Asia Pacific Journal of Clinical Nutrition
Volume 15, issue 4
(December 2006)


Full Papers

Contents	Abstract	Papers
Original Articles High protein high fibre snack bars reduce food intake and improve short term glucose and insulin profiles compared with high fat snack bars GEMMA WILLIAMS, MANNY NOAKES, JENNIFER KEOGH, PAUL FOSTER AND PETER CLIFTON Asia Pac J Clin Nutr. 2006;15(4):443-450.	html	pdf
Precision in nutritional information declarations on food labels STEFAN U FABIANSSON Asia Pac J Clin Nutr. 2006;15(4):451-458.	html	pdf
Under-reporting of energy intake affects estimates of nutrient intakes PARVIN MIRMIRAN, AHMAD ESMAILLZADEH AND FEREIDOUN AZIZI Asia Pac J Clin Nutr. 2006;15(4):459-464.	html	pdf
Calibration and reliability of a school food checklist: a new tool for assessing school food and beverage consumption PETER J KREMER, A COLIN BELL AND BOYD A SWINBURN Asia Pac J Clin Nutr. 2006;15(4):465-473.	html	pdf
Primary school children from northeast Thailand are not at risk of selenium deficiency WORAVIMOL KRITTAPHOL, KARL B BAILEY, TIPPAWAN PONGCHAROEN, PATTANEE WINICHAGOON, CHRISTINE THOMSON AND ROSALIND S GIBSON Asia Pac J Clin Nutr. 2006;15(4):474-481.	html	pdf
Obesity and undernutrition in sub-Saharan African immigrant and refugee children in Victoria, Australia ANDRÉ MN RENZAHO, CARL GIBBONS, BOYD SWINBURN, DAMIEN JOLLEY AND CATE BURNS Asia Pac J Clin Nutr. 2006;15(4):482-490.	html	pdf
Risk factors for malnutrition among rural Nigerian children SENBANJO IDOWU ODUNAYO AND ADEODU OLUWAGBEMIGA OYEWOLE Asia Pac J Clin Nutr. 2006;15(4):491-495.	html	pdf
Low density lipoprotein subclasses in Asian and Caucasian adolescent boys VERENA RASCHKE, IBRAHIM ELMADFA, MARGARET A BERMINGHAM AND KATE STEINBECK Asia Pac J Clin Nutr. 2006;15(4):496-501.	html	pdf
Is the BMI cut-off level for Japanese females for obesity set too high? - A consideration from a body composition perspective MASAHARU KAGAWA, KAZUHIRO UENISHI, CHIHARU KUROIWA, MIKI MORI AND COLIN W BINNS Asia Pac J Clin Nutr. 2006;15(4):502-507.	html	pdf
The relationship between obesity and health related quality of life of women in a Turkish city with a high prevalence of obesity GÖNÜL DINÇ, ERHAN ESER, GÜL SAATLI, ÜMIT ATMAN CIHAN, AHMET ORAL, HAKAN BAYDUR AND CEMIL ÖZCAN Asia Pac J Clin Nutr. 2006;15(4):508-515.	html	pdf
Obesity among university students, Tehran, Iran MARZIEH NOJOMI AND SHAHANDOKHT NAJAMABADI Asia Pac J Clin Nutr. 2006;15(4):516-520.	html	pdf
Alternative anthropometric measurements for the Thai elderly: Mindex and Demiquet PRASERT ASSANTACHAI, PREYANUJ YAMWONG AND SOMSONG LEKHAKULA Asia Pac J Clin Nutr. 2006;15(4):521-527.	html	pdf
Persistence of iodine deficiency in Gangetic flood-prone area, West Bengal, India TAPAS KUMAR SEN, AKHIL BANDHU BISWAS, INDRANIL CHAKRABARTY, DILIP KUMAR DAS, RAMACHANDRAN RAMAKRISHNAN, PUNNAIH MANICKAM AND YVAN HUTIN Asia Pac J Clin Nutr. 2006;15(4):528-532.	html	pdf
Status of iodine nutrition in pregnant and lactating women in national capital district, Papua New Guinea VICTOR J TEMPLE, BENJAMIN HAINDAPA, ROBERT TURARE, ANDREW MASTA, APEWASU B AMOA AND PAULUS RIPA Asia Pac J Clin Nutr. 2006;15(4):533-537.	html	pdf
The relationship of neonatal serum vitamin B12 status with birth weight S MUTHAYYA, P DWARKANATH, M MHASKAR, R MHASKAR, A THOMAS, CP DUGGAN, W W FAWZI, S BHAT, M VAZ AND AV KURPAD Asia Pac J Clin Nutr. 2006;15(4):538-543.	html	pdf
Anti-inflammatory and anticatabolic effects of short-term -hydroxy- -methylbutyrate supplementation on chronic obstructive pulmonary disease patients in intensive care unit LAN-CHI HSIEH, SHU-LING CHIEN, MING-SHONG HUANG, HUNG-FU TSENG AND CHEN-KANG CHANG Asia Pac J Clin Nutr. 2006;15(4):544-550.	html	pdf
Effects of dietary supplements on the Fischer ratio before and after pulmonary rehabilitation HIROKAZU KUBO, NORITSUGU HONDA, FUMIO TSUJI, TAKASHI IWANAGA, MASATO MURAKI AND YUJI TOHDA Asia Pac J Clin Nutr. 2006;15(4):551-555.	html	pdf
Influencing health through intestinal microbiota modulation and probiotics ANDREW SINCLAIR AND SEPPO SALMINEN Asia Pac J Clin Nutr. 2006;15(4):556-557.	html	pdf
Intestinal colonisation, microbiota and future probiotics? SEPPO SALMINEN, YOSHIMI BENNO AND WILLEM DE VOS Asia Pac J Clin Nutr. 2006;15(4):558-562.	html	pdf
Safety of probiotics DIANA C DONOHUE Asia Pac J Clin Nutr. 2006;15(4):563-569.	html	pdf
Protection mechanism of probiotic combination against human pathogens: in vitro adhesion to human intestinal mucus M CARMEN COLLADO, LOTTA JALONEN, JUSSI MERILUOTO AND SEPPO SALMINEN Asia Pac J Clin Nutr. 2006;15(4):570-575.	html	pdf
Clinical studies on alleviating the symptoms of irritable bowel syndrome KAJSA KAJANDER AND RIITTA KORPELA Asia Pac J Clin Nutr. 2006;15(4):576-580.	html	pdf

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High protein high fibre snack bars reduce food intake and improve short term glucose and insulin profiles compared with high fat snack bars
GEMMA WILLIAMS, MANNY NOAKES, JENNIFER KEOGH, PAUL FOSTER AND PETER CLIFTON
The replacement in the diet of refined carbohydrate and fat with fibre and protein has been shown to promote satiety and improve glucose and insulin profiles. It is less clear whether the macronutrient composition of individual foods such as snacks have any meaningful impact on metabolic parameters and satiety. We examined if the consumption of higher protein higher fibre snack bars would result in reducing outcome measures such as food intake and glucose and insulin patterns compared to a conventional isocaloric high fat high refined carbohydrate snack bar. Twenty three women were randomized in a single blind cross over study with 2 interventions, a high fat high sugar snack bar and a comparatively higher protein, higher fibre snack bar intervention. Snack bars were eaten at mid morning and mid afternoon, and a standard breakfast and ad libitum buffet lunch. The glucose and insulin responses over 9 hours were significantly lower (P = 0.014 and P = 0.012 respectively) during the high protein snack bar intervention. Peak glucose levels were also 16% lower after the morning HP bar (P <0.001). The morning high protein bar reduced the energy intake at the buffet lunch meal by 5% (4657 ± 1025KJ vs 4901 ± 1186KJ, P < 0.05). Altering the macronutrient composition of a snack bar can assist in reducing the energy intake at a subsequent meal and improve short term glucose and insulin profiles.
Keywords: snack foods, satiety, high protein, glucose, insulin response
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Precision in nutritional information declarations on food labels
STEFAN U FABIANSSON
Nutrition labels guide consumers in making their food choice. New requirements for mandatory nutrition labelling have been in force in Australia since late 2002. The present study, analysing 350 samples comprising 70 different products for nutritional compounds declared on the label, is the first larger attempt to quantify the precision in nutrition labelling of food products on the Australian market. A significant discrepancy between actual and declared values was detected with an average variation in precision of -13% to +61% for individual nutritional components. There is no tolerance limit established in the Australian food legislation but a ± 20% discrepancy is allowed in some countries and others have separate upper and lower limits and allow a maximum discrepancy of -20% for beneficial nutritional compounds and +20% for unfavourable compounds. Only 16% of the 70 products in the study would fully comply should a leeway of ±20% be introduced for any nutritional compound on the label. With separate upper and lower limits, 51% of products would fully comply. Compliance improved to 27% and 70% of products, respectively, when excluding variations in minor amounts irrelevant to consumers (counting all variations of less than 1g/100g, or 10kJ/100g for energy and 10mg/100g for sodium, potassium, calcium and cholesterol, as compliant). It is proposed that adoption of an upper and lower tolerance limit, excluding minor amounts, be considered as a way of better assisting the consumer in making relevant comparisons of product nutritional value and that any nutritional component should comply with the limit for the product to comply. Applying such a limit, 30% of products in the survey would not be compliant.
Key Words: Australia, nutrition labelling, food standards, analytical precision.

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Under-reporting of energy intake affects estimates of nutrient intakes
PARVIN MIRMIRAN, AHMAD ESMAILLZADEH AND FEREIDOUN AZIZI
Under-reporting of energy intake is a common problem in nutritional epidemiological studies. The aim of the present study was to determine the effect of under-reporting of energy intake on the estimates of nutrient intakes. In this cross-sectional study, 901 subjects aged >16 y were randomly selected from participants of the Tehran Lipid and Glucose Study. Dietary intake was assessed by means of two 24-hour dietary recalls. Basal metabolic rate (BMR) was determined according to age, sex and weight. The ratio of energy intake (EI) to BMR was calculated. Under-reporting of energy intake was defined as EI:BMR<1.35 and normal-reporting of dietary intake as EI : BMR = 1.35 - 2.39. To obtain energy-adjusted amounts of macro- and micronutrients, the residual method was used. Under-reporting of energy intake was revealed in 31% of the subjects and was more common among females (40%) than males (19%, P <0.01). The mean age of females who under-reported was significantly lower than the normal-reporting females (32 ± 13 vs. 35 ± 14 y, P <0.05); however, the age difference between the two groups was not significant in men. Under-reporters had higher BMIs compared to normal-reporters in both genders. The absolute intakes of macro- and micronutrients (except for B12 in females and B6 and zinc in both genders) were lower in under-reporters, but following adjustment, no significant differences were seen. The results have revealed that under-reporting of energy intake affects the estimates of nutrient intakes; thus in studies aimed at determining the association between a certain chronic disease and a nutrient intake, we suggest adjustments be made for energy intake.
Key Words: Under-reporting, energy intake, nutrients, diet, Iran.
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Calibration and reliability of a school food checklist: a new tool for assessing school food and beverage consumption
PETER J KREMER, A COLIN BELL AND BOYD A SWINBURN
There is a pressing need in Australia and other countries to develop systems for monitoring secular trends in childhood obesity and related behavioural and environmental determinants. Energy from foods and beverages consumed at school is an accessible indicator of children's eating patterns and we have developed a school food checklist (SFC) to measure this. The SFC records the number of serves and source (home, canteen, vending machine) of 20 food and beverage categories. This study aims to assess the accuracy and to calibrate the SFC by comparing it to a weighed record (WR) and to evaluate inter-recorder reliability. Participants were 910 primary school children aged 5 to 12 years from a rural township in Victoria, Australia. WR were collected from a non-random sub-sample of 106 and a second sub-sample (n=46) had intake measured twice using the SFC to assess inter-recorder reliability. Mean energy values were 2992 kJ ± 924 and 3008 kJ ± 952 for the SFC and WR respectively and the correlation coefficient was strong (Pearson r = 0.77). The mean difference between the WR and SFC methods was 15 kJ (95% CI, -107 kJ to 138 kJ) and the limits of agreement (+2 standard deviations) were ± 1270 kJ. The SFC overestimated the energy/serve of breads and fruit drinks and under-estimated energy/serve from fat spreads, biscuits/crackers, muesli/fruit bars and fruit. Inter-recorder reliability was good (kappa 0.51). The SFC was designed to measure energy from food and beverages in schools. It has good accuracy and reliability and the revised version should further improve accuracy of the instrument.
Key Words: dietary assessment, schools, obesity prevention, children
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Primary school children from northeast Thailand are not at risk of selenium deficiency
WORAVIMOL KRITTAPHOL, KARL B BAILEY, TIPPAWAN PONGCHAROEN, PATTANEE WINICHAGOON, CHRISTINE THOMSON AND ROSALIND S GIBSON
Selenium has important roles as an antioxidant, in thyroid hormone metabolism, redox reactions, reproduction and immune function, but information on the selenium status of Thai children is limited. We have assessed the selenium status of 515 northeast Thai children (259 males; 256 females) aged 6 to 13 years from 10 rural schools in Ubon Ratchthani province. Serum selenium (n=515) was analyzed by Graphite Furnace Atomic Absorption Spectrophotometry and dietary selenium intake by Hydride Generation Absorption Spectrophotometry from one-day duplicate diet composites, from 80 (40 females; 40 males) randomly selected children. Inter-relationships between serum selenium and selenium intakes, and other biochemical micronutrient indices were also examined. Mean (SD) serum selenium was 1.46 (0.24) µmol/L. Concentrations were not affected by infection or haemoglobinopathies, but were dependent on school (P<0.001), sex (P=0.038), and age group (P=0.003), with serum zinc as a significant covariate. None of the children had serum selenium concentrations indicative of clinical selenium deficiency (i.e. < 0.1 µmol/L). Significant correlations existed between serum selenium and serum zinc (r= 0.216; P < 0.001), serum retinol (r = 0.273; P < 0.001), urinary iodine (r = -0.110; P = 0.014), haemoglobin (r = 0.298; P <0.001), and haematocrit (r = 0.303; P<0.001). Mean (SD) dietary selenium intake was 46 (22) µg/d. Children with low serum selenium concentrations had a lower mean selenium intake than those with high serum selenium concentrations (38 ± 17 vs. 51 ± 24 µg/d; P<0.010). In conclusion, there appears to be no risk of selenium deficiency among these northeast Thai children.
Key Words: selenium, serum, diet, zinc, children, Thailand.

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Obesity and undernutrition in sub-Saharan African immigrant and refugee children in Victoria, Australia
ANDRÉ MN RENZAHO, CARL GIBBONS, BOYD SWINBURN, DAMIEN JOLLEY AND CATE BURNS
The study assessed the anthropometric status of 337 sub-Saharan African children aged between 3-12 years who migrated to Australia. These children were selected using a snowball sampling method stratified by age, gender and region of origin. The prevalence rates for overweight and obesity were 18.4% (95%CI: 14 - 23%) and 8.6% (95%CI: 6% -12%) respectively. The prevalence rates for the indicators of undernutrition were: wasting 4.3% (95%CI: 1.6%-9.1%), underweight 1.2% (95%CI: 0.3%-3.0%), and stunting 0.3 (95%CI: 0.0%-1.6%). Higher prevalence of overweight/obesity was associated with lower household income level, fewer siblings, lower birth weight, western African background, and single parent households (after controlling for demographic and socio-economic factors). Higher prevalence rates for underweight and wasting were associated with lower household income and shorter lengths of stay in Australia respectively. No effect was found for child's age, gender, parental education and occupation for both obesity and undernutrition indices. In conclusion, obesity and overweight are very prevalent in SSA migrant children and undernutrition, especially wasting, was also not uncommon in this target group.
Key Words: obesity, undernutrition, sub-Saharan Africa, children, migration, refugees

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Risk factors for malnutrition among rural Nigerian children
SENBANJO IDOWU ODUNAYO AND ADEODU OLUWAGBEMIGA OYEWOLE
Protein Energy Malnutrition (PEM) remains a major public health problem in the developing world. The aim of this study was to determine the current nutritional status and the influence of feeding practices and family characteristics on the nutritional status of under-five rural Nigerian children. It was conducted using a cross sectional, community based survey design. From 344 households, 420 children were studied. Using the modified Wellcome Classification, the prevalence of PEM was 20.5 percent whereas the prevalence of underweight, wasting and stunting using the World Health Organization/ National Centre for Health Statistics (WHO/ NCHS) standards were 23.1 percent, 9 percent and 26.7 percent respectively. Young age was significantly associated with a higher prevalence of underweight (P = 0.004). Overcrowding, low maternal income and the use of infant formula feeds in children who have attained the age of 6 months and above were associated with a higher prevalence of wasting (P = 0.029, P = 0.031 and P = 0.005 respectively). Improved living standard of families, empowerment of mothers with the aim of augmenting family income and parental education on appropriate feeding practices may help in reducing the incidence of under-five malnutrition in communities. The low prevalence rate of malnutrition was probably due to activities of the NGO in this community. This method of intervention is similarly achievable in any other community.
Key Words: malnutrition, risk factors, children, rural, Nigeria, Africa
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Low density lipoprotein subclasses in Asian and Caucasian adolescent boys
VERENA RASCHKE, IBRAHIM ELMADFA, MARGARET A BERMINGHAM AND KATE STEINBECK
South Asian adults are known to have very high rates of Coronary heart disease (CHD) and insulin resistance and, even as adolescents, may show higher risk factors for CHD. The aim of this study was to investigate the prevalence of small, dense low density lipoprotein (sdLDL) subclasses in a cohort of adolescent boys. The specific objective was to investigate the relationship between measures of fatness, ethnicity and LDL diameter in this cohort. Preformed native (non-denaturing) polyacrylamide 3-13% gradient gels and a multipurpose vertical electrophoresis system were used for the separation of LDL sub-fractions in a single school year cohort of boys aged 15-16 years (n=135). Latex beads and thyroglobulin standards were used to construct a calibration curve in order to calculate LDL particle diameters by regression (Total Lab Software v1.11). ANOVA was used to compare LDL size among different ethnic groups (SPSS and Stat View). The study sample was comprised of 45.2% Caucasians, 41.5% East Asians and 13.3% from the Indian subcontinent (South Asians).There was a non-significant trend for South Asians to have a lower LDL diameter than either Caucasians or East Asian boys which was independent of % total body fat (%TBF) and body mass index (BMI). This is the first adolescent cohort to examine sdLDL which included Caucasians, East and South Asians. It appears that the higher risk profile for CHD and diabetes noted in South Asian adults may be evident even during adolescence.
Key Words: adolescence, coronary heart disease, arteriosclerosis, small dense low density lipoproteins, LDL size, lipoprotein subtractions, non-denaturing gradient gel electrophoresis, Caucasian, Asian, Australia.


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Is the BMI cut-off level for Japanese females for obesity set too high? - A consideration from a body composition perspective
MASAHARU KAGAWA, KAZUHIRO UENISHI, CHIHARU KUROIWA, MIKI MORI AND COLIN W BINNS
The aim of the study was to determine the sensitivity and specificity of the BMI cut-off points that have been applied in the National Nutritional Survey in Japan (NNS-J) for young Japanese females. The relationship between the body mass index (BMI) and percentage body fat (%BF) of 139 young Japanese females (aged 18-27 years old) was examined using dual energy x-ray absorptiometry (DXA) and anthropometry. The sensitivity and specificity of the BMI cut-off point that has been in use in Japan was compared with the cut-off point proposed for Asia-Pacific population (the WPRO classification). The regression equation calculated for the relationship between the BMI and %BF using the DXA scan data was %BF = -15.152+2.058*BMI; R2 = 0.612, SEE = 3.66. From this equation the BMI value that corresponded with %BF of 30% was calculated to be 21.9kg/m2 (95%CI: 16.9-28.6). From the sensitivity and specificity analysis, it was found that more than 90% of Japanese females with %BF >30% were misclassified as "not obese" when the BMI value of 25kg/m2 was used to identify obese individuals. The misclassification reduced to 60% when the BMI value of 23kg/m2 was used as a cut-off point. The results indicate that the current classification used in the NNS-J may not precisely reflect the obesity status of young Japanese females and a considerable proportion of females with a large fat deposition would be misclassified as not obese. The current study shows the importance of including detailed body composition assessments to determine obesity level of individuals.
Key Words: Body Mass Index, body fat, BMI cut-off points, Japanese, females

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The relationship between obesity and health related quality of life of women in a Turkish city with a high prevalence of obesity
GÖNÜL DINÇ, ERHAN ESER, GÜL SAATLI, ÜMIT ATMAN CIHAN, AHMET ORAL, HAKAN BAYDUR AND CEMIL ÖZCAN
The purpose of this study was to demonstrate the relationship between body weight and HRQOL in a representative sample of nonpregnant women in reproductive age period. The data of this cross-sectional study was extracted from a survey: Manisa Demographic and Health Survey (MDHS) conducted in Manisa city in 2000. The study population of MDHS is a representative sample of 1602 reproductive (15-49) age women. World Health Organization Quality of Life Questionnaire abbreviated version (WHOQOL-BREF), which was composed of four domain factors (physical, psychological, social relations and the environment), was used to assess HRQOL. Each of four domains had a possible score ranged between 0 (poor HRQOL) and 20 (excellent HRQOL). The mean age of the women was 35.29 8.19 years. Among them, 35.8 % had normal weight (BMI 18.5 to 24.9), 32.3 % were overweight (BMI 25.0 to 29.9) while 31.9 % were moderate and 3.4% were morbidly obese. After adjusting for age, level of education and co-morbid illnesses, subjects with a BMI higher than normal value, had significantly lower HRQOL scores, compared to normal-weight individuals on each of the domains, except for the environmental domain. Our results suggested that the body weight alone could negatively affect HRQOL. In other words, obesity not only increased the risk of morbidity and mortality, but also affected the perceived health and life quality negatively. In conclusion, in addition to age, socioeconomic status and co-morbid illnesses, body weight should also be controlled in studies examining HRQOL..
Key words: Health Related Quality of Life, obesity, women, WHOQOL, general health-related quality, Turkey.

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Obesity among university students, Tehran, Iran
MARZIEH NOJOMI AND SHAHANDOKHT NAJAMABADI
Evaluating the nutritional status of individuals and population groups is an important tool in public health and a feasible indicator of standards of living. The objective of this study was to determine the frequency of obesity and present nutritional status of university students of Iran University of Medical Sciences in Tehran. The survey was conducted between Oct 2004 and June 2005. The statistical population included all students from School of medicine, nursing and midwifery, health services, management, science, and rehabilitation. The method of sampling was multistage random. The sample size for the survey was 1150 students. We used a self-administered 24h food recall questionnaire. We categorized BMI to two groups in bivariate analysis (BMI = 25 kg m-2 as obese and less than 25 kg m-2 as non-obese). Mean BMI for all subjects was 21.7 ± 2.9 kg m-2. Almost 88% of the subjects were classified into a non-obese group (BMI <25 kg m-2). About 10% were underweight and 12.4% of the students had a BMI more than 25 kg m-2. A significant difference was observed for BMI between males and females; 7.9% of males versus 22.5% of females had BMIs over 25. About 18% of students aged 23 years and over had BMIs over 25 versus 7.7% of students aged under 18. Intakes of fiber, pre-vitamin A, folacin and iron were significantly different between BMI groups. Intakes of these nutrients were higher in the obese students than the students with BMIs less than 25 kg m-2. Our results indicate that about 12.4% of the students had a BMI more than 25 kg m-2. There was a significant association between BMI, and smoking habits, age, sex, place of resident and having specific dietary regimen.
Key Words: obesity , BMI, University students, nutrients intakes, Iran
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Alternative anthropometric measurements for the Thai elderly: Mindex and Demiquet
PRASERT ASSANTACHAI, PREYANUJ YAMWONG AND SOMSONG LEKHAKULA
This cross-sectional study examined the relationship between alternative anthropometric indices and the nutritional and metabolic status of the Thai elderly. Four rural communities, each from the 4 main regions of Thailand were surveyed. A total of 2324 subjects, 60 years old and over were included in the study. Mindex and Demiquet had a very strong relationship to body mass index with the r values of 0.93 and 0.88, respectively. Fat weight had the highest correlation with body mass index in older women, r = 0.94 (P<0.001) and with Mindex, r = 0.93 (P<0.001). In regard to anthropometric measurements, the mid-arm circumference had the strongest relationship to all three Quetelet indices, r = 0.76-0.87 (P<0.001), while subscapular skinfold thickness performed best among skinfold measurements, r = 0.69-0.74 (P<0.001). BMI achieved a significantly higher degree of correlation with triceps and supra-iliac skinfold thickness, mid-arm circumference and fat weight than Demiquet (P<0.001 for all variables). The lymphocyte count was the only laboratory test that related rather well to all three Quetelet indices. All three Quetelet indices had nearly the same pattern of relationship to various nutritional parameters. The cut-off points of Mindex denoting under-nutrition, overweight and obesity I in women were 55.95, 69.55 and 75.60 kilogram/metre, respectively. At the same time, the cut-off points of Demiquet denoting under-nutrition, overweight and obesity I in men were 75.60, 93.98 and 102.16 kilogram/metre2, respectively. All this information supports the benefit of using Mindex and Demiquet as alternatives to body mass index for nutritional assessment in older Asian people, especially for the malnourished ones.
Key Words: Mindex, Demiquet, anthropometric, elders, rural, Thai
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Persistence of iodine deficiency in Gangetic flood-prone area, West Bengal, India
TAPAS KUMAR SEN, AKHIL BANDHU BISWAS, INDRANIL CHAKRABARTY, DILIP KUMAR DAS, RAMACHANDRAN RAMAKRISHNAN, PUNNAIH MANICKAM AND YVAN HUTIN
In 2000, India revoked the ban on production and sale of non-iodised salt. We conducted a study in the north 24 parganas district in the state of West Bengal to assess the prevalence of goitre, status of urinary iodine excretion (UIE) level and to estimate iodine content of salts at the household level. We surveyed 363 school children aged eight to ten years selected using a multistage cluster sampling technique. We estimated goitre prevalence and urinary iodine excretion (UIE) using methods and criteria recommended by the World Health Organization. We estimated the iodine content of salt samples collected from the households of the study subjects using spot iodine testing kit. Of the 363 children, 73 (20%) had goitre. The median UIE was 160 µg/l (normal: 100 µg/l) and only 6% children had a level below 50 µg/l. Only 253 of 363 salt samples (70%) were sufficiently iodised. The combination of high goitre prevalence with normal median urinary excretion indicates that the North 24 Parganas district is in transition from iodine deficient to iodine sufficient state. However, the persistence of non-iodised salt consumption indicates that an intensification of universal salt iodisation program is needed.
Key Words: goitre, iodine deficiency, total goitre rate (TGR), urinary iodine excretion (UIE), iodine content of the salt, cross-sectional study, India
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Status of iodine nutrition in pregnant and lactating women in national capital district, Papua New Guinea
VICTOR J TEMPLE, BENJAMIN HAINDAPA, ROBERT TURARE, ANDREW MASTA, APEWASU B AMOA AND PAULUS RIPA

Urinary Iodine excretion is a useful and important indicator of the iodine status of a population. This study attempts to determine the urinary iodine concentration of non-pregnant, pregnant and lactating women, resident in the National Capital District of Papua New Guinea, so as to evaluate their status of iodine nutrition. The study population was made up of 56 non-pregnant, 40 lactating and 212 pregnant women. Of the 212 pregnant women, 14 were in the first, 64 in the second, and 134 in the third Trimester of pregnancy. Casual urine samples were collected and analysed for urinary iodine by Sandell-Kolthoff reaction. The median urinary iodine concentration for the non-pregnant, lactating and pregnant women was 163.0ug/L, 134.0ug/L and 180.0ug/L, respectively. Median urinary iodine for the first, second and third trimesters were 165.0ug/L, 221.5ug/L and 178.0ug/L, respectively. The 20th percentile urinary iodine values were higher than 50ug/L for all the groups. This indicates adequate intake of dietary iodine and optimal status of iodine nutrition amongst women in the various groups. Mild to severe status of iodine nutrition was found in 30.4% of non-pregnant, 35.0% of lactating, 22.2% of pregnant women, 28.5% of women in the first, 18.8% in the second, and 23.1% in the third trimester of pregnancy. To achieve optimal iodine nutrition in pregnant and lactating women, an increase in their intake of dietary iodine is recommended.
Key Words: urinary iodine, pregnancy, lactation, trimesters, non-pregnant, Papua New Guinea
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The relationship of neonatal serum vitamin B12 status with birth weight
S MUTHAYYA, P DWARKANATH, M MHASKAR, R MHASKAR, A THOMAS, CP DUGGAN, W W FAWZI, S BHAT, M VAZ AND AV KURPAD
Earlier studies have shown a relationship between maternal vitamin B12 status and birth weight. This study extends those findings directly in terms of neonatal vitamin B12 status and birth weight. One hundred and twelve women were followed from the first trimester of pregnancy and maternal blood was obtained in all three trimesters along with cord blood at birth of their neonates. The maternal and cord serum vitamin B12 concentrations were examined in relation to birth weight. There was a significant correlation between vitamin B12 concentration in maternal antenatal serum during each of the trimesters of pregnancy and cord serum (all P<0.01). Neonates that were born with lower birth weights (categories of < 2500 g and 2500-2999 g) had significantly lower mean cord serum vitamin B12 concentrations when compared to those who were = 3000 g (P = 0.02 and P = 0.05 respectively). A similar, however, non significant trend was observed for antenatal vitamin B12 concentrations at first and third trimesters. Cord serum vitamin B12 concentrations were significantly correlated with birth weight, up to 40 weeks of pregnancy (r=0.28, P=0.01) but not beyond that (= 40 weeks gestation). Vitamin B12 status in the mother was related to neonatal vitamin B12 status as measured by cord serum vitamin B12 concentration. In addition, low neonatal vitamin B12 concentrations were adversely associated with low birth weights.

Key Words: neonatal vitamin B12, birth weight, India

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Anti-inflammatory and anticatabolic effects of short-term -hydroxy- -methylbutyrate supplementation on chronic obstructive pulmonary disease patients in intensive care unit
LAN-CHI HSIEH, SHU-LING CHIEN, MING-SHONG HUANG, HUNG-FU TSENG AND CHEN-KANG CHANG
Elevated inflammatory markers and muscle wasting were common in chronic obstructive pulmonary disease (COPD) patients. The purpose of this study was to investigate the effect of 7-day -hydroxy- -methylbutyrate (HMB) supplementation on inflammation, protein metabolism, and pulmonary function in COPD patients in an intensive care unit. Thirty-four COPD patients who required mechanical ventilators were randomly assigned to HMB (n=18) or control (n=16) groups. The HMB group received 3 g/d for 7 days. White blood cell count, C-reactive protein, and creatinine were significantly lower, while cholesterol and total protein were significantly higher after supplementation. The body weight remained unchanged in both groups. Ten subjects (55.6%) in the HMB group and 4 subjects (25.0%) in the control group had improved pulmonary function, indicated by their ventilator modes. This short-term study suggests that supplementation may have anti-inflammatory and anticatabolic effect and improve pulmonary function in COPD patients in an intensive care unit setting.
Key Words: -hydroxy- -methylbutyrate, inflammation, C-reactive protein, chronic obstructive pulmonary disease


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Effects of dietary supplements on the Fischer ratio before and after pulmonary rehabilitation
HIROKAZU KUBO, NORITSUGU HONDA, FUMIO TSUJI, TAKASHI IWANAGA, MASATO MURAKI AND YUJI TOHDA

Recently, efforts in comprehensive pulmonary rehabilitation for COPD have been made, including education, physical therapy, occupational therapy, nutrition, nursing, medication and counseling. Each patient focuses on a different element. Supplying adequate nutrition, among others, is essential for comprehensive pulmonary rehabilitation, as well as survival. In this study, the utility of efficient nutritional supplement therapy before and after pulmonary physical therapy was investigated by adding an amino acid drink with a high Fisher ratio to comprehensive pulmonary rehabilitation. The subjects were eight patients with COPD with obstructive ventilation disorder as severe as 31.5 ± 6% of FEV 1.0%. Pulmonary physical therapy was performed for eight weeks in a group administered one bottle of dietary supplement with a high Fisher ratio abundant in branched chain amino acids once daily (200 kCal/200 mL, Fisher ratio 40), and in another group without administration. Before and after the physical therapy, six-minute waking examination, QOL assessment (using CRQ), serum protein and serum Fisher ratio were comparatively examined between the two groups. After the eight weeks of pulmonary physical therapy, serum Fisher ratios were evidently reduced and serum protein measurements were also decreased in the group without dietary supplement abundant in branched chain amino acids. Accordingly, more amino acid is needed due to enhanced consumption of muscular protein during pulmonary physical therapy, during which nutrient ingestion including a sufficient amount of branched amino acid is necessary. It is an important element in continuing comprehensive pulmonary rehabilitation for a longer period.
Key Words: chronic obstructive pulmonary disease, branched-chain amino acid, Fisher ratio, nutrition assessment, pulmonary rehabilitation


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Influencing health through intestinal microbiota modulation and probiotics
ANDREW SINCLAIR AND SEPPO SALMINEN
Science has progressed fast in providing answers to probiotic health benefits to the consumers. This symposium also proves that progress is fast. However, several challenges still need to be solved and more effective strains and strain combinations discovered. This will pave the way from good probiotics to specific products for clearly identified target populations. The intestinal microbiota and its interaction(s) with probiotics challenges researchers to turn to the next new page to discover new approaches and treatment modalities that utilize probiotics as means of providing good nutrition with clear health benefits to all consumers.
Key Words: probiotics, microbiota, probiotic bacteria, safety, clinical trials, intestinal microbiota, genomics, nutrition

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Intestinal colonisation, microbiota and future probiotics?
SEPPO SALMINEN, YOSHIMI BENNO AND WILLEM DE VOS
The human intestine is colonized by a large number of microorganisms, collectively termed microbiota, which support a variety of physiological functions. As the major part of the microbiota has not yet been cultured, molecular methods are required to determine microbial composition and the impact of specific dietary components including probiotics. Probiotics are viable microbial food supplements, which have a beneficial impact on human health. Health-promoting properties have been demonstrated for specific probiotic products. The most significant demonstrations for probiotic efficacy include prevention and treatment of antibiotic associated diarrhea, rotavirus diarrhea and allergy prevention. Lactobacillus rhamnosus GG (=ATCC 53103) and Bifidobacterium lactis Bb12 are the among the best-characterized and most studied probiotic strains with demonstrated impact on human health. New complex targets for probiotics include irritable bowel syndrome and Helicobacter pylori infection. For future probiotics the most important target is a demonstrated clinical benefit supported by knowledge on the mechanistic actions in the microbiota of the target population. Molecular and genomics-based knowledge of the composition and functions of the microbiota, as well as deviations from the balanced microbiota, will advance the selection of new and specific probiotics. Potential combinations of specific probiotics may prove to be the next step to reduce the risk on intestinal diseases and reconstruct specific microbial deviations.
Key Words: Intestinal microbiota, diversity, genomics, probiotic, clinical studies, Lactobacillus GG


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Safety of probiotics
DIANA C DONOHUE
New species and more specific strains of probiotic bacteria are constantly being sought for novel probiotic products. Prior to the incorporation of novel strains into food or therapeutic products a careful evaluation of their efficacy is required and an assessment made as to whether they share the safety status of traditional food organisms. Food organisms intrinsic to the production of traditional foods have been arbitrarily classified as safe in the absence of scientific criteria. Evidence for the safety and efficacy of probiotics has until recently been largely anecdotal or based on relatively little, and often poorly designed research. The demonstration of efficacy in probiotics offers vast opportunities for the development of human and veterinary products. The introduction of a new probiotic culture demands that it be at least as safe as its conventional counterparts. Many bacteria are being tested to find a putative probiotic, yielding conflicting data, sometimes for the same organism. Comparisons between studies and organisms cannot be readily made because of non-standardized dosing procedures. Information is not readily available on the equivalence of formulations for different probiotic preparations. There is vigorous debate on what constitutes appropriate safety testing for novel probiotic strains proposed for human consumption. Conventional toxicology and safety evaluation is of limited value in assessing the safety of probiotics. The addition of novel bacterial strains to foods and therapeutic products requires reconsideration of the procedures for safety assessment. This paper provides an overview of these issues.
Key Words: : probiotic, safety, bacteraemia, clinical trial, guidelines, efficacy.


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Protection mechanism of probiotic combination against human pathogens: in vitro adhesion to human intestinal mucus
M CARMEN COLLADO, LOTTA JALONEN, JUSSI MERILUOTO AND SEPPO SALMINEN
In this study we evaluated the ability of commercial strains (L. rhamnosus GG, L. rhamnosus LC705, and P. freudenreichii ssp. shermanii JS) in combination with B. breve 99 or B. lactis Bb12 to inhibit, displace and compete with model pathogens in order to test their influence on the adhesion of selected pathogens to immobilized human intestinal mucus. Our results demonstrate that specific probiotic combinations are able to enhance the inhibition percentages of pathogens adhesion to intestinal mucus when compared to individual strains. This suggests that combinations of probiotic strains are useful and more effective in inhibition of pathogen adhesion than individual strains. Such combinations should be assessed in clinical studies in subjects where the intestinal microbiota aberrancies have been identified.
Key Words: Adhesion, pathogens, Lactobacillus, Bifidobacterium, Propionibacterium, combinations, synergy


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Clinical studies on alleviating the symptoms of irritable bowel syndrome
KAJSA KAJANDER AND RIITTA KORPELA
Irritable bowel syndrome (IBS) is one of the most common diagnoses in gastroenterology, but current therapies are inefficient. Recent clinical trials suggest beneficial effects of certain probiotics in IBS. Because of the heterogeneity of IBS a probiotic combination may be more efficient than a single strain. We screened for optimal strains, and developed a multispecies probiotic combination consisting of L. rhamnosus GG, L. rhamnosus Lc705, P. freudenreichii ssp. shermanii JS and Bifidobacterium breve Bb99. The clinical efficacy of the probiotic combination was evaluated in IBS patients in a randomised, double-blind, placebo-controlled six-month intervention. During six months the subjects received daily either probiotic supplementation or placebo. IBS symptoms were followed by symptom diaries. The probiotic supplementation demonstrated significant value in reducing IBS symptoms. At the end of the study period the total symptom score (abdominal pain + distension + flatulence + rumbling) had reduced with 42% in probiotic group versus 6% in the placebo group. The treatment difference in the baseline-adjusted symptom score between the groups was -7.7 points (95% CI 13.9 to 1.6) in the favour of the probiotic supplementation. The underlying mechanisms could involve for instance anti-inflammatory effects, balancing of the microbiota or motility-related effects induced by the probiotic. The probiotic activity may be enhanced by synergistic effects of the combination that each strain alone would not hold. In conclusion, we found a probiotic combination of LGG and three other strains to be effective in alleviating IBS symptoms.
Key Words: gastrointestinal symptoms, irritable bowel syndrome, probiotics, probiotic combination

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Last Updated: Nov 2006