Nonprotein calorie supplement improves adherence to low-protein diet and exerts beneficial responses on renal function in chronic kidney disease.

OBJECTIVE: Malnutrition is common in patients with chronic kidney disease (CKD) who are on low-protein diets and is a powerful predictor of morbidity and mortality in CKD. Studies have shown that patients on low-protein diets often have difficulty meeting nutritional energy requirements. Our study evaluated the effects of a nonprotein calorie (NPC) supplement on renal function and nutritional status in patients on a low-protein diet. DESIGN: This was a prospective, randomized, open-label, controlled clinical trial. SUBJECTS: A total of 109 patients with CKD (men, 67%; mean age, 54.5 ± 13 years) with stage 3 to 4 disease were randomly assigned to the intervention group (n = 55) or the control group (n = 54). INTERVENTION: All participants received individualized dietary counseling aimed at achieving a daily protein intake of 0.6 to 0.8 g and a daily energy intake of 30 to 35 kcal/kg. The intervention group consumed a 200-kcal NPC supplement daily. The control group received dietary counseling only. MAIN OUTCOME MEASURE: The estimated glomerular filtration rate (eGFR) was calculated using the 4-variable Modification of Diet in Renal Disease (MDRD) Study equation. Urine protein excretion, dietary protein and energy intake, and serum levels of creatinine, urea nitrogen, cholesterol, triglycerides, and albumin were assessed at baseline, at 12 weeks, and at 24 weeks. RESULTS: Dietary protein intake and urine protein excretion levels decreased significantly in the intervention group and were significantly lower than those of the control group. In addition, serum levels of creatinine and urea nitrogen decreased significantly, and eGFR increased significantly in the intervention group compared with baseline assessments. No significant differences were observed in the control group. CONCLUSIONS: The NPC supplement improved patient adherence to the low-protein diet and reduced urine protein excretion in patients with CKD.

Psychoimmunological effects of dioscorea in ovariectomized rats: role of anxiety level.

BACKGROUND: Anxiety levels in rats are correlated with interleukin-2 (IL-2) levels in the brain. The aim of the present study was to investigate the effects of dioscorea (wild yam), a Chinese medicine, on emotional behavior and IL-2 levels in the brain of ovariectomized (OVX) rats. METHODS: One month after ovariectomy, female Wistar rats were screened in the elevated plus-maze (EPM) test to measure anxiety levels and divided into low anxiety (LA) and high anxiety (HA) groups, which were then given dioscorea (250, 750, or 1500 mg/kg/day) by oral gavage for 27 days and were tested in the EPM on day 23 of administration and in the forced swim test (FST) on days 24 and 25, then 3 days later, the brain was removed and IL-2 levels measured. RESULTS: Compared to sham-operated rats, anxiety behavior in the EPM was increased in half of the OVX rats. After chronic dioscorea treatment, a decrease in anxiety and IL-2 levels was observed in the HA OVX rats. Despair behavior in the FST was inhibited by the highest dosage of dioscorea. CONCLUSION: These results show that OVX-induced anxiety and changes in neuroimmunological function in the cortex are reversed by dioscorea treatment. Furthermore, individual differences need to be taken into account when psychoneuroimmunological issues are measured and the EPM is a useful tool for determining anxiety levels when examining anxiety-related issues.

Optimal Dietary and Plasma Magnesium Statuses Depend on Dietary Quality for a Reduction in the Risk of All-Cause Mortality in Older Adults.

The association between dietary or plasma magnesium (Mg) with diabetes incidence and with mortality in free-living elderly was investigated. A total of 1400 participants from the Taiwanese Nutrition Survey, aged ≥ 65 years, and diabetes-free from the 1999-2000 were assessed. The dietary intake and plasma Mg concentration were obtained through 24h dietary recall and health examination at baseline. Participants were classified by quartiles (Q) of dietary Mg or by the plasma Mg normal range (0.75-0.95 mmol/L). Dietary diversity score (DDS, range 1-6) represented the dietary quality. During 8 and 10 years, 231 incident diabetes cases and 475 deaths were identified. Cox's proportional-hazards regression was used to evaluate the association between Mg and health outcomes. The hazard ratios (95% confidence interval) for death in Q2 and Q3 of Mg intakes with DDS > 4 were 0.57 (0.44-0.74) and 0.59 (0.39-0.88), respectively, compared with the lowest intake and DDS ≤ 4 participants. Participants with normal and high plasma Mg in conjunction with high DDS had relative risks of 0.58 (0.37-0.89) and 0.46 (0.25-0.85) in mortality compared with low plasma Mg and lower DDS. Optimal dietary Mg intake and plasma Mg depend on dietary quality to reduce the mortality risk in older adults.

Low body weight gain, low white blood cell count and high serum ferritin as markers of poor nutrition and increased risk for preterm delivery.

This study determined factors of preterm delivery in Taiwan. Healthy women (n=520, age 29.1±4.2 y) at 8-12 weeks of pregnancy were recruited from prenatal clinics. Background information, anthropometrics, biochemical parameters, and dietary intake, collected by 24 h-recall were obtained from the first, second, and third trimesters to delivery. Clinical outcomes of neonates were also collected. The results show that 53.7% of women were primiparous and that the incidence of preterm delivery was 6.2%. Body weight gains in the first trimester and throughout pregnancy were significantly lower in mothers with preterm delivery (preterm group) than in mothers with term delivery (term group, p<0.05). Maternal cholesterol intake, circulating white blood cell counts (WBC) and serum albumin were significantly lower and that serum magnesium and ferritin were significantly higher in the preterm group than in the term group. Maternal weight gain was positively correlated with caloric and nutrient intake (p<0.05). Neonatal birth weight was positively correlated with maternal weight gain and intakes of protein and phosphate during pregnancy; with intakes of calories, vitamin B-1 and B-2 in the first trimester; and with intakes of calcium, magnesium, iron and zinc, as well as circulating WBC in the third trimester. However, neonatal birth weight was negatively correlated with serum iron in the third trimester and with serum iron and ferritin at the time of delivery. In conclusion, maternal weight gain in early pregnancy and WBC, mineral intake and iron status in late pregnancy seem to be major factors affecting delivery and neonatal outcomes.

Trends and nutritional status for magnesium in Taiwan from NAHSIT 1993 to 2008.

Data from nationwide population-based nutrition surveys in Taiwan were used to investigate trends and nutritional status for magnesium from 1993 to 2008. Dietary magnesium intake was estimated from 24-hour dietary recalls. Serum and urinary magnesium were also measured. In Nutrition and Health Survey in Taiwan (NAHSIT) 2005-2008, average magnesium intake was 305 mg and 259 mg for adult males and females, respectively, which is equivalent to 82-85% of relevant Taiwanese Dietary Reference Intakes (DRIs). After correcting intra-individual variation, 74-81% of adult subjects' dietary magnesium was estimated as sub-optimal. Mean serum magnesium concentration was 0.866 mmol/L and 0.861 mmol/L for the males and females, respectively. The prevalence of low serum magnesium (<0.8 mmol/L) was 12.3% and 23.7% for the males and females, respectively. There was positive association among dietary magnesium, blood magnesium, and urinary magnesium/creatinine ratio. From NAHSIT 1993-1996 to NAHSIT 2005-2008, dietary magnesium significantly increased (p<0.05), the blood magnesium and urinary magnesium/creatinine ratio decreased (p<0.05). The findings suggest that the relationships between dietary magnesium and biochemical markers among different nutrition and health surveys are not straightforward and need to be further clarified.

Dietary supplements usage among elderly Taiwanese during 2005-2008.

This study describes dietary supplement consumption practices among the Taiwanese population over the age of 65. Data for the analyses were derived from the 2005-2008 Nutrition and Health Survey in Taiwan. Data from a total of 914 participants (456 men and 458 women) was collected in the study to delineate patterns of supplement usage. The results indicated that the percentage of individuals taking supplements was 45.7% for men and 52.2% for women. There were no significant differences in supplement use by gender, age group, geographic stratum, current employment status, household monthly income, self-reported health status or marital status, except for higher education and adequate perceived financial resources. Half of both men and women chose to take only one supplement. In addition, as the number of supplements taken increased, the number of people decreased. The elderly with higher education levels were more likely to take two kinds of supplements. The top five supplements consumed from highest to lowest were: glucosamine, multivitamins and minerals, calcium, fish oil and vitamin B complex. The major reason for supplements use for men was to supplement an unbalanced diet, and that for women was to prevent joint degeneration. The main factor influencing choice of supplements in the elderly was receiving the supplement as a gift from another person. Note that mean intakes of vitamins A, C, E, B-1, B-2, B-6, B-12, biotin, niacin, and pantothenic acid from supplements over-exceeded DRIs in Taiwan.

Use of supplements by Taiwanese adults aged 19-44 during 2005-2008.

The aim of the study was to understand the use of supplements in Taiwan. Data used in this study came from the 2005-2008 Nutrition and Health Survey in Taiwan. The total sample available for analysis of supplement use included 973 adults (485 men and 488 women), aged 19-44 years. Survey data were weighted to adjust for the survey design effect and to make the sample nationally representative. Our results showed that 33.2% of Taiwanese adults aged 19-44 took supplements (26.6% of men and 40.0% of women). Gender was the only demographic factor found to be associated with the total number of supplement types taken. Men were more likely to take only one supplement. In contrast, women were 2.6 times more likely than men to take two or more supplements. The most commonly taken supplements by adults were multivitamins and minerals (35.8%), followed by vitamin B group (20.6%) and calcium (9.3%). We found that in both men and women, nutrient intakes from supplements exceeded DRIs for vitamins A, D, E, B-1, B-2, B-6, B-12, pantothenic acid and biotin. Men were more likely than women to take excess iron. Women were more likely than men to take excess vitamin C and niacin. Our study results may be used by government agencies to develop policies regarding supplement use in Taiwan.

Practice to introduce complementary foods to infants in Taiwan--changes from 1997 to 2008.

The purpose of the study was to understand present infant complementary foods eating and compare trends over the past 10 years in Taiwan. We investigated the methods used to introduce infants to complementary foods, difficulties encountered, sources of information and the principle caregiver's knowledge about infant feeding. This study focused on findings from the 2005-2008 Nutrition and Health Survey in Taiwan (NAHSIT) and compared with those from the 1997-1999 Child NAHSIT. Interviews in both surveys were carried out by trained interviewers. In 2005-2008 survey, 50% of infants aged 7-12 months had started eating baby cereals or juice at age 4-6 months as recommended. The proportions of infants aged 10-12 months who were introduced to particular complementary foods at recommended periods varied from biscuits (51.1%) to tofu (1.1%). The proportions were higher in 2005-2008 than in 1997-1999 for only 3 items. In both survey, more than 80% of mothers were the one who made the decision to introduce their children to complementary foods. More than 75% of caregivers fed baby cereals to their babies from milk bottles. In 2005-2008, the most commonly encountered problem was that the child wouldn't eat. Nutrition knowledge of the caregivers have improved since 1999, but still needs fostering. The timing to introduce complementary foods become later than ten years ago. Whether the delay will affect the normal dietary intakes of children after one year of age needs attention. The government should not only promote breastfeeding, but also reevaluate current evidence-based recommendation on complementary food introduction time.

Magnesium deficiency and its lack of association with asthma in Taiwanese elementary school children.

The purpose of this study was to investigate magnesium nutritional status and its association with asthma in elementary school children (1277 boys and 1109 girls) participating in the Nutrition and Health Survey in Taiwan (NAHSIT children 2001-2002). Dietary magnesium intake was based on 24-hour dietary recalls. Serum magnesium was measured. Average magnesium intake was 247 mg and 228 mg for the boys and girls, respectively, which is equivalent to 135-123% of the relevant Taiwanese Dietary Reference Intakes (DRIs). Mean serum magnesium concentration was 0.87 mmol/L and 0.86 mmol/L, respectively. The prevalence of serum magnesium <0.8 mmol/L was 10.5-13.5% in both gender in our sample of elementary school children. In Taiwan, asthma was diagnosed in about 5.8% and 4.7% of boys and girls, respectively. In this study, there were no associations between asthma prevalence, dietary magnesium and serum magnesium concentration. In about 40% of our sample of school children, however, dietary magnesium may be suboptimal. This deficit should be targeted though improved intake of magnesium-rich foods such as whole grains, green vegetables and soybean products, particularly in Taiwanese school children whose dietary intakes are below the DRIs and/or who have low serum magnesium levels.

Dietary supplement usage among elementary school children in Taiwan: their school performance and emotional status.

Dietary supplement consumption practices among 2417 children (1295 boys and 1122 girls) aged 6 to 12 years in Taiwan were derived from the Nutrition and Health Survey in Taiwan Elementary School Children (NAHSIT 2001-2002). The proportion (22%) of boys and girls using supplements was equivalent. Some 77% of the child supplement takers took only one type of supplement. The top five supplements consumed were: multivitamins and minerals, calcium, vitamin C, cod-liver oil and bee propolis in that order. Children in the most urbanized southern Taiwan had the highest usage (33%), but prevalence was lowest in the mountainous areas (5%). Higher parental education level and household monthly income were associated with higher intakes. Supplement users were more competent at school; however, the frequency and number of supplement types were not related to competence.

The usage of dietary supplements among the elderly individuals in Taiwan.

This study describes dietary supplement consumption practices among the Taiwanese population over the age of 65. Data for the analyses were derived from the Elderly Nutrition and Health Survey in Taiwan (1999-2000) which was carried out from 1999-2000. Data from a total of 1937 participants (970 men and 967 women) were collected in the study to delineate patterns of supplement usage. The results indicated that the percentage of women taking supplements was 34.9%, which was higher than 30.1% for men. About 50% of male and female supplement takers took only one type of supplement. The numbers of people taking supplements decreased as the total number of supplement types chosen increased. The top five types of supplements consumed from highest to lowest were: multivitamins and minerals, calcium, vitamin E, vitamin C and fish oil. The elderly residing in the first stratum in the northern areas of Taiwan had the highest rate of taking supplements compared to other locations. In contrast, the elderly residing in mountain areas, eastern areas, and the third stratum in the central areas of Taiwan had a significantly lower rate of supplement ingestion. In addition, elderly people with the following characteristics had a significantly higher rate of taking supplements: higher education, higher monthly income, sufficient disposable income, higher scores in nutrition knowledge, daily ingestion of vitamin or mineral supplements, awareness of nutritional knowledge, regular ingestion of health-enhancing medicines, a lacto-ovo vegetarian diet, good understanding of their own health status, and frequent exercisers.

Magnesium status and association with diabetes in the Taiwanese elderly.

The average dietary intake of magnesium is below recommended dietary allowances in many affluent Western countries. Prolonged low magnesium intake tends to result in hypomagnesaemia which might increase the risk of chronic diseases in elderly people. A national population-based cross-sectional nutrition survey, the Elderly Nutrition and Health Survey in Taiwan (1999-2000), was used to investigate the magnesium status and association with diabetes in the Taiwanese elderly. Dietary magnesium intake was based on 24-hour dietary recalls. Blood biochemical parameters including plasma magnesium and blood glucose were also measured. Average magnesium intake was 250 mg in men and 216 mg in women, which is equivalent to 68-70% of relevant Taiwanese Dietary Reference Intakes. The mean plasma magnesium concentration was 0.903 mmol/L in men and 0.906 mmol/L in women. The prevalence of a plasma magnesium level of <0.7 mmol/L was 0.7-0.9% in the elderly, and that of <0.8 mmol/L was 8.0-9.1%. Elderly vegans had a significantly lower magnesium intake than ovo-lacto vegetarians and non-vegetarians. Diabetic men and women had significantly higher blood glucose levels than non-diabetics. The risk of diabetes was elevated 3.25 times at plasma magnesium levels<0.863 mmol/L. There was an inverse association between plasma magnesium concentration and the prevalence of diabetes. However, no association was found between diabetes and low dietary magnesium. Taiwanese elderly persons had suboptimal levels of dietary magnesium intake, which although may be sufficient to avoid overt magnesium deficiency, may not be sufficient to reduce the risk of diabetes in the elderly. Further prospective study is required to help explain the differential results between dietary and plasma magnesium levels.

Intake levels and major food sources of energy and nutrients in the Taiwanese elderly.

The purpose of this article is to examine dietary intake levels and major food sources of energy and nutrients for the Taiwanese elderly in order to relate nutrient intakes to food choices and to provide suggestions for dietary improvement. The data were derived from the 24-hour recalls from 1,911 subjects (955 males and 956 females) aged 65 and above, who participated in the Elderly NAHSIT carried out from 1999 to 2000. The differences in food consumption patterns between the elderly and younger adults (aged 19 to 64) were also evaluated by comparison with data obtained from NAHSIT 1993-1996. The results revealed that cereals/roots, meat, other protein-rich foods and fats/oils contributed most to daily energy intake. The energy contributions from fats/oils, poultry, meat, other protein-rich foods, refreshments/snacks, alcoholic beverages, and miscellaneous food groups were lower in elderly diets compared with those of younger adults. Meat and cereals/roots were the major food sources of protein. The main carbohydrate-contributing food group was cereals/roots, while primary lipid sources were meat and fats/oils for the elderly. The food groups with a high contribution to vitamin intake were the following: vegetables for vitamin A; meat and cereals/roots for vitamin B1; dairy products, vegetables, cereals/roots and meat for vitamin B2; cereals/roots, seafood and meat for niacin; meat, vegetables and cereals/roots for vitamin B6; plant oils for vitamin E; and vegetables and fruit for vitamin C. The highest ranked food sources for minerals are listed as follows: dairy products, vegetables and seafood for calcium; dairy products and cereals/roots for phosphorous; vegetables and meat for iron; and vegetables, cereals/ roots, other protein-rich foods and seafood for magnesium. The elderly were found to consume more salt, dairy products and vegetables, but less poultry and meat than their younger counterparts. In summary, differences in consumption patterns between the elderly and younger adults was reflected in differences in common food sources of energy and specific nutrients. The dietary patterns of the elderly are in general "healthier" than that of younger adults except for higher salt intake among the elderly. Nonetheless, our elderly population needs to increase their intake of calcium, magnesium, vitamins E and B6, and dietary fiber, and decrease their consumption of salt. Promoting the ingestion of whole-grain and nut products may be a useful strategy to improve the nutritional status of the Taiwanese elderly, aiming at increasing the percentage of energy obtained from carbohydrates and the daily intake of vitamins E and B6, magnesium, and dietary fiber. Suitable strategies are also needed to improve the calcium status of Taiwanese elderly, particularly as a high proportion of them are either lactose intolerant or dislike dairy products.

Prevalence of overweight and obesity and its associated factors: findings from National Nutrition and Health Survey in Taiwan, 1993-1996.

BACKGROUND: To report the overall and regional prevalence of obesity/overweight in Taiwan and to study its associated risk factors. METHODS: A total of 3046 adults > or = 20 years of age collected in National Nutrition and Health Survey in Taiwan, 1993-1996. RESULTS: Prevalence rates of overweight and obesity were 21.1 and 4.0% under the current WHO definition. The prevalence rates of overweight and obesity, using the Taiwanese definition (BMI = 24-26.99 kg/m(2) and > or = 27 kg/m(2), respectively), were 22.9 and 10.5% for males and 20.3 and 13.2% for females, respectively. The highest prevalence rates of obesity were found in the mountainous areas. In addition to age and residing location, education level in women and metabolic equivalent (MET) score and alcohol consumption in men were correlates of obesity. Effects of nutrition/health-related behaviors might be in part explained by education level and residing location of the subjects. CONCLUSION: The prevalence of obesity defined by WHO criteria among people in Taiwan was moderate, with considerable regional variation. The regional differences in obesity prevalence could not be completely accounted for by the sociodemographic and lifestyle factors studied.