• 期刊

An Original Discovery: Selenium Deficiency and Keshan Disease (an Endemic Heart Disease)

本文報告50年前中國的一項硒缺乏與克山病（一種高致死率的地方性心臟病）的研究，作爲營養學轉化研究的一個實例。大量橫斷面流行病學研究表明，糧食硒含量低和人群硒營養狀況低下與克山病發病相關。數個用口服亞硒酸鈉片的大型人群干預實驗，見到克山病發病明顯下降。根據上述證據，得出硒缺乏是克山病主要病因的結論；儘管不能完全排除其他致病因素。這些研究發現有以下意義：提供了硒為人體必需微量元素的重要證據；確定硒的人體最低需要量並為RDA/RNI提供了科學依据；爲制定中國有效防治克山病的措施提供了堅實的參考信息。

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Sasang Types May Differ in Eating Rate, Meal Size, and Regular Appetite: A Systematic Literature Review

飲食行為或許和肥胖與代謝失調的盛行率漸增有關連。四象醫學是韓國的一種傳統醫學，根據外在表徵和先天本質（包括飲食行為）將人的體質分成四類型。本篇研究目的為廓清四象不同型的人之飲食行為，並對未來相關研究提出建議。從六個韓國和一個英國數據庫中檢索相關文獻。最後找到十篇相關研究文獻。將檢索出的資料歸類為：食物的喜好、食用速度、食用開始和結束、用餐分量、飲食規律、日常食慾、飲食失調及心理因素。食用速度和用餐分量是最被關注且在四象類型中最有差異的特點。太陰型的人之飲食行為似乎與肥胖攸關，包括吃得快、吃得多和食慾好，此特點與少陰人正好相反。少陽人與太陰人或少陰人各有部分相似。未來的研究應使用更可靠、客觀和可量化的評估工具，例如：三因子飲食行為量表或荷蘭飲食行為問卷。

• 期刊

Comparison between Measured and Predicted Resting Energy Expenditure in Mechanically Ventilated Patients with COPD

为了研究机械通气的慢性阻塞性肺病（COPD）患者的能量代谢特点，比较间接测热法测定与Harris-Benedict公式预测的静息能量消耗（REE）的差异。并以此为依据，分析低能量的营养支持是否能改善患者蛋白质营养状况。纳入了33例（男20例，女13例）COPD患者，并测定其REE。比较测定的REE（REEm）和HB公式计算的REE（REEH-B）及其校正值之间的差异，同时还分析了REEm与APACHEⅡ评分之间的关系。33例患者被随机分成低能量组（REEm的50%－90%）和常规能量组（REEm的90%－130%），按照以上标准进行营养支持。比较营养支持前和支持后7天的白蛋白、前白蛋白、转铁蛋白、血红蛋白和淋巴细胞计数。REEH-B和用1.2校正的值均明显低于REEm（p＜0.01）；REEm与APACHEⅡ评分之间存在正相关（p＜0.05或p＜0.01）。营养支持后，常规能量组的血红蛋白明显降低（p＜0.05），两组患者的淋巴细胞计数，以及常规能量组的转铁蛋白和前白蛋白均明显升高（p＜0.05或p＜0.01）。结果提示：1）机械通气的COPD患者的REE升高；2）间接测热法是确定REE的最好方法，在不能作间接测热法時，Harris-Benedict公式可用于计算患者的REE，但要参照APACHEⅡ评分予以校正；3）低能量的营养支持在改善机械通气COPD患者的蛋白质营养状况优于常规能量的营养支持。

• 期刊

Height Prediction from Anthropometric Length Parameters in Thai People

身高為一個重要的臨床參數。然而對於特定的臨床狀態，卻沒有一個專一的測量方法。雖然有許多體位測量方法被建議用來估量泰國人民的身高，但尚未有一個公式用於計算身高。這篇研究之目的在於發展出一個有效且能用以預測身高的公式。將2000位自願者根據年齡及性別加以區分。模式組及效度組再進一步獨立區分。用線性迴歸分析產生預測模式。共測量10個參數並放入分析。在這10個參數當中，中指尖到胸骨中心的距離、坐高及膝高與身高的相關係數，無論在男性或女性，及在各年齡層均大於0.5，且皆具有顯著相關。接著提出這3個參數單獨、具有高預測值的雙變項（坐高與膝高）及三變項的迴歸模式，並加以修飾成簡化的公式。在進行原始及簡化公式的效度檢測後，發現兩者在相關係數、量性誤差及相對誤差都不相上下。按照誤差上限10公分的條件下，簡化的公式在效度組有大於90%的精確度（範圍是89.7%至99.0%）。而這些單獨變項中，膝高在各組別有最小的預測誤差。雙變項及三變項模式只有在年輕族群有降低誤差。總結而論，體位參數中以中指尖到體中央的距離、坐高、膝高以及兩者或三者合併模式可用來預測泰國成人的身高，而其誤差是可以被接受的範圍。但這些公式應只被用於無法直接測量身高的人。

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Development and Evaluation of a Semi-Quantitative Food Frequency Questionnaire for Use in Urban and Rural India

本篇研究目的為發展一份半定量飲食頻率問卷，並評估此問卷是否能有效測量印度都市及鄉村地區研究對象的飲食情形。以一份簡單的飲食頻率問卷在印度四個區域的城鎮及鄉村測試。為評估問卷效度，首先以飲食頻率問卷面訪530位工廠工人及鄉村居民，相隔至少一周後，接續進行三次的24小時飲食回憶 記錄。將營養素及食物類別攝取量以中位數、一致性檢定（kappa statistics）、相關性檢定（Spearman's correlation coefficients）及Bland-Altman plots等方法，比較兩種飲食測量方法之相關性。與24小時飲食回憶記錄相比，飲食頻率問卷有高估的現象（平均能量攝取差異為1743 kJ）；kappa統計量之範圍為0.07（雞蛋）至0.51（醣類）。結果顯示，此半定量飲食頻率問卷可用來評估印度不同地區的膳食攝取，並且有足夠效度以量測食物類別的攝取。

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Combined Intensive Nutrition Education and Micronutrient Powder Supplementation Improved Nutritional Status of Mildly Wasted Children on Nias Island, Indonesia

To assess the impact of intensive nutrition education (INE) with or without the provision of micronutrient powder (MNP) on the nutritional status of mildly wasted children in Nias, Indonesia, two groups of mildly wasted (≥-1.5 to ＜-1.0 WHZ) children aged ≥6 to ＜60 months in the Church World Service (CWS) project areas were assigned by village randomization to receive INE (n=64) or INE+MNP (n=51) in a weekly program. Another two groups of mildly wasted children who were living at a clear distance from INE and INE+MNP villages were selected to receive a monthly non-intensive nutrition education program (NNE) with or without MNP (n=50 both respectively). WHZ, weight, height, haemoglobin (Hb) level, and morbidity data were assessed at admission, during the study, and at individual discharge. Children's weight gain (g/kg body weight/day) was highest in INE+MNP group (2.2±2.1), followed by INE (1.1±0.9), NNE+MNP (0.3±0.5) and NNE (0.3±0.4) group. In both MNP intervention groups (INE+MNP, NNE+MNP), supplements significantly increased Hb value (g/L) of respective children (10.0±10.0; p＜0.001 and 3.0±8.0; p＜0.05 respectively). Proportion of children who reached discharge criterion was highest among the INE+MNP (70.6%; n=36), followed by INE (64.1%; n=41), NNE+MNP (26.0%; n=13), and NNE (20.0%; n=10) groups (p＜0.001). Shortest length of stay until recovery was observed among children in the INE+MNP group (29.9 days), followed by INE (40.0 days), NNE+MNP (80.6 days), and NNE (86.2 days) respectively (p＜0.001). Weekly intensive nutrition education supported by MNP supplementation produced the best results regarding weight gain and haemoglobin status of mildly wasted children.

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Supplementary Feeding with Locally-Produced Ready-to-Use Food (RUF) for Mildly Wasted Children on Nias Island, Indonesia: Comparison of Daily and Weekly Program Outcomes

Ready-to-Use Foods (RUFs) in the form of fortified cereal/nut/legume-based biscuits (±500 kcal and 8-10% protein per 100 g) were tested among mildly wasted children from October 2007 to June 2008, and were labelled as RUF-Nias biscuits. This study reports on a comparison of supplementary feeding program outcomes of mildly wasted children with weight-for-height z-score (WHZ) ≥-2 to ＜-1.5 SD aged ≥6 to ＜60 months old given locally produced RUF-Nias biscuits within daily (in semi-urban areas) and weekly (in rural remote regions) distribution and supervision program settings. In the Church World Service project area, all eligible children were recruited continuously from monthly community-based screening programs and admitted into existing nutrition centers managed by the community on Nias Island, Indonesia. Individual discharge criterion of the programs was WHZ ≥-1.5 SD. Of the index children admitted in daily programs (n=51), 80.4% reached target WHZ, which was higher than in weekly programs (72.9%; n=48) by a similar length of stay of about 6 weeks. Weight gain of the children in daily programs was higher (3.1±3.6 g/kg body weight/day) than in weekly programs (2.0±2.1 g/kg body weight/day), and they achieved significantly higher WHZ at discharge. However, the majority of caretakers preferred weekly programs due to lower time constraints. Locally produced RUF in the form of biscuits for treatment of mild wasting among children demonstrated promising results both in daily and weekly community-based intervention programs.

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Glutamine for Chemotherapy Induced Diarrhea: A Meta-Analysis

谷氨酰胺在预防化疗相关性腹泻中的临床疗效仍存在争议，因此本次荟萃分析纳入了尽可能多的临床随机对照研究，来明确谷氨酰胺在预防化疗性腹泻中的疗效。方法：搜索EMBASE数据库、Medline数据库、Cochrane图书馆和BIOSIS数据库，所有比较谷氨酰胺与安慰剂对预防化疗相关性腹泻作用的随机对照研究均纳入本次荟萃分析。主要分析结果为腹泻评分和腹泻天数。结果：8个随机对照研究，共298名患者纳入了本次研究，其中谷氨酰胺组147名，安慰剂对照组151名。两组腹泻天数有很大差别（WMD，-1；95%可信区间：-1.73，-0.26），但是腹泻评分无明显差别（WMD，-0.49；95%可信区间：-1.73，0.39）。结论：谷氨酰胺可以减少化疗相关性腹泻的天数，但可能无法减轻腹泻程度。

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The Complexity of Treating Wasting in Ambulatory Rehabilitation: Is It Starvation, Sarcopenia, Cachexia or a Combination of These Conditions?

非卧床復康中病人的營養狀況多有受損。消瘦情況可分類為飢餓性、老年肌肉衰減症或惡病質。然而此等分類之區別不甚明確，錯誤診斷下可導致不恰當的調理。本文就187名年齡為60歲或以上的非卧床復康中病人的之數據作進一步分析，旨在識別其中患有一種或多種消瘦情況的病人，並探討其對於一般復康指標之影響。用於界定飢餓的標準為無脂肪體重指數及食慾評估量表（Council on Nutrition Appetite Questionnaire）的得分；老年肌肉衰減症以無脂肪體重指數及四頭肌力量來評定；惡病質則根據無脂肪體重指數及血清C-反應蛋白。本硏究根據幾項擬定的復康指標，就患有一種或多種消瘦狀況與沒有消瘦狀況的病人作出比較。被判斷為飢餓的消瘦病人（n=30），全數均患有老年肌肉衰減症，而其中有20名病人亦同時有惡病質的情況。被判斷為患老年肌肉衰減症的消瘦病人（n=75）當中，30名有飢餓的情況，37名有惡病質的情況。被判斷為惡病質的消瘦病人中（n=37），有20名有飢餓的情況，並全數患有老年肌肉衰減症。同時存在三種狀況的病人則有20名。與沒有消瘦徵狀的病人相比，飢餓病人的抑鬱程度較高（p=0.003），病者自我健康評估較差（p=0.032），身體機能亦較差（動作p=0.006；程序p=0.004）。患有老年肌肉衰減症的病人中，其身體機能亦較差（動作p=0.012；程序p=0.003）。患有惡病質的病人亦如是（動作p=0.025；程序p=0.042）。硏究結果示意，要於門診臨床環境下作出消瘦狀況的界定，會有困難。本次分析顯示，分類時會有所重叠，故百分之四十的消瘦病人（75/187）有可能被錯誤診斷，從而被處方不恰當的營養輔助。

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Plasma Phospholipid Polyunsaturated Fatty Acids and Homocysteine in Chinese Type 2 Diabetes Patients

The main aim of the present study was to investigate the plasma phospholipids (PL) fatty acids status and its association with plasma Hcy in patients with type 2 diabetes mellitus (T2DM). One hundred and four T2DM (aged 57.3±13.4 y) and 150 healthy subjects (aged 48.4±8.7 y) were recruited. Plasma Hcy and PL fatty acids were determined by standard methods. Plasma Hcy concentration in T2DM was significantly higher than that in healthy subjects (p＜0.001). The prevalence of hyperhomocysteinemia was significantly higher in T2DM (36.54%) than that in healthy subjects (17.32%) (p=0.012). Plasma PL 20:4n-6 (r=0.303, p=0.012), 22:5n-3 (r=0.312, p=0.01), total PUFA (r=0.303, p=0.012), n-6 PUFA (r=0.261, p=0.032) were significantly positively associated with plasma Hcy concentration in T2DM. While, plasma PL n-3:n-6 PUFA (r=-0.400, p=0.046) was negatively associated with plasma Hcy in T2DM. In healthy subjects, plasma PL 22:6n-3 (r=-0.201, p=0.042) was negatively associated with plasma Hcy. In addition, plasma PL 22:6n-3 (r=0.193, p=0.044) and 22:5n-6 (r=0.234, p=0.038) were significantly negatively associated with plasma vitamin B-12 in healthy subjects. Our results suggested that increased plasma Hcy levels in T2DM associated with low n-3:n-6 ratio intake. We suggest that T2DM increase their long chain n-3 PUFA intake from fish or fish oil while decrease n-6 PUFA intake.