A mini-flipped, game-based Mediterranean diet learning program on dietary behavior and cognitive function among community-dwelling older adults in Taiwan: A cluster-randomized controlled trial.

The Mediterranean diet has been recommended to delay cognitive decline, but adherence to the diet among older adults remain poor, and research on interventions that effectively promote the diet has been inconclusive. This study examined the effects of a mini-flipped, game-based Mediterranean diet learning program in improving dietary behavior and cognitive function in community-dwelling older adults in Taiwan. A cluster randomized controlled trial was conducted. The experimental group completed an 8-week, mini-flipped, game-based learning program. Data were collected at baseline and 8 weeks after intervention. Outcome measures included dietary behavior, global cognitive function, and subjective cognitive dysfunction. Compared with the control group, the experimental group exhibited significantly improved Mediterranean diet behavior and global cognitive function after the intervention, although there was no significant difference in subjective cognitive function. Future research should be conducted with larger populations and longer-term follow-up to evaluate the effect of this learning program.

A prospective study of dietary intakes and influential factors from pregnancy to postpartum on maternal weight retention in Taipei, Taiwan.

Excessive gestational weight gain and postpartum weight retention are risk factors for female obesity. The present study was to examine dietary intakes and weight history from a prospective follow-up study from early pregnancy to 1 year postpartum. A total of 151 pregnant women within 20 weeks of pregnancy in Taipei, Taiwan were interviewed periodically to collect dietary and lifestyle information. The participants had an average age of 30 years and the average gestational weight gain was 14 kg, with an average daily intake of 7830 kJ (1870 kcal) in the 1 year following parturition. By bivariate analyses, maternal age, pre-pregnancy BMI and breast-feeding were not related to postpartum weight retention, but gestational weight gain had significant positive correlations (r 0.54 at 6 months, r 0.44 at 1 year; P < 0.05). The generalised estimating equations showed that the average weight before pregnancy, at 6 months and 1 year postpartum was 53.35 kg, 55.75 kg (weight retention 2.36 kg; P < 0.01) and 54.75 kg (weight retention 1.48 kg; P < 0.01), respectively. After controlling for age, pre-pregnancy BMI, gestational weight gain and parity, we found at 6 months that the adjusted weight retention at postpartum was 0.79 kg (P < 0.01), but at 1 year it was - 0.08 kg (P>0.05). From multivariate analyses, dietary energy intake and energy intake per kg body weight as a long-term physical activity index could explain 24 % of the variation at 6 months and 27 % of the variation at 1 year in postpartum weight retention. These results suggest that pregnant women should be advised to control gestational weight gain, decrease energy intakes after child-bearing and maintain regular exercise in order to prevent postpartum obesity.

A case-control study of the association of diet and obesity with gout in Taiwan.

BACKGROUND: Gout has been a significant metabolic disorder for Chinese men in Taiwan; however, there is insufficient information on diet and lifestyle risk factors in this population. OBJECTIVE: The purpose of this case-control study was to explore potential dietary and lifestyle risk factors associated with gout in Chinese men. DESIGN: Between 1998 and 1999, we recruited and conducted face-to-face interviews with patients from outpatient clinics in Taipei who had incident gout (n = 92) and with their healthy coworkers (controls; n = 92). RESULTS: Systolic blood pressure, diastolic blood pressure, waist-to-hip ratio, waist-to-height ratio, and body mass index were significantly higher in cases than in controls. Family histories of gout and diabetes mellitus were strong risk factors for gout. Frequencies of vegetable and fruit consumption were significantly lower in cases than in controls. Logistic regression analyses showed that high alcohol intake and low intakes of fiber, folate, and vitamin C increased the risk of gout, but no association was found with purine intake. After covariates were controlled for, the adjusted odds ratios for the middle and highest tertiles of waist-to-height ratio (0.50-0.54 and >/==" BORDER="0"> 0.55, respectively) were 3.89 (95% CI: 1.32, 11.46) and 4.37 (1.18, 16.22), respectively, but no linear association was found for waist-to-hip ratio and waist circumference. CONCLUSIONS: Consumption of alcohol, but not of purine, may be a significant dietary risk factor for gout. Food sources rich in dietary fiber, folate, and vitamin C, such as fruit and vegetables, protect against gout. Waist-to-height ratio, which indicates central obesity, has a significant linear effect on gout occurrence, independent of body mass index.

Comparisons of four dietary assessment methods during pregnancy in Taiwanese women.

OBJECTIVE: The purpose of this methodology study is to examine the relative validity of four dietary assessment methods during pregnancy and to understand the pros and cons of each method. MATERIALS AND METHODS: We recruited 181 healthy pregnant women with less than 20 weeks of gestation and collected information through personal and telephone interviews in Taipei, Taiwan. Dietary assessment methods including 24-hour recalls, 3-day food records, and the weekly food frequency questionnaire during the 3 trimesters and the meal-based Chinese food frequency questionnaire (CFFQ) in the 3(rd) trimester were used in this prospective study. RESULTS: The percentages of energy from protein (15%), fat (31-34%), and carbohydrate (50-54%) were similar by the recall and record methods. The energy intakes from 24-hour recalls were 1924 kcal, 1980 kcal, and 2172 kcal in the 1(st), 2(nd), and 3(rd) trimesters, respectively. The weekly food frequency questionnaire resulted in significantly higher intakes of all energy nutrients, especially for protein and fat intakes (percentages and densities) for the 3 trimesters; a further adjustment for the food list is needed. The CFFQ showed comparable results with the quantitative methods in estimating dietary patterns for the entire pregnancy. The 24-hour recalls by telephone interviews provided reasonable results in the assessment of the average nutrient intakes during the trimesters. CONCLUSION: The combinations of 24-hour recalls for the short-term dietary changes and the CFFQ for long-term dietary patterns are suggested as appropriate dietary assessment methods during pregnancy in Taiwan.

Development of nutrient databases for epidemiological studies in Taiwan.

The nutrient and related databases are essential for calculating intake values in epidemiological studies. To suit our research needs, we have developed an integrated management system not only for processing individual dietary questionnaires including 24-hour recalls, food records and Chinese food frequency questionnaires (CFFQ), but also for maintaining and tracking updated food composition databases. The recall and record calculation system (Normal University Food and Nutrient Calculation System: NUCAL system) considers date of recall/record, number of days and meal separations. The CFFQ editing system (CFFQES system) contains the management of food list, and frequency and portion size selections to facilitate processing the various versions of CFFQ. Since the extension of many bioactive compounds including polyphenols, pollutants and carcinogens in foods and water is considered by epidemiological hypotheses, limitation of current food composition tables needs to be noticed and improved. Laboratory analyses are the foundation of food databases, more resources and efforts are urgently needed for analysing the local food items. In practical uses of efficient data processing procedures, the multiple grouping and nomenclature systems need further attention in the future. Nutrient databases need multidisciplinary efforts and play the key role for the success of epidemiological studies.

Meal distribution, relative validity and reproducibility of a meal-based food frequency questionnaire in Taiwan.

Food frequency questionnaire is an important assessment tool for public health nutrition research. We describe the development history and conducted the validity and reproducibility studies for a meal-based Chinese food frequency questionnaire (Chinese FFQ) by five meal sequences. A total of 51 subjects were recruited to collect dietary information twice (6 months apart) with one 24-hr recall, 7-day food records and the Chinese FFQ. Combining data from both time sets, Chinese FFQ showed strong correlations of macro and micronutrients with 7-day records (n = 60, r = 0.29-0.50, p < 0.05), but not with 24-hr recalls (n = 60, r = 0.01-0.23, p > 0.05). The reproducibility of this Chinese FFQ (n = 22) was consistently high for most nutrients, with Spearman correction coefficients between 0.42 for vitamin A to 0.79 for vitamin B12. From a larger sample of 231 subjects who completed the Chinese FFQ and one 24-hr recall, we found the energy distributions of breakfast, lunch, dinner, afternoon and evening snacks combined from Chinese FFQ were 20%, 37%, 37% and 6%, and from 24-hour recalls were 19%, 36%, 44% and 1%, respectively. These results showed acceptable reproducibility and relative validity of this meal-based Chinese FFQ.

High prevalence of hyperuricemia in elderly Taiwanese.

Serum urate status, the prevalence of hyperuricemia and their relationship to the metabolic syndrome in elderly Taiwanese were described using data from the Elderly Nutrition and Health Survey in Taiwan (1999-2000), in which a stratified multi-stage clustered sampling scheme was applied. Complete data from biochemical assays and anthropometric measures for 1225 males and 1167 females were included in the analysis. The mean urate level and 95% confidence interval was 411 (398, 424) microM for males and 357 (347, 367) microM for females. Males had significantly higher serum urate levels than females across all age groups (P<0.05). No significant difference in mean serum urate was found among the four age groups of males. On the other hand, females of 75-79 years had significantly higher serum urate levels (376 microM) than that of the 65-69 and>or=80 age groups. The overall prevalence of hyperuricemia (>or=416.7 microM (7.0 mg/dL) in the elderly was 36% (46% for males and 26% for females). Among the participants, 4.2% of males and 1.1% of females were taking medication to lower uric acid. The elderly (males 455 microM; females 416 microM) of the Mountain areas, mainly indigenes, had the highest mean serum urate overall, however, the highest prevalence of hyperuricemia in males was found in the PengHu islands (62%) and that for females in the Mountain areas (51%). The odds ratio (OR) for hyperuricemia was 2.84 for males in the PengHu islands and 4.33 for females in Mountain areas, compared with their counterparts in the third stratum in the northern areas. Adjusting for obesity, alcohol and other related covariates did not alter the relative rank of the ORs in the various strata. Elderly males (22%) had a significantly lower rate of metabolic syndrome (MS) than females (39%) (P<0.05). For both genders, those with MS had a significantly higher mean serum urate (males 436 microM vs. 405 microM; females 389 microM vs. 338 microM) and prevalence of hyperuricemia (males 56% vs. 43%; females 38% vs.19%) (P<0.05). The population attributable risk for MS from hyperuricemia was 18.8% in men and 15.5% in women. In conclusion, the mean serum urate and prevalence of hyperuricemia in the elderly in Taiwan were higher than those found in other populations and was significantly associated with MS. Gene-environmental interaction may play a key role since great geographical variation exists within various Han Chinese groups in Taiwan and between Han Chinese and Taiwanese indigenes.

Inter-relationships of nutrient intakes for urban Chinese spouses in Taiwan.

This study was to examine dietary intakes and the inter-relationships in urban Chinese spouses in Taipei, Taiwan. We analyzed the dietary intakes and related household factors for 82 wives and their husbands by 24-h recalls and a Chinese food frequency questionnaire (CFFQ) designed with meal sequences in Taipei, Taiwan. The distributions of energy assessed from CFFQ by meals were similar for husbands and wives, with 16% for breakfast, 39% for lunch, 40% for dinner and 5% for snacks (afternoon and evening combined). Assessed by 24-h recalls, the means for total energy, the energy per kilogram body weight, and the percent energy from fat, protein, and carbohydrate were different: 2394 kcal, 34.4 kcal/kg, 31%, 15%, and 51% for husbands; and 1729 kcal, 32.0 kcal/kg, 34%, 16%, and 50% for wives, respectively. The P/M/S (polyunsaturated fat/monounsaturated fat/saturated fat) ratios were 1.5/1.2/1 for husbands and 1.3/1.2/1 for wives. A high eating-out frequency may account for the low correlations for most nutrient intakes between husbands and wives. Canonical correlation analysis for total energy, protein and carbohydrate reveals significant inter-relationships between husbands and wives. Carbohydrate is the consistent and important variable that weighted in an opposite direction with protein and energy intakes in both husbands and wives. These results support the observation that decreased rice consumption as a staple food, cooked at home, for urban Chinese couples, indicated by decreased carbohydrate intake in wives, may account for the increase of energy and protein intakes for husbands.