bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of interdigital tinea pedis with 25% and 50% tea tree oil solution: A randomized, placebo‐controlled, blinded study
Authors: Satchell Andrew C , Saurajen Anne , Bell Craig , Barnetson Ross StC
Published: March 2003

Tea tree oil has been shown to have activity against dermatophytes in vitro. We have conducted a randomized, controlled, double‐blinded study to determine the efficacy and safety of 25% and 50% tea tree oil in the treatment of interdigital tinea pedis. One hundred and fifty‐eight patients with tinea pedis clinically and microscopy suggestive of a dermatophyte infection were randomized to receive either placebo, 25% or 50% tea tree oil solution. Patients applied the solution twice daily to affected areas for 4 weeks and were reviewed after 2 and 4 weeks of treatment. There was a marked clinical response seen in 68% of the 50% tea tree oil group and 72% of the 25% tea tree oil group, compared to 39% in the placebo group. Mycological cure was assessed by culture of skin scrapings taken at baseline and after 4 weeks of treatment. The mycological cure rate was 64% in the 50% tea tree oil group, compared to 31% in the placebo group. Four (3.8%) patients applying tea tree oil developed moderate to severe dermatitis that improved quickly on stopping the study medication.
Efficacy, cutaneous tolerance and cosmetic acceptability of desonide 0.05% lotion (Desowen®) versus vehicle in the short‐term treatment of facial atopic or seborrhoeic dermatitis
Authors: Freeman Susanne , Howard Anne , Foley Peter , Rosen Robert , Wood Glenda , See Jo‐Ann , Gray Susan
Published: March 2003

The differences between topical corticosteroids are based mainly on their potency, safety and patient acceptability. The aim of this study was to evaluate a mild‐ to mid‐potent topical corticosteroid, desonide 0.05%, on these three parameters in an Australian cohort of patients with facial seborrhoeic or atopic dermatitis. Eighty‐one adult patients were randomized to receive desonide 0.05% lotion or its vehicle, applied twice daily for 3 weeks under double‐blind conditions. In the active treatment group, 88% of patients had their skin condition cleared or almost cleared and only two patients experienced cutaneous adverse events (rash and pruritus). The acceptability of the lotion was high; 95% of patients stated they would use this topical corticosteroid again. These data support the short‐term use of desonide 0.05% lotion as a suitable agent for the short‐term treatment of facial dermatitis.
Stage IV CD30+ anaplastic large cell lymphoma: Response to acitretin and interferon‐α
Authors: Ong Colin , Sullivan John , Hertzberg Mark , Stapleton Karen
Published: March 2003

Retinoids and interferon (IFN)‐α induce differentiation, affect cell proliferation and alter various immune parameters. In combination, their effects may be additive or even synergistic in the treatment of malignancy. We present a 53‐year‐old woman with stage IV CD30+ anaplastic large cell lymphoma with brain, lung and skin involvement. The patient had been on methotrexate for rheumatoid arthritis. After a combination of oral acitretin 50 mg daily and IFN‐α 3 million units subcutaneously 3 times per week, the skin lesions cleared within 2 months, lung lesions by 5 months and brain leisons by 7 months. Although we cannot exclude that methotrexate played a role in the development of this lymphoma and that its withdrawal contributed to the clearance of lesions, we propose that the patient's disease responded to the combination of acitretin and IFN‐α.
Localized cutaneous necrosis associated with the antiphospholipid syndrome
Authors: Sharkey Michael P , Daryanani Indiver I , Gillett Martin B , Jones Stephen K
Published: March 2003

A 34‐year‐old woman with systemic lupus erythematosus and high titres of antiphospholipid antibodies was admitted to hospital suffering a viral illness but developed haemorrhagic and necrotic areas on the neck and anterior chest 7 days following cessation of warfarin. Anticoagulation had been initiated following a retinal vein thrombosis, but was ceased on day 4 of admission when she was found to be excessively anticoagulated (international normalized ratio (INR) > 10). However, at the time of developing the cutaneous lesions, the INR was sub‐therapeutic. Histology of a skin biopsy from the neck revealed thrombosis of upper dermal blood vessels without vasculitis, consistent with antiphospholipid antibody‐related skin necrosis. This case illustrates one of the cutaneous features that can occur in patients with elevated titres of antiphospholipid antibodies and the importance of closely monitoring anticoagulation in such patients.
Lupus panniculitis clinically simulating alopecia areata
Authors: Kossard Steven
Published: March 2003

A 27‐year‐old woman with a known history of lupus erythematosus presented with two circumscribed patches of non‐scarring alopecia closely resembling alopecia areata. Scalp biopsy showed a predominantly subcutaneous and deep dermal lymphocytic infiltrate that surrounded the deep follicular segments and hair bulbs, as well as the eccrine glands. There was associated hyaline fat sclerosis. The epidermis, infundibular and isthmus segments of follicles were relatively spared and lacked the lichenoid inflammation and fibrosis seen with lupus erythematosus.

The biopsy findings illustrate that the deep variant of lupus panniculitis may be concentrated around the hair bulbs and deep temporary segments of hair follicles and spare the permanent stem cell‐rich follicular segments. This pattern is capable of producing a temporary hair‐loss, clinically simulating alopecia areata. The clinical history, presence of subtle erythema and scalp tenderness on physical examination, as well as the biopsy findings, were important clues in distinguishing our case from a true combination of alopecia areata and lupus erythematosus.
Prospective study of depressive symptoms and quality of life in acne vulgaris patients treated with isotretinoin compared to antibiotic and topical therapy
Authors: Ng Chee H , Tam Mei M , Celi Elizabeth , Tate Bruce , Schweitzer Isaac
Published: March 2003

There have been recent concerns about the possible association between isotretinoin therapy and depressive symptoms. We conducted a prospective study to evaluate depressive symptoms and quality of life in acne patients having either isotretinoin or antibiotics/topical treatments. There were 215 patients (mean age 20 years) included in the study. Depression, quality of life and acne severity ratings were administered at baseline, 1 month, 3 months and end of treatment or 6 months, and compared between both treatment groups. The changes in the mean depression scores did not differ significantly between both groups (P = 0.62). The incidence of isotretinoin patients with moderate depressive symptoms remained relatively unchanged from baseline. The changes in the quality‐of‐life measures scores between treatment groups showed no significant difference. No correlation between isotretinoin dose and depression score was found. Although five isotretinoin patients were withdrawn during the study because of worsening of mood, no definite causal relationship was established. This pilot study does not appear to support any direct link between depression and isotretinoin, apart from being a rare unpredictable idiosyncratic side‐effect. However, because of the study limitations, a larger study is needed to confirm the findings.
Paediatric atopic dermatitis in Perth general practice
Authors: Thom Graham A , Halbert Anne R
Published: March 2003

Ninety‐seven Perth general practitioners completed a self‐administered postal questionnaire that aimed to examine their caseload and management practices for childhood atopic dermatitis (AD). General practitioners saw a median of two new cases and three follow‐up consultations per month for childhood AD, and referred a median of 10% of cases to a specialist, usually a dermatologist. Most (77%) recommended emollients for all patients, but only 21% specifically reported advising their use immediately after bathing. Sixty‐one percent would use topical corticosteroids in all or most patients, but cream preparations were more commonly used (58%) than ointments (40%). Atrophy was rated as a common or very common side‐effect of topical corticosteroid therapy by 23% of general practitioners. Twenty‐six percent reported using oral corticosteroids in children with AD. Dietary changes would be recommended in at least a few AD patients by 79% of general practitioners, and 31% would recommend a change from cow's milk to soy in the absence of a history of dietary triggers. We conclude that general practitioners appeared generally well informed about AD management. However, dermatologists, through targeted education, may be in a position to help general practitioners further improve outcomes for these patients.
Topical diclofenac in hyaluronan gel for the treatment of solar keratoses
Authors: Gebauer Kurt , Brown Pam , Varigos George
Published: March 2003

This randomized, double‐blind, placebo‐controlled study assessed the efficacy and safety of a topical gel containing 3% diclofenac in 2.5% hyaluronan in 150 patients with solar keratoses (SK). The active treatment was compared with the vehicle only, hyaluronan gel, as placebo over a 12‐week period. Patients in both groups applied the active treatment or placebo to a targeted area of skin (0.25 g b.d.). At 12 weeks the mean lesion‐count reduction in the targeted area was not significantly different between treatments. However, at post‐termination follow up (16 weeks), there was a highly significant decrease in the number of lesions, 6.2 ± 7.5 standard deviations (SD) (56.1% reduction) in the active treatment group compared with 2.4 ± 4.3 SD (23.6% reduction) in the placebo group (P < 0.001). Other efficacy measures (complete lesion resolution, >50% lesion reduction) were also significantly different (P < 0.01) between treatments at 16 weeks. In conclusion, topical 3% diclofenac in 2.5% hyaluronan gel was effective and well tolerated in this study, suggesting a role for this therapy in the treatment of SK.
Imaging the skin
Authors: Aspres Nicholas , Egerton Ian B , Lim Adrian C , Shumack Stephen P
Published: March 2003

Since the discovery of X‐rays, the use of imaging technology has continued to play an important role in medicine. Technological advancements have led to the development of various imaging modalities, most of which have been used to image organs deep within the human body. More recently, attention has focused on the application of imaging technology for evaluation of the skin. A variety of techniques are currently being used to examine the skin and these include specialized photography, surface microscopy, ultrasound, laser Doppler perfusion imaging, confocal microscopy, and magnetic resonance imaging. These modalities can provide information that can assist in the management of skin problems. Although many of these techniques are still undergoing research, they are showing promise as useful clinical tools in dermatology.
Predation risk for herbivorous insects on tropical vegetation: A search for enemy‐free space and time
Authors: Novotny V. , Basset Y. , Auga J. , Boen W. , Dal C. , Drozd P. , Kasbal M. , Isua B. , Kutil R. , Manumbor M.
Published: March 2003

Spatial and temporal variability in predation risk for herbivores on 13 rainforest species ofFicus(Moraceae) in Papua New Guinea was studied in order to assess whether predator‐free refuges exist on their foliage and if so, whether herbivorous insects concentrate their activity in such refugia. Predation risk from invertebrate predators was measured as the disappearance rate of live termites set up as baits on the foliage. By far the most important predators were ants, accounting for 77% of attacks. No consistent differences in predation rate betweenFicusspecies were found so that tree identity could not be used as an indicator of enemy‐free space. Predation risk was highly variable among conspecific trees and also changed rapidly in time, over periods as short as 10 days. Such short‐term and unpredictable predator‐free refuges may be difficult for herbivores to find and exploit. Predation risk during the day was three times higher than during the night, but abundance of herbivores on the foliage was also higher during the day. Thus, night was confirmed as a relatively enemy‐free time which, however, was not exploited by herbivores.
The place of carbohydrates in newer food formulations: Opportunities for nutritional advancement and their safety
Authors: Wahlqvist Mark L
Published: March 2003

Carbohydrates, from food, have a high degree of acceptability in the human diet as safe and are usually associated with other important nutrients, notably protein and various micronutrients (vitamins and minerals), but also biologically advantageous phytochemicals, although there is a wide spectrum of nutrient (or food component) densities between grains, root and other vegetables and fruits. As the human diet has evolved, less nutritious forms of edible carbohydrate have been in evidence, because of refining and co‐presentation with fat (e.g. a sugary pastry). These are nutritional safety issues in their own right. But, as newer food formulations develop, greater attention can be paid to the chemical (which simple sugars, oligosaccharides or polysaccharides), physical (the food structure retained or conferred) or functional properties (glycaemic, digestible, fermentable) of the carbohydrate, along with the presence or absence of companion compounds (macro‐, micro‐ and phyto‐nutrients). These developments present opportunities and limitations in altering physiology and health outcomes and create new risk−benefit relationships. More now needs to be understood by food and nutrition policy makers, manufacturers and health‐care professionals about the future of such foods, how they will influence food choice, what the regulatory arrangements will be, and how their use will be monitored for safety, sustainability and health.
Omega‐3 fatty acids in wild plants, nuts and seeds
Authors: Simopoulos Artemis P
Published: March 2003

Human beings evolved consuming a diet that contained approximately equal amounts of omega‐6 and omega‐3 essential fatty acids. Over the past 100−150 years there has been an enormous increase in the consumption of omega‐6 fatty acids due to the increased intake of vegetable oils from seeds of corn, sunflower, safflower, cotton and soybeans. Today, in Western diets, the ratio of omega‐6 to omega‐3 fatty acids ranges from 10 to 20:1 instead of the traditional range of 1−2:1. Studies indicate that a high intake of omega‐6 fatty acids shifts the physiologic state to one that is prothrombotic and proaggregatory, characterized by increases in blood viscosity, vasospasm, and vasoconstriction and decreases in bleeding time, whereas omega‐3 fatty acids have anti‐inflammatory, antithrombotic, anti‐arrhythmic, hypolipidemic, and vasodilatory properties. These beneficial effects of omega‐3 fatty acids have been shown in the secondary prevention of coronary heart disease and hypertension, as for example, in the Lyon Heart Study, the GISSI Prevenzione Trial, and in the The Dietary Approaches to Stop Hypertension Study. Most of the studies have been carried out with fish oils (eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)). However, α‐linolenic acid (ALA), found in green leafy vegetables, flaxseed, rapeseed, and walnuts, desaturates and elongates in the body to EPA and DHA and by itself may have beneficial effects in health and in the control of chronic diseases. The present paper identifies multiple sources of ALA from plants, legumes, nuts and seeds and emphasizes the importance of the ratio of omega‐6 to omega‐3 fatty acids for proper desaturation and elongation of ALA into EPA and DHA. α‐linolenic acid is not equivalent in its biological effects to the long‐chain omega‐3 fatty acids found in marine oils. Eicosapentaenoic acid and DHA are more rapidly incorporated into plasma and membrane lipids and produce more rapid effects than does ALA. Relatively large reserves of linoleic acid in body fat, as are found in vegans or in the diet of omnivores in Western societies, would tend to slow down the formation of long‐chain omega‐3 fatty acids from ALA. Therefore, the role of ALA in human nutrition becomes important in terms of long‐term dietary intake. One advantage of the consumption of ALA over omega‐3 fatty acids from fish is that the problem of insufficient vitamin E intake does not exist with high intake of ALA from plant sources.
Cholesterolaemic effect of palmitic acid in relation to other dietary fatty acids
Authors: French Margaret A , Sundram Kalyana , Clandinin M Thomas
Published: March 2003

The effect of dietary intake of high palmitic acid levels in combination with other fatty acids in normal subjects was assessed. Palmitic acid (10% of energy) was fed in conjunction with decreasing levels of linoleic acid to determine if a threshold level of linoleic acid prevented palmitic acid from being hypercholesterolaemic. Healthy subjects received each of the diet treatments for 21 days, followed by washout periods of 7 days. In a second experiment, the effect of exchanging palmitic acid for trans fatty acids on plasma lipoprotein cholesterol levels and on rates for endogenous synthesis of cholesterol in normal subjects was investigated. Diet treatment lasted for 30 days. On day 30 of each diet treatment, a priming dose of deuterium was consumed, followed by a subsequent blood sample at 24 h. Blood cholesterol fractions were isolated and analysed by isotope ratio mass spectrometry to measure cholesterol fractional synthetic rates. In the first experiment, total plasma cholesterol levels increased as the percentage of linoleic acid decreased. The data indicated that high levels of palmitic acid were not hypercholesterolaemic if intake of linoleic acid was greater than 4.5% of energy. When the diet contained trans fatty acids plasma total and low‐density lipoprotein‐cholesterol increased and cholesterol synthesis increased with a decrease in high‐density lipoprotein‐cholesterol.
Effect of vitamin E on plasma malondialdehyde, antioxidant enzyme levels and the rates of wound closures during wound healing in normal and diabetic rats
Authors: Musalmah Mazlan , Fairuz Abd Halim , Gapor Mat Top , Wan Ngah Wan Zurinah
Published: March 2003

Vitamin E is composed of various subfamilies that include tocopherols and tocotrienols. These compounds have antioxidant properties but differ in structure, dietary source and potency. In this study we evaluated the efficacy of α‐tocopherol as an antioxidant and its role in wound closure in normal and streptozotocin‐induced diabetic rats. The healing of 6 cm linear incisions created on the back of each male Sprague−Dawley rat (250−300 g) was monitored by measuring the length of the wounds daily. The rats were divided into two categories; normal and streptozotocin‐induced diabetic rats. For each category, the animals were further divided into two groups; those untreated and those receiving 200 mg/kg bodyweight α‐tocopherols daily by oral gavage. All rats were fed standard food and water ad libitum. Blood samples were taken at 0, 5 and 10 days after the wounds were created for the determination of malondialdehyde levels and red cell superoxide dismutase, catalase and glutathione peroxidase activities. The results showed that α‐tocopherol reduced plasma malondialdehyde levels, increased glutathione peroxidase activity and accelerated the rate of wound closure in treated rats.
Trends in dietary habits of the elderly: The Indonesian case
Authors: Boedhi‐Darmojo R
Published: March 2003

Based on community surveys of the elderly of their nutritional habits in big cities throughout Indonesia and in urban and rural areas, the following observations are reported: (i) the elderly tend to reduce their food intake by themselves, in calories, carbohydrate, fat, protein content (15−30% less); (ii) they even reduce their traditional fatty food by themselves in spite of their already low fat intake daily (30−40% less); (iii) they very seldom eat snacks between meals (6.7−25.5%) of the respondents only; (iv) they tend to eat (very seldom − never) new ‘trendy foods’ (78−95%) such as hamburger, pizza, fried chicken etc., which are available in big cities; (v) the elderly usually eat just enough before satiety (84.3%); (vi) the majority of the elderly usually eat rice or other local staple foods, with mostly vegetables every day (50−80%), especially the traditional témpé (soybean cake) and tahu (soybean curd) and green vegetables (80%); fruits are consumed less than vegetables (40%); (vii) milk consumption still needs to be improved; (viii) fish consumption, the best healthy animal protein source, still needs to be promoted to the whole country, especially to the elderly on Java island; and (ix) an urban−rural difference was noted, the urban elderly having a higher intake of calories, fat and protein. Gender differences were practically not observed, except the higher calorie intake in men. The following findings support the aforementioned observations. The elderly have a lower mean body mass index (BMI); only 15.9% are overweight and only 4.5% are obese, although it is admitted that there are many elderly people who are underweight and malnourished. They also have lower mean cholesterol, triglyceride and haemoglobin values, but a higher prevalence of glucose intolerance, hypertension, coronary heart disease etc. is reported in many studies. In conclusion, the elderly in general have good eating habits, and they adjust their food intake to the reduced daily physical activities they perform. However, the consumption of eggs and fish (as low‐cost protein sources) needs to be improved. Hence overeating and obesity are not a problem for the Indonesian elderly people, although it is admitted that undernutrition will be a problem unless properly anticipated. They usually prefer to eat the already healthy traditional food, especially the still popular vegetable source of protein and anti‐oxidants. They eat the traditional food, témpé and tahu, making them a stronghold against diet ‘westernization’, and they should be used as a good example for the younger generation. Reduced calorie intake among the elderly is also observed in Japan, but not yet in most European elderly populations.
New perspectives on regional opportunities for community nutrition
Authors: Scrimshaw Nevin S
Published: March 2003

This brief keynote speech provides an annotated check list for topics to be covered during the meeting. The topics presented include specific indicators of nutrition, new regional information and communication technologies, empowerment of communities, effective nutrition and health interventions, advances in agricultural research, progress in food technology and the potential of biotechnology and genomics to benefit the region. Other issues to be considered are land decentralization, south‐south and south‐north cooperation, program monitoring and evaluation, human rights and ethics.
Food safety courses for nutritionists and other health professionals through intersectorial cooperation
Authors: Iswarawanti Dwi Nastiti , Lan Maria Catharina Phan Ju , Crowther John Stephen
Published: March 2003

The present paper describes the development of a food safety course that was initially given as part of the Master of Science programme in community nutrition at the South‐East Asian Ministers of Education Organization, Tropical Medicine Regional Centre for Community Nutrition at the University of Indonesia. This course is an example of intersectorial collaboration between industry, government and academia. Several years later the course was rolled out to other countries.
Micronutrient supplementation and its relationship to nutritional status, health and diseases
Authors: Untoro Juliawati , Muslimatun Siti , Karyadi Elvina
Published: March 2003

Micronutrient deficiency is still a major problem in many developing countries and multiple micronutrient deficiencies often occur concomitantly. Micronutrient supplementation may be the preferred option because it is cost‐effective. Supplementation with iodized peanut oil was more efficacious and gave a longer protection period in preventing iodine deficiency than did iodized poppy seed oil. Inclusion of vitamin A in the iron supplement improved the vitamin A status of pregnant women and their infants. Daily or weekly multimicronutrient supplementation improved growth of stunted young children, whereas weekly multimicronutrient or iron−folic acid supplementation improved the productivity of female workers. In addition, vitamin A and zinc supplementation improved the impact of tuberculosis medication, particularly during the first 2 months. In conclusion, multimicronutrient supplementation has beneficial effects on the improvement of nutritional status, work productivity, health and diseases. The challenge is how to translate the efficacy of supplementation strategies into a large‐scale setting.
Food and nutrition security in poverty alleviation: Concepts, strategies, and experiences at the German Agency for Technical Cooperation*
Authors: Gross Rainer
Published: March 2003

Poverty alleviation and food and nutrition security remain one of the priority areas of development policies for the German government. Poverty exists when individuals or groups are not able to satisfy their basic needs adequately. Poverty consists of at least three dimensions: (i) the availability of essential resources for basic needs; (ii) financial and other means of poor individuals and groups; and (iii) the physical, intellectual, social, and cultural status and position of poor individuals and groups. Following this model, the severity of poverty is the collective gap between the availability of the essential resources (i) and the individual ability to meet basic needs (ii) + (iii). Basic needs are not covered if individuals or groups are not able to develop themselves physically, intellectually, and/or socially according to their genetic potentials. As a result, growth retardation of children (‘stunting’), who are biologically and socially the most vulnerable individuals of the society, is a valid cultural independent indicator for poverty. One form of poverty is food and nutrition insecurity. Food security is achieved if adequate food (quantity, quality, safety, sociocultural acceptability) is available and accessible for and satisfactorily utilized by all individuals at all times to live a healthy and happy life. Food and nutrition programmes have four dimensions: (i) categorical; (ii) socio‐organizational; (iii) managerial; and (iv) situation‐related dimensions. As shown in three examples of Indonesian−German programmes, despite the complexity of poverty and food and nutrition security, with adequate targeting of the most vulnerable population, adequate identification of problems for a proper selection of interventions and frequent evaluation, reduction of poverty and food insecurity can be achieved.
Malnutrition and poverty alleviation*
Authors: Susilowati Dwi , Karyadi Darwin
Published: March 2003

The aim of the present paper is to understand the relationship between malnutrition and poverty, and how to generate ideas and concepts for developing studies leading to policy and programme implementation in the context of establishing collaborating networks among South‐East Asian Ministers of Education Organization (SEAMEO) centres. Malnutrition is found at all stages of life, from the fetus to older people, in what is considered to be ‘nutrition throughout the life cycle’. Low birthweight could become an important indicator of fetal/intrauterine nutrition. The consequences of being born undernourished extend into adulthood. Stunting is an indicator for poverty, it demonstrates early poor nutrition. Malnourished children face terrifying long‐term results when they grow to adults, deprived of their full mental and intellectual capacity. The way to break the poverty cycle is to focus on children. Seventy per cent of the world's poor are women, which is considered as a feminization of poverty. Women play an important role in giving birth to the next generation, in food security, and as caregivers for the family. It is therefore important to increase the physical, mental, and intellectual well‐being of every woman as a good investment for the well‐being of future society and a human right. However, the gender issues are rarely openly acknowledged in national antipoverty strategies. Adequate nutrition, healthy ageing, and the ability to function independently are thus essential components of a good quality of life. Food security refers to access at all times to sufficient, nutritionally adequate, and safe food. It is important for healthy and peaceful development. Nutrition policy must be an integral part of health policy, from the national to the grass‐roots level. The strategy is to focus government, NGOs and community activities on the reduction of poverty, hunger, and malnutrition in developing countries; determine who the poor people are, where they live, why they are poor and how our research could contribute and reduce both poverty and malnutrition.
Implications for food regulations of novel food: Safety and labeling
Authors: Lupien John R
Published: March 2003

Novel or functional foods may provide health and nutritional benefits due to non‐nutritice components such as fiber, flavonoids, and phenols. National, regional and international regulations are discussed as a means to control label claims, composition and uses.
Macronutrient innovations: The role of fats and sterols in human health
Authors: Li Duo , Sinclair Andrew J
Published: March 2003

Dietary intake of fats and sterols has long been known to play a critical role in human health. High proportions of saturated fat, which increase blood cholesterol levels, are mainly found in animal fat and some plant oil (e.g. cocoa butter, palm oil etc.). The predominant polyunsaturated fatty acid (PUFA) in the Western diet is linoleic acid (LA; 18:2n‐6), an essential fatty acid, which is commonly found in vegetable seed oils. This is the parent fatty acid of n‐6 series PUFA, which can be converted in vivo to C20 and C22 n‐6 long chain (LC) PUFA. α‐linolenic acid (ALA; 18:3n‐3) is less abundant than LA and is another essential fatty acid; ALA is also present in some vegetable oils such as perilla, flaxseed, canola, soybean and walnut oils, and is the precursor of C20 and C22 n‐3 LC PUFA. Sterols are widely distributed in animal tissue and plants, with cholesterol being the major sterol in animal tissue and β‐sitosterol, campesterol and stigmasterol being the main sterols in plants. It has long been recognized that an increased dietary intake of saturated fat and (to a lesser extent) cholesterol, raises plasma/serum total and low‐density lipoprotein (LDL)‐cholesterol, and PUFA decreases these levels. Results from recent studies have shown that plasma/serum levels of lipids and lipoprotein lipids can also be decreased by plant sterols (phytosterols) and diacylglycerol (DAG). Conjugated linoleic acid (CLA, cis‐9,trans‐11−18:2) has been reported to have anticancer and antidiabetic activities. Fat as the DAG form has also been reported to have anti‐obesity effects. Omega‐3 PUFA have a beneficial effect on increased heart rate variability, decreased risk of stroke, reduction of both systolic and diastolic blood pressure and may be effective in managing depression in adults. Gamma‐linolenic acid (GLA) and phytosterols have an anti‐inflammatory activity. The GLA, when combined with docosahexaenoic acid (DHA), have been reported to have a beneficial effect in hyperactive children. These data show that various lipids are powerful bioactive compounds.
Phytochemical composition: A paradigm shift for food‐health considerations
Authors: Premier Robert
Published: March 2003

Foods derived from plants, such as fruits and vegetables, have been the backbone of human nutrition since the beginning of time. Hunting and fishing supplemented diets with protein‐rich foods but nutrition was predominantly based on the availability of plant foods. The importance of various plant foods in the development of some civilizations and economies has been well documented: maize in the Americas, potatoes in parts of Europe after their introduction from the Americas, and wheat in Australia. Plant industries are still the backbone of cultures and economies in almost every corner of the world and production figures support the fact that plant industries are still regarded as the most important source of nutrition. Nutrition parameters found in plant foods vary between crops but there is a consensus that plant foods can supply most, if not all, of the essential components for human nutrition. These components were discovered slowly by trial and error during human history, a classic example was the prevention of scurvy in seafarers. When fresh fruit and vegetables were missing from their diet, they learned that products such as pickled cabbages and citrus, rich in vitamin C, could prevent the manifestation of this dehabilitating dietary disease. As early as the turn of the century scientists learned that diet not only affected nutrition but also had an effect on health and well‐being. But it was not until 1933 that a direct relationship between consumption of fruit and vegetables and diseases such as cancer was shown. Fruit and vegetables not only have become the backbone of local agricultural markets but also play a major role in international trade. Competition for local and international markets is driving extensive research and development to produce new cultivars. Until recent times research has concentrated on producing new varieties that store longer, yield better, look better, taste better, suit local climates, display disease and pest resistance and suit processing technologies. A new wave of research is addressing the newly developing interest in heath‐based foods. Molecular biologists, biochemists, botanists and medical researchers are linking in with plant breeding programmes to develop new varieties of fruit and vegetables that are tailor‐made to produce higher levels of health‐related phytochemicals. New phytochemical‐enhanced products such as broccoli, tomato, oranges and berries are currently being evaluated for commercial exploitation. The present paper will discuss some of the products that are being produced, the driving forces behind their production, the phytochemicals targeted and the problems that must be addressed if this new approach in human nutrition and health is to be of benefit to consumers.
Communicating food science and technology: From a developing country to a developed country point of view
Authors: Winarno FG
Published: March 2003

The history of food is a history of thousands of years of human choice set in the context of an almost Darwinian process of natural selection. Around the world, food is eaten to fill stomachs and to keep bodies strong and healthy. In Asia there is, frequently, a shift in emphasis. The Asian people, like everyone else, eat to survive, but they also eat to keep their bodies finely tuned, physically and spiritually. No food is a nutritious food if it is not safe. Food safety is of paramount importance for food trade, both domestically and internationally. Developed Asian nations such as Japan, Singapore, and South Korea have been paying more attention to healthy eating. Fearful of health problems, they are returning to traditional foods. On average, life expectancy has more than doubled from 34 years at the turn of the 19th century to 76 years in developed countries today. With the advance of medical science and technology, the figure is set to rise. There is growing scientific evidence that these major diseases are closely associated with lifestyle, dietary habits in particular. There are many well‐accepted observations that show that protective immune responses are impaired in old age, that immune deficiency causes an increased risk of more frequent and more severe infections, and that nutritional deficiencies occur frequently and are a detrime determinant of the immunocompetence of aging. The relationships of nutrition, aging and immune competence are attracting more and more attention. The world trend in foods will be focused into four food groups, which are characterized for their positive effect on human life in the future: (i) foods that will improve cardiovascular disease; (ii) foods that enhance the immune system; (iii) foods that increase women's health, fitness and beauty; and (iv) foods that could improve the nutritional status of children. To communicate better, there is an urgent need for easily available local‐based textbooks that successfully discuss applications of food science and nutrition to people of the particular developing countries, and at the same time discuss in simple national language all the basic principles of foods and nutrition. If developing countries are to give their children the heritage of health as well as freedom, the people must change their attitude toward food. They must learn from each other and from the world about the kind of foodstuffs that make a person healthy.
Obesity in Asia: prevalence and issues in assessment methodologies
Authors: Tee E‐Siong
Published: March 2003

The dramatic changes in the lifestyle of many Asian communities, and the resultant changes in the food and nutrition issues facing the communities in the region have been documented by various investigators. Health authorities and researchers have given greater attention to the problem of overweight and obesity. Available data are lacking, but various estimates have indicated that the emerging problem of overweight amongst children cannot be ignored. Estimates of overweight by the World Health Organization (WHO) amongst preschool children in Asia in 1995 was around 2.9%. Data extracted from selected studies in individual Asian countries show much higher prevalences, ranging from 5% to 9% amongst several urban cities in Asia. In several other developing countries in the region, the prevalence is probably very low, with prevalences of less than 1%. There is thus considerable variation in this prevalence amongst the various countries. The problem of increasing overweight and obesity amongst adults in Asia has been highlighted for more than a decade. The database on the extent of the problem is far from being comprehensive, but various studies have pointed out the severity of the problem. Various reports in the 1990s have pointed out prevalences of overweight of over 20% and obesity of over 5% amongst urban population groups of the more developed countries in the region. It is also to be noted that there are also reports indicating that the most affluent societies in the region, such as Seoul and Tokyo, did not have the highest prevalence of overweight. There are also data on increasing prevalence of overweight among rural areas in the last 10 years. The situation for children is similar: there is considerable variation in the severity of the problem. In the Philippines National Surveys, for example, slightly lower prevalences have been reported. Countries in the region will continue to progress, accompanied by continued changes in lifestyle of communities. It is therefore of utmost importance to continue to monitor the nutritional status of communities. The lack of nationally representative data which is regularly updated is a major concern. The lack of data for certain age groups such as the adolescents and the elderly need to be addressed. One of the main obstacles in the formulation and effective implementation of intervention programs in developing countries is the lack of comprehensive data on the extent of the problems in many cases and the causes of such problems specific to the communities concerned. In addition to the lack of good data, other concerns too need to be addressed. These include methodological issues such as the need for harmonization of methods in assessment of nutritional status for the various groups, the appropriateness of criteria for cut‐offs, growth reference to be used, and association of overweight and obesity with comorbidities.
Pharmacotherapy and surgery in the treatment of obesity: evaluating risks and benefits
Authors: Sum Chee Fang
Published: March 2003

The prevalence of obesity is rising in many parts of the world. In Singapore, the 1998 National Health Survey reported the crude prevalence of obesity (BMI ≥ 30 kg/m2) amongst adults as 6%. Together with the increase in obesity in certain sectors of the Singapore population (Malay community) there has been a parallel increase in the prevalence of impaired glucose tolerance. If left unchecked, this epidemic of obesity and its comorbidities will lead to reduced quality of life amongst its sufferers as well as an increase in consumption of healthcare resources. Although strategies at the community level are important to check this epidemic, when managing the individual patient with clinically significant obesity and its comorbidities, adjunctive pharmacotherapy and surgical measures are sometimes required besides lifestyle measures and behaviour therapy. Since these therapeutic measures are not without risks, a customized approach utilizing risk‐benefit evaluation is appro­priate. Pharmacotherapy for the management of obesity has had a chequered history Prom the early disrepute brought about by patient dependence when using amphetamine‐like agents, it improved in standing when obesity became more widely accepted as a chronic disorder requiring chronic adjunctive pharmacotherapy. However, the adverse cardiovascular effects reported with the ‘fen‐phen’ combination again reduced enthusiasm for long‐term pharmacotherapy. Subsequently, the availability of intestinal lipase inhibitor, orlistat, followed by the mixed noradrenergic‐serotoninergic re‐uptake inhibitor, sibutramine, gave fresh impetus to this therapeutic area. Both agents were made available for clinical use only after published clinical trial experience of one to two years duration. The difficulties encountered in management of patients with marked obesity have prompted adjunctive surgical initiatives. Follow‐up reports from the Swedish Obese Subjects study which began in 1987, have provided valuable data on the effect of surgery on obesity as well as its comorbidities. At the same time, technological advances in surgery have facilitated the widespread use of less invasive approaches to bariatric surgery. It is hoped that with these technological advances, this group of patients will be able to enjoy the benefits of surgery without being exposed to excessive surgical risks.
Body mass index as an indicator of obesity
Authors: Weisell Robert C
Published: March 2003

Undernutrition and hunger have always formed the foundation of the Food and Agriculture Organisation's (FAO) mandate. Working in collaboration with the International Dietary Energy Consultative Group (IDECG), FAO began to examine both appropriate cut‐off points of the body mass index (BMI) at the lower end of the spectrum and the functional consequences of low BMI (<16.0 = Category III Chronic Energy Deficiency (CED); 16.0 − 16.9 = Category II CED; 17.0 − 18.4 = Category I CED). Over the past decade FAO has recognized the growing obesity epidemic occurring not only in the developed world but also among all income and socio‐economic groups of the developing world. In response, FAO and the World Health Organization (WHO) have collaborated together in joint initiatives. Following the WHO 1998 Obesity Consultation on Preventing and Managing the Global Epidemic, a number of regions examined their individual situation regarding obesity. In looking at the BMI risk‐based cut‐off points, there appeared to be need for a tailoring of the cut‐off points for Asia. The publication The Asia‐Pacific Perspective: Redefining Obesity and its Treatment (2000) proposed area‐specific cut points. While such efforts to individualize reference values to a region or situation are attractive and even commendable, there is always the danger of creating confusion particularly if later these figures are changed. It is very important that before values are promulgated, a thorough review is conducted and full confidence can be placed on them.
Impact of physical activity on the emerging crisis of obesity in Asia
Authors: Levine James , Peters John , Saris Wim , Hill James
Published: March 2003

Obesity is associated with devastating health and fiscal consequences in countries where it is epidemic. It is beholden on us all to try to prevent obesity emerging in countries where its prevalence is starting to increase. There are many countries in Asia where this is so. Obesity prevention necessitates attention to both increasing physical activity and improving nutrition. In this paper we discuss a strategic approach for increasing physical activity. First, we need to better understand physical activity levels and the factors that impact it. Next, we need to design specific and targeted governmentally supported strategies to promote physical activity. Finally we need to critically and objectively evaluate these strategies and then promote those that are successful, and channel limited resources away from those that are not. These goals are achievable through collaborating and sharing technologies. We hope to prevent obesity from engulfing Asia.
The challenge of managing body weight in the modern world
Authors: Peters John C
Published: March 2003

Obesity prevalence has increased dramatically in parallel with rapid economic development and rising standards of living around the world. There is growing recognition that this ‘epidemic’ of overweight is being driven by environmental factors that affect our eating and physical activity behaviours. In effect, the environment overwhelms our biological capacity to maintain a healthy weight. There is little scientific evidence to quantify the relative contributions of various environmental factors to risk of overweight and obesity. However, it is easy to characterize the environment as one in which food is readily available, convenient, inexpensive and great tasting. Likewise, the modern environment discourages physical activity at work, at home and in the community, and attractive sedentary pursuits compete with activity for leisure time. In fact, the causes of obesity in our society are so manifold as to be inseparable from the way we live. Many of the forces that drive individuals to eat too much and move too little are coupled to a desire for self‐efficacy and increased productivity. It can be argued therefore that obesity is an unintended consequence of the emphasis we collectively place on productivity and a desire to achieve ‘the good life’. In this sense, obesity is not really a biological problem, but a social problem that requires a multifactorial social solution. In order to create demand for environmental change to promote healthy lifestyle behaviours, we will need to create a greater sense of crisis among average citizens. We will need to explore solutions that make economic sense for everyone. We will need to create a new social norm for healthy eating and active living. The magnitude of the challenge is daunting, but we can begin by engaging broad scale public private partnerships. After all, we are all part of the global community that is affected by this emerging crisis.