Editorial. Nutrition research in the Asia Pacific region. MARK L WAHLQVIST
Abstracts:
Cardiovascular risk factor prevalence in three Chinese communities in 1989
Xuxu Rao, Bridget H-H Hsu-Hage, Mark L Wahlqvist, Yihe Li, Xiaoqing Liu, Kui Zhang, Tiehan Kuang, Daolin Zhang, Zongrong Dai, and the Australia-PR China Collaborative Health Study team
Asia Pacific Journal of Clinical Nutrition (1995) Volume 4, Number 3: 278-286
The cardiovascular risk prevalence of 1000 935 adult Chinese living in Chauzhou, Meizhou, and Xinhui cities of Guangdong Province, China, is reported. The three communities are geographically separated, and represent the three major dialect group in Guangdong Province (Teochew, Hakka and Cantonese respectively) which are also the major donor populations of overseas Chinese to Australia and South East Asia. Taking into account historical data, the conventional cardiovascular risk factor prevalence of these combined communities in China as a whole is on the increase and approaches or even exceeds that in Western Society. However, the three communities are not very alike in their prevalences of individual conventional cardiovascular risk factors, notably for hyperlipidaemia (most prevalent in Chauzhou), hypertension (most prevalent in Chauzhou men at 12.4% and least in Meizhou women 5.0%) and cigarette smoking (most prevalent in Xinhui men at 72.7% and least in Xinhui women, 0%). They are similar in stature, body weight, BMI, and waist-to-hip ratio, with very low prevalences of overweight/obesity, or abdominal obesity. An understanding of the contributors to sub-ethnic difference in cardiovascular risk should emerge with further study of these Chinese populations.
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Nutrition transition in China: the growth of affluent diseases with the alleviation of undernutrition
Xiao-Shu Chen, MD and Ke-You Ge, MD
Asia Pacific Journal of Clinical Nutrition (1995) Volume 4, Number 4: 287-293
Since 1950, the annual GNP in China increased from 104 to 1401 Yuan per capita, while household real purchasing power quadrupled. In addition, food production and distribution also rose. China's improved standard of living has brought about several health changes: a reduction in diseases of poverty (high infant mortality, communicable disease, nutritional deficiency), the doubling of life expectancy from 35 years in the 1950s to 67 (male) and 71 (female) years, but it has increased diseases of affluence, such as obesity and cardiovascular disease. The three leading causes of death in China today are cancer, cerebrovascular disease, and myocardial infarction, while deaths from tuberculosis and acute infectious illness are markedly reduced. About 60 million of the population suffer from hypertension and a quarter that number has diabetes. Because China is a vast territory with different levels of development and types of diet, pockets of nutritional deficiency remain; about 35 million people are undernourished. While most of the population receive sufficient macronutrients to satisfy the Chinese RDA, they frequently lack micronutrients. Childhood rickets and iron deficiency anaemia are prevalent in rural regions and close to half of the children under three years of age in the autonomous regions and provinces suffer from these conditions.
Chinese diets are changing. They are becoming more westernised and people are consuming more food of animal origin. This is most noticeable in cities where, in 1988, fat accounted for 30% of the caloric intake (up from 26% in 1981). In urban areas about 10% of woman and 5% of men are now obese. China is encouraging citizens to eat a variety of foods along more traditional lines, with plant foods constituting the bu 1000 lk of intake, and a lesser amount of food of animal origin. In 1993, the State Council approved a national position paper entitled "Outlines for China's Food Structure Reform and Development in the 1990s". The government hopes that this will lead to a healthier national diet by the year 2000.
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Studies on the relationship between changes in dietary patterns and health status
Zhao Faji, MD, Guo Junsheng, MD and Chen Hongchang, MD
Asia Pacific Journal of Clinical Nutrition (1995) Volume 4, Number 4: 294-297
In order to study the relationship between dietary composition and health and disease, we investigated retrospectively the changes in diet composition, health status and disease specific mortality of the Shanghai population from 1950 to 1985. The results showed that remarkable changes occurred in dietary composition, health status and disease mortality. The energy from grain products decreased from 80-83% in the 1950s to 68-72% in the 1980s, and the energy from animal foods increased from 6.5-8.5% in the 1950s to 17.5-18.0% in the 1980s. With the changes in dietary composition, notable changes also occurred in the nutritional composition of the diet. From the 1950s to the 1980s, energy from fat was increased from 16.3-20.1% to 24.0-28.0%, and the energy from carbohydrates decreased from 72.0-73.5% to 62.2-65.8%. Almost certainly as a result of the changes in diet, health status and disease mortality also changed. For example, the average height in males of 18-20 years old increased from 164.89 cm in 1955 to 167.33 cm in 1974, and the average life span of males and females increased from 42.0 years and 45.6 years in 1950 to 72.1 years and 76.4 years in 1985, respectively. At the same time, the rank order of mortality causes also changed. Before 1950, the first three causes of death were measles, tuberculosis and senility, but in 1985 they were malignant tumours, cerebrovascular disease, and ischaemic heart disease. In particular, the mortality from ischaemic heart disease is now higher than in Japan. The causes of these changes may be the changes of dietary composition and nutritional composition of diet, although there are other factors. Therefore, changes in dietary composition which maintain or improve life expectancy, yet decrease the burden of chronic non-communicable disease is required.
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HLA gene and clinical study of insulin dependent diabetes mellitus (IDDM) in Chinese individuals
Wang Heng, MD
Asia Pacific Journal of Clinical Nutrition (1995) Volume 4, Numb 1000 er 4: 298-300
The prevalence rate of diabetes in China was 0.67% in 1980. For the last ten years, the prevalence rate has increased 0.1% every year. The total number of diabetics in China is enormous, in the range of 12-15 million people; 10% have insulin dependent diabetes (IDDM) and 90% have non insulin dependent diabetes (NIDDM).
1) HLA Typing DR3 was statistically increased in Chinese IDDM patients; relative risk 7.89, Fisher's p 5.91 x 10-6 corrected p 4.14 x 10-6. DR3 is increased in most Caucasians and American Blacks, but not in Japanese individuals.
2) HLA-DQA1 and B1 alleles contribute to susceptibility to IDDM IDDM is strongly associated with the presence of arginine in position 52 of the DQ chain and absence of aspartic acid in position 57 of the DQ chain in Caucasians. To confirm this association in Chinese, extensive oligonucleotide dot blot hybridisation of PCR-amplified DQA1 and DQB1 genes were studied using samples from 48 IDDM patients and 46 healthy non diabetic control subjects. DQ 52-Arg and DQ 57-non-Asp are strongly associated with IDDM susceptibility as compared with controls (p < 0.001 and 0.006, respectively). DQ 57-non-Asp homozygosity is associated with increased susceptibility to IDDM. DQ 57-Asp homozygosity is associated with protection against IDDM; 14.6% of IDDM patients were homozygous for DQ -Asp, compared with 0% of American patients; 22.9% of IDDM patients were homozygous for DQ 57-nonAsp, compared with 96% of American diabetic subjects in a previous study. These results suggest that the effect of the DQ 57-Asp variation on Chinese IDDM susceptibility is not as remarkable as in Caucasians, and there may be other alleles which contribute to IDDM susceptibility in Chinese individuals.
3) Familial Aggregation and HLA Typing of Pedigrees in IDDM In 280 cases with IDDM positive family histories of diabetes have been found to be present in 26.8% of IDDM probands. The prevalence of diabetes in relatives has been shown to be 68% in first degree relatives, 28% in second degree relatives and 4% in the third degree relatives. HLA data support the hypothesis that IDDM is a multigenic hereditary disorder.
4). Clinical Features of Microvascular Complications in Long Term IDDM One hundred sixty three individuals with IDDM of more than 10 years in duration were followed. Most complications were microvascular, such as proliferative retinopathy (39/163, 23.9%) and nephropathy (19/163, 11.7%).
We have found that the development and degree of microvascular complications depend on the age of onset, diabetes duration and the long term glycaemic control. Especially, microvascular complications were found to be significantly influenced by glycaemic control in the first ten years after onset.
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Continuing medical education in clinical nutrition
Neil Paget
Asia Pacific Journal of Clinical Nutrition (1995) Volume 4, Number 3: 301-303
To achieve better promotion and acceptance of clinical nutrition at all levels of public and medical education requires involvement in educational services based on sound educatio 1000 nal theory and practice. Adult learning theory has established principles that support effective learning which, in turn, influence people's attitudes and behaviour. Application of these principles in Continuing Medical Education implies that as much emphasis must be placed on the educational skills necessary to produce self-directed lifelong learners as on clinical content. This article presents guidelines to assist in the planning and implementation of activities in clinical nutrition, and offers illustrative examples from other disciplines.
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Review article. Diet, hyperlipidaemia and cardiovascular disease
Jonathan M Hodgson, Mark L Wahlqvist, Bridget Hsu-Hage
Asia Pacific Journal of Clinical Nutrition (1995) Volume 4, Number 3: 304-313
Reviewed here are results of intervention studies examining relationships between diet and hyperlipidaemia, or diet and cardiovascular disease (CVD). A reduction in the intake of saturated fatty acids (SFAs) and trans-fatty acids (TFAs), and an increase in the intake of polyunsaturated fatty acids (PUFAs), are favourable to lipoprotein status. Where a reduction in total fat intake is achieved by a reduction in dietary SFAs, there would appear to be a favourable effect on CVD events and mortality, although the evidence for this from intervention studies is not strong. Adequate dietary PUFA intake, both 6 and 3, may be associated with reduced risk for CVD events more via pathways other than those which operate through lipoproteins. Other macronutrients including carbohydrates, proteins and alcohol can have significant effects on lipoproteins, although the effects of dietary intervention with these nutrients on coronary and total mortality are virtually unknown. Non-nutrient components of foods with small lipid lowering properties may be cumulatively important in an overall diet. In relation to food, results of secondary intervention studies provide support for a beneficial role of plant food and fish in reducing coronary and total mortality. Therefore as far as both hyperlipidaemia and CVD are concerned, the total dietary approach may be more important than the single nutrient approach.
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The relationship between linoleic acid level in serum, adipose tissue and myocardium in humans
Peter T Sexton, Andrew J Sinclair, Kerin O'Dea, Andrew J Sanigorski, Jan Walsh
Asia Pacific Journal of Clinical Nutrition (1995) Volume 4, Number 3: 314-318
A cross-sectional study of 80 consecutive cases at necropsy was underta 1000 ken to determine the relationship between linoleic acid in the serum, adipose tissue and myocardium of humans. The sample consisted of 55 males and 25 females aged 7 to 92 years who had died from cardiac and non-cardiac causes in the Southern Region of Tasmania, Australia. Fatty acids were extracted from samples of serum, adipose tissue and myocardium and separated using capillary gas liquid chromatography. Means and standard deviations were calculated for each of the main fatty acids in the three tissues studied. In serum and adipose tissue, there were significantly higher levels of linoleic acid (p<0.001 and p<0.001 in serum and adipose tissue, respectively) and total n-6 fatty acids (p< 0.002 and p< 0.001 in serum and adipose tissue, respectively) and significantly lower levels of oleic acid in females than in males (p< 0.001 and p<0.05 in serum and adipose tissue, respectively). In serum and adipose tissue, the ratio of total n-6 to total n-3 fatty acids was significantly higher in females than males (p<0.02 and p<0.001 in serum and adipose tissue, respectively). In myocardium, there were significantly higher levels of oleic acid (p<0.05) and linoleic acid (p<0.001) and significantly lower levels of arachidonic acid (p<0.001) and docosapentaenoic acid (p<0.02) in females than males. Total n-3 fatty acids in myocardium were significantly lower in females (p<0.001) resulting in a significantly higher ratio of total n-6 to total n-3 fatty acids in females (p<0.001). Highly significant Pearson correlations were found between levels of linoleic acid in adipose tissue and myocardium (p<0.0001), between adipose tissue and serum (p<0.001 ) and between serum and myocardium (p<0.001). The proportion of total polyunsaturated fatty acids (PUFA) in the myocardium was inversely related to the proportion of monounsaturated fatty acids (p<0.001) and inversely related to the proportion of saturated fatty acids (p<0.001). There was a significant positive correlation between the ratio of linoleic acid to linolenic acid in all three tissues. This study showed that there was a very strong relationship between the level of linoleic acid in adipose tissue and myocardial tissue, which suggests that dietary linoleic acid influences the level of myocardial linoleic acid. These findings support the hypothesis that dietary linoleic acid has a direct influence on myocardial membrane linoleic acid levels.
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Nutritional status of women and children in Malaysian rural populations
Osman Ali & Zaleha Md Isa
Asia Pacific Journal of Clinical Nutrition (1995) Volume 4, Number 3: 319-324
This study was conducted to investigate the nutritional status of the rural population in Malaysia, especially women and children. A total of 262 women aged 18 and over and 183 children aged 2-6 years were selected using multistage cluster sampling from four locations in rural areas. It was found that the prevalence of malnutrition among children 2-6 years old ranged between 25.5% in the Malays Felda settlement scheme to 80% in the Orang Asli settlement. Malnutrition was associated with worm infestations, bottle feeding and early weaning. More than 30% of Orang Asli women were malnourished compar 599 ed to less than 15% of Malay Felda settlement women. On the other hand, Malay women in the land settlement scheme had a higher risk of developing overweight and diabetes. Goitre was found among 11.5% of children; however, no cretinism was found. Breast feeding was still a common practice among rural mothers, but inadequate health education tended to reduce the duration of breast feeding and increased early weaning. Upgrading women's status in the rural areas will ultimately improve the nutritional and health status of the children and community as a whole.
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Clinical Nutrition]. All rights reserved.
Revised: January 19, 1999.