bluuebunny/crossref_metadata_2025 huggingface dataset:
The burden of obesity in Asia: Challenges in assessment, prevention and management
Authors: Florentino Rodolfo F
Published: March 2003

Overweight and obesity have started to emerge as a significant public health problem in Asia. As a whole, the situation has arisen from the changing dietary pattern towards energy‐dense and high fat diets, together with a more sedentary lifestyle arising from increasing urbanization. Obesity's threat to the health and economy of the population gives urgency to meeting the problem headlong before it gets any worse. Fundamental knowledge gaps, however, constrain the institution of appropriate measures to prevent and manage this growing problem. Foremost is the paucity of national prevalence and epidemiological data in many countries in the region, coupled with a lack of uniformity in reference standards and cut‐off points. While the principles of dietary management, physical activity and behaviour modification are well known, integrating these strategies into a national policy and program in the face of competing priorities is the greatest challenge of all. This requires the collaboration of government, academia, the food industry, the private sector, NGOs and the community, with the assistance of international and bilateral aid agencies, to develop and implement such policies and programs.
Causes and consequences of adult obesity: health, social and economic impacts in the United States
Authors: Wellman Nancy S , Friedberg Barbara
Published: March 2003

Obesity has been identified as an epidemic in the United States for more than two decades and yet the numbers of overweight and obese adults and children continue to grow. Currently, the rates of both overweight and obesity in the US are 61% and 14% in adults and children, respectively. Among US adults aged 20−74 years, the prevalence of overweight (defined as BMI 25.0−29.9) has increased from 33% in 1980 to 35% of the population in 1999. In the same population, obesity (defined as BMI ≥ 30) has nearly doubled from approximately 15% in 1980 to an estimated 27% in 1999. The percentage of children and adolescents who are defined as overweight has more than doubled since the early 1970s. About 14% of children and adolescents are now seriously overweight. Obesity burdens the health care system, strains economic resources, and has far reaching social consequences. The disease is associated with several serious health conditions including: type 2 diabetes mellitus, heart disease, high blood pressure and stroke. It is also linked to higher rates of certain types of cancer. Obesity is an independent risk factor for heart disease, hypoxia, sleep apnea, hernia, and arthritis. Obesity is the seventh leading cause of death in the US. The total cost of overweight and obesity by some estimates is $100 billion annually. Others put the cost of health care for obesity alone at $70 billion. Other annual costs associated with obesity are 40 million workdays of productivity lost, 63 million doctors’ office visits made, and 239 million restricted activity days and 90 million bed‐bound days. Emotional suffering may be among the most painful aspects of obesity. American society emphasizes physical appearance and often equates attractiveness with slimness, especially for women. Such messages may be devastating to overweight people. Many think that obese individuals are gluttonous, lazy, or both, even though this is not true. As a result, obese people often face prejudice or discrimination in the job market, at school, and in social situations. Feelings of rejection, shame, or depression are common. Since the 1950s, national dietary recommendations have come to acknowledge obesity as a significant societal trend. The Surgeon General's 2001 Call To Action, Healthy People 2010, and the Dietary Guidelines for Americans 2000 all emphasize the importance of healthy weight. There are some new tools available to help in the fight against overweight and obesity: Weight Control Information Network, The Third National Cholesterol Education Program's Adult Treatment Panel, and The Practical Guide: Identifi­cation, Evaluation, & Treatment of Overweight & Obesity in Adults from the National Institutes of Health and National Heart Lung and Blood Institute.
Predictive values of body mass index and waist circumference for risk factors of certain related diseases in Chinese adults: study on optimal cut‐off points of body mass index and waist circumference in Chinese adults
Authors: Bei‐Fan Zhou ,   the Cooperative Meta‐analysis Group of Working Group on Obesity in China
Published: March 2003

For prevention of obesity in the Chinese population, it is necessary to define the optimal range of healthy weight and the appropriate cut‐off points of body mass index (BMI) and waist circumference for Chinese adults. The Working Group on Obesity in China under the support of the International Life Sciences Institute Focal Point in China organized a meta‐analysis on the relationship between BMI, waist circumference and risk factors of related chronic diseases (e.g., high diabetes, diabetes mellitus, and lipoprotein disorders). Thirteen population studies in all met the criteria for enrolment, with data of 239 972 adults (20−70 years of age) surveyed in the 1990s. Data on waist circumference was available for 111 411 persons, and data on serum lipids and glucose were available for more than 80 000. The study populations were located in 21 provinces, municipalities and autonomous regions in mainland China as well as in Taiwan. Each enrolled study provided data according to a common protocol and uniform format. The Center for Data Management in the Department of Epidemiology, Fu Wai Hospital, was responsible for the statistical analysis. The prevalence of hypertension, diabetes, dyslipidemia and clustering of risk factors all increased with increasing levels of BMI or waist circumference. A BMI of 24 with best sensitivity and specificity for identification of the risk factors was recommended as the cut‐off point for overweight; a BMI of 28, which may identify the risk factors with specificity around 90%, was recommended as the cut‐off point for obesity. A waist circumference over 85 cm for men and over 80 cm for women were recommended as the cut‐off points for central obesity. Analysis of a population‐attributable risk percentage illustrated that reducing the BMI to the normal range (<24) could prevent 45−50% of the clustering of risk factors. Treatment of obese persons (BMI = 28) with drugs could prevent 15−17% of clustering of risk factors. When waist circumference is controlled at under 85 cm for men and under 80 cm for women, it could prevent 47−58% of clustering of risk factors. Based on these guidelines, a classification of overweight and obesity for Chinese adults is recommended.
Discrepancies in nutritional recommendations: the need for evidence based nutrition
Authors: Mann Jim
Published: March 2003

The widespread acceptance that ‘evidence‐based medicine’ should determine all aspects of clinical practice leads to a consideration as to whether ‘evidence‐based nutrition’ should be based on similar principles. Randomised controlled trials (RCT) are universally regarded as the gold standard by which to determine whether a drug is appropriate in a particular clinical situation. The evidence for some nutritional recommendations is indeed substantiated by RCT but in the case of some chronic diseases, notably cancers, where nutritional factors may operate as promoters or protectors many years before the onset of clinical disease, RCT may not be particularly appropriate. A range of experimental studies and descriptive epidemiological approaches may be regarded as sufficient to justify nutritional recommendations or dietary guidelines. Recommendations for the prevention and treatment of selected diseases will be considered in the context of their evidence‐base.
Risk of suboptimal iron and zinc nutriture among adolescent girls in Australia and New Zealand: causes, consequences, and solutions
Authors: Gibson R S , Heath A‐L M , Ferguson E L
Published: March 2003

Surveys in Australia, New Zealand and other industrialised countries report that many adolescent girls have dietary intakes of iron and zinc that fail to meet their high physiological requirements for growing body tissues, expanding red cell mass, and onset of menarche. Such dietary inadequacies can be attributed to poor food selection patterns, and low energy intakes. Additional exacerbating non‐dietary factors may include high menstrual losses, strenuous exercise, pregnancy, low socioeconomic status and ethnicity. These findings are cause for concern because iron and zinc play essential roles in numerous metabolic functions and are required for optimal growth, immune and cognitive function, work capacity, sexual maturation, and bone mineralization. Moreover, if adolescents enter pregnancy with a compromised iron and zinc status, and continue to receive intakes of iron and zinc that do not meet their increased needs, their poor iron and zinc status could adversely affect the pregnancy outcome. Clearly, intervention strategies may be needed to improve the iron and zinc status of high risk adolescent subgroups in Australia and New Zealand. The recommended treatment for iron deficiency anaemia and moderate zinc deficiency is supplementation. Although dietary intervention is often recommended for treating non‐anaemic iron deficiency and mild zinc deficiency, it is probably more effective and appropriate for prevention than for the treatment of suboptimal iron and zinc status. Many of the strategies for enhancing the content and bioavailability of dietary iron are also appropriate for zinc.
Nutrition and the early origins of adult disease
Authors: Newnham John P , Moss Timothy JM , Nitsos Ilias , Sloboda Deborah M , Challis John RG
Published: March 2003

There is now overwhelming evidence that much of our predisposition to adult illness is determined by the time of birth. These diseases appear to result from interactions between our genes, our intrauterine environment and our postnatal lifestyle. Those at greatest risk are individuals in communities making a rapid transition from lives of ‘thrift’ to a lives of ‘plenty’. From a global perspective, such origins of diabetes, coronary heart disease and stroke, should render research in these fields as one of the highest priorities in human health care. Prevention will be enhanced by elucidation of the mechanisms by which the fetus is programmed by the mother for the life she expects it to live. At the present time, there is evidence that fetal nutrition and premature exposure to cortisol are effective intrauterine triggers, but a multitude of alternative pathways require investigation. It is also likely that programming extends across generations, and may involve the embryo and perhaps the oocyte. An oocyte that becomes an adult human develops in the uterus of its grandmother, so further research is required to describe the role of environments of grandmothers and mothers in predisposing offspring to health or illness in adult life.
Will feeding mothers prevent the Asian metabolic syndrome epidemic?
Authors: James W Philip T
Published: March 2003

Evolutionary pressures have probably amplified the mechanisms for minimizing the impact of environmental factors through compensatory maternal mechanisms. Nevertheless, experimentally there are clear long‐term programming effects of manipulations to the maternal diet on the likelihood of neural‐tube defects associated with folate deficiency The fat/lean ratios of the newborn, and subsequent development, seem to be linked to amino acid or folate supply. An altered balance in the hypothalamic−pituitary−adrenal axis, which experimentally has profound effects on brain development, is induced by low‐protein maternal diets. Such diets are linked to a reduced pancreatic capacity for insulin production and to an altered hepatic architecture, with a change in the control of glucose metabolism. Human studies suggest that what happens in pregnancy is modified by the child's diet in the first months of life. Low birthweight is linked to early stunting, and predisposes to abdominal obesity and metabolic syndrome in later life. Metabolic syndrome amplifies the risks of diabetes, hypertension, coronary heart disease and probably some cancers. Mothers with gestational diabetes are themselves prone to early type 2 diabetes and produce heavier babies prone to childhood obesity and adolescent type 2 diabetes. There is increasing evidence of an intergenerational effect, with big babies being prone to excess weight gain, which then, in girls, predisposes them to diabetes in pregnancy, which, in turn, promotes an accelerating cycle of early diabetes in subsequent generations. Essential fatty acids and fat soluble vitamins are important, but we need early interventions and monitoring systems to justify coherent policies.
Importance of preventing weight gain in adulthood
Authors: Gill Tim
Published: March 2003

In the last 20 years, there has been a dramatic upsurge in the average weight of Australian adults. In this period, on average, Australian women have gained 4.8 kg, whilst Australian men have gained 3.6 kg. Consequently, the prevalence of obesity in men has increased from 8% to 19% and in women from 7% to 21%. This threatens to wipe away many recent health gains, as obesity has been associated with a wide range of chronic and debilitating illnesses, such as diabetes, heart disease, some cancers, sleep apnoea and osteoarthritis. Any weight gain in adulthood is usually as a result of an increase in fat stores, and the risk of ill‐health from increasing weight actually begins at quite low BMI. Unfortunately, weight gain can be difficult or slow to reverse in the middle years because of physiological and behavioural changes that occur at this time of life. Adults should focus on preventing or minimizing weight gain over time by retaining physical activity within their daily living and by sensible dietary changes. Even if weight gain does occur with age, a regimen of regular exercise and a diet rich in fruit and vegetables and low in fat will provide some protection against a rapid decline in health.
Can food variety add years to your life?
Authors: Savige Gayle S
Published: March 2003

The traditional food habits of Greeks and Japanese differ widely, yet both populations have the longest life expectancies in the world. Food variety is one feature common to both food cultures. By eating a wide variety of foods, numerous chemicals that give rise to the diverse range of colours, tastes, textures and smells of different foods are consumed. Many of these naturally occurring chemicals are likely to play a role in health. Within the broad scope of foods available, foods for thought include fish, legumes and nuts. These foods are also likely to protect older adults against some of the diseases more prevalent with ageing such as coronary heart disease and cancer.
Sustaining dietary changes for preventing obesity and diabetes: lessons learned from the successes of other epidemic control programs
Authors: Swinburn Boyd
Published: March 2003

A degree of success has been achieved in controlling several epidemics of infectious and non‐infectious causes of death in countries, such as, Australia and New Zealand. Using the epidemiological triad (host, vector, environment) as a model, the key components of the control of these epidemics have been identified and compared to the current status of interventions to prevent obesity and its main disease consequence, type 2 diabetes. Reductions in mortality from tobacco, cardiovascular diseases, road crashes, cervical cancer and sudden infant death syndrome have been achieved by addressing all corners of the triad. Similarly, prevention programs have minimized the mortality from HIV AIDS and melanoma mortality rates are no longer rising. The main lessons learned from these prevention programs that could be applied to the obesity/diabetes epidemic are: taking a more comprehensive approach by increasing the environmental (mainly policy‐based) initiatives; increasing the ‘dose’ of interventions through greater investment in programs; exploring opportunities to further influence the energy density of manufactured foods (one of the main vectors for increased energy intake); developing and communicating specific, action messages; and developing a stronger advocacy voice so that there is greater professional, public and political support for action. Successes in the other epidemics have been achieved in the face of substantial barriers within individuals, society, the private sector and government. The barriers for preventing obesity/diabetes are no less formidable, but the strategies for surmounting them have been well tested in other epidemics.
Nutrition: the new world disorder
Authors: Cannon Geoffrey
Published: March 2003

Scale up ‘we are what we eat’ and nutrition is revealed as an aspect of world governance. The quality and nature of food systems has always tended to determine not only the health and welfare but also the fate of nations. The independence of nations depends on their development of their own human and natural resources, including food systems, which, if resilient, are indigenous, traditional, or evolved over time to climate, terrain and culture. Rapid adoption of untested or foreign food systems is hazardous not only to health, but also to security and sovereignty. Immediate gain may cause permanent loss. Dietary guidelines that recommend strange foods are liable to disrupt previous established food cultures. Since the 1960s the ‘green revolution’ has increased crop yield, and has also accelerated the exodus of hundreds of millions of farmers and their families from the land into lives of misery in mega‐cities. This is a root cause of increased global inequity, instability and violence. ‘Free trade’ of food, in which value is determined by price, is imposed by dominant governments in alliance with industry when they believe they can thereby control the markets. The World Trade Organization and other agencies coordinate the work of transnational corporations that are the modern equivalents of the East India companies. Scientists should consider the wider dimensions of their work, nutrition scientists not least, because of the key place of food systems in all societies.
Eating well: ageing gracefully!
Authors: Charlton Karen E
Published: March 2003

The potential impact of dietary manipulation on the maintenance of physical and cognitive function between middle and old age has profound consequences for optimization of health, independence and well‐being for the latter years. This review article considers four key areas: the role of diet and longevity; potential dietary measures to prevent sarcopenia; diet and cognitive function; and dietary interventions with regard to primary or secondary prevention of age‐related chronic disorders. Caloric restriction has been shown to slow ageing and maintain health status in both primates and rats. The evidence has limited applicability to humans, since it is unlikely that 30% reduced diets could be maintained long‐term. The causes of sarcopenia, which manifests as loss of strength, disability and reduced quality of life, are multifactorial. However, resistance with ageing to regulatory amino acids known to modulate translation and initiation, particularly leucine, raise possibilities with regard to dietary intervention. The pattern of protein intake appears to be important in whole‐body protein retention in older adults. A body of evidence is emerging that associates various dietary factors with a reduction in cognitive decline with age, or a delay in the progression of Alzheimer's disease, particularly with regard to intake of vitamin E and C‐containing foods, as well as fish intake. Epidemiological evidence demonstrates a role for dietary intervention in the primary prevention of chronic diseases, even in old age. However, the potentially harmful effects of micronutrient supplementation in the secondary prevention of coronary heart disease raise concern regarding appropriate dietary messages for the elderly. The role of the antioxidants, lycopene, lutein and zeaxanthin, in the prevention of cataracts and age‐related macular degeneration support the almost universal dietary guideline ‘eat more fruit and vegetables’. In future dietary guidelines for the elderly need to be evidence‐based and take into account protective food patterns, rather than target specific foods.
A pilot study on the changes of event‐related potentials in school‐aged children with iron deficiency anaemia
Authors: Shi TH , Yu LF , Huang LZ , Ma XH , Zhu QH
Published: March 2003

Event‐related potentials (ERP) were assessed in 70 school‐aged children with a diagnosis of asymptomatic iron deficiency anaemia (IDA), based on low haemoglobin and either low serum ferritin or high free erythrocyte protoporphyrin levels. The IDA subjects were randomized into treatment and placebo groups of 35 cases each, and compared with a normal control group of 30 age‐ and gender‐matched healthy subjects without iron deficiency. Further haematological and ERP assessment was carried out after 3 months, during which time the active group received iron supplementation with 10 mg ferrous sulphate, together with vitamin C, malic acid and folic acid. Pre‐treatment, both IDA groups had prolonged P300 latencies in comparison with the non‐IDA controls (P < 0.01). The proportion of cases with distorted wave appearance was more than twice as high in the IDA groups as in the non‐IDA controls, although intergroup differences did not reach statistical significance. After treatment, the active treatment IDA group showed a significant increase in haemoglobin levels and shortening in P300 latencies. After treatment, neither value was statistically different from non‐IDA controls. There was a decrease in the number of cases with abnormal waveforms in the active treatment group, compared with an increase in the number within the placebo group (P = 0.002). Testing of ERP shows promise as a non‐invasive, sensitive and objective marker for assessing cognitive impairment in children with IDA.
Effect of catfish supplementation on the fatty acid status and growth of undernourished rural preschool children under 6 years of age: An intervention trial in Lebowa, South Africa
Authors: Tichelaar HY , Steyn NP , Nel JH , Smuts CM , Van Jaarsveld PJ , Prinsloo< JF , Van Rooyen J , Lombard CJ , Dhansay MA , Benadé AJS
Published: March 2003

A group of 102 preschool children aged 13–69 months from a rural area of Lebowa were selected from a cross‐sectional study of 659 children for an intervention trial (12 months) to study the effect of catfish (Clarias gariepinus) supplementation on their plasma phospholipid fatty acid status and growth. They were classified into undernourished and control groups according to their weight‐for‐age. The undernourished children (n = 52) received 43 g fish and 7.5 g sunflower cooking oil per day, whereas a matched (age and sex) well‐nourished control group (n = 50) was not supplemented. At baseline, after 6 months and after 12 months of the study, anthropometry, haematology, blood biochemistry and plasma phospholipid fatty acid analyses were done. In the undernourished group, high baseline oleic acid (18:1ω9) levels in plasma phosphatidylcholine (PC) were replaced by docosahexaenoic acid (22:6ω3) with supplementation. In plasma PC, this reduction in 18:1ω9 and increase in 22:6ω3 was associated with significant increases in weight‐for‐age Z‐scores, P = 0.0378 and P = 0.0415, respectively. The fish supplement and cooking oil that supplied additional 7% energy (7% E) and nutrients promoted growth of undernourished children, although this was inadequate for sustained growth during the second 6 months of intervention.
Chronic energy deficiency and relative abdominal overfatness coexist in free‐living elderly individuals in Ho Chi Minh City, Vietnam
Authors: Tam Tran Thi Thanh , Gross Rainer , Lukito Widjaja , Rumawas Johanna Sp
Published: March 2003

As part of the Cross‐Cultural Research on Nutrition of Older Subjects (CRONOS) project, the aim of this cross‐sectional study was to observe the nutritional status and body composition of free‐living elderly and middle‐aged people in a low‐income area of Ho Chi Minh City, Vietnam. Anthropometric data (weight; height; arm span; four skinfold thicknesses; left upper mid‐arm, abdomen, hip and calf circumferences) were collected from 50 Vietnamese men and 50 Vietnamese women aged between 35 and 44 years and 50 men and 50 women aged between 60 and 74 years who lived in Village 2, District 4, Ho Chi Minh City. The prevalence of chronic energy deficiency (CED) in the elderly men (BMI = 19.9 ± 2.8 kg/m2) was higher (52 vs 34%) than that in the middle‐aged men (BMI = 19.2 ± 3.4 kg/m2). Fat‐free mass and calf circumference of the elderly were lower than those of the middle‐aged (P < 0.001). However, the Vietnamese elderly had higher body fat content, higher abdomen‐to‐hip ratios and lower fat‐free mass than their younger counterparts (P < 0.05). In particular, 36% of middle‐aged women and 20% of elderly women were classified with ‘relative abdominal overfatness’. Vietnamese middle‐aged and older adults are shorter and thinner than their counterparts in American and European countries but overfatness increases with age, particularly in women. Urban elderly are vulnerable to both undernutrition and overnutrition, both of which merit consideration in the geriatric care system in Vietnam.
Effects of dumb‐bell exercise with and without energy restriction on resting metabolic rate, diet‐induced thermogenesis and body composition in mildly obese women
Authors: Matsuo Tatsuhiro , Suzuki Masashige
Published: March 2003

The effects of dumb‐bell exercise (aerobic‐resistance exercise) with and without low calorie diet (LCD) therapy on resting metabolic rate (RMR), diet‐induced thermogenesis (DIT) and body composition were studied in 12 mildly obese women aged 19–20 years. The subjects were randomly assigned to one of the following two groups: dumb‐bell exercise with LCD (DEx + LCD group), and dumb‐bell exercise only (DEx group). The subjects performed dumb‐bell exercises with pairs of 2 kg dumb‐bells every day after dinner for approximately 20 min. In the DEx + LCD group, subjects also received a liquid‐formula diet based on a commercially available diet supplement, Micro Diet, for two of their three daily meals. Thus, they were restricted to approximately 4.18 MJ of energy intake per day for 12 weeks. Subjects underwent several measurements (body composition, RMR and DIT tests) before commencing the experiment and again after 12 weeks while still dieting. During the 12 week experimental period, body weight and body fat decreased significantly in both the DEx + LCD and the DEx groups without reducing fat free mass (FFM). The decreases in body weight and body fat were significantly larger in the LCD + DEx group than in the DEx group. These results suggest that dumb‐bell exercise decreases body weight and body fat without reducing FFM in relation to increasing RMR and DIT. Micro Diet LCD may strengthen the effect of dumb‐bell exercise on body weight and body fat, but weaken the effects on RMR and DIT.
Nutrition scenario in Karnataka, a state in southern India
Authors: Sheela K
Published: March 2003

India is an agricultural country and the majority of India’s population live in rural areas. This is so in Karnataka, a state in southern India. The present report consists of a detailed nutrition situation analysis. Karnataka has a population of 45 million, which is approximately 3–5% of India’s population. One in every two women are agricultural labourers, reflecting women’s predominance in the field of agriculture. The state has a literacy rate of 56%. The food consumption patterns reveal that cereals and millets are the main food items. However, protective foods (i.e. foods that are rich in proteins, vitamins and minerals) are consumed in lesser amounts. When compared with the average Indian recommended dietary intake (RDI), the intake of energy in adults was found to be higher, as was protein. The average intake of vitamins, however, was 50% less than the RDI. Unlike adults, energy deficiency is a problem in the diets of preschool children. Growth retardation has been observed in a vast majority of children in Karnataka. An improvement in the nutritional status of rural adults has been observed in recent years. Protein energy malnutrition, vitamin A deficiency and B‐complex deficiencies are the major nutritional deficiencies among preschool children, while anaemia remains a major health problem in women. Improvement in the healthcare system has brought a decline in the infant mortality rate in Karnataka and the state attained universal immunization coverage in 1990. The National Nutrition Programme – Integrated Child Development Scheme provides an integrated package of services to residents of Karnataka.
Endogenous carotenoid concentrations in cancerous and non‐cancerous tissues of gastric cancer patients in Korea*
Authors: Paiva SAR , Yeum K‐J , Lee KS , Park IS , Lee‐Kim YC , Russell RM
Published: March 2003

Carotenoid concentrations were measured in serum and in both non‐cancerous and cancerous gastric mucosal tissues of Korean patients with gastric cancer (n = 18). Carotenoids in serum and gastric tissue were extracted with chloroform/methanol (2:1), and measured using reverse‐phase high‐performance liquid chromatography with a C30 column. Cryptoxanthin and β‐carotene were the major carotenoids in the Korean blood and they had a median ratio of non‐cancerous tissue/serum levels which was less than 1.0. No significant differences of cryptoxanthin and β‐carotene levels were found between non‐cancerous and cancerous tissues. After incubation of β‐carotene with gastric tissue, significantly higher levels of β‐carotene breakdown products were produced in the homogenates of cancerous tissue when compared with non‐cancerous tissue. Lutein, zeaxanthin and α‐carotene were the minor carotenoid constituents in the blood and their median ratio of non‐cancerous tissue/serum levels was greater than 1.0. Cancerous tissue had significantly lower levels of lutein, zeaxanthin and α‐carotene than did non‐cancerous tissue. It appears that the increased breakdown of β‐carotene and cryptoxanthin in cancerous tissue can be compensated for by an increased uptake of circulating carotenoids by cancerous tissue, whereas lutein, zeaxanthin and α‐carotene levels in cancerous tissue are not able to be maintained.
Measuring the dietary intake of Samoans living in New Zealand: Comparison of a food frequency questionnaire and a 7 day diet record
Authors: Bell A Colin , Swinburn Boyd A , Amosa Henga , Scragg Robert , Sharpe Susan J
Published: March 2003

The purpose of this study was to determine the accuracy of a quantitative food frequency questionnaire for measuring the usual dietary intake of Samoans living in New Zealand. We compared a self‐administered 89 item quantitative food frequency questionnaire (FFQ) with a 7 day diet record (DR) in a sample of 55 Samoan adults aged 20 years and over. The FFQ asked people to report their dietary intake in frequency and amount and included photos of standard serving sizes. The DR was collected over non‐consecutive three and four day periods, including two weekend days. Food weighing scales and measuring cups and spoons were provided to measure food portions. Correlations between the two methods were poor for both crude (range –0.03–0.48) and energy‐adjusted (range –0.12–0.54) nutrient intakes. Approximately 29–53% of people fell into the same tertile when classified by the two methods and 9–22% of subjects were grossly misclassified into opposite tertiles. Agreement was also poor when the differences in energy, fat, protein and carbohydrate intake between the methods were plotted against mean intake. Relative to an estimate of energy expenditure, both methods underestimated usual energy intake; however, underestimation occurred to a greater extent with the DR. We conclude that agreement between the two dietary assessment methods was poor and we were unable to use the DR to calibrate the FFQ. In terms of total energy, the FFQ gave a better assessment of usual dietary intake than did the DR.
Manifestation of cardiovascular risk factors at low levels of body mass index and waist‐to‐hip ratio in Singaporean Chinese
Authors: Deurenberg‐Yap Mabel , Yian Tan Bee , Kai Chew Suok , Deurenberg Paul , Staveren Wija A van
Published: March 2003

The global prevalence of obesity, characterised by a body mass index (BMI) ≥ 30 kg/m2, is high and is increasing. Obesity is associated with a higher risk of developing non‐communicable diseases such as cardiovascular disease (CVD) and cancer. In Singapore the prevalence of obesity differs among the three main ethnic groups (Chinese, Malays and Indians) but is relatively low compared to Western societies. Despite the low prevalence of obesity (BMI ≥ 30 kg/m2), the morbidity and mortality for CVD are high in Singapore. In this paper, the odds ratio for presence of risk factors for CVD was studied in relation to BMI quintiles and in relation to body fat distribution as measured by waist‐to‐hip ratio (WHR) quintiles in a representative sample of adult Singaporean Chinese. The lowest quintile was used as the reference category. The boundaries for the BMI quintiles were 18.9, 20.7, 22.6 and 25.0 kg/m2 for females and 20.0, 21.7, 23.5 and 25.6 kg/m2 for males. The boundaries for WHR quintiles were 0.68, 0.71, 0.74 and 0.79 for females and 0.77, 0.82, 0.85 and 0.89 for males. As observed in other studies, the odds ratios for high serum total cholesterol, low HDL cholesterol, high total cholesterol/HDL cholesterol ratio, high serum triglyceride level, high blood pressure and high fasting blood glucose were higher in upper BMI and WHR quintiles. The effects were more pronounced in males compared with females. The odds ratios for having at least one of the mentioned risk factors in the different BMI quintiles for females were 1.3 (not significant (ns)), 1.6, 2.1 and 2.7, while in males they were 2.7, 4.1, 6.2 and 7.3. For the WHR quintiles the odds ratios were 0.9 (ns), 1.3 (ns), 1.9 and 2.1 for females, while for males they were 2.1, 4.7, 6.7 and 12.6. As the elevated risks are already apparent at low levels of BMI and low levels of WHR, it can be queried whether the cut‐off points for obesity based on BMI and for abdominal fat distribution based on WHR as suggested by the WHO are applicable to the Singaporean Chinese population. There are indications in the literature that Asian populations have higher body fat percentages at lower BMI. This may explain the high odds ratios for CVD risk factors at low BMI and WHR and the high morbidity and mortality from CVD in Singapore, despite relatively low population mean BMI and obesity rates.
Dietary factors as determinants of hypertension: A case control study in an urban Indian population
Authors: Kodali Vijayalakshmi , Kodavanti Mallikharjuna Rao , Tripuraribhatla Prasanna Krishna , Ram Thummala C Raghu , Eswaran Parvathi , Krishnaswamy Kamala
Published: March 2003

Hypertension, an important risk factor for coronary heart disease (CHD), is often associated with certain dietary habits which can either adversely affect or decrease blood pressure. Several Western studies have documented the role of diet, especially excess energy, both quality and quantity of fat and salt, in the aetiopathogenesis of chronic diseases such as hypertension, diabetes and CHD. Indians are particularly susceptible to these chronic diseases. A study was therefore undertaken to investigate the role of dietary factors in relation to hypertension. A total of 158 newly diagnosed cases were selected from the out‐patient department of the 1000‐bed Osmania General Hospital along with 172 age and gender‐matched controls. A detailed diet history was collected and validated. An energy adjustment method was adopted by transforming the data on a log scale as all the nutrients depended upon the intake of energy. A total of 86 hypertensives and 79 controls participated in the study. Among those classified as hypertensives, men reported higher intakes of dietary fat and salt while women reported higher intakes of dietary protein and salt. Risk calculated by Odds ratio revealed that higher intakes of fat, protein and salt increase the risk for hypertension. Multivariate stepwise logistic regression identified salt as the risk factor in men and protein as the risk factor in women. These results suggest a role for dietary fat, protein and salt in hypertension.
Arterial pressures in fish‐consuming and non‐fish‐consuming populations of coastal south India
Authors: Bulliyya Gandham , Reddy Palakuru Chengal , Reddanna Pallu
Published: March 2003

It has been suggested that fish‐consuming populations have lower blood pressure levels. The aim of this study was to determine and compare the mean blood pressure levels among fish‐consuming populations with those among populations who do not consume fish, as a risk marker for cardiovascular disease. A cross‐sectional study was conducted among 1000 healthy Indian adult men and women (aged ≥ 20 years) randomly chosen from two representative age and sex‐matched samples, one of which was fish‐consuming (n = 500) and the other of which was non‐fish‐consuming (n = 500). The systolic and diastolic blood pressures and pulse rates were studied. The mean systolic and diastolic blood pressures and pulse rates were found to be lower in older men and women who were fish consumers in comparison with those who were non‐fish consumers, and the levels increased with advancing age. The population and sex differences were significant for certain age groups. The percentile cut‐off values for diagnosis of systolic hypertension showed lower prevalence in fish consumers than in non‐fish consumers. The results indicate that people who ate fish regularly appeared to have a better cardiovascular risk profile than did non‐fish consumers, which is of public health significance. The relationship between fish consumption and blood pressure deserves further studies in normotensive and hypertensive populations.
Clinical trials in nutrition
Authors: Wahlqvist Mark L , Hsu‐Hage Bridget H‐H , Lukito Widjaja
Published: March 2003

Trials of nutritional intervention in a wide range of health and disease states, preventive and therapeutic, are required. Not only has the emergence of chronic non‐communicable disease (CNCD) with acknowledged nutritional pathogenesis created this imperative need, but so also have other conditions which, previously, had not been regarded as nutritionally based. Among the latter are health problems associated with ageing: the menopause, a decline in immune function, and a decline in cognitive function. At the same time, there is a new set of materno‐foetal and infant nutrition issues for investigation which relate to new food exposures and the long‐term effects of nutritionally mediated gene expression. The emergence of the new food science of phytochemicals with human biological importance also sets the scene for their evaluation in traditional diets and novel foods. Such trials are more complex than comparable pharmacotherapeutic studies because of the complexity of food chemistry, as well as the food behavioural changes which may accompany a nutritional intervention, and the general problem of there not being a ‘gold standard’ for food intake methodology. Choice of study population is also a key issue in relation to the extrapolation of findings from a particular trial, with population representativeness being an advantage. In order to obtain useful information on manageable sample sizes, either intermediate end‐points (short of morbidity and mortality) need to be studied or high‐risk groups (such as the aged) need to be recruited. There are some unique ethical issues which must inform clinical nutrition trials. These include certain preventive imperatives like the right to be fed, the risks in disruption of food cultures and the need for food security and sustainability. Rapid changes in the food supply do, however, make such trials more important, while the value of food‐health knowledge that cannot be obtained by trial must still be appreciated.
Food and nutrient intakes and overall survival of elderly Japanese
Authors: Darmadi Irene , Horie Yoshimitsu , Wahlqvist Mark L , Kouris‐Blazos Antigone , Horie Kazuyo , Sugase Kimiko , Wattanapenpaiboon Naiyana
Published: March 2003

As part of the International Union of Nutritional Sciences (IUNS) Food Habits in Later Life Project, a group of 89 free‐living Japanese aged 70 years and over (43 men and 46 women) residing in semiurban Okazaki, located in the middle of Honshu Island in Japan, were studied. They were followed up in order to determine whether nutrition plays a role in Japanese longevity. Information on food and nutrient intake was collected at study entry. During 55 months follow‐up, eight men and five women died. The consumption of various food groups, after adjustment for energy intake to 10.5 MJ for men and 8.4 MJ for women, was similar for survivors and deceased, but there was a greater consumption of mushrooms and fats and oils among the survivors (P< 0.05). Furthermore, survivors had a higher intake of total n‐3 fatty acids, especially alpha‐linolenic acid, compared with the deceased (P< 0.05). Subjects who were not chronically energy deficient (BMI ≥ 18.5 kg/m2) showed a better survival probability with a higher intake of total n‐3 fatty acids (≥ 2.1 g/day, 25th percentile). A similar result for total n‐3 fatty acids and alpha‐linolenic acid was found using Cox proportional hazards analyses adjusted for age, gender and smoking status (P< 0.05). After adjustment for bodyweight, the conditionally essential amino acid tyrosine was higher in women who survived (P< 0.05). These findings suggest that the intake of n‐3 fatty acids and of certain amino acids might be particularly important in elderly people for living longer.
Acute effects of acarbose on post‐prandial glucose and triglycerides in type 2 diabetics following intake of different Malaysian foods
Authors: Nawawi Hapizah Mohd , Yazid Tengku Norita , Ismail Faridah , Khalid B Abdul Kadir
Published: March 2003

Acarbose inhibits intestinal alpha‐glucosidases resulting in diminished and delayed postprandial hyperglycaemia (PPH). Studies on effects of acarbose on postprandial lipaemia (PPL) have been inconclusive. Little is known about the effects of acarbose on PPH and PPL following intake of a polysaccharide diet. We studied 30 type 2 diabetic patients on dietary and/or oral hypoglycaemic agent(s). Thirty patients were recruited for food A (nasi lemak), 28 for food B (mee goreng) and 28 for food C (roti telur), which represent the typical diets of the three main races in Malaysia. Serial blood samples were taken at 15 min before and up to 240 min after each food intake, without acarbose. Subsequently, three doses of 50 mg acarbose were given orally and the same procedure was repeated the following day. There were significantly lower mean increments in plasma glucose levels after compared to before acarbose treatment 30, 45 and 60 min for food A and at 30, 45, 60, 120, 180 and 240 min for food C, but no significant difference was noted for food B. There was a significantly lower mean fasting glucose level after compared with before acarbose treatment following intake of food A and C but not food B. Short‐term treatment with acarbose caused significant diminished and delayed PPH response with food A and C but not with food B. Acarbose was more effective in reducing PPH response in polysaccharide foods with a higher and earlier postprandial glucose peak than in those with a lower and lagged peak. There were no significant differences in the mean fasting or postprandial triglyceride levels before and after acarbose treatment, following intake of all three foods for up to 4 hours. Depending on the food absorption pattern, overnight low dose treatment with acarbose leads to diminished fasting and peak plasma glucose levels, and delayed PPH but insignificant reduction in postprandial lipaemia in poorly controlled type 2 diabetics following intake of racially different Malaysian food.
Cardiovascular risk factors in elderly Koreans in Australia and Korea
Authors: Richman Rosemary M , Bermingham Margaret , Ko Jae‐Ryung , Mahajan Deepika , Steinbeck Katherine S , Caterson Ian D
Published: March 2003

Koreans are a recent but relatively small ethnic minority group in Australia. This descriptive cross‐sectional, comparative intercountry study examines the effect of Australian acculturation among elderly Koreans on cardiovascular disease (CVD) risk factors, compared with their counterparts in Korea. Fifty‐one (72.4 ± 8.7 years) Australian Koreans (AK) and 48 (75.7 ± 6.9 years) Koreans (K) living in Seoul participated in the study. Diabetes was reported by 10.2% of AK and 17.4% of K and hypertension by 38.8 and 29.8% of AK and K, respectively. Significantly, more AK (85.7%) than K (53.2%) reported undertaking physical activity (P = 0.0005) and fewer AK were current smokers (6%vs 26.1%; P = 0.0077). After controlling for age, body mass index and waist‐to‐hip ratio no differences were found in lipid profiles between AK and K men or women. The effect of acculturation may be reflected among Australian Koreans by increased physical activity and reduced smoking levels and increased levels of abdominal obesity.
Nutritional status and food security in Sub‐Saharan Africa: Predictions for 2020
Authors: Steyn Nelia P , Walker Alexander RP
Published: March 2003

The subject of the future regarding nutritional status and food security, and of their ramifications in terms of nutrition‐related disorders/diseases in Sub‐Saharan African (SSA) populations, is a complex one. As well as social unrest, a country’s socioeconomic situation may affect food availability and, crucially, influence the generally low proportions of the Gross National Product devoted to health services. Additional determinants include changes in the roles of non‐dietary adverse factors (i.e. smoking practice, alcohol consumption, physical inactivity) and of infections (i.e. gastroenteritis, malaria, tuberculosis and, particularly, HIV). As to future health in 2020, major increases in socioeconomic status are very unlikely; in fact, there has been a deterioration in some countries with food shortages affecting nutrition status and food security. However, with some measures of prosperity there are likely to be decreases in family size and falls in the proportions of children born with low birthweights or with protein‐energy‐malnutrition (PEM), and of children lying under the 5th percentile of growth reference standards. Simultaneously, though. there will be variable rises, especially in urban dwellers, in the occurrence of hypertension, diabetes, cardiovascular disease and certain cancers. Improvements in the health status of both children and adults are likely to be strongly affected by whether HIV infection can be controlled or whether it becomes rampant.