Elevated C-Reactive Protein Levels Modify the Effect of Magnesium on Depressive Symptoms: A Population-Based Study.

Depression is a profound public health concern, yet its etiology remains unclear. A body's magnesium status and low-grade systemic inflammation are associated with depression. However, the interaction of magnesium status and inflammation on depression/depressive symptoms is unknown. We assessed the association between serum magnesium levels and depressive symptoms by analyzing data from the Nutrition and Health Survey in Taiwan 2005-2008. In total, 2196 participants aged ≥20 years were included. Depressive symptoms were assessed using the 5-item Brief-Symptom Rating Scale. We performed logistic regression and multiple linear regression analyses to examine the association. A dose-response analysis was performed using restricted cubic spline models, and stratification by chronic inflammation was also performed. We found that higher serum magnesium levels were associated with lower depression scores and a lower risk of depression. In the subgroup analysis, serum magnesium levels were inversely associated with depressive symptoms more prominently among people with higher CRP levels, with a threshold at 5 mg/L (≥5 vs. <5) showing a greater difference than at 3 mg/L (≥3 vs. <3). Conclusions: Serum magnesium levels were inversely associated with depressive symptoms. This inverse association was affected by inflammation level. A dose-response relationship was also observed.

The Association of Serum and Dietary Magnesium with Depressive Symptoms.

Depression is a leading cause of the global burden of disease and has a multifactorial etiology that includes nutrients. Magnesium status has been associated with depression with inconclusive results. The impact of chronic latent magnesium deficiency (CLMD, 0.75 ≤ serum magnesium < 0.85 mmol/L) on depression has not yet been investigated. We assessed the association between serum magnesium levels/dietary magnesium intake and depressive symptoms by analyzing nationally representative data from Taiwan (Nutrition and Health Survey in Taiwan, NAHSIT). We used the 5-item Brief Symptom Rating Scale to measure depressive symptoms. Subgroup analysis by sex was also performed. Serum magnesium levels had a low correlation with dietary magnesium intake. Higher serum magnesium levels were associated with lower depressive scores and a lower risk of depressive symptoms, but dietary magnesium intake showed no association. Sex differences were found. Compared with subjects with serum magnesium <0.75 mmol/L, those with ≥0.85 mmol/L had lower depressive scores. In conclusion, serum magnesium was inversely associated with depressive symptoms, but dietary magnesium intake was not. Subjects with CLMD showed similar depressive scores and were at a similar risk of depressive symptoms to those with serum magnesium < 0.75 mmol/L. CLMD should be considered while assessing the association between magnesium status and depressive symptoms.

The Combined Effects of Dietary Diversity and Frailty on Mortality in Older Taiwanese People.

OBJECTIVE: To assess the prospective association between frailty and dietary diversity on mortality. METHOD: This prospective cohort study used the 2005-2008 Nutrition and Health Survey in Taiwan (N = 330; age ≥ 65 years) and this was linked to the Death Registry where we used the data that was recorded up to 31 January 2020. Dietary intake information was assessed using a 24-h dietary recall and food-frequency questionnaire, which were calculated a dietary diversity score (DDS; range, 0-6) and food consumption frequency. Assessment of frailty phenotypes was based on FRAIL scale which was proposed by the International Academy on Nutrition and Aging. RESULTS: Frail older adults had a higher risk of all-cause mortality when they were compared to those with robust physiologies (hazard ratio [HR]: 3.73, 95% confidence interval [CI]: 2.13-6.52). Frailty and a lower DDS were associated with a higher risk of mortality (joint adjusted HR: 2.30, 95% CI: 1.11-4.75) which, compared with a robust physiology and higher DDS, were associated with a lower risk of mortality. CONCLUSIONS: Frailty and a lower DDS were associated with a higher mortality. Prefrailty and frailty with a higher DDS were associated with a lower risk of mortality when compared with those with prefrailty and frailty and a lower DDS. These results suggest that eating a wide variety of foods might reduce the risk of mortality in older adults with prefrailty and frailty.

Identification of Serum Oxylipins Associated with the Development of Coronary Artery Disease: A Nested Case-Control Study.

Coronary artery disease (CAD) is among the leading causes of death globally. The American Heart Association recommends that people should consume more PUFA-rich plant foods to replace SFA-rich ones to lower serum cholesterol and prevent CAD. However, PUFA may be susceptible to oxidation and generate oxidized products such as oxylipins. In this study, we investigated whether the blood oxylipin profile is associated with the risk of developing CAD and whether including identified oxylipins may improve the predictability of CAD risk. We designed a nested case-control study with 77 cases and 148 matched controls from a 10-year follow-up of the Nutrition and Health Survey in a Taiwanese cohort of 720 people aged 50 to 70. A panel of 46 oxylipins was measured for baseline serum samples. We discovered four oxylipins associated with CAD risk. 13-oxo-ODE, which has been previously found in formed plagues, was positively associated with CAD (OR = 5.02, 95%CI = 0.85 to 15.6). PGE2/PGD2, previously shown to increase cardiac output, was inversely associated (OR = 0.16, 95%CI = 0.06 to 0.42). 15-deoxy-PGJ2, with anti-inflammatory and anti-apoptosis effects on cardiomyocytes (OR = 0.26, 95%CI = 0.09 to 0.76), and 5-HETE, which was associated with inflammation (OR = 0.28, 95%CI = 0.10 to 0.78), were also negatively associated as protective factors. Adding these four oxylipins to the traditional risk prediction model significantly improved CAD prediction.

Association between dietary flavonoid intakes and C-reactive protein levels: a cross-sectional study in Taiwan.

Although the intake of specific flavonoid-rich foods may reduce C-reactive protein (CRP) levels, the association between dietary flavonoid intakes and CRP is inconsistent. We aim to describe dietary flavonoid intakes in a Taiwanese nationally representative sample and to investigate the association between flavonoid intakes and CRP. We conducted a cross-sectional study based on 2592 adults from the Nutrition and Health Survey in Taiwan 2005-8. Flavonoid intakes were estimated by linking the 24-h dietary recall with the U.S. Department of Agriculture flavonoid database and divided into quartiles. Adjusted estimates of the flavonoid intakes for the continuous and binary (elevated CRP: >0⋅3 mg/dl) variables were performed by using general linear and logistic regression. We found that tea, orange, tofu and sweet potato leaves/water spinach constituted the major food items of the total flavonoid intake. The total flavonoid intake was lower among women and elderly. Compared with the lowest total flavonoid intake quartile, participants in higher quartiles were associated with a lower CRP status (adjusted odds ratio (OR): 0⋅61, 95 % confidence interval (CI): 0⋅44-0⋅86 for the highest quartiles). The trends were similar for flavonol and flavan-3-ol intakes. Compared with non-consumers, tea consumers were likely to have a lower CRP status (adjusted OR: 0⋅74, 95 % CI: 0⋅57-0⋅97). In brief, a higher total flavonoid intake and tea consumption were inversely associated with CRP levels, indicating that a high-flavonoid diet may contribute to anti-inflammatory effects. A Taiwanese flavonoid content table is necessary for conducting further studies related to flavonoids in Taiwan.

Frailty Severity and Cognitive Impairment Associated with Dietary Diversity in Older Adults in Taiwan.

This study aims to investigate whether frailty severity in conjunction with cognitive function, termed as" cognitive frailty", is associated with dietary diversity in older adults. This cross-sectional study used the data from the 2014-2016 Nutrition and Health Survey in Taiwan (N = 1115; age ≥ 65 years). Dietary intake was assessed using a 24 h dietary recall and food-frequency questionnaire, and dietary diversity score (DDS; range, 0-6) and food intake frequency were calculated. The presence of frailty phenotypes was determined using the FRAIL scale, which was proposed by the International Association of Nutrition and Aging, and cognitive function was assessed using the Mini-Mental State Examination (MMSE) score. The prevalence of cognitive frailty (FRAIL scale score ≥ 3 and MMSE score ≤ 26) was 4.2%. A higher consumption frequency of dairy products, whole grains, vegetables, fruit, fish and seafood, nuts, tea, and coffee, as well as lower pickled vegetable, was inversely associated with cognitive frailty. Those with prefrailty or frailty and lower DDS demonstrated a higher cognitive impairment risk (adjust odds ratio (OR) = 2.15, 95% confidence interval = 1.21-3.83) than those without frailty and higher DDS. Older adults with cognitive prefrailty or cognitive frailty were associated with lower DDS, and frailty with lower DDS was associated with worsening cognitive function.

Serum uric acid and blood pressure among adolescents: data from the Nutrition and Health Survey in Taiwan (NAHSIT) 2010-2011.

PURPOSE: Elevated serum uric acid (UA) is frequently observed in adults with high blood pressure (BP); however, data from adolescents are limited. We examined the association between serum UA and BP in a nationally representative sample of Taiwan adolescents. MATERIAL AND METHODS: Some 1384 participants, aged 14-19 years, from the Nutrition and Health Survey in Taiwan 2010-2011 were included for the study. Elevated BP was defined as systolic or diastolic BP ≥120/80 mmHg. The analyses examined the relationship between serum UA and BP using linear regression and odds ratios of having an elevated BP using logistic regression. RESULTS: In this study population, the mean age was 16.0 years, mean serum UA was 5.8 mg/dL, 22.5% were obese (body mass index ≥24 kg/m2) and 9.8% had an elevated BP. Compared to girls, boys are more likely to be obese and to have higher serum UA and BP. After full adjustments, systolic BP, diastolic BP and mean arterial pressure increased 0.45, 0.48 and 0.47 mmHg, respectively, for each 1-mg/dL increase in UA (p = 0.07, 0.03 and 0.02, respectively). The odds of having an elevated BP were 3.4 times higher in subjects of the upper tertile of serum UA than those of the lower tertile (p = 0.02). CONCLUSION: Adolescents with factors as male, obesity, and UA ≥5.5 mg/dL were prone to have an elevated BP, regardless of age and family history of hypertension. The present study found that serum UA levels are significantly correlated to BP in Taiwanese adolescents.

Adherence to Daily Food Guides Is Associated with Lower Risk of Metabolic Syndrome: The Nutrition and Health Survey in Taiwan.

Although nutritional health knowledge serves as the basis for the daily food guides, limited epidemiologic studies were conducted to verify whether adherence to the daily food guides reduced the prevalence of diseases. This study aims to examine whether adherence to the daily food guides relates to the lower risk of having metabolic syndrome, as well as to assess the association between levels of adherence to daily food guides and demographic characteristics. A cross-sectional study was conducted using data from the Nutrition and Health Survey in Taiwan (NAHSIT) 2014-2016. Face-to-face dietary assessments were conducted using a validated food-frequency questionnaire. Six food groups were defined according to the daily food guides in Taiwan. We constructed a daily food guide index to measure the levels of adherence to the daily food guides. Logistic regression was performed to assess the association between the levels of adherence to the daily food guides and the risk of having metabolic syndrome. A total of 2534 participants (51% of females) were included in the final analysis. After adjusting for age, sex, body mass index, education level, marital status, and family income, we found a negative correlation between the levels of adherence to daily food guides and the prevalence of metabolic syndrome. The odds ratios (ORs) for the highest versus lowest quartile of the adherence level was 0.65 (95% confidence interval (CI) = 0.48-0.88). In addition, males, younger age, lower education, divorced, separated, and widowed, and lower family income were associated with lower adherence to daily food guides. In conclusion, participants reporting better adherence to the daily food guides during the past month had a lower risk of having metabolic syndrome.

High sugar-sweetened beverage intake frequency is associated with smoking, irregular meal intake and higher serum uric acid in Taiwanese adolescents.

Types of sugar-sweetened beverages (SSB) can differ greatly between countries, with greater consumption of sweetened tea in Asia. This study aimed to understand changes in SSB consumption by adolescents in Taiwan over 18 years and their association with demographic characteristics and clinical outcome. This study used survey data from the 1993-1996 and 2010-2011 Nutrition and Health Surveys in Taiwan. Participants were high school students aged 13 to 18 years. Data were weighted and analysed using SUDAAN 11.0 and SAS 9.4. Participants were asked about intake frequencies of SSB and were grouped into four different SSB intake groups based on the combination of high or low frequency (including moderate frequency) of intake of sweetened tea and soda/sports/energy drinks. Results indicated over 99 % of teens reported having at least one SSB in the past week. Smoking status was significantly associated with SSB intake types with high tea intake (high tea and low soda (HL) group, OR 7·56, P < 0·001; high tea and high soda (HH) group, OR 9·96, P < 0·001). After adjustment for potential confounders, adolescents in the low tea and high soda (LH) group (ß = 0·05, P = 0·034) had significantly higher mean serum uric acid values. In conclusion, sugary tea remains the SSB of choice for Taiwanese adolescents. Those with a frequent intake of soda/sports/energy drinks had a higher chance of being hyperuricaemic.

Dietary Patterns and Foods Associated With Cognitive Function in Taiwanese Older Adults: The Cross-sectional and Longitudinal Studies.

OBJECTIVES: To find dietary patterns and foods associated with cognitive function. DESIGN: A cross-sectional study of short-term effects and a prospective study for long-term effects. SETTING: Nutrition and Health Survey in Taiwan (NAHSIT) 2014-2016 and NAHSIT 1999-2000. PARTICIPANTS: A total of 1245 older patients enrolled in the NAHSIT 2014-2016 and 1436 in the NAHSIT 1999-2000. MEASUREMENTS: Dietary intake was appraised with a food-frequency questionnaire. Cognitive function was assessed by the Mini-Mental State Examination score (MMSE). RESULTS: Using reduced rank regression to data-mine NAHSIT 2014-2016 cross-sectional data, we found in both genders a dietary pattern associated with high MMSE score, which was characterized by higher intakes of fresh fruits, nuts and seeds, whole grains, breakfast cereals, coffee, dairy products, seafood products, and fish. Moreover, in women, the pattern included a few additional items: tea, eggs, soybean products, and vegetables. Presence of mild cognitive impairment was inversely associated with the dietary pattern score, with declined adjusted odds ratio (95% confidence interval) from tertile 1 (as reference), tertile 2, to tertile 3 in both men [1 → 0.85(0.45-1.61) → 0.32 (0.14-0.78)] and women [1→0.44 (0.25-0.76) → 0.39 (0.20-0.75)]. Using the NAHSIT 1999-2000 as a baseline, along with 11 years of follow-up, we found with the Cox proportional hazards model that higher intake (≥4 vs <1 time/wk) of either tea or fish, but not other foods, was associated with a lower risk of developing dementia. Higher intakes of both tea and fish were associated with an even lower risk. CONCLUSIONS/IMPLICATIONS: A dietary pattern characterized by high intakes of phytonutrient-rich plant foods (fruits, whole grains, nuts/seeds, and vegetables), tea and coffee, and protein-rich foods such as eggs, dairy products, and fish, was associated with the presence of better cognitive function in older adult. Higher intakes of fish and tea combined showed a long-term protective effect. Further research is warranted to understand the long- and short-term effects of diet.

A decline in the prevalence of angina pectoris: Data from the Nutrition and Health Survey in Taiwan.

BACKGROUND: Angina pectoris (AP) is one of common symptoms of heart disease. The prevalence of AP varies by genders, age and ethnics. This study aimed to estimate the AP prevalence in adults and its change between surveys. METHODS: Data was derived from the Nutrition and Health Survey in Taiwan (NAHSIT) between 1993 and 1996, and between 2005 and 2008. Participants aged ≥19 years old and grouped according to sex and age range (19-44.9, 45-64.9, and ≥65 years). The national weight prevalence rates in three types of AP (possible, definite, and confirmed) were estimated and we also estimated its change between surveys. RESULTS: A total of 5031(1993-1996) and 4686 (2005-2008) adults were enrolled for this study. The aged-adjusted prevalence of possible, definite, and confirmed AP was 9.2%, 5.6%, and 2.1%, respectively, in 1993-1996, and 4.7%, 3.5%, and 1.1%, respectively, in 2005-2008. The age-adjusted prevalence of definite AP significantly declined from 5.6 (1993-1996) to 3.5 (2005-2008). Women had greater decline in the prevalence for possible (5.8% vs. 3.2%), definite (2.9% vs. 1.3%) and confirmed (1.6% vs. 0.5%) AP than men in both surveys. All AP prevalence rates increased by age in men in both surveys, however, the positive association between AP prevalence and age groups among women only was in 1993-1996. CONCLUSIONS: The AP prevalence significantly declined from 1993 to 1996 to 2005-2008. The AP prevalence in women was higher. The prevalence increased with age in men, but not in women. Continuous monitoring of AP prevalence is recommended to better understand the disease burden.

Secular trend towards ultra-processed food consumption and expenditure compromises dietary quality among Taiwanese adolescents.

OBJECTIVE: To compare two Nutrition and Health Surveys in Taiwan (NAHSITs) 15-18 years apart to evaluate secular changes in ultra-processed food (UPF) consumption and expenditure among Taiwanese adolescents aged 16-18 years and the influences of such changes on dietary quality. DESIGN: This cross-sectional study was based on two representative surveys (NAHSIT 1993-1996, n = 788; NAHSIT 2011, n = 1,274) of senior high school students. Dietary information and food expenditure were based on 24-h dietary recall. All food items were classified into original foods, processed culinary ingredients, processed foods, and UPFs based on NOVA criteria. Dietary quality was categorized as poor or good based on the mean of the Youth Healthy Eating Index-Taiwan Revised. RESULTS: Compared to 1993-1996, adolescents consumed less energy from original foods (55 vs. 39%) but more from processed foods (12 vs. 18%) and UPFs (21 vs. 25%) in 2011, with no apparent gender differences. Those who consumed more UPFs had the lowest proportions of protein energy intake in both surveys (13.7 and 13.1%). Those who consumed more UPFs had higher levels of saturated fat and lower levels of monounsaturated and polyunsaturated fat, dietary fiber, and micronutrient intakes. The participants who consumed more UPFs and fewer original foods exhibited poorer dietary quality. Boys and girls exhibited equal UPF expenditure in both surveys despite an increase in UPF energy consumption. The adjusted odds ratios (95% confidence interval) were 1.33 (1.16-1.52) and 1.36 (1.10-1.69) for the risk of poor dietary quality with 10% increases in UPF energy intake and expenditure, respectively, in 2011. CONCLUSIONS: UPF energy consumption among Taiwanese adolescents increased between 1993-1996 and 2011. Observed trends in expenditure suggest that lower UPF costs influenced food choices during this period. Increasing UPF intake and expenditure was associated with poor dietary quality.

Dietary Pattern Associated with Frailty: Results from Nutrition and Health Survey in Taiwan.

OBJECTIVES: To investigate whether dietary patterns are associated with frailty phenotypes in an elderly Taiwanese population. DESIGN: Cross-sectional. SETTING: Nutrition and Health Survey in Taiwan (NAHSIT), 2014-2016. PARTICIPANTS: Noninstitutionalized Taiwanese nationals aged 65 years and older enrolled in the NAHSIT (N = 923). MEASUREMENTS: Dietary intake was assessed using a 79-item food-frequency questionnaire (FFQ). Presence of 5 frailty phenotypes was determined using modified Fried criteria and are summed into a frailty score. Using data from the NAHSIT (2014-15), reduced rank regression was used to find a dietary pattern that explained maximal degree of variation of the frailty scores. Logistic regression models were used to estimate the association between frailty and dietary pattern. The findings were validated with data from 2016. RESULTS: The derived dietary pattern was characterized with a high consumption of fruit, nuts and seeds, tea, vegetables, whole grains, shellfish, milk, and fish. The prevalence of frailty was 7.8% and of prefrailty was 50.8%, defined using the modified Fried criteria. Using data from the NAHSIT (2014-15), the dietary pattern score showed an inverse dose-response relationship with prevalence of frailty and pre-frailty. Individuals in the second dietary pattern tertile were one-third as likely to be frail as those in the first tertile (adjusted odds ratio (aOR) = 0.32, 95% confidence interval (CI) = 0.12-0.85), and those in the third tertile were 4% as likely to be frail as those in the first tertile (aOR = 0.04, 95% CI = 0.01-0.18). The dietary pattern score estimated using FFQ data from the NAHSIT 2016 was also significantly and inversely associated with frailty. CONCLUSION: Individuals with a dietary pattern with more phytonutrient-rich plant foods, tea, omega-3-rich deep-sea fish, and other protein-rich foods such as shellfish and milk had a reduced prevalence of frailty. Further research is necessary to confirm these findings and investigate whether related dietary interventions can reduce frailty in older adults.

Food safety risk assessment for estimating dietary intake of sulfites in the Taiwanese population.

The purpose of this study was to assess the health risk associated with dietary intake of sulfites for Taiwanese general consumers by conducting a total diet study (TDS). We evaluated the exposure of Taiwanese to sulfites in the diet and its associated health risk. This study used a list of 128 food items representing 83% of the total daily diet. Among the 128 food items, 59 items may contain sulfites. Samples of the 59 food items were collected and subjected to chemical analysis to determine the sulfur dioxide concentration. Health risk was assessed by calculating the ratio of exposure level to the acceptable daily intake (ADI) level of the analyte. For high-intake consumers, the HI of sulfites was 19.7% ADI for males over the age of three years at the 95th percentile; whereas for females over the age of 66, the HI was 17.8% ADI. The HI for high-intake consumers was above 10% ADI. This suggests that regulatory actions must be continued and that consumers should be advised to be aware of processed foods with relatively high contamination to avoid excessive exposure.

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.

Probabilistic risk assessment of exposure to leucomalachite green residues from fish products.

To assess the potential risk of human exposure to carcinogenic leucomalachite green (LMG) due to fish consumption, the probabilistic risk assessment was conducted for adolescent, adult and senior adult consumers in Taiwan. The residues of LMG with the mean concentration of 13.378±20.56 µg kg(-1) (BFDA, 2009) in fish was converted into dose, considering fish intake reported for three consumer groups by NAHSIT (1993-1996) and body weight of an average individual of the group. The lifetime average and high 95th percentile dietary intakes of LMG from fish consumption for Taiwanese consumers were estimated at up to 0.0135 and 0.0451 µg kg-bw(-1) day(-1), respectively. Human equivalent dose (HED) of 2.875 mg kg-bw(-1) day(-1) obtained from a lower-bound benchmark dose (BMDL10) in mice by interspecies extrapolation was linearly extrapolated to oral cancer slope factor (CSF) of 0.035 (mgkg-bw(-1)day(-1))(-1) for humans. Although, the assumptions and methods are different, the results of lifetime cancer risk varying from 3×10(-7) to 1.6×10(-6) were comparable to those of margin of exposures (MOEs) varying from 410,000 to 4,800,000. In conclusions, Taiwanese fish consumers with the 95th percentile LADD of LMG have greater risk of liver cancer and need to an action of risk management in Taiwan.