caucasian males living in Australia and Japanese males living in Japan MASAHARU KAGAWA, YOKO SAITO, DEBORAH KERR , HAYATO UCHIDA AND COLIN W BINNS Asia Pac J Clin Nutr. 2006;15(2):208-216.	html	pdf
Physical activity and nutritional status of children of low socioeconomic status. Two interrelated problems: undernutrition and overweight PAULO ROBERTO DOS SANTOS AMORIM, RICARDO CAMPOS DE FARIA, NUALA M BYRNE AND ANDREW P HILLS Asia Pac J Clin Nutr. 2006;15(2):217-223.	html	pdf
Diet composition and body mass index in Tehranian adults PARVIN MIRMIRAN, AHMAD ESMAILLZADEH AND FEREIDOUN AZIZI Asia Pac J Clin Nutr. 2006;15(2):224-230.	html	pdf
Skinfold thickness, body fat percentage and body mass index in obese and non-obese Indian boys SATIPATI CHATTERJEE, PRATIMA CHATTERJEE AND AMIT BANDYOPADHYAY Asia Pac J Clin Nutr. 2006;15(2):231-235.	html	pdf
Prevalence of obesity, overweight and underweight in a Hong Kong community: the United Christian Nethersole Community Health Service (UCNCHS) primary health care program 1996-1997 GARY TC KO AND JOYCE SF TANG Asia Pac J Clin Nutr. 2006;15(2):236-241.	html	pdf
Are energy drinks contributing to the obesity epidemic? ELAINE RUSH, STEPHANIE SCHULZ, VLADIMIR OBOLONKIN, DAVID SIMMONS AND LINDSAY PLANK Asia Pac J Clin Nutr. 2006;15(2):242-244.	html	pdf
Fruits and vegetables, 5+ a day: Are we getting the message across? PAULINE AL ASHFIELD-WATT Asia Pac J Clin Nutr. 2006;15(2):245-252.	html	pdf
Drinking tea is associated with lower plasma total homocysteine in older women JONATHAN M HODGSON, AMANDA DEVINE, IAN B PUDDEY, JOHN BEILBY AND RICHARD L PRINCE Asia Pac J Clin Nutr. 2006;15(2):253-258.	html	pdf
Concordance of diets and eating practices in a rural Guatemalan setting with the cancer prevention recommendations of the World Cancer Research Fund: Estimates from existing dietary intake ROXANA VALDES-RAMOS, INES CERVANTES, IVAN MENDOZA-PERDOMO, ANNIE S ANDERSON, NOEL W SOLOMONS Asia Pac J Clin Nutr. 2006;15(2):259-266.	html	pdf
Lactagogue effects of Torbangun, a Bataknese traditional cuisine RIZAL DAMANIK , MARK L. WAHLQVIST AND N. WATTANAPENPAIBOON Asia Pac J Clin Nutr. 2006;15(2):267-274.	html	pdf
Phytochemical intakes of the Fijian population JIMAIMA LAKO, NAIYANA WATTANAPENPAIBOON, MARK L WAHLQVIST AND CRAIGE TRENERRY Asia Pac J Clin Nutr. 2006;15(2):275-285.	html	pdf

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Body mass index and risk of diabetes mellitus in the Asia-Pacific region
ASIA PACIFIC COHORT STUDIES COLLABORATION
Few prospective data from the Asia Pacific region are available relating body mass index to the risk of diabetes. Our objective was to provide reliable age, sex and region specific estimates of the associations between body mass index and diabetes. Twenty-seven cohort studies from Asia, New Zealand and Australia, including 154,989 participants, contributed 1,244,793 person-years of follow-up. Outcome data included a combination of incidence of diabetes (based on blood glucose measurements) and fatal diabetes events. Hazard ratios were calculated from Cox models, stratified by sex and cohort, and adjusted for age at risk and smoking. During follow-up (mean = 8 years), 75 fatal diabetes events and 242 new cases of diabetes were documented. There were continuous positive associations between baseline body mass index and risk of diabetes with each 2 kg/m2 lower body mass index associated with a 27% (23-30%) lower risk of diabetes. The associations were stronger in younger age groups, and regional comparisons demonstrated slightly stronger associations in Asian than in Australasian cohorts (P = 0.04). This overview provides evidence of a strong continuous association between body mass index and diabetes in the Asia Pacific region. The results indicate considerable potential for reduction in incidence of diabetes with population-wide lowering of body mass index in this region..
Key Words: Body mass index, obesity, diabetes mellitus, Asia
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Dietary patterns and metabolic syndrome - a review of epidemiologic evidence
AMANDA J BAXTER, TERRY COYNE AND CHRISTINE McCLINTOCK
Metabolic syndrome is associated with increased risk of coronary heart disease and type 2 diabetes, and appears to be widely prevalent in both developed and developing countries. While lifestyle modification is recommended for management of the syndrome, the dietary pattern most beneficial for patients is yet to be ascertained. Original research papers from the Medline database were examined for dietary patterns that may be associated with the syndrome. Three large-scale epidemiological studies were found fitting our criteria. Dietary patterns high in fruit and vegetable content were generally found to be associated with lower prevalence of metabolic syndrome. Diet patterns with high meat intake were frequently associated with components of metabolic syndrome, particularly impaired glucose tolerance. High dairy intake was generally associated with reduced risk for components of metabolic syndrome with some inconsistency in the literature regarding risk of obesity. Minimally processed cereals appeared to be associated with decreased risk of metabolic syndrome, while highly processed cereals with high glycaemic index are associated with higher risk. Fried foods were noticeably absent from any dietary pattern associated with decreased prevalence of metabolic syndrome. The conclusion of this review is that no individual dietary component could be considered wholly responsible for the association of diet with metabolic syndrome. Rather it is the overall quality of the diet that appears to offer protection against lifestyle disease such as metabolic syndrome. Further research is required into conditions, such as overweight and obesity, which may influence the effect of diet on the development of metabolic syndrome.
Key Words: metabolic syndrome, X syndrome, literature, review, diet, diet quality, dietary patterns

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Natural products and anti-inflammatory activity
GAOFENG YUAN, MARK L WAHLQVIST, GUOQING HE, MIN YANG AND DUO LI
The aim of this review paper was to summarise some commonly available natural products and their anti-inflammatory activity. We have collected data from MEDLINE, Current Contents and scientific journals, which included 92 publications. There are numerous natural products detailed in this literature; however we have summarized a few of the most commonly available and potent ones. In this paper, the natural products with anti-inflammatory activity including curcumin, parthenolide, cucurbitacins, 1,8-cineole, pseudopterosins, lyprinol, bromelain, flavonoids, saponins, marine sponge natural products and Boswellia serrata gum resin were reviewed. Natural products play a significant role in human health in relation to the prevention and treatment of inflammatory conditions. Further studies are being conducted to investigate the mechanism of action, metabolism, safety and long term side effect of these natural products, as well as interactions between these natural products with food and drug components.
Key Words: inflammation, anti-inflammatory activity, natural products, anti-inflammatory food, pain, migraine, arthritis, asthma, chronic colitis, inflammatory based diseases.
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The KOJACH food frequency questionnaire for Chaoshan, China: development and description
LI KE, TOSHIRO TAKEZAKI, SONG FENG-YAN, YU PING, LIN XU-KAI, YANG HE-LIN, DENG XIAO-LING, ZHANG YU-QI, LV LAI-WEN, HUANG XIN-EN AND KAZUO TAJIMA
This paper aims to develop a data-based Semi-Quantitative Food Frequency Questionnaire (SQFFQ) covering both urban and rural areas in the Chaoshan region of Guangdong Province, China, for the investigation of relationships between food intake and lifestyle-related diseases among middle-aged Chinese. We recruited 417 subjects from the general population and performed an assessment of the diet, using a 3-day weighed dietary record survey. We employed contribution analysis (CA) and multiple regression analysis (MRA) to select food items covering up to a 90% contribution and a 0.90 R2, respectively. The total number of food items consumed was 523 (443 in the urban and 417 in the rural population) and the intake of 29 nutrients was calculated according to the actual consumption by foods/recipes. The CA selected 233, 194 and 183 foods/recipes for the combined, the urban and the rural areas, respectively, and then 196, 157 and 160 were chosen by the MRA. Finally, 125 foods/recipes were selected for the final questionnaire. The frequencies were classified into eight categories and standard portion sizes were also calculated. For adoption of the area-specific SQFFQ, Validity and reproducibility tests are now planned to determine how the combined SQFFQ performs in actual assessment of disease risk and benefit.
Key Words: nutrients, weighed diet records, contribution analysis, multiple regression analysis
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Reproducibility and validity of a Chinese food frequency questionnaire used in Taiwan
MEEI-SHYUAN LEE, WEN-HARN PAN, KAI-LI LIU AND MEI-SHU YU
A 64-item Chinese food frequency questionnaire (FFQ) combined with open questions on types of staples and cooking oil most frequently consumed was designed for a prospective study in Taiwan to appraise participants' usual intake. We examined its reproducibility and validity. The form was administered three times at three-month intervals by face-to-face interview to 83 senior college students majoring in nutrition, in order to recall their usual dietary intake over the past six months. They also completed five-day (includes both weekends) diet records (DR) after each interview. Averaged intake levels of most nutrients assessed by the three FFQs were slightly higher than those of 15-day DR. Intraclass correlation coefficients for nutrient intakes assessed by three FFQs three months apart ranged from 0.37 for saturated fat to 0.82 for alcohol (average: 0.52). Averaged Pearson correlation coefficients between the unadjusted and energy-adjusted nutrient intakes measured by DR and by the third FFQ (which asked about diet during the six months encompassing the diet records) were 0.40 and 0.35, respectively, not including vitamins A and C. These correlations were higher (average: 0.47) after adjusting for the daily variation of the diet records. On average, 50% subjects were correctly classified into the same tertiles by both methods; 11% of the subjects were misclassified to extreme categories. These data indicate that this FFQ for Chinese-speaking people in Taiwan is reproducible and provides a useful measure of intake for many nutrients over a six-month period.
Key Words: Chinese Food-frequency questionnaire, Taiwan, diet record, reproducibility, validity, ratio of within- to between-person variation
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Item non-responses in mailed food frequency questionnaires in a Korean male cancer cohort study
YOUNJHIN AHN, HEE YOUNG PAIK AND YOON-OK AHN
Item non-responses are frequently encountered in mailed food frequency questionnaires (FFQs) in epidemiological studies. The effects of item non-responses in a FFQ on presumed nutrient intake and subject classifications were examined in this study of a male cancer cohort in Korea. A semi-quantitative FFQ was developed and mailed to adult males aged between 40 and 59 in Seoul. Among the 14,533 cohort participants, 7,647 subjects who fully completed the FFQ initially and 216 subjects who completed the frequency missing items at resurvey were compared. When item non-responses were treated as not eaten, the average nutrient intakes of this group were significantly lower than both the average intake of subjects who fully completed at the initial survey and the average intake of those who completed at the resurvey. Increases in nutrient intakes during resurvey were substantively proportional to the number of items originally omitted. Cross classifications of item non-response subjects by nutrient intake after the initial survey and after resurvey showed misclassification towards lower quantile. Moreover, distribution of 'never or seldom' answer of resurvey group was similar to initial complete group. These results indicate that treating item non-responses as not eaten introduces bias when estimating nutrient intakes or when classifying subjects on the basis of nutrient intakes. More study is required to determine how best to treat non-response items in FFQ..
Key Words: cross classification, food frequency questionnaire (FFQ), item non-response, cancer cohort study, Korea

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An Aboriginal-driven program to prevent, control and manage nutrition-related "lifestyle" diseases including diabetes
MICHAEL GRACEY, ERNIE BRIDGE, DAVID MARTIN, TIMOTHY JONES, RANDOLPH M SPARGO, MARK SHEPHARD, AND ELIZABETH A DAVIS
Type 2 diabetes and other nutrition-related so-called "lifestyle" diseases, including obesity, and cardiovascular and chronic renal disease, are very prevalent in Australian Aboriginal people and contribute to their high rates of chronic illness and premature mortality. An Aboriginal-driven, community-based health protection, health promotion and improved disease detection, management and care program was introduced in four remote, discrete communities in the far north of Western Australia (WA) in order to attempt to prevent these disorders through community-based lifestyle modification. More energetic screening for early risk factors is involved as well as early dietary and exercise interventions and medical treatment, when indicated. Distinctive features of this program include its Aboriginal initiatives and perspectives, committed partnerships between the communities, the Unity of First People of Australia of Australia (UFPA) and its carers, the communities' health care providers, external clinical specialists, other external agencies and a locally-operated point-of-care (POC) pathology testing capability that is conducted by local and UFPA personnel. The POC component is quality managed by Flinders University. These features have ensured the viability of the program in three of the communities; the other one decided not to continue with the program despite risks of serious long-term health consequences. The pre-program prevalence of diabetes in screened adults was almost 40% and in adults aged 35 years was almost 60%. After several months of the program's operation, there have been positive changes in knowledge about food, nutrition, exercise and disease and altered attitudes and behaviours related to dietary and exercise patterns. There have also been improvements in weight control and in pathology test results relevant to the risk of subsequent development of diabetes and cardiovascular disease.
Key Words: Australian Aborigines, overweight, obesity, diabetes, cardiovascular disease.
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Anthropometric, metabolic and dietary fatty acids profiles in lean and obese diabetic Asian Indian subjects
ARNAB GHOSH
The present study was aimed to study anthropometric, metabolic and dietary fatty acids profiles among 200 (Group I: lean control, N = 80; Group II: lean diabetic, N = 70 and Group III: obese diabetic, N = 50) Asian Indians (aged 30 years and above) living in the eastern part of India. Anthropometric [height, weight, waist (WC) and hip circumference] metabolic [total cholesterol (TC), triglyceride (TG), high (HDL), low density lipoprotein (LDL) and fasting plasma glucose (FPG)] and dietary profiles were collected from each participant. Body mass index (BMI), waist-hip ratio (WHR) and conicity index (CI) were subsequently computed from anthropometric measures. An open-ended 24 h food recall proforma consisting of three sections and in local language was used to collect nutrient information from each participant. Daily intake of nutrients including saturated (SFA), monounsaturated (MUFA) and polyunsaturated fatty acids (PUFA) were estimated by adding all the foodstuffs consumed on weekly and monthly basis. One-way ANOVA with Scheffe's post-hoc test revealed that Group I has significantly lower mean than both Group II and Group III for age, WC, WHR, CI, TC, TG, LDL, FPG and total carbohydrates; Group I has significantly lower mean than Group II only for HDL and Group I has significantly lower mean than Group III only for BMI, total proteins and total fats. On the other hand, Group I has significantly greater mean than both Group II and Group III for UFA/SFA, MUFA/SFA and PUFA/SFA whereas Group I has significantly lower mean than Group III only for trans fatty acids and Erucic acid. Pearson's partial correlation (controlling age and sex) analysis showed that the ratios of unsaturated fatty acids and saturated fatty acids had significant negative association with lipids, lipoprotein and fasting glucose. Discriminant analysis revealed that overall 86.2% of all cases were correctly (positively) classified in three groups using fatty acids and their ratios. In conclusion, it seems reasonable to argue that dietary management including dietary guidelines would be useful to retard the growing incidence of diabetes in Indian population.
Key Words: obesity, central obesity, dietary fatty acids, lipids, diabetes, Asians, India.

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Parental overweight as an indicator of childhood overweight: how sensitive?
KAYOUNG LEE, EUN-RYOUNG KWON, TAE-JIN PARK, MIN-SEON PARK AND CARINE M LENDERS
This study determined the sensitivity and specificity of parental overweight from self-reported height and weight to identify families with overweight school age children. A cross sectional study was conducted among 3059 parents and their children (1558 boys and 1501 girls) aged 7-12 years in five primary schools of Busan, Korea. BMI was calculated from parental reported height and weight and from children's measured height and weight. Parents were considered overweight when their BMI was >25 kg/m2 (WHO, 2000). Children were considered overweight when their BMI was >95th percentile (CDC, 2000). Prevalence of overweight was calculated and logistic regressions were performed. The sensitivity and specificity of parental overweight were calculated. A total of 26% (805/3059) parents were overweight. Of the families with one overweight parent, 15% (N = 109) had an overweight child. When both parents were overweight, 17% (N = 9) had an overweight child. After adjusting for child's age and gender, parental education, family income, and spouse's BMI as required, the odds of having an overweight child were 2.5 [1.8, 3.3] for one overweight parent, and 3.2 [1.4, 7.1] for both overweight parents. While the sensitivity of one overweight parent to identify families with overweight school age children was 44%, specificity was 75%. The presence of both overweight parents provided a 3% sensitivity and 98% specificity for the identification of an overweight school age child. Although parental overweight was obtained from self-reported weight and height in Busan (Korea), it is a practical indicator to identify families with an overweight school age child, it has poor sensitivity.
Key Words: BMI, parent, children, overweight, sensitivity, specificity, Korea.

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Body image differences among Malay, Samoan, and Australian women
ANDREW J MCDOWELL AND MALCOLM J BOND
Comparisons of body attitudes and associated behaviours were undertaken using Malay, Samoan, and Australian female students. The general goal of the research was to determine the degree to which the observed pattern of attitudes and behaviours was attributable to culture. The specific analyses comprised an examination of group differences using standard measures that included the Body Attitudes Questionnaire, the Three-Factor Eating Questionnaire and detailed questions concerning the use of diet and exercise as weight control strategies. The main findings concerned a number of cultural differences, particularly in relation to diet and exercise, that were evident even with the effect of body mass index held constant. These results are interpreted in terms of the efficacy of entrenched cultural beliefs in protecting against introduced, more dominant, cultural values. The Australian sample exhibited the most negative body image, although there was some evidence that Malays and Samoans were influenced by Western ideals of weight and shape. It is proposed that to fully understand the differential meaning of negative body image across cultures and the potential impact of westernisation, both within-group and between-group differences in body size need to be acknowledged.
Key words: body image, body mass index, cross-cultural comparison, diet, exercise.

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Differences in nutrient intakes and physical activity levels of Japanese and Australian Caucasian males living in Australia and Japanese males living in Japan
MASAHARU KAGAWA, YOKO SAITO, DEBORAH KERR , HAYATO UCHIDA AND COLIN W BINNS
The aim of the study was to determine the nutritional status and nutrient intakes of young Japanese males living in Australia and compared with Japanese males living in Japan and Australian Caucasian males. Four-day dietary records were obtained from 65 Japanese living in Australia (JA), 81 Japanese living in Japan (JJ), and 70 Australian Caucasian males (AA) aged 18-30 years old, together with body composition and physical activity level assessments using anthropometry and the questionnaire. Australian males were significantly taller and heavier than the Japanese counterparts and also showed a greater percent body fat (%BF) and height-corrected sum of skinfolds compared with Japanese males living in Japan (%BF: JJ = 16.6 ± 5.2, AA = 18.7 ± 5.6; height corrected sum of skinfolds: JJ = 78.8 ± 37.3, AA = 96.0 ± 39.5) (P <0.05). A greater proportion of Australian Caucasian males (98.6%) were involved in vigorous physical exercise than Japanese males (JA = 72.3%; JJ = 85.2%). The JA group consumed a greater amount of energy from protein and fat sources as well as greater calcium, iron, dietary fibre and niacin equivalents intakes than the JJ group (P <0.05). The results suggest that Japanese males living in Australia consumed more energy-dense westernised diet than Japanese males living in Japan. Because of lower physical activity level than Australian males, consumption of energy-dense diet may increase the risk of weight gain among Japanese males who stay in Australia for a long-term.
Key Words: nutrient intakes, energy contribution, physical activity, Japanese males, Australia.
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Physical activity and nutritional status of children of low socioeconomic status. Two interrelated problems: undernutrition and overweight
PAULO ROBERTO DOS SANTOS AMORIM, RICARDO CAMPOS DE FARIA, NUALA M BYRNE AND ANDREW P HILLS

The aim of this study was to analyse the level of habitual physical activity (HPA) and nutritional status of children attending selected public schools in Brazil. The sample comprised 1719 participants who ranged in age from 11 to 14 yrs with 861 females (F) aged 12.7±1.0yr and 858 males (M) aged 12.7±1.0yr. The short form of the International Physical Activity Questionnaire (IPAQ) was used to measure HPA. Nutritional status was assessed using the body mass index (BMI). Statistical analyses included ANOVA followed by the post-hoc Tukey-test (P < 0.05) which showed a statistically significant difference between M and F in time spent in moderate intensity physical activity. F completed more moderate intensity physical activity than M whereas time in vigorous physical activities was higher in M than F. Analyses of BMI and IPAQ categorical score using Pearson product moment correlations with subsequent Fisher Z transformation showed values of Z = 0.49 for females and Z = 0.44 for males, indicating a low relationship between these variables. HPA levels showed 93.7% of the M and 91.1% of the F were at least minimally active. According to BMI values, 7.3% of the cohort was underweight; 83.0% normal weight; 8.3% overweight and 1.3% obese. These results demand attention, particularly for children at the lower end of nutritional status and HPA levels due to the potential negative impact on their growth and development. At the other end of the nutritional spectrum, one needs to be concerned regarding the levels of excess body weight, mainly considering the poor region in which the children live.
Key Words: child, physical activity, nutritional status, obesity, overweight, socioeconomic factors, Brazil.
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Diet composition and body mass index in Tehranian adults
PARVIN MIRMIRAN, AHMAD ESMAILLZADEH AND FEREIDOUN AZIZI

Human studies investigating the relationship between macronutrients intake and obesity, have failed to achieve consistent findings. This study was undertaken to assess the relationship between macronutrients intake and body mass index in a group of Tehranians. From 15005 participants of the Tehran Lipid and Glucose Study, 1290 subjects aged over 10 years (565 males and 725 females) were selected randomly for dietary survey. Anthropometric indices were measured according to standard protocols and BMI was calculated. Dietary data were collected by trained interviewers using two non-consecutive 24-hour dietary recalls. Data on smoking habits, educational level and physical activity were compiled. Under- and over-reporting of energy intake were defined as EI: BMR<1.35 and >=2.4, respectively. Calorie-adjusted amounts of macronutrients were calculated by the residual method, following which energy intakes from all calorie-adjusted macronutrients were simultaneously included in the multiple regression models controlling for age, physical activity, educational level and smoking and mutual effects of macronutrients. Total energy intake was not included to avoid collinearity. BMI increased with age in either gender. Controlling for confounding variables, energy intake from fat was positively associated with BMI in males in the 10-18, 19-24, 25-50 and 51+ year age categories (ß=0.06, 0.13, 0.33, 0.48, P<0.05 for all, respectively) and females in the 19-24, 25-50 and 51+ age categories (ß=0.17, 0.43, 0.52, P<0.05 for all, respectively). This relationship remained after excluding misreporters (ß=0.06, 0.15, 0.36, 0.50 for males and ß= 0.21, 0.46, 0.54 for females in the corresponding age categories, respectively). The correlation of fat intake to BMI was not significant in younger females (10-18 year). No association was seen between energy intake from protein and carbohydrate with BMI in subjects before and after exclusion of misreporters. In conclusion, energy from fat was found to be independently and positively associated with obesity in adults. No other association was observed between energy from protein and carbohydrate with BMI
Key Words: carbohydrate, fat, protein, macronutrients, obesity, BMI, Tehran Lipid and Glucose Study, Iran
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Skinfold thickness, body fat percentage and body mass index in obese and non-obese Indian boys
SATIPATI CHATTERJEE, PRATIMA CHATTERJEE AND AMIT BANDYOPADHYAY

Childhood obesity is presently increasing worldwide and has created enormous concern for researchers working in the field of obesity related diseases with special interest in child health and development. Selected anthropometric measurements including stature, body mass, and skinfolds are globally accepted sensitive indicators of growth patterns and health status of a child. The present study was therefore aimed not only at evaluating the body mass index (BMI), skinfolds, body fat percentage (%fat) in obese school going boys of West Bengal, India, but also aimed to compare these data with their non-obese counterparts. Ten to sixteen year old obese boys (N = 158) were separated from their non-obese counterparts using the age-wise international cut-off points of BMI. Skinfolds were measured using skinfold calipers, BMI and %fat were calculated from standard equations. Body mass, BMI, skinfolds and %fat were significantly (P <0.001) higher for the sample of obese boys when compared to their non-obese counterparts. The obese group also showed progressive age-wise increments in all recorded anthropometric parameters. Stature (cm) showed no significant inter-group variation except in the 10 year age group (P <0.001). All data for the non-obese group were comparable with other national and international studies, but those collected for the obese group could not feasibly be compared because the availability of data on obese children is limited. Current data and prediction equations will not only serve as a reference standard, but also be of vital clinical importance in order to identify or categorize obese boys, and to take preventative steps to minimise serious health problems that appear during the later part of life.
Key Words: obesity, skinfolds, BMI, %fat, boys, India
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Prevalence of obesity, overweight and underweight in a Hong Kong community: the United Christian Nethersole Community Health Service (UCNCHS) primary health care program 1996-1997
GARY TC KO AND JOYCE SF TANG

The aim of this cross-sectional observation study was to assess thoroughly the body mass index (BMI) profile in Hong Kong Chinese and report all categories of BMI cutoff points as suggested by the World Health Organization (WHO). A cohort of 17242 subjects (4822 men and 12420 women) aged 15 or above from the community of Hong Kong presenting themselves voluntarily from April 1996 to August 1997 for primary health assessment at the Three Health Centers of the United Christian Nethersole Community Health Service (UCNCHS). The mean age ( SD) was 51.0 16.2 years (range 15-96 years, median 49.6 years). The mean BMI of the 17242 subjects was 23.5 3.3 kg/m2 in men and 23.0 3.7 kg/m2 in women. The BMI peaked at age 30 to 50 years in men and 50 to 70 years in women. The age-standardized prevalence of BMI 30 kg/m2 or 25 kg/m2 in Hong Kong Chinese was 3.0% in men and 3.2% in women, and 29.1% in men and 21.3% in women, respectively. For underweight, 35.9% and 27.8% of women and 27.5% and 10.3% of men aged 15-20 and 20-30 years, respectively, had BMI <18.5 kg/m2. In conclusion, a significant proportion of Hong Kong Chinese had a BMI 25 kg/m2. Among Hong Kong Chinese aged <30 years, the prevalence of underweight was also high.
Key Words: body mass index, obesity, overweight, underweight, Hong Kong Chinese.

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Are energy drinks contributing to the obesity epidemic?
ELAINE RUSH, STEPHANIE SCHULZ, VLADIMIR OBOLONKIN, DAVID SIMMONS AND LINDSAY PLANK

The consumption of energy drinks containing sucrose and caffeine is increasing worldwide. Ten healthy women aged 18 to 22 years and fasted overnight were randomly allocated to a standardised dose of sucrose either as an "energy " drink (containing sucrose and caffeine) or lemonade on the first day and then crossed over to the alternative drink on a second day. For thirty minutes before and thirty minutes after drinking oxygen consumption and carbon dioxide production were measured in the resting subject breath-by-breath by indirect calorimetry and the rates of carbohydrate and fat oxidation calculated. Energy drink consumption apparently caused increased carbohydrate oxidation (P = 0.004) and reduced lipid oxidation (P = 0.004) compared to lemonade. The longer term effects of combined caffeine and sucrose intake, particularly in sedentary individuals, on metabolism and body fatness needs further examination.
Key Words: lipogenesis, caffeine, sucrose, carbonated beverage, fat oxidation, carbohydrate oxidation.


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Fruits and vegetables, 5+ a day: Are we getting the message across?
PAULINE AL ASHFIELD-WATT

Fruit and vegetables have important health promoting properties. The 5+ a day programme aims to promote awareness of the need to eat more of these foods. This paper presents and discusses the results of two surveys designed to determine the success of the 5+ a day programme across New Zealand. Household surveys were carried out by a marketing research company in 1999 and 2000. The 1999 questionnaire focused on awareness and understanding of the 5+ a day campaign. The 2000 questionnaire focused on attitudes to health and on intakes of fruits and vegetables. Data were collected from households nationwide (1999 survey N = 200, 2000 survey N = 520). Spontaneous consumer awareness of messages promoting the need to eat more fruit and vegetables was high. Seventy-one percent of all respondents identified the 5 servings a day message from the 5+ a day logo regardless of whether they had seen it before. The meaning of the hand in the logo was less clear with only 2.5% identifying the 'serving size' element of the logo. Fruit and vegetable intakes of respondents were influenced by demographic factors: gender, ethnicity, education and occupation (all P = 0.05). Positive attitude towards the relationship between fruit, vegetables and health was influenced by similar factors and in turn affected fruit and vegetable intakes. The 5+ a day message is well recognised and understood. Portion size is less well understood. The 5+ a day message promotes positive attitudes towards healthy eating which are associated with healthier eating habits, but some groups within society may need further attention.
Key Words: fruits, vegetables, health promotion, nutrition survey, social marketing.


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Drinking tea is associated with lower plasma total homocysteine in older women
JONATHAN M HODGSON, AMANDA DEVINE, IAN B PUDDEY, JOHN BEILBY AND RICHARD L PRINCE

Dietary polyphenols are suggested to elevate plasma total homocysteine concentration (tHcy). Although tea is rich in polyphenols, it has been associated with lower tHcy, which may be due to its folate content. Our aims were to investigate relationships of tea intake and 4-O-methylgallic acid (4OMGA) - a biomarker of exposure to tea-derived polyphenols - with tHcy in older women. In a cross-sectional study of 232 women over 70 years of age, we measured tHcy, tea intake, 24 h urinary excretion of 4OMGA, and red cell folate. Tea intake and 4OMGA excretion were inversely related to tHcy. Tea intake (>2 cups) and 4OMGA excretion above the median were associated with lower tHcy by ~1mmol/L (P <0.01). Red cell folate was not associated with tea intake or 4OMGA excretion. The observed lower tHcy in women with higher tea intake is consistent in direction and magnitude with previous epidemiological studies, but any mechanisms remain unclear.
Key Words: tea, polyphenols, homocysteine, folate, women.


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Concordance of diets and eating practices in a rural Guatemalan setting with the cancer prevention recommendations of the World Cancer Research Fund: Estimates from existing dietary intake
ROXANA VALDES-RAMOS, INES CERVANTES, IVAN MENDOZA-PERDOMO, ANNIE S ANDERSON, NOEL W SOLOMONS

To evaluate concordance of eating practices in a rural Guatemalan setting with the 14-point cancer prevention recommendations of the World Cancer Research Fund/American Institute for Cancer Research. Two-hundred sixty nine food-frequency questionnaires based on the Willett model were analysed with respect to concordance with the recommendations, aimed at constraining intakes of: fat, sugar, salt, red meat and alcoholic beverages within specific ranges; restricting nutritional supplements' use for the express purpose of avoiding cancer; maximizing the consumption of: edible plants, especially fruits, vegetables, cereals, tubers and legumes; achieving dietary variety and nutrient adequacy; avoiding high-temperature cooking, and exposure to food additives, pesticides and residues; adequately preserving perishable and fungal-prone foods; maintaining normal body composition and regular levels of physical activity. The study was conducted in the county seat and three hamlets from the rural province of Santa Rosa. 214 females and 55 males were evaluated. Daily food servings of plant origin varied from 18.2 to 99.1% (74.6 ± 10.7%). The guidelines' criteria were met by more than 80% for total fat, red meat, ethanol, fruits and vegetables, cereals-tubers-legumes, sugar and nutritional adequacy, whereas 80% concordance was not met for nutritional supplements, and dietary variety. The other variables could not be evaluated. Concordance with national standards for micronutrient intake was not achieved most frequently for calcium, riboflavin, and iron. Guatemalan cuisine and diet in this rural setting has features of a cancer-protective diet, but complementary actions must be taken, within the social and economic realities of the region.
Key Words: total energy intake, cancer prevention, chronic disease epidemiology, nutritional epidemiology, food frequency questionnaire, dietary guidelines, Guatemala.


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Lactagogue effects of Torbangun, a Bataknese traditional cuisine
RIZAL DAMANIK , MARK L. WAHLQVIST AND N. WATTANAPENPAIBOON

Coleus amboinicus Lour (CA) has been used as a breast milk stimulant (a lactagogue) by Bataknese people in Indonesia for hundreds of years. However, the traditional use of CA is not well documented, and scientific evidence is limited to establish CA as a lactagogue. This investigation was conducted to elucidate the effect of traditional use of CA during the first month of lactation on quantity and quality of the breast milk. The results collected from the study show that CA supplementation increased breast milk production without compromising the nutritional quality of the breast milk. Lactating women receiving CA supplementation had a 65% increase in milk volume during the last two weeks of supplementation (from Day 14 to Day 28). This increase was greater than that of lactating women receiving Molocco+B12™ tablets (10%) or Fenugreek seeds (20%). The residual effects of CA supplementation were seen even after the supplementation had ended for one month. Results of the present study confirmed the belief and the practice amongst the Bataknese people that CA can be used as a lactagogue in humans, and the use of CA might be suitable for lactating women in general.
Key Words: Coleus amboinicus Lour, Torbangun, lactagogue, Bataknese Simalungun, traditional cuisine, Indonesia.

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Phytochemical intakes of the Fijian population
JIMAIMA LAKO, NAIYANA WATTANAPENPAIBOON, MARK L WAHLQVIST AND CRAIGE TRENERRY

The dietary intakes of major phytochemicals in Fijian population were estimated from the consumption of 90 plant foods reported in five major surveys conducted in Fiji from 1952 to 2001. These surveys included the Naduri Longitudinal study, for which food intake data were collected on four occasions in 1952, 1953, 1963 and 1994), the 1982 and 1993 National Nutritional Surveys, the 1996 Suva-Nausori Corridor cross-sectional study, the 1999 Verata cross-sectional study, and the 2001 Fiji Food Choice study. It was found that the Fijian population generally had low intakes of total phenols (275 mg/day), and total flavonoids (17.5 mg/day), but high intake of total carotenoids (20 mg/day), in comparisons with the intakes of other populations reported in literature. It has been speculated that the change of eating patterns resulting in the low intakes of phytochemicals may have partly contributed to the increase in the nutritionally chronic disease morbidity and mortality among the Fijians. It is further recommended that the traditional Fijian food patterns with high fruits and vegetables should be revived, and the consumption of sweet potato leaves and drumstick leaves, both of which were rich in phytochemicals, should be promoted.
Key Words: phytochemicals, flavonoids, carotenoids, anthocyanins, polyphenols, food intake, Fijians, Fiji.


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Last Updated: May 2006