Volume 5, Number 3
Editorial. Modern lifestyles and micronutrient deficiency. WIDJAJA LUKITO, RAINER GROSS, DARWIN KARYADI, MUHILAL
Abstracts:
H Muhilal PhD
Asia Pacific Journal of Clinical Nutrition (1996) Volume 5, Number 3: 132-134
Key Words: Diet, cardiovascular disease risk factors, animal fat consumption.
Indonesia is in the midst of major transitions in food intake and health patterns. These changes are predicated on economic growth, rising levels of education and globalisation of culture. Somehow retaining the food-health advantages of traditional Indonesian lifestyle and accommodating the advances which the West has made, especially in life expectancy, without their increasing health problems and costs, is required. From 1972 to 1992, mortality ranking for cardiovascular disease in Indonesia had gone from the 11th most common to the most common. The Jakarta Monica studies (1988 and 1993) provide prima facie evidence that similar cardiovascular risk factors to those in industrialised countries are operative for the emergent cardiovascular disease problem - positive energy balance with obesity, increased animal fat consumption and decreased intake of plant-derived foods, with their many biologically active components, both nutrient and non-nutrient. Nutrition surveys show that the contribution of fat to energy intake has doubled from 1974 to 1992 (10.4% in 1974 to 20.5% in 1992). Effort is now required to enable consumers to overcome prejudice against plant foods, for whatever reason, to use low fat animal-derived food and for food products and their promotion to favour healthy choice.
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Soesmalijah Soewondo PhD
Asia Pacific Journal of Clinical Nutrition (1996) Volume 5, Number 3: 135-137
Key words: modern lifestyle, stress
An Indonesian perspective of lifestyle in an urban environment is likely to be sharper because of how recent and substantial urbanisation has been. Contrasts between rural and new urban ways of life make the stressors more obvious than they may be to those in societies where the industrial revolution occurred much earlier. Additionally, the post-industrial society is grafted onto a recent industrial society in cities like Jakarta. The impact on nutritional flows through work patterns, eating styles and family life requires attention. There are medical-physiological and psychological approaches to the understanding of stress. In this way, an appreciation of factors other than the food supply itself on nutritional status can be gained. These include fashion, peer pressure, relationships, physical activity patterns and food patterns. Management of these stressors provides additional opportunities for preventive health.
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M Alwi Dahlan PhD
Asia Pacific Journal of Clinical Nutrition (1996) Volume 5, Number 3: 138-140
Communication and information technologies are rapidly changing the way we learn, live, and relate to others. There are societal and direct personal consequences, along with the impact of communication as a process, with which we need to reckon. As in other domains of life and health, nutritional well-being may be profoundly affected, favourably or unfavourably, depending on how we manage the new technologies. It is opportune for nutrition scientists and practitioners to embrace proactively these developments.
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Umar Fahmi Achmadi PhD
Asia Pacific Journal of Clinical Nutrition (1996) Volume 5, Number 3: 141-144
Key words: pollution, urban areas, health
The current levels of environmental pollutant in Indonesian cities, especially in Jakarta and Surabaya, as well as other cities in Java island, already have the potential for public health impact. Of particular concern and surveillance value are atmospheric particulate matter, sulphur dioxide, nitrous oxide, carbon monoxide, heavy metals (lead, cadmium and mercury) and pesticide residuals. These are also entering the food and water supply with particular risk to the socio-economically disadvantaged. Control strategies for environmental pollution are needed and public health programs for high risk groups are a must.
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Schultink W PhD, Gross R PhD, Sastroamidjojo S MD, Karyadi D MD, PhD
Asia Pacific Journal of Clinical Nutrition (1996) Volume 5, Number 3: 145-148
Urbanisation runs in parallel with economic growth. Urban areas are characterised by income inequality between population groups. Because of inequality in socioeconomic situation, Indonesian urban areas are confronted with problems of undernutrition and overnutrition. Selected studies conducted by the SEAMEO-TROPMED Regional Centre for Community Nutrition have demonstrated that food intake of the lower socioeconomic class households is deficient. Furthermore, intrahousehold food distribution among the lower economic class households is contributory to the determination of food intake. The prevalence of anaemia in urban Jakarta ranges from as low as 4.5% in female school children to as high as 63.2% in pregnant women. Zinc deficiency might also be prevalent among lactating mothers. Strategies for improvement of urban micronutrient status are required and may include food-based, nutrient supplementation of fortification methods.
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CM Smuts MSc, HY Tichelaar MSc, PJ van Jaarsveld PhD, J van Rooyen PhD, AJS Benadé DSc
Asia Pacific Journal of Clinical Nutrition (1996) Volume 5, Number 3: 149-156
Key words: Essential fatty acids, atherosclerosis, African Green monkey
Controversy surrounds the effects of dietary fish oil supplementation on atherosclerosis. Three studies were undertaken, where Vervet monkeys were fed either a Western atherogenic diet (WAD) or a high carbohydrate diet (HCD). The first study indicated that enhanced atherosclerosis may be the result of an imbalance of fatty acids in plasma and tissue lipids as eicosapentaenoic acid (EPA; C20:53) was increased with fish oil (FO) supplementation at the expense of arachidonic acid (AA; C20:46). The second study investigated the effect of diet on the metabolism of EPA. Disappearance of EPA, after EPA loading, was delayed in Vervets on the WAD in comparison with those on the HCD. Results of this study indicate that diet is able to modulate EPA metabolism, and that the beneficial effects of a HCD on plasma lipoprotein concentrations can be augmented by EPA supplementation. The third study investigated the combined effect of a supplement that contained different ratios and dosages of gamma-linolenic acid (GLA; C18:36) and EPA during ingestion of the WAD. Based on a favourable response to plasma lipoprotein cholesterol and a phosphatidylcholine fatty acid metabolism with increases in both EPA and dihomogamma-linolenic acid (DGLA; C20:36), we conclude that a 4:1 6/3 fatty acid supplement at 200 mg/day would be the optimum supplement in our animal model. The long-term effects of this supplement on lipoprotein metabolism and atherosclerosis in the non-human primate model, is currently under investigation.
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Klaus Pietrzik MD and A Brönstrup MSc
Asia Pacific Journal of Clinical Nutrition (1996) Volume 5, Number 3: 157-160
Key words: homocysteine, cardiovascular disease
Elevated homocysteine blood concentrations have been identified as an independent risk factor for the development of atherosclerotic lesions. The metabolism of the amino acid homocysteine in the human body involves the vitamins folic acid, B-12 and B-6 as essential cofactors and coenzymes, respectively. There is an inverse relationship between the status of the relevant B-vitamins and the homocysteine blood concentration. Supplementation of these vitamins results in a significant reduction of the homocysteine level. However, nutritive amounts seems to be sufficient to obtain this reduction, even in the case of elevated homocysteine levels.
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Peter Bung MD, Reinhold Prinz-Langenohl PhD, Barbara Thorand PhD and Klaus Pietrzik PhD
Asia Pacific Journal of Clinical Nutrition (1996) Volume 5, Number 3:161-163
Key words: Pregnancy, nutrition, micronutrients, folic acid, iodine, iron
During pregnancy the demands for energy and nutrients are increased. Despite increasing awareness about nutrition in the population of a western country like Germany, there is a discrepancy between actual food intake and recommended quantities of certain nutrients, particularly during pregnancy. There are correlations between deficiencies in micro-nutrients such as iodine, iron and folic acid and the course and outcome of pregnancy. The consequences of an insufficient supply of these micronutrients during pregnancy are described and high-risk-groups for an inadequate supply are defined. Recommendations for nutrition counselling during this period of life are given.
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Regina A Pedro, Luz V Candelaria, Felicitas F Bacos, Berna D Ungson and Eleanor M Lanot
Asia Pacific Journal of Clinical Nutrition (1996) Volume 5, Number 3: 164-169
The study aimed 1) to develop a locally adapted SDA (simplified dietary assessment) questionnaire taking into consideration available vitamin A rich foods and portion sizes in the study sites, and 2) to compare the SDA methodology vis-a-vis the long method of dietary vitamin A assessment. Field testing of the SDA questionnaire was carried out among 433 preschoolers belonging to households with or without home gardens in 3 selected municipalities. Vitamin A status of the children was assessed using the SDA and long method of dietary evaluation.
Comparison of vitamin A status using SDA vis-a-vis the long method revealed that 85 and 86% of those found to have high risk for vitamin A inadequacy using the SDA actually had <67% vitamin A adequacy using the long method, during the lean and peak periods of home gardening, respectively (significant at 0.01). The SDA also showed high sensitivity in identifying preschool children with high VAD risk with 88-90% positive predictive value, and a high specificity in not classifying as low (96%) or moderate (91%) VAD risk cases those children who did not meet 100% RDA or had vitamin A intake which was either 100% adequacy or <67% RDA for vitamin A.
The SDA method provides a simple and rapid approach to assessment of risk for dietary inadequacy of vitamin A among population groups or individuals. The availability of the SDA empowers the Local Government Units (LGUs), Non-Government Organisations (NGOs) and People's Organisations to assess VAD in their areas on a more timely basis and facilitates feedback to mothers of children at-risk through nutrition education and counselling.
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Umesh Kapil, Nandini Saxena, M Srivastava, L Jailkhani, B Nayyar, P Chikkara, S Ramachandran, N Gnanasekaran
Asia Pacific Journal of Clinical Nutrition (1996) Volume 5, Number 3:170-172
A study was conducted to assess the magnitude of Vitamin A deficiency in two urban slum communities of Delhi. Biological and ecological indicators suggested by WHO/UNICEF 1992, were used. Five hundred and fifty two children in the age group of 0-5 years were studied. Data was collected on socio economic status, breastfeeding pattern, immunisation, morbidity profile and presence of vitamin A deficiency. Height and weight were recorded using standard techniques. Vitamin A intake of subjects was assessed using food frequency and 24 hr recall methods. It was found that 63.9% children >1 year of age were fully immunised. Colostrum was received by only 28.1% of children. Only 32% infants <4 months of age were exclusively breastfed. Breast milk was being received by 93.5% children <6 months old. 18.1% children had diarrhoea within last 15 days of survey. 7.1% children gave history of helminthic infestations. 47.8% children <3 yrs were stunted while 26.9% were wasted. None of the children had Bitot's spots but nightblindness was observed in 1.2% children. 35.7% children (12-24 months) consumed vitamin A rich foods less than once A week. The frequency of consumption of vitamin A rich foods was significantly higher in winter as compared to summer and rainy seasons (p<0.05). The mean daily vitamin A intake for 6-11 months and 12-71 months old children was 1187±755 g and 847±111g respectively. It was concluded that moderate vitamin A deficiency was present in the study area.
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Che Sam Lo MD, PhD, ML Wahlqvist MD,FRACP and Y Horie PhD
Asia Pacific Journal of Clinical Nutrition (1996) Volume 5, Number 3: 173-174
Key words: Retinoic acid, retinol, HPLC, Japanese, Caucasian
A sensitive, specific and simple method for simultaneous determination of retinoic acid and retinol in human serum by reverse phase HPLC with UV detector has been developed. Retinoic acid is measurable at physiological concentration in human serum by this method. There is no significant difference in serum retinoic acid level between Caucasian and Japanese subjects. However, the serum retinol level in Japanese women is significantly lower than that in Caucasian women
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RF Florentino MD PhD, CC Tanchoco RND MPH, MP Rodriguez RMT, AJ Cruz RND
Asia Pacific Journal of Clinical Nutrition (1996) Volume 5, Number 3: 175-180
Data gathered from the 1987 National Nutrition Survey in the Philippines provided the opportunity to study the interactions among micronutrient deficiencies and undernutrition in different age groups as a basis for program targeting. A randomly selected subset of 50% of the households (3,200) covered by the national survey served as source of subjects. Results showed that there was a greater proportion of anaemia among the undernourished (as judged by weight -for-age in children and weight-for-height in adults (66.0%) than among the adequately nourished (54.6%) alpha=0.01). However, the observed differences in the proportion of serum vitamin A deficiency and of goitre among the undernourished compared to the adequately nourished were not significant. Also not significant were the observed higher- prevalence of anaemia among subjects with acceptable serum vitamin A levels for both adequately nourished and undernourished, and the higher prevalence of vitamin A deficiency among the non-anaemic. Again there were no significant difference in the prevalence of anaemia among goitrous and non-goitrous subjects, as well as the prevalence of goitre among anaemic and non-anaemic subjects. Neither were there significant differences in the prevalence of vitamin A deficiency among goitrous and non goitrous subjects, but there were significant differences in the prevalence of goitre among vitamin A deficient and non-vitamin A deficient subjects among the 7-14 year olds and among pregnant and lactating women. The study concludes that at the national level there is apparently an interaction between anaemia and protein-energy undernutrition and possibly also between goitre and vitamin A deficiency in the high risk age groups, but not between anaemia on the one hand and goitre and vitamin A deficiency in another, perhaps because of clustering in the latter conditions not found in anaemia and general undernutrition. These findings may be useful in targeting communities with high prevalence of micronutrient deficiencies by using prevalence of underweight and goitre as indicators for high prevalence of anaemia and vitamin A deficiency, respectively.
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Antje Kätelhut MSc, Werner Schultink PhD, Imelda Angeles MSc, Rainer Gross PhD, Klaus Pietrzik PhD
Asia Pacific Journal of Clinical Nutrition (1996) Volume 5, Number 3: 181-185
Key words: Anaemia, iron supplementation, vitamin A, adolescents, Indonesia
The goal of the study was to determine whether the addition of vitamins A and C and extra folate to the commonly distributed iron-folate supplement administered on a weekly basis would result in improved iron status in anaemic and non-anaemic female adolescents. Subjects (n=84) were selected if their haemoglobin concentration in venous blood was 140g/L. Subjects were randomly allocated into 2 groups. One group received 60mg iron, 500g folic acid, 20 000 IU vitamin A and 60mg vitamin C weekly, while the other group received 60 mg iron and 250g folic acid weekly for a period of 5 weeks. Before and after treatment, haemoglobin, serum ferritin and body height and weight were determined. All subjects received anthelmintic drugs before supplementation. A complete data set was obtained from 42 young women in the group supplemented with iron, folic acid, vitamin A and vitamin C and from 40 young women in the group supplemented with iron and folic acid. Haemoglobin, mean cell volume and serum ferritin increased significantly in both groups (P<0.05). Among anaemic adolescents, the rise in haemoglobin concentration in the multisupplement group was higher than that in the iron folate group. The result confirms that weekly supplementation is effective in improving iron status in a short time (5 weeks) and that supplementation with vitamins as well as iron results in an additional improvement in haemoglobin concentration.
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M Abdulla, AH Khan, MF Reis
Asia Pacific Journal of Clinical Nutrition (1996) Volume 5, Number 3: 186-190
Key words: trace elements, developing countries, toxic metals, functional indices, nutritional epidemiology, clinical trials, IAEA, UNESCO
Trace element status in humans is often poorly established in developed, let alone developing, countries. There have been assumptions about inevitable adequacy, especially for ultra-trace elements, like chromium, with varied diets. However, new pressures on trace element adequacy are emerging, like developments in food technology with the new formulated foods and element pollutants (toxic metals) with potential interactions with essential elements. Improved, more sensitive methods for trace element measurements in foods and biological specimens, functional indices of trace element status, with application to nutritional epidemiology, and the pursuit of clinical trials, should allow appropriate revision of current views. This process is likely to more consequential in developing countries.
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Shumin Zhang, Banoo Parpia Gonghao Wang, Junling Wang, Linda Youngman, T Colin Campbell and Junshi Chen
Asia Pacific Journal of Clinical Nutrition (1996) Volume 5, Number 3: 191-195
Zinc nutriture was assessed in 6500 adults aged 35-64 years old in 65 mostly rural counties (two communes per county) in China on the basis of plasma zinc levels and dietary zinc intakes. In addition, the use of plasma albumin and red blood cell superoxide dismutase (SOD) for assessing zinc nutritional status was evaluated. Plasma levels of zinc and albumin were highly correlated between sexes (p<0.001) and between neighbouring communes in the same county (p<0.005), indicating a high degree of data reliability as assessed by this measure of "within county" homogeneity. Zinc deficiency, defined as plasma zinc values less than 70 g/dL, was not observed for the populations in any of the 65 counties included in the survey. Dietary zinc intake was estimated on the basis of the newly revised Chinese food composition tables in conjunction with a 3-day household dietary survey of approximately 2000 households in the same study. Average dietary zinc intake was 11.9 mg/day, with a wide variability (7.4-34.9 mg/day) across the sample of 65 counties. The average levels of plasma zinc and dietary zinc intake observed in this adult rural Chinese population were comparable to those reported in healthy U.S. subjects, suggesting that zinc deficiency may not be a cause for concern in rural Chinese adults. However, marginal zinc deficiency may be prevalent in some rural areas.
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Carol Wham MSc, BHSc, Dip Ed
Asia Pacific Journal of Clinical Nutrition (1996) Volume 5, Number 3: 196-200
Key words: Anaemia, children, iron deficiency, iron intake, New Zealand
Aim. To determine the prevalence of iron deficiency in healthy young children and whether there is an association between food habits and dietary iron intake and iron status.
Methods. 53 children aged 9-24 months were recruited into the study over a 12 month period from a general practice and Plunket child health clinics. Children with intercurrent infections were excluded. Iron status was determined from a full blood count and iron studies. Nutrient intake was assessed by a 24 hour food recall and dietary history questionnaire with nutrient analysis using the New Zealand Food Composition database from the New Zealand Institute of Crop and Food Research Ltd.
Results. 10 children (20%) were anaemic (haemoglobin <110g/L) and 7 children were iron deficient (serum ferritin <10g/L). The daily mean iron intake was 5.13.1mg, which was 0.66 RDI for 9-12 months, and 0.80 for 12-24 months. There was no statistically significant relationship between iron status and food iron intake. Children in the top quintile for iron intake (mean 17.5 mg/day) consumed iron mainly from iron-fortified formula and baby food whereas the main source of iron in the lowest quintile (mean intake 2.0mg/day) was from a diverse range of foods including vegetables, bread and bakery goods, dairy products, breakfast cereals and fruit. In this group only one child consumed formula and three children consumed baby foods.
Conclusion. A high prevalence of anaemia and of iron deficiency was found amongst the otherwise healthy children in the sample, without their being a relationship between dietary iron intake and either haemoglobin or serum iron indices, except for ferritin.
Copyright © 1996 [Asia Pacific Journal of Clinical Nutrition].
All rights reserved.
Revised: January 19, 1999.
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