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Critical examination of evidence for the nutritional status of children in Papua New Guinea - a systematic review

Background and Objectives: Undernutrition remains a significant cause of childhood illness, poor growth, development, and death in Papua New Guinea (PNG). Studies on child nutritional outcomes in PNG vary by design, measurement protocols and quality. We conducted a systematic review to assess the evidence for the prevalence of child undernutrition across different study populations, geographical locations and time periods. Methods and Study Design: Six electronic databases and additional grey literature were searched for articles describing the nutritional status by wasting, stunting and underweight, of PNG children under five years of age, published between 1990 and April 2015. Prevalence data using different scales of measurement and reference populations were standardized according to WHO protocols. Results: The search yielded 566 articles, of which, 31 studies met the inclusion criteria. The prevalence of child undernutrition varied from 1% to 76% for wasting (median 11%), 5% to 92% for stunting (median 51%), and 14% to 59% for underweight (median 32%). Wide variations exist according to the index used for measurement, the population characteristics and the geographical region in which they live. Prevalence estimates increase significantly when data using different scales of measurement and population references are standardized to the WHO protocols. Conclusions: Child undernutrition in PNG is regionally variable due to a complex interplay of poverty, disease, food-security, cultural, environmental and sociopolitical issues requiring a complex mix of solutions by governments, health systems and local communities. Area- specific surveys using multiple measures are necessary to inform local solutions for this important problem.

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Non-communicable diseases, food and nutrition in Vietnam from 1975 to 2015: the burden and national response

Background and Objectives: This review manuscript examines the burden and national response to non-communicable diseases (NCDs), food and nutrition security in Vietnam from 1975 to 2015. Methods and Study Design: We extracted data from peer-reviewed manuscripts and reports of nationally representative surveys and related policies in Vietnam. Results: In 2010, NCDs accounted for 318,000 deaths (72% of total deaths), 6.7 million years of life lost, and 14 million disability-adjusted life years in Vietnam. Cardiovascular diseases, cancers, chronic obstructive pulmonary disease, and diabetes mellitus were major contributors to the NCD burden. Adults had an increased prevalence of overweight and obesity (2.3% in 1993 to 15% in 2015) and hypertension (15% in 2002 to 20% in 2015). Among 25-64 years old in 2015, the prevalence of diabetes mellitus was 4.1% and the elevated blood cholesterol was 32%. Vietnamese had a low physical activity level, a high consumption of salt, instant noodles and sweetened non-alcoholic beverages as well as low consumption of fruit and vegetables and seafood. The alcohol consumption and smoking prevalence were high in men. Exposure to second-hand tobacco smoke was high in men, women and youths at home, work, and public places. In Vietnam, policies for NCD prevention and control need to be combined with strengthened law enforcement and increased program coverage. There were increased food production and improved dietary intake (e.g., energy intake and protein-rich foods thanked to appropriate economic, agriculture, and nutrition strategies. Conclusions: NCDs and their risk factors are emerging problems in Vietnam, which need both disease-specific and sensitive strategies in health and related sectors.

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Prevalence, cause and diagnosis of lactose intolerance in children aged 1-5 years: a systematic review of 1995-2015 literature

Background and Objectives: To assess the prevalence, etiology, diagnosis of primary and secondary lactose intolerance (LI), including age of onset, among children 1-5 years of age. Suspected/perceived lactose intolerance can lead to dietary restrictions which may increase risk of future health issues. Methods and Study Design: MEDLINE, CAB Abstract, and Embase were searched for articles published from January 1995-June 2015 related to lactose intolerance in young children. Authors independently screened titles/abstracts, full text articles, for eligibility against a priori inclusion/exclusion criteria. Two reviewers extracted data and assessed quality of the included studies. Results: The search identified 579 articles; 20 studies, the majority of which were cross-sectional, were included in the qualitative synthesis. Few studies reported prevalence of primary LI in children aged 1-5 years; those that did reported a range between 0-17.9%. Prevalence of secondary LI was 0-19%. Hydrogen breath test was the most common method used to diagnose LI. None of the included studies reported age of onset of primary LI. Conclusions: There is limited recent evidence on the prevalence of LI in this age group. The low number of studies and wide range of methodologies used to diagnose LI means that comparison and interpretation, particularly of geographical trends, is compromised. Current understanding appears to rely on data generated in the 1960/70s, with varied qualities of evidence. New, high quality studies are necessary to understand the true prevalence of LI. This review is registered with the International Prospective Register for Systematic Reviews (PROSPERO).

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Consumption and sources of added sugar in Indonesia: a review

Background and Objectives: The present report summarized the best available evidence regarding consumption level and sources of free or added sugars in Indonesia. Methods and Study Design: Information was extracted from food balance sheets, household expenditure surveys, nutrition surveys, published studies, unpublished theses/dissertations, and government reports. Results: A total of 18 references were obtained, showing varying results. Indonesia's national surveys suggested intakes of sugar below 50 grams per day or below 10% of energy intake. Published studies suggested higher levels of intake. Studies used expenditure surveys or a single day of recall to determine dietary intake. None made use of biomarkers to determine the level of sugar intake. The 2014 Total Diet Study estimated that 11.8% of the population consumed ＞50 grams sugar per day. Common food sources were table sugar, wheat products, milk products, sweetened drinks, condiments, candies and chocolate products. Conclusions: Insufficient evidence exists regarding the levels and sources of added sugar intake of different population groups in Indonesia. A nationwide survey using multiple (at least two) 24-hour recalls to allow estimation of usual intake and to identify food sources, and the use of biomarkers to validate intake will provide more accurate information on which to base policy decisions

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Development and validation of a pediatric nutritional screening score (PNSS) for hospitalized children

Background and Objectives: There is no evidence on the most effective nutritional screening tool for hospitalized children. The objective of this study was to develop and validate a pediatric nutritional screening tool to assess undernutrition risk upon hospital admission. Methods and Study Design: The study had a two-phase prospective observational design. A novel pediatric nutritional screening score (PNSS) was developed and sensitivity, specificity, and reliability were evaluated by comparing with a complete dietetic assessment. Length of hospital stay, weight loss, disease complications, and nutritional support were recorded. Results: PNSS consisted of three elements: disease with malnutrition risks, changes in food intake, and anthropometric measurements, with a score of 0–2 for each element. The optimal cut-off score to identify patients (n=96) at risk of undernutrition was two. The agreement between PNSS and the complete dietetic assessment was moderate (κ=0.435, 95% CI=0.373- 0.498). Sensitivity and specificity values of PNSS were 82% (95% CI=76%-87%) and 71% (95% CI=67%-74%), respectively. Inter-rater agreement had a κ value of 0.596 (95% CI=0.529-0.664, p＜0.001). The percentage of children with undernutrition risk was 44.9%. Children with oncologic, gastrointestinal, and cardiac diseases were most likely to be at risk of undernutrition. The at-risk group was associated significantly with longer length of hospital stay and higher percentage of weight loss compared with the not-at-risk group. Conclusion: PNSS is the first nutritional screening tool developed for hospitalized children and validated in a large population of patients in China.

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Relative validity of an indirect calorimetry device for measuring resting energy expenditure and respiratory quotient

Background and Objectives: Resting energy expenditure (REE) and respiratory quotient (RQ) are important for optimal nutritional care. The purpose of this study was to assess the accuracy and repeatability of an indirect calorimetry device (IIM-IC-100) in the measurement of REE and RQ in healthy Chinese adults. Methods and Study Design: A total of 38 healthy adults (19 male and 19 female) aged 18-52 years (25±6 years) were enrolled in this study. REE and RQ were measured by IIM-IC-100 and by VO2000, alternately and in duplicate. Results: There was a highly significant correlation between IIM-IC-100 REE and VO2000 REE (r=0.906, p＜0.001), with mean IIM-IC-100 REE significantly higher than that of VO2000 (1475±269 vs 1394±313 kcal/d, p=0.002). Bland- Altman analysis revealed that the mean difference between IIM-IC-100 REE and VO2000 REE was 81.3 kcal/d, with limits of agreement of -185 to +347 kcal/d. There was no significant difference in RQ between the two devices. No significant differences were observed between the repeated measurements for both devices. Intrasubject coefficients of variation (CVs) of REE were smaller for IIM-IC-100 (5.8%) than for VO2000 (10.5%), while CVs of RQ were similar for IIM-IC-100 (7.2%) and VO2000 (6.9%). Conclusions: These preliminary data indicated that the IIM-IC-100 showed promise as an accurate and precise tool in the assessment of REE and RQ in healthy Chinese adults.

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The Geriatric Nutritional Risk Index predicts mortality in nonagenarians and centenarians receiving home care

Background and Objectives: The increasing prevalence of malnutrition in old people is related to the risk of illness and death. A number of screening tools to detect malnutrition have been used in the elderly to assess nutritional status and predict prognosis. The aim of the present study was to investigate the ability of the Geriatric Nutritional Risk Index (GNRI) to assess nutritional status and predict mortality in very old home-care people by using a cross-sectional study of Chinese older people aged 90-105 years. Methods and Study Design: The present study was based on a 4-year follow-up of mortality data from a previous cross-sectional study. The study was conducted with a very elderly population with a mean age of 93.5±3.2 years (n=716; 230 men and 486 women). In 2005, trained researchers performed face-to-face interviews and physical and geriatric assessments to obtain information on sociodemographic factors, self-reported medical diseases, geriatric-specific conditions, anthropometric factors, biochemical data, and the GNRI score. In 2009, vital status were requested from the local government. Results: After 4 years of follow-up, 371 participants died (125 men and 246 women, 51.8%). The median follow-up time was significantly worse in the nutritional risk group (GNRI ≤98) (30.26±15.80 vs 42.27±11.82 months, p＜0.001). Activities of daily living (ADL) impairment (hazard ratio [HR]=1.414, 95% CI=1.121-1.783), and GNRI score (HR=0.92, 95% CI=0.908-0.932) were associated with all-cause mortality according to a Cox regression analysis. Conclusions: The GNRI, a nutrition-related risk index, can predict mortality in very old Chinese home-care people.

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Development and evaluation of nutritional, sensory and glycemic properties of finger millet (Eleusine coracana L.) based food products

Background and Objectives: Finger millet (Eleusine coracana L.) (FM) is rich in dietary fibre and is therefore expected to elicit a lower glycemic response compared to other grains. However, there is little data on the glycemic properties of FM-based products. We evaluated the nutritional, sensory and glycemic properties of decorticated millet with lower polish (DFM-LDP), flakes (FMF), vermicelli (FMV) and extruded snack (FMES) (both FMV and FMES with 7-8% added soluble fibre). Methods and Study Design: The nutrient contents of the FM products were evaluated by standard AOAC (Association of Official Analytical Chemists) and AACC (American Association of Cereal Chemists) methods. Sensory evaluation was conducted monadically using a 9-point hedonic scale using untrained panel members. GI testing was conducted using a standardized validated protocol. The study was conducted according to the guidelines laid down by the Declaration of Helsinki, and was approved by the Ethics Committee of the Madras Diabetes Research Foundation. Results: The products had dietary fibre (DF) content between 5.8-15.6 g%. FMES was unique in having a very low fat content (0.17%). Evaluation of sensory perception revealed moderate acceptance of millet based products. The glycemic indices (GI) (mean±SEM) of the products were 84.7±7.7%, 82.3±6.4%, 65.5±5.1% and 65.0±6.6% for DFM-LDP, FMF, FMV and FMES respectively. Conclusions: DFM-LDP and FMF (purely finger millet based products) elicited higher glycemic responses. Comparatively, FMV and FMES (with added functional ingredients) exhibited medium GI values and, are healthier dietary options. It is possible to prepare FM products with lower GI by utilizing functional ingredients.

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Chronic low grade inflammation measured by dietary inflammatory index and its association with obesity among school teachers in Yangon, Myanmar

Background and Objectives: This study was aimed to investigate the association between obesity and chronic low grade inflammation (CLGI) measured by Dietary Inflammatory Index (DII) as a proxy indicator of CLGI among obese and non-obese teachers. Methods and Study Design: We conducted a cross sectional study among 128 non-obese (BMI ＜25) and 116 obese (BMI ≥25) female teachers aged 25-60 years from six urban schools in Yangon, Myanmar between January and March 2015. Usual dietary intake was collected by 3-day nonconsecutive estimated 24 hour's dietary records and semi-quantitative Food Frequency Questionnaires. Adapted DII was calculated by standardized methods using literature-derived population-based dietary inflammatory weights of 31 food parameters. C-reactive protein (CRP) was analysed by a sandwich Enzyme-Linked Immunosorbent Assay (ELISA) technique. Mean DII between obese and non-obese was compared by independent t test. The association between obesity indices and high DII (DII ≥1.1) and high CRP (＞3 mg/L) were investigated by logistic regression. Results: Obese teachers had lower intakes of anti-inflammatory nutrients (vitamin B-6, vitamin A and zinc)/food (onion) compared with non-obese teachers (p＜0.05) and obesity was significantly associated with CRP (Odd ratio (OR)=5.5, 95% Confidence interval (CI) 1.2-24.1, p=0.02). However, there was no significant association between obesity and DII (OR=1.4, 95% CI -0.8-2.3, p=0.23). Conclusions: Role of anti-inflammatory foods should be promoted for prevention of obesity and related diseases. Further use of DII among Myanmar general population for prevention of obesity and its related diseases should be explored with longitudinal studies.

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Salivary cariogenic bacteria counts are associated with obesity in student women at a Malaysian university

Background and Objectives: The counts of cariogenic bacteria lactobacilli and mutans streptococci have been studied and correlated with sugar intake. This study was to investigate the association between salivary lactobacilli and mutans streptococci counts with sweet food eating behavior and sweet sensitivity among 120 Malaysian women (101 ethnic Chinese, 19 ethnic Indians), while taking into account anthropometric and menstruation variables. Methods and Study Design: Demographics, anthropometric measurements and menstrual history were taken. Hedonic preference, intake frequency of a list of sweet foods, intensity perception and pleasantness ratings of sweet stimuli were assessed. Saliva was collected for lactobacilli and mutans streptococci culture. Results: We found that centrally obese subjects (high waist circumference and waist-hip ratio) had significantly higher salivary lactobacilli and mutans streptococci counts (all p＜0.05), while overweight and high total body fat subjects had significantly higher salivary mutans streptococci counts (p＜0.001). The sweetness intensity perception of chocolate malt drinks was significantly lower in women who were in their pre-menstrual (post-ovulation) phase. However, menstruation variables (menstrual phases, regularity and pre-menstrual syndromes) did not play a role in determining compulsive eating, sweets/chocolate craving and salivary lactobacilli and mutans streptococci counts. Conclusions: Taken together, salivary lactobacilli and mutans streptococci counts of the Malaysian women are associated with central obesity, but not sweet food eating behaviour, sweet sensitivity and menstruation variables. Salivary microbiome analysis could be useful as a potential diagnostic indicator of diseases such as obesity.