Asia Pacific Journal of Clinical Nutrition (ASIA PAC J CLIN NUTR )

Publisher: Asia Pacific Clinical Nutrition Society; Australasian Clinical Nutrition Society; Asia Pacific Public Health Nutrition Association; International Union of Nutritional Sciences, Blackwell Publishing


Asia Pacific Journal of Clinical Nutrition is a peer reviewed journal published for the Asia Pacific Clinical Nutrition Society.The aims of the Asia Pacific Clinical Nutrition Society (APCNS) are to promote the education and training of clinical nutritionists in the region and to enhance the practice of human nutrition and related disciplines in their application to health and the prevention of disease.Asia Pacific Journal of Clinical Nutrition publishes original research reports, short communications reviews, and letters to the editors. Letters to the editors may take several forms: they may be very short articles (500 words) containing new material, case reports, or comments on previous papers or on other topics of current interest. News, book reviews and other items may also be included.

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Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Iodine deficiency disorders (IDD) constitute the single most important preventable cause of mental handicap at global level. Recognizing the importance of coordination and synergy of the activities of wide range of universal salt iodisation (USI) stakeholders, WHO/ Unicef/ ICCIDD has prescribed a national multi-sectoral coalition as one of the ten indicators essential for attaining sustainable elimination of IDD at national level. Challenge for coordination among different stakeholders of IDD/USI is even greater in democratic and diverse country like India. In the present article we present successful experience from India regarding formation of a national coalition and contributions made by the coalition towards promoting USI in India. The activities of the national coalition in India are classified into three phases; 1) Phase 1- year 2006 to 2009- the inception; 2) Phase 2- year 2009 to 2012- consolidation; 3) Phase 3- year 2013 and ongoing- expansion. The National coalition for Sustained Optimal Iodine Intake (NSOI) has been instrumental in ensuring greater coordination and synergy amongst IDD and USI stakeholders in India and partially responsible for the current 71 percentage household level coverage of adequately iodised salt. The most significant contribution of the national coalition has been to act as a high level advocacy channel and provide a platform for regular dialogue for all partners of the coalition. With "mission" approach and allocation of optimal resource, India can achieve and should achieve USI by 2015, an apt culmination of a decade of existence of the national coalition.
    Asia Pacific Journal of Clinical Nutrition 11/2014; 23 Suppl 1:S38-45.
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    ABSTRACT: Being home to 31% of the world's children who are stunted and 42% of those who are underweight, and with many children and adults affected by micronutrient deficiencies, India is facing huge challenges in the field of nutrition. Even though the Indian Government is investing vast amounts of money into programs that aim to enhance food security, health and nutrition (the Integrated Child Development Services program alone costs 3 billion USD per year), overall impact has been rather disappointing. However, there are some bright spots on the horizon. The recent District Level Health Surveys (DLHS-4) do show significant progress, ie a reduction in stunting of around 15% over the past 6 years in a few states for which preliminary results are available. The reasons for this reduction are not unambiguous and appear to include state government commitment, focus on the 'window of opportunity', improved status and education of women, a lowered fertility rate, and combinations of nutrition- specific and nutrition-sensitive interventions. Apart from the government many other agencies play a role in driving improvements in nutrition. Since 2006 the Global Alliance for Improved Nutrition (GAIN) has worked with a range of partners to improve access to nutritious foods for large parts of the population, through public and private delivery channels. This supplement presents a selection of these activities, ranging from a capacityassessment of frontline workers in the ICDS system, large scale staple food fortification, salt iodization, fortification of mid-day meals for school children and decentralized complementary food production.
    Asia Pacific Journal of Clinical Nutrition 11/2014; 23 Suppl 1:S1-3.
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    ABSTRACT: The burden of micronutrient malnutrition is very high in India. Food fortification is one of the most cost-effective and sustainable strategies to deliver micronutrients to large population groups. Global Alliance for Improved Nutrition (GAIN) is supporting large-scale, voluntary, staple food fortification in Rajasthan and Madhya Pradesh because of the high burden of malnutrition, availability of industries capable of and willing to introduce fortified staples, consumption patterns of target foods and a conducive and enabling environment. High extraction wheat flour from roller flour mills, edible soybean oil and milk from dairy cooperatives were chosen as the vehicles for fortification. Micronutrients and levels of fortification were selected based on vehicle characteristics and consumption levels. Industry recruitment was done after a careful assessment of capability and willingness. Production units were equipped with necessary equipment for fortification. Staffs were trained in fortification and quality control. Social marketing and communication activities were carried out as per the strategy developed. A state food fortification alliance was formed in Madhya Pradesh with all relevant stakeholders. Over 260,000 MT of edible oil, 300,000 MT of wheat flour and 500,000 MT of milk are being fortified annually and marketed. Rajasthan is also distributing 840,000 MT of fortified wheat flour annually through its Public Distribution System and 1.1 million fortified Mid-day meals daily through the centralised kitchens. Concurrent monitoring in Rajasthan and Madhya has demonstrated high compliance with all quality standards in fortified foods.
    Asia Pacific Journal of Clinical Nutrition 11/2014; 23 Suppl 1:S4-S11.
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    ABSTRACT: Integrated Child Development Services in India through its supplementary nutrition programme covers over 100 million children, pregnant and lactating women across the country. Providing a hot cooked meal each day to children aged between 3-6 years and a take-home ration to children aged between 6-36 months, pregnant and lactating women, the Integrated Child Development Services faces a monumental task to deliver this component of services of desired quality and regularity at scale. From intermediaries or contractors who acted as agents for procuring and distributing food to procurement directly from large food manufacturers to using women groups as food producers, different State Governments have adopted a variety of strategies to procure and distribute food, especially the take-home ration. India's Supreme Court, through its directive of 2004, encouraged the Government to engage women's groups for the production of the supplementary food. This study was conducted to determine the operational performance, economic sustainability and social impact of a decentralised production model for India's Supplementary Nutrition Program, in which women groups run smallscale industrialised units. Data were collected through observation, interviews and group discussions with key stakeholders. Operational performance was analysed through standard performance indicators that measured consistency in production, compliance with quality standards and distribution regularity. Assessment of the economic viability included cost structure analysis, five-year projections, and financial ratios. Social impact was assessed using a qualitative approach. The pilot unit has demonstrated its operational performance and cost-efficiency. More data is needed to evaluate the scalability and sustainability of this decentralised model.
    Asia Pacific Journal of Clinical Nutrition 11/2014; 23 Suppl 1:S20-8.
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    ABSTRACT: Micronutrient malnutrition is widely prevalent in school children in India. India's national school feeding program, the Mid-Day Meal (MDM) scheme, is the largest in the world and caters to 120 million children in primary schools. Complementary strategies such as deworming or fortifying meals provided through the MDM scheme could increase the nutritional impact of this program. India's Supreme Court has directed that only hot, cooked meals be provided in MDM, through a decentralised model. However, in urban areas, big centralised kitchens cook and serve a large number of schools, with some kitchens serving up to 150,000 children daily. The objective of this project was to test the operational feasibility of fortifying the school meal in centralised kitchens, as well as the acceptability of fortified meals by recipients. A pilot was conducted in 19 central kitchens run by the Naandi Foundation in four different States. Several food vehicles were used for fortification: wheat flour, soyadal- analogue and biscuits. More than 750, 000 children were reached with fortified food on all school days for a period of one year. Fortified food was found to be acceptable to all stakeholders. The government is in favour of continuing fortification. The Naandi Foundation has adopted fortification as their norm and continues to fortify all meals provided from their central kitchens.
    Asia Pacific Journal of Clinical Nutrition 11/2014; 23 Suppl 1:S12-9.
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    ABSTRACT: Feeding practices during early childhood play an important aetiological role in early childhood caries (ECC). The role of feeding practices in causation of ECC is debated. The objective of this study was to assess the aetiological role of feeding practices on ECC. A descriptive cross sectional study was conducted at a paediatric unit in Sri Lanka. Two hundred and eighty-five children between 36 to 60 months, admitted to the unit were randomly selected for the study. An interviewer administered questionnaire asked about socio-demographic characteristics and feeding practices. The mouths of children were examined for dental caries. Out of 285 children, 61% had exclusive breast feeding up to six months, 69% continued breast feeding beyond two years and 82% had overnight feeding after two years of age. One hundred and thirty-six children (47.7%) had dental caries with a mean deft score of 1.81. Overnight feeding with any type of milk beyond two years significantly increased dental caries incidence and severity. Children exclusively breast fed for six months or had breast feeding beyond two years had a higher prevalence of caries than children not exclusively breast fed or who were not breast feed beyond two years, but the difference was not significant. Overnight feeding with any type of milk beyond two years should be discouraged.
    Asia Pacific Journal of Clinical Nutrition 06/2014; 23(2):272-277.
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    ABSTRACT: Background: Associations of copper (Cu) and zinc (Zn) serum levels with risk factors for cardiovascular disease (CVD) have not been extensively studied in elderly Asian people. Methods: Relationships to CVD risk factors were examined in 202 freely-living elderly Japanese women. Results: By univariate analysis, log high-sensitivity C-reactive protein (hsCRP) and non-HDL cholesterol were associated with serum Cu concentrations. An independent predictor of Cu was log hsCRP. Serum Zn concentrations decreased with age. After adjustment for age, serum albumin, HDL cholesterol and red blood cell (RBC) were positively and serum insulin and log hsCRP were inversely associated with serum Zn. In stepwise multiple regression analysis (model 1), serum albumin and HDL cholesterol were associated with serum Zn. In analysis excluding albumin from model 1 (model 2), independent determinants were log hsCRP (inverse) and the total number of RBC. In analysis including serum creatinine in model 2, creatinine has emerged as a determinant in addition to log hsCRP and RBC number. In analysis including estimated glomerular filtration rate (eGFR) instead of creatinine and excluding age in model 2, eGFR has emerged as a determinant of serum Zn in addition to log hsCRP and RBC number. Conclusions: Systemic low-grade inflammation may contribute to elevated serum Cu and decreased serum Zn concentrations in the elderly, and may represent an important confounder of the relationship between the serum trace elements and mortality in this population.
    Asia Pacific Journal of Clinical Nutrition 06/2014; 23(2):239-245.
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    ABSTRACT: Objective: This study aims to describe the lifestyle of Chinese centenarians and to identify the beneficial factors that are correlated to their longevity. Methods: A census-based survey was conducted among centenarians in Chongqing, Southwest China, to identify the lifestyle factors affecting their health. From screening identification cards, 878 centenarians (age range 100-117, mean 102) were identified and interviewed. Results: The survey indicated that 64% centenarians were able to take care of themselves. The majority of centenarians were nonsmokers (92%) and non-drinkers (83%). No significant difference was observed between urban and rural distributions (Χ2=0.939, p=0.625). Moreover, 43% centenarians maintained a regular diet, and only 33% had a sedentary lifestyle. Conclusions: A nutritious diet, adequate physical exercise, and a harmonious family environment may be the key lifestyle factors for their longevity of centenarians in Chongqing. These observations might be helpful in designing health promotion and welfare strategies for the elderly.
    Asia Pacific Journal of Clinical Nutrition 06/2014; 23(2):309-314.
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    ABSTRACT: Obesity is a risk factor for the onset of liver cancer in patients with cirrhosis. To prevent overfeeding and obesity, estimation of energy requirement is important, but energy expenditure in patients with liver cirrhosis has not been fully elucidated. This study aimed to investigate resting energy expenditure (REE) and energy intake in patients with cirrhosis and determine adequate energy intake criteria. In this cross-sectional study, indirect calorimetry measurement was conducted in 488 Japanese inpatients with cirrhosis. We compared REE measured by indirect calorimetry (M-REE) with basal energy expenditure (BEE) predicted by the Harris-Benedict equation (H-BEE) and Dietary Reference Intakes (DRI) for Japanese (D-BEE). Mean M-REE (1256 kcal) was significantly lower than H-BEE (1279 kcal); however, it was not significantly different from D-BEE (1254 kcal). Mean M-REE expressed in relation to body weight (BW; REE/kg BW) was 21.7 kcal/kg BW. H-BEE was significantly higher than M-REE in patients in the first and second quartiles of BMI, and D-BEE was significantly different from MREE in patients in the highest and lowest quartiles of BMI. Average energy intake was 30.5 kcal/kg BW, which was 1.4 times greater than REE/kg BW. Although DRI is a useful tool for the estimation of REE in patients in the second and third quartiles of BMI, M-REE is recommended to ensure the provision of adequate nutritional care to patients with cirrhosis, including those in the highest and lowest quartiles of BMI.
    Asia Pacific Journal of Clinical Nutrition 06/2014; 23(2):197-204.
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    ABSTRACT: Background: Micro (mi) RNAs have been found to play an important role in the regulation of adipogenesis and insulin sensitivity. However, associations between miRNA and insulin signalling-related gene expressions in abdominal adipose tissues in obese subjects remain unclear. Methods: We used a microarray platform to screen miRNA expressions in abdominal adipose tissues between genders in severely obese subjects and found that the top-ranking miRNA in abdominal omental adipose tissues was miRNA-125a-3p. MicroR-125a-3p and insulin signalling-related gene expressions in abdominal omental adipose tissues of all subjects (11 men and 10 women) were subsequently quantified by a real-time PCR. Also, associations of miR-125a-3p with insulin signallingrelated gene expression and biochemical markers in obese subjects were analyzed by a linear regression analysis. Results: miR-125a-3p expressed by abdominal omental adipose tissues was much higher in obese men than women. No gender difference was observed in abdominal subcutaneous adipose tissues. Concomitant with high miR-125a-3p, c-Jun N-terminal kinase gene expression was also higher, whereas insulin receptor was lower in men than women. There were negative associations of miR-125a-3p with the insulin receptor and phosphatidylinositol 3-kinase expressions. Fasting plasma glucose and cholesterol levels were positively associated with miR- 125a-3p expression. These associations were obvious in obese men but not women. Conclusion: Our results support the involvement of miR-125a-3p in regulating the insulin signalling pathway and imply that increased miR- 125a-3p expression in omental adipose tissues may be a characteristic feature of insulin resistance in obese men.
    Asia Pacific Journal of Clinical Nutrition 06/2014; 23(2):331-337.
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    ABSTRACT: Objective: To evaluate a 3-week program comprising cooking demonstrations with free food samples in motivating elderly adults to cook more and improve their nutritional status. Design: An experimental pre-post study. Setting: Three districts in Hong Kong. Participants: Sixty aged 59-95 home-living adults. Intervention: Group A (one 1-day food sample given free weekly) and Group B (three 1-day food samples given free weekly). Main Outcome Measure: Satisfaction questionnaires were conducted every week. Mini Nutritional Assessment (MNA) scores were assessed at baseline and 6 months after the program's completion. Analysis: Nutritional status was assessed before and after intervention. Repeated analysis of variance measures of compliance, appetite, easiness of program at 3-week time-points were calculated to differentiate a more frequent (Group B) and a less frequent (Group A) provision of food sample reinforced their cooking skills to a greater extent. Results: The compliance rate of Group B was higher than that of Group A. More than 60% of the participants intended to continue cooking and a third of the participants expressed satisfaction with the program. The MNA scores had improved 6 months later (combined data from both groups). Conclusions: Nutrition education through cooking demonstrations and the community-based distribution of food ingredients can improve the nutrition status of the elderly population.
    Asia Pacific Journal of Clinical Nutrition 06/2014; 23(2):315-320.
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    ABSTRACT: This study aimed to assess the nutritional status of infants aged 0 to 5 months by different feeding approaches. A cross-sectional study on infant nutrition was performed in eight cities in China. A total of 622 infants from birth to 2 months of age and 456 infants from 3 months to 5 months of age were included in this study. Mix-fed infants received breast milk and complementary foods from birth to 2 months of age. Approximately 38.2% of mix-fed infants received excessive vitamin A, and 15.6% of infants exceeded the tolerable upper intake levels (ULs) of zinc. For artificially fed infants who received only complementary foods, approximately 20% and 12.5% infants received inadequate dietary vitamin A and zinc intakes, respectively. The vitamin A and zinc intakes of half of the infants exceeded the ULs. Results showed that the usual intake distribution of the infants from 3 months to 5 months of age were similar to that of the infants from birth to 2 months of age. The common vitamin A and zinc intakes were also severely imbalanced. In addition, higher disease prevalence and lower Z scores of length-forage, weight-for-age, and weight-for-length were found in artificially fed infants and mix-fed infants compared with those in breast-fed infants. In conclusion, the usual nutrient intakes were adequate for the majority of Chinese infants, except for an important number of infants at risk for imbalance of vitamin A and zinc intakes.
    Asia Pacific Journal of Clinical Nutrition 06/2014; 23(2):282-292.
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    ABSTRACT: Osteoporosis and atherosclerosis often present atypically in postmenopausal women, making clinical recognition difficult. Prospective studies suggest independent associations between bone mass and vascular calcification through vitamin D deficiency as an established predictor of both conditions. We aimed to examine the relationship between serum osteocalcin and vitamin D status in postmenopausal women with and without angiographic evidence of coronary artery disease (CAD). One hundred and eighty postmenopausal women undergoing coronary angiography were selected sequentially from the Catheterization unit of King Abdulaziz University Hospital. Socio-demographic, anthropometric parameters and dietary habits were measured. Biochemical variables were estimated in blood samples. Half of the postmenopausal women did not have significant CAD, 24% had significant CAD in a single and/or double coronary vessels, 26% had significant CAD in three coronary vessels. Mean serum vitamin D concentrations showed that vitamin D deficiency was a common finding in the whole population. Vitamin D and calcium intakes were uniformly low in the study cohort. Serum osteocalcin was significantly correlated with dietary vitamin D in all subgroups (r=-0.172, p<0.05) and positively correlated among the patients (r=0.269, p=0.01). Serum magnesium, alkaline phosphatase, dietary vitamin D, and body weight were independent variables of serum osteocalcin level. In conclusion, elevated levels of serum C reactive protein and vitamin D were associated with low serum osteocalcin levels. Therefore, osteocalcin may be a potential cardiovascular risk marker. However, further studies are needed to clarify the pathophysiological processes underlying the relationship between serum osteocalcin level and atherosclerosis parameters.
    Asia Pacific Journal of Clinical Nutrition 06/2014; 23(2):246-255.
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    ABSTRACT: Serum undercarboxylated osteocalcin (ucOC) is an index of vitamin K nutritional status in treatment-naive postmenopausal osteoporotic women. The purpose of the present study was to reveal the association between vitamin K nutritional status and serum ucOC concentrations in postmenopausal osteoporotic women taking bisphosphonates. Eighty-six postmenopausal women with osteoporosis (age range: 47-90 years) initiated bisphosphonate treatment. Vitamin K nutritional status was evaluated using a simple vitamin K-intake questionnaire and serum ucOC concentrations were measured after 6 months of treatment. The patients were divided into two groups according to the simple vitamin K-intake questionnaire score: a low vitamin K-intake (score <40) group (n=67) and a normal vitamin K-intake (score >=40) group (n=19). There were no significant differences between the groups in baseline parameters including age, height, body weight, body mass index, serum alkaline phosphatase (ALP), urinary cross-linked N-terminal telopeptides of type I collagen (NTX), and changes in serum ALP and urinary NTX concentrations during the 6-month treatment period. However, the mean serum ucOC concentration after 6 months of treatment was significantly higher in the low vitamin K-intake group (2.79 ng/mL) than in the normal vitamin K-intake group (2.20 ng/mL). These results suggest that 78% of postmenopausal osteoporotic women treated with bisphosphonates may have vitamin K deficiency as indicated by low vitamin K-intake and high serum ucOC concentrations, despite having a similar reduction in bone turnover to women who have normal vitamin K-intake.
    Asia Pacific Journal of Clinical Nutrition 06/2014; 23(2):256-262.
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    ABSTRACT: This survey was initiated to examine possible coastal-inland differences in cadmium (Cd) burden in general Korean populations. In total, 268 healthy non-smoking middle-aged women (30 to 49 years; 88 residents in 8 coastal areas and 180 residents in 15 inland areas) participated in the study. They offered peripheral blood and spot urine samples so that cadmium in blood (Cd-B) and urine (Cd-U) were taken as exposure markers. Determination of Cd-B and Cd-U was carried out by graphite furnace atomic absorption spectrophotometry. With regard to Cd burden, geometric means for the coastal and inland residents were 1.70 and 1.72 μg/L for Cd-B, 1.54 and 1.00 μg/L for Cd-U as observed (Cd-U), 2.59 and 1.81 μg/g creatinine for Cd-U as corrected for creatinine (Cd-Ucr), respectively. Cd-U and Cd-Ucr were higher in the coastal areas than in inland areas. Reasons for higher Cd-U in the coastal areas than in the inland areas were are discussed in relation to major sources of Cd in daily life of the residents. Attention was paid to consumption of fish and shellfish in the coastal areas as major sources of dietary Cd intake. This study shows that Cd burdens were higher in coastal areas than in inland areas in Korea.
    Asia Pacific Journal of Clinical Nutrition 06/2014; 23(2):219-224.
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    ABSTRACT: Objective: This cross-sectional study was carried out to determine the prevalence of overweight and obesity among secondary school children aged 12 to 14 years in the city of Mashhad, Iran and its association with parental body mass index. Methods: A total of 1189 secondary school children (579 males and 610 females) aged 12- 14 years old were selected through a stratified multistage random sampling. All adolescents were measured for weight and height. Household socio-demographic information and parental weight and height were self-reported by parents. Adolescents were classified as overweight or obese based on BMI-for age Z-score. Multivariable logistic Regression (MLR) determined the relationship between parental BMI and adolescent overweight and obesity. Results: The overall prevalence of overweight and obesity among secondary school children in Mashhad was 17.2% and 11.9%, respectively. A higher proportion of male (30.7%) than female (27.4%) children were overweight or obese. BMI of the children was significantly related to parental BMI (p<0.001), gender (p= 0.02), birth order (p<0.01), parents' education level (p<0.001), father's employment status (p<0.001), and family income (p<0.001). MLR showed that the father's BMI was significantly associated with male BMI (OR: 2.02) and female BMI (OR: 1.59), whereas the mother's BMI was significantly associated with female BMI only (OR: 0.514). Conclusion: The high prevalence of overweight/obesity among the research population compared with previous studies in Iran could be related to the changing lifestyle of the population. The strong relationship with parental BMI was probably related to a combination of genetic and lifestyle factors. Strategies to address childhood obesity should consider the interaction of these factors.
    Asia Pacific Journal of Clinical Nutrition 06/2014; 23(2):225-231.