• 期刊

Dietary choline and folate relationships with serum hepatic inflammatory injury markers in Taiwanese adults

Background and Objectives: The relationships of dietary choline and folate intake with hepatic function have yet to be established in the Taiwanese population. We investigated the associations of choline and folate intake with hepatic inflammatory injury in Taiwanese adults. Methods and Study Design: Blood samples and data on dietary choline components and folate intake from 548 Taiwanese adults without pathological liver disease were collected. Dietary intake was derived using a semiquantitative food-frequency questionnaire. Serum liver injury markers of alanine transaminase, aspartate transaminase, and hepatitis viral infection were measured. Results: Elevated serum hepatic injury markers (＞40 U/L) were associated with low folate and free choline intake (p＜0.05). Folate intake was the most significant dietary determinant of serum aspartate transaminase concentration (beta=−0.05, p=0.04), followed by free choline intake (beta=−0.249, p=0.055). Folate intake exceeding the median level (268 μg/d) was correlated with a reduced rate of hepatitis viral infection (p=0.032) and with normalized serum aspartate transaminase (odds ratio [OR]=0.998, 95% confidence interval [CI]=0.996-1, p=0.042) and alanine transaminase (OR=0.998, 95% CI=0.007-1, p=0.019). Total choline intake exceeding the median level (233 mg/d) was associated with normalized serum aspartate transaminase (OR=0.518, 95% CI=0.360-0.745, p=0.018). Conclusions: The newly established relationships of dietary intake of total choline and folate with normalized hepatic inflammatory markers can guide the development of dietary choline and folate intake recommendations for Taiwanese adults.

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Determination of new anthropometric cut-off values for obesity screening in Indonesian adults

Background and Objectives: Body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-stature ratio (WSR) have increasingly been used as screening tools for obesity. However, optimal cut-off values may be different between populations. The current study determined the optimum cut-off values for BMI, WC, WHR, and WSR for obesity screening in Indonesian adults using receiver-operating characteristic (ROC) analysis. Methods and Study Design: Stature, body weight, waist and hip circumferences were measured on 600 Indonesians aged 18-65 years (males, n=292; females, n=308) and BMI, WHR, and WSR calculated. Percentage of body fat (%BF) was determined using the deuterium isotope (D2O) dilution technique. Some existing cut-off points for obesity determination were evaluated for sensitivity and specificity. Results: The existing cutoff values showed low sensitivity in our sample (between 18.4 and 71.1%) and new proposed cut-offs increased the sensitivity to reach 66.7 to 88.5%. The new cut-offs for BMI, WC, WHR, and WSR for determination of obesity were 21.9 (kg/m^2), 76.8 (cm), 0.86, and 0.48, respectively, for males and 23.6 (kg/m^2), 71.7 (cm), 0.77, and 0.47, respectively, for females. Conclusions: WC and WSR are the most predictive both for males and females, and therefore are considered as better screening tools for obesity in this population.

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Dietary behaviours, weight loss attempts and change in waist circumference: 15-year longitudinal study in Australian adults

Background and Objectives: Dietary behaviours are suitable as clearly identifiable targets of dietary counselling to prevent weight gain. We therefore investigated associations between dietary behaviours, weight loss attempts and waist circumference change. Methods and Study Design: Participants were a community-based sample population residing in Nambour, Australia, including 1,317 adults, aged 25-75 years at baseline. Waist circumference was measured in 1992 and 2007, and dietary behaviours data were derived concurrently from repeated self-completed short dietary questions. Multivariable models, stratified by sex, were adjusted for potential confounders. Results: In men, consumption of visible fat on meat and in women, weight loss attempts in the last 10 years were the most important predictors of waist circumference gain independent of socio-demographic and lifestyle characteristics and energy intake. Men who consumed most visible fat on meat had a 2.6 times larger yearly increase in waist circumference than men who tended to cut the fat off meat: 0.47 (95% CI 0.23, 0.72) vs 0.18 (95% CI 0.01, 0.34) cm/year, p=0.01. Women who reported that they were always trying to lose weight had a 2.7 times larger yearly increase in waist circumference than women who never tried to lose weight: 0.78 (0.54, 1.02) vs 0.29 (0.06, 0.52) cm/year, p=0.0001. Other dietary behaviours were not associated with change in waist circumference. Conclusions: Consumption of visible fat on meat by men and more frequent attempts to lose weight by women were main dietary behaviours associated with gain in abdominal adiposity in Australian adults.

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Nutritional status and dietary diversity of Kamea in Gulf Province, Papua New Guinea

Background and Objectives: To assess the nutritional status of infants, children and non-pregnant women and underlying factors, dietary diversity and community food security, in the Kamea community in Gulf Province, Papua New Guinea. Methods and Study Design: Prospective cross sectional study. Study population 69 infants (0-59 months), 151 children (6-12 years) and 79 non-pregnant women from 10 villages in Kotidanga Local Level Government, Kerema District, Gulf Province, Papua New Guinea. Results: Among infants prevalence of moderate stunting, wasting and underweight were 38.9%, 8.3% and 44.4%, respectively; after adjusting Hb concentration for altitude, the anaemia prevalence was 53.8%. Among children prevalence of severe stunting was 21.2%; moderate stunting, wasting and underweight were 57.6%, 12.2% and 48.5%, respectively; anaemia was 30.3%; median urinary iodine concentration was 32.0 μg/L and iodine deficiency was prevalent among 88.1%. Among women, mean height, weight and BMI were 1.46±0.04 m, 43.9±5.91 kg and 20.4±2.32 kg/m^2, respectively; low BMI (＜18.5 kg/m^2) and anaemia were prevalent among 22.8% and 35.4%, respectively; median urinary iodine concentration was 36.0 μg/L and iodine deficiency was prevalent among 80.3%. Exclusive breastfeeding was universal for young infants; complementary foods were limited in variety and frequency. Dietary diversity was limited, implementation of the universal salt iodisation strategy restricted and community food security was inadequate. Conclusions: The high prevalence of malnutrition and anaemia among the three age groups, including moderate status of iodine deficiency among women and children, are significant public health concerns. Improvements in dietary diversity, adequate use of iodised salt and community food security are needed.

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Goitre and urinary iodine in coastal and inland areas with low and high iodized salt coverage in Zhejiang province, China

Background and Objectives: WHO recommended that iodized salt are more than 90% of households in USI programs, which may not be suitable for all regions, especially in coastal areas. This study intended to find out levels of iodine nutrition and give advice from the USI programs for areas with different iodized salt coverage. Methods and Study Design: Coastal and inland areas were selected according to geographical regions in Zhejiang Province, China. The water iodine concentration (spectrophotometer analysis), salt iodine concentration (the colorimetric titration method), salt intake, urinary iodine concentration (spectrophotometer analysis), and thyroid volume examination (ultrasonography), as well as questionnaire, were measured in the two areas. Results: Mean Urinary Iodine concentration (MUIs) of children in coastal areas was 149 μg/L, which was significantly lower than that in inland areas (191 μg/L). MUIs of pregnant women in coastal and inland areas were111 and 138 μg/L, respectively. Pregnant women who consumed iodine-containing supplements had higher MUIs (207 μg/L) than those did not (134 μg/L) in inland areas. Prevalence of goitre in children reached 7.0% and 6.6% in coastal and inland areas, respectively. The lowest prevalence of goitre was reached when the urinary iodine concentration was approximately 120-160 μg/L in coastal areas. Conclusion: Iodine levels of coastal and inland areas were in the adequate range. Advice from the USI program should be specialized for different areas to appropriately reduce the salt iodine concentrations in inland areas and to determine an appropriate proportion of households using iodized salt in coastal areas. Moreover, iodine supplement intake during pregnancy should officially be recommended.

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The influence of mandatory iodine fortification on the iodine status of Australian school children residing in an iodine sufficient region

Background and Objectives: To counter emerging iodine deficiency mandatory iodine fortification of bread was introduced throughout Australia in 2009. This study investigated the impact of iodine fortification on the iodine status of school aged children living in the iodine replete state of Queensland, and investigated which foods had greatest influence on overall iodine status. Methods and Study Design: A convenience sample of 30 children aged 8.0-10.9 years living in south east Queensland, Australia, provided spot morning and afternoon urine samples on two consecutive days. Iodine status was categorised by the World Health Organization criterion. Semiquantitative food questionnaires (FFQ) completed by carers were used to investigate which foods were having the greatest influence on UIC. Analysis of variance was used to reduce the within person variation observed in urinary iodine concentrations (UIC) and the data were log transformed before statistical analysis. Results: Adjusted median UIC was 144 ug/L (IQR 120-210 ug/L) indicating iodine sufficient status. No samples were above the cut off for excessive UIC. Bread was the only statistically significant contributor to UIC (standardized β=0.37, p=0.04) with 14% of variation in UIC explained by bread consumption. UIC increased by 8.7% for each additional serve of bread. Conclusions: Iodine fortification of bread has increased the iodine status of school aged children in this Queensland cohort. Despite the small sample size in this study, improvements in methodology allowed its findings to be comparable to other, larger surveys.

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Body mass index is associated with fat mass in normal, overweight/obese, and stunted preschool children in central Thailand

Background and Objectives: Body mass index (BMI) is widely used as a surrogate measure of adiposity. The relationship between BMI and body fatness varies by race, sex, and age and more variations have been found among children. This study investigated the relationship between BMI and fat mass among 3-5 year old children having different nutritional status. Methods and Study Design: A cross-sectional study was conducted in 15 daycare centers in central Thailand. 137 healthy preschool children were recruited according to their nutritional status: thin [BMI for age Z scores, (BAZ) ＜-2 SD], normal BMI (-2 SD≤ BAZ ≤+2 SD), overweight/obese (BAZ ＞+2 SD), and stunted [height for age Z scores ＜ -2 SD]. Fat-free mass was determined by deuterium dilution technique. Fat mass (FM) in kilograms (TFM) and in percentage (FM%), and fat mass index (FMI, FM/height^2) were calculated. Results: FM and FMI were the highest in the overweight/obese groups. In the thin group, girls had higher FMI compared to boys (3.2 vs 2.8 kg/m^2, p＜0.05). The relationship between BMI with FMI and FM differed by nutritional status. BMI was more strongly associated with FMI, TFM, and FM% in the overweight/ obese (r=0.97, 0.95, 0.80, p＜0.05) and the normal (r=0.88, 0.84, 0.68, p＜0.05) groups but not in the stunted group, and inconsistent in the thin group. Conclusions: The inconsistency in the relationship between BMI and body fatness suggests that BMI is appropriate for reflecting adiposity in normal and overweight/obese children, but not undernourished preschool children.

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Normal-weight central obesity is associated with metabolic disorders in Chinese postmenopausal women

Background and Objectives: This cross-sectional study examined whether normal-weight central obesity, defined as a high waist-to-height ratio (WHtR), is associated with metabolic disorders in Chinese postmenopausal women. Methods and Study Design: We recruited 634 community-dwelling postmenopausal women with a normal body mass index (BMI) who participated in an annual health checkup. Normal-weight obesity (NWO) was defined as a normal BMI and WHtR in the highest tertile of the study population. The updated National Cholesterol Education Program/Adult Treatment Panel III criteria were used to assess metabolic abnormalities, and binary logistic regression models were employed to estimate the associations between NWO and metabolic disorders. Results: The prevalence of each metabolic disorder showed a graded increase (p＜0.05) across the WHtR tertiles in the study population. NWO was significantly associated with some non-adipose components of metabolic syndrome (MetS) (p＜0.05) after adjusting for age, smoking status, drinking status, inflammatory markers, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), body fat percentage (BF%), and the remaining non-adipose MetS components. Participants in the highest WHtR tertile had a higher odds ratio [2.00 (1.19- 3.33), p＜0.01] for the presence of at least two non-adipose MetS components than those in the lowest tertile after adjusting for age, lifestyle factors, inflammatory markers, TC, LDL-c, and BF%. Conclusions: NWO is significantly associated with metabolic disorders, suggesting that a clinical assessment of abdominal obesity indices should be conducted in postmenopausal women, even in those with a normal BMI.

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High consumption of salt-fermented vegetables and hypertension risk in adults: a 12-year follow-up study

Background and Objectives: The aim of this study was to investigate the causal relationship between high consumption of salt-fermented vegetables and hypertension risk in adults. Methods and Study Design: Data came from the Korean Genome and Epidemiology Study, an ongoing community-based cohort study that began in 2001. In the final analysis, a total of 5,932 participants (men=2,822, women=3,110) was included. Daily energy, nutrient, and major salt-fermented vegetables for Korean (kimchi) intakes were assessed using a semi-quantitative food frequency questionnaire. Relative risks and 95% CIs associated with kimchi intake by gender and body mass index (BMI) were estimated using the multivariate Cox proportional hazards regression model. Results: Out of the 5,932 participants, 1,798 (905 men, 893 women) developed hypertension during the 12-year follow-up period. A significant difference in baseline BMI was shown between the non-hypertension and hypertension groups. There was no significant difference with regard to the risk of developing hypertension across quintiles for total kimchi intake and quartile or quartiles for specific kimchi intake in multivariate models by gender and baseline BMI. The trend for increased risk of hypertension according to increasing quartile of watery kimchi intake was significant for obese men in the multivariate model (p＜0.05). Conclusion: High consumption of salt-fermented vegetables was not shown to be associated with increased risk of hypertension. The trend for increased risk of hypertension according to increasing quartile of watery kimchi intake was significant only in obese men.

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Bimodal distribution of fasting plasma glucose in the Uyghur and Han populations of Xinjiang, China

Background and Objectives: Bimodality in fasting plasma glucose (FPG) distribution has been detected in several populations. However, information regarding this phenomenon among Chinese ethnic groups is minimal. This study aimed to describe and update the distribution of FPG in the Uyghur and Han populations of Xinjiang, China, as well as to estimate the cut points of FPG on the basis of bimodal distribution. Methods and Study Design: A cross-sectional study was performed among the Uyghur and Han populations of Xinjiang, China in 2013. Questionnaire survey and FPG tests were conducted among 5,923 participants aged 20-80 years. We fitted the unimodal and bimodal distributions into the FPG data by ethnicity, age, gender, and location to test whether the FPG values were consistent with a bimodal distribution. Results: The FPG distribution could be described as bimodal, except for the age group of 50 years old and below among the Uyghur and Han populations and the age group of 70-80 years old among the Uyghur population (p＜0.01). However, most of the cut points estimated using this method did not fall between the corresponding means of the first and second modes. Conclusions: Although a bimodal distribution of FPG was observed in the Uyghur and Han populations of Xinjiang, China, the cut points estimated using this method were not biologically meaningful, and thus, a bimodal distribution of FPG was not useful for defining cut points to diagnose diabetes in Xinjiang.