Objective: Short stature may reflect health in early life and be an enduring disability. How birt... more Objective: Short stature may reflect health in early life and be an enduring disability. How birth weight, gender, household, elementary schooling and diet play a role in associations between stature and overall school competence (OSC) have been assessed. Design: The 2001–2002 Nutrition and Health Survey in Taiwan (NAHSIT) for elementary schoolchildren (n 2274, 52·1 % boys) was linked to birth records. It provided sociodemographic, dietary quality, body compositional and school performance (as Scale for Assessing Emotional Disturbance, SAED; OSC as an SAED subscale) data. Lower birth weight was ≤15th percentile: 2850 g for boys and 2700 g for girls, and stature as z-scores for Taiwanese. Multivariable linear regression was used for relationships between OSC and stature. Trends in OSC by stature and school grade were assessed. Setting: The 2001–2002 NAHSIT for elementary schoolchildren. Participants: Totally, 2274 schoolchildren aged 6–13 years. Results: Compared to normal height (−2...
Objective: Short stature may reflect health in early life and be an enduring disability. How birt... more Objective: Short stature may reflect health in early life and be an enduring disability. How birth weight, gender, household, elementary schooling and diet play a role in associations between stature and overall school competence (OSC) have been assessed. Design: The 2001–2002 Nutrition and Health Survey in Taiwan (NAHSIT) for elementary schoolchildren (n 2274, 52·1 % boys) was linked to birth records. It provided sociodemographic, dietary quality, body compositional and school performance (as Scale for Assessing Emotional Disturbance, SAED; OSC as an SAED subscale) data. Lower birth weight was ≤15th percentile: 2850 g for boys and 2700 g for girls, and stature as z-scores for Taiwanese. Multivariable linear regression was used for relationships between OSC and stature. Trends in OSC by stature and school grade were assessed. Setting: The 2001–2002 NAHSIT for elementary schoolchildren. Participants: Totally, 2274 schoolchildren aged 6–13 years. Results: Compared to normal height (−2...
Child undernutrition is a major health problem in Malawi. We assessed the association between mat... more Child undernutrition is a major health problem in Malawi. We assessed the association between maternal autonomy and child stunting in Malawi. We utilized nationally representative pooled cross-sectional data from the 2010 and 2015/16 Malawi Demographic and Health Surveys (MDHS), which included 7348 mother (28.1 ± 6.8 years, range 15–49 years)—child (27.6 ± 16.7 months, range 0–59 months) pairs. Maternal autonomy composite scores captured decision-making power, tolerance of domestic violence, and financial independence. The nutritional outcome measure was stunting (height-for-age z score
Child undernutrition is a major health problem in Malawi. We assessed the association between mat... more Child undernutrition is a major health problem in Malawi. We assessed the association between maternal autonomy and child stunting in Malawi. We utilized nationally representative pooled cross-sectional data from the 2010 and 2015/16 Malawi Demographic and Health Surveys (MDHS), which included 7348 mother (28.1 ± 6.8 years, range 15–49 years)—child (27.6 ± 16.7 months, range 0–59 months) pairs. Maternal autonomy composite scores captured decision-making power, tolerance of domestic violence, and financial independence. The nutritional outcome measure was stunting (height-for-age z score < – 2). Logistic regression assessed associations between maternal autonomy and stunting, and dominance analysis evaluated the relative importance of the associated factors. From the two surveys combined, 39.2% were stunted. Stunting decreased from 45.0% in 2010 to 34.6% in 2015/16; concurrently, maternal autonomy improved and was evidently associated with stunting (aOR = 0.81, 95% CI = 0.71, 0.93...
Objective:To investigate whether an after-school nutrition education (ASNE) programme can improve... more Objective:To investigate whether an after-school nutrition education (ASNE) programme can improve the nutrition knowledge and healthy eating behaviour of adolescents from economically disadvantaged families.Design:One-group pretest and posttest design. Nutrition knowledge and dietary intake were collected using a questionnaire, and anthropometric measurements were measured before and after the intervention. Nine components of healthy eating behaviour were assessed with reference to the Dietary Guideline of Taiwan. Pretest and posttest differences were analysed using generalised estimating equations.Setting:Three after-school programmes in central and southern Taiwan. The ASNE programme comprised three monthly 1-h sessions (20–30-min lecture and 30–40-min interaction).Participants:A total of 153 adolescents aged 10–15 years from economically disadvantaged families (seventy-eight elementary students and seventy-five junior high school students).Results:Elementary and junior high schoo...
This study aims to investigate whether frailty severity in conjunction with cognitive function, t... more 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 associat...
Nutritional factors contributing to disability and mortality are modifiable in later life. Indice... more Nutritional factors contributing to disability and mortality are modifiable in later life. Indices would add utility. We developed a gender-specific Healthy Ageing Nutrition Index (HANI) for all-cause mortality in free-living elderly. We stratified 1898 participants aged ≥65 y from the 1999-2000 Nutrition and Health Survey in Taiwan by region and randomly allocated them into development and validation sets. Linkage to the National Death Registry database until December 31, 2008 enabled mortality prediction using Cox proportional-hazards models. Four factors (appetite, eating with others, dietary diversity score, and BMI) with best total of 25 HANI points for men; and 3 factors (cooking frequency, dietary diversity score, and BMI) with best total of 27 HANI points for women, were developed. In the validation set, the highest HANI group exhibited a greater intake of plant-derived food and associated nutrients, a favourable quality of life, and more muscle mass, compared with the lowest group. The highest HANI group predicts mortality risk lower by 44 percent in men and 61 percent in women. Adjusted mortality HRs were comparable between sets. HANI is a simple, non-invasive, inexpensive, and potentially modifiable tool for nutrition monitoring and survival prediction for older adults, superior to its individual components. Population Ageing is a critical concern for global public health, because of its varied rates of increase and quality 1. Quality of life (QOL) and disability compromise the value and extent of longevity and the majority of health expenditure is incurred in the last year of life 2. Time trends which demonstrate reductions in age-specific disability provide evidence of avoidability 3. To reduce the burden of disease and increase life expectancy in later life, the focus has been on chronic disease with its behavioural, social, and environmental contributors 4-6. Some modifiable contributors include diet, physical activity, and substance abuse affecting well-being, disability, disease and survival 4,7-11. Diet-related factors are a leading cause of death globally 12-14. Ageing is affected by demographic, epidemiologic, and nutritional transitions 15 with nutrition-related factors the most modifiable. Nutritional factors derive from the underlying food system which is reflected in the food supply and shopping 16 , nutritional knowledge 17 , skills such as cooking 18 , along with dietary patterns and quality 9,19. There are age-related nutritional conditions such as the anorexia of ageing 20,21 , chewing disability 22 , cognitive impairment 23 and problems with food and eating 24. The marked differences in health and survival between genders might be partly attributed to nutritional status 25,26. These might be on account of women tending to exhibit more health-seeking behavior 26,27 , higher apparent morbidity, and a higher use of health care services 28 than men. For example, the consumption of fruits and
ObjectivesSocial activities such as ‘eating-with-others’ can positively affect the ageing process... more ObjectivesSocial activities such as ‘eating-with-others’ can positively affect the ageing process. We investigated the gender-specific association between eating arrangements and risk of all-cause mortality among free-living older adults.SettingA representative sample from the Elderly Nutrition and Health Survey in Taiwan during 1999–2000.ParticipantsSome 1894 participants (955 men and 939 women) who aged ≥65 and completed eating arrangement question as well as confirmed survivorship information.Primary and secondary outcome measuresEating arrangements, health condition and 24-hour dietary recall information were collected at baseline. We classified eating arrangements as the daily frequency of eating-with-others (0–3). Survivorship was determined by the National Death Registry until the end of 2008. Cox proportional-hazards regression was used to assess the association between eating-with-others and mortality risk.ResultsOverall, 63.1% of men and 56.4% of women ate with others thre...
The international journal of behavioral nutrition and physical activity, Mar 14, 2017
Age-related loss of skeletal muscle mass (SMM) and function (sarcopenia) are associated with poor... more Age-related loss of skeletal muscle mass (SMM) and function (sarcopenia) are associated with poor health outcomes and an economic burden on health care services. An appropriate diet and physical activity have been proposed for prevention and treatment of sarcopenia. Nevertheless, the effects on medical service utilization and costs remain unclear. This study determined the effects of SMM in conjunction with diet quality and physical activity on medical service utilization and expenditure in community-dwelling older Taiwanese. In total, 1337 participants from the Elderly Nutrition and Health Survey in Taiwan (1999-2000) were enrolled. An SMM index [SMMI, calculated by dividing SMM (kg) by height (m(2))] was used as the marker of sarcopenia. Participants with the lowest SMMI quartiles (<11.4 kg/m(2) for men and 8.50 kg/m(2) for women) comprised the high-risk group, and the remainder comprised the low-risk group. Dietary information (dietary diversity: low and high) and physical act...
A higher intake of fruits and vegetables (F&V) compared with animal-derived foods is associated w... more A higher intake of fruits and vegetables (F&V) compared with animal-derived foods is associated with lower risks of all-cause-, cancer- and CVD-related mortalities. However, the association between consumption patterns and medical costs remains unclear. The effects of various food group costs on medical service utilisation and costs were investigated. The study cohort was recruited through the Elderly Nutrition and Health Survey in Taiwan between 1999 and 2000 and followed-up for 8 years until 2006. It comprised free-living elderly participants who provided a 24-h dietary recall. Daily energy-adjusted food group costs were estimated. Annual medical service utilisation and costs for 1445 participants aged 65–79 years were calculated from the National Health Insurance claim data. Generalised linear models were used to appraise the associations between the food group costs and medical service utilisation and costs. Older adults with the highest F&V cost tertile had significantly fewer ...
To assess the relative predictive ability for mortality of the Overall Dietary Index-Revised (ODI... more To assess the relative predictive ability for mortality of the Overall Dietary Index-Revised (ODI-R) and the Dietary Diversity Score (DDS) among representative Taiwanese aged 65 and older. Prospective cohort. The Elderly Nutrition and Health Survey in Taiwan during 1999-2000. One thousand seven hundred forty three (860 men and 883 women). Dietary quality measures, the ODI-R (0-100) and DDS (0-6) were based on 24-hour dietary recall and a food frequency questionnaire at baseline. Death by National Death Registry up to 2008 was the outcome measure. During follow-up, 624 subjects died. The survivors had both significantly higher (P <0.001) ODI-R (66.9 vs. 63.6) and DDS (4.69 vs. 4.30) than the deceased. The two indices were correlated (r=0.46). After adjustment for potential covariates, the hazard ratios (HR) (95% CI) were 0.63 (0.42-0.97), 0.71 (0.49-1.04) and 0.53 (0.37-0.76) for those whose ODI-R scores were 60-65, 65-70, >70, respectively, compared to those whose ODI-R scores...
This study aimed to assess the predictive ability of appetite for mortality among representative ... more This study aimed to assess the predictive ability of appetite for mortality among representative free-living Taiwanese older adults. A total of 1856 participants aged 65 years or over from the Elderly Nutrition and Health Survey during 1999-2000 completed an appetite question in a larger questionnaire. Personal information was obtained by face-to-face interview at baseline, together with a 24-hour dietary recall and simplified food frequency questionnaire which provided a dietary diversity score and food intake frequency. Survivorship was ascertained from the Death Registry until December 31, 2008. Participants with a poor appetite had lower dietary diversity scores (DDS) and intake frequencies of meat, fish and sea food, egg, vegetable and fruit intake, along with lower energy, protein, vitamin B-1, niacin, iron and phosphate intakes. Those who had fair and poor appetites had a higher risk of all-cause mortality compared to those with good appetite, with hazard ratios (HR) (95% con...
Journal of the American College of Nutrition, 2014
Dairy foods help achieve essential nutrient adequacy. This role may be conflicted where so-called... more Dairy foods help achieve essential nutrient adequacy. This role may be conflicted where so-called chronic diseases prevail. We have examined associations between dairy intake and mortality where dairy foods have not been traditional. A representative Taiwanese cohort of 3810 subjects, aged 19-64 years, derived from the Nutrition and Health Survey in Taiwan (NAHSIT, 1993-1996) was linked to death registration (1993-2008). Participants were categorized by 4 dairy weekly intake frequencies from 0 to >7 times. Mortality hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox proportional-hazards models. Nonconsumers of dairy products included 30.7% of the men and 22.1% of the women. Adverse sociodemographic and personal behaviors were generally significantly associated with lower dairy consumption. After adjustment for covariates, together with body mass index (BMI) and supplement use, those with 3-7 times/week intakes had an HR (95% CI) for all-cause mortal...
To examine the significance of underweight and physical function as well as their interaction on ... more To examine the significance of underweight and physical function as well as their interaction on mortality in the aged. Prospective cohort. The Elderly Nutrition and Health Survey in Taiwan during 1999-2000. Total of 1435 representative free-living elders (739 men and 696 women). Body composition was assessed by various anthropometrics. Physical function score (PF, ranged 0-100) was derived from the SF-36(®). Death by December 31, 2006 was the outcome measure. After 7.9 (median: 7.0) years follow-up, 381 (223 men, 158 women) of 1435 eligible participants had died. Those with the lowest PF (<45) had 3.43 (hazards ratio (HR), 95% confidence interval (CI) = 2.20-5.36) times the all-cause mortality risk of the highest PF (≥58). Interactions for PF and BMI (P =0.02) and for PF and wrist circumference (P =0.09) on death were found after controlling for potential confounders. Jointly, compared to normal-BMI-highest-PF, the greatest HR for death occurred where BMI <18.5 kg/m2 was comb...
A 28-item simplified food frequency questionnaire (SFFQ) combined with 9 open questions about bas... more A 28-item simplified food frequency questionnaire (SFFQ) combined with 9 open questions about basic commodities was designed for the Elderly Nutrient and Health Survey in Taiwan (NAHSIT) to collect participants' usual intake of the previous month. We have examined the validity this SFFQ as assessed by multiple 24-hour dietary recall (n=81) and biomarkers (n=1473). All questionnaires were completed by face-to-face interview and fasting blood taken. Thirty seven males and 44 females were randomly selected from NAHSIT participants. Of these, 31 and 50 subjects completed 2 or 3 24-hour dietary recalls within one month, respectively. Mean daily intake frequencies for each food group were calculated from the SFFQ and 24-hr recalls, respectively. Spearman rank correlation coefficients between frequencies of food intake from the FFQ and dietary recalls ranged from 0.132 to 0.678 for men; 0.052 to 0.759 for women. For food weight, the trends were similar to frequency findings. For biomar...
Evidence-based nutrition (EBN) has gained currency as part of the growing role of evidence-based ... more Evidence-based nutrition (EBN) has gained currency as part of the growing role of evidence-based medicine (EBM) to increase the validity, utility and cost-effectiveness of both clinical practice and, increasingly, public health endeavours. Nutritionally-related disorders and diseases (NRD) account for a relatively large proportion of the burden of ill-health, disease and mortality, especially as the nexus between them and both infectious disease and so-called chronic disease is understood. As resource allocation is increasingly dependent on the evidence for preventive or therapeutic effect, the case for nutrition interventions also needs to be underpinned by evidence. However, feeding studies are not as amenable to the designs familiar to clinical trialists and dietary interventions in public health may be complex in their conduct and interpretation, making other approaches like cohort studies more attractive even if costly and long in the execution. With a number of food system cha...
Hyperhomocysteinemia and cognitive impairment both predict mortality and partly because of dietar... more Hyperhomocysteinemia and cognitive impairment both predict mortality and partly because of dietary associations. We have hypothesized that for, nutritional reasons, homocysteine and cognition may act jointly to determine elder survival. In a Nutrition and Health Survey in Taiwan (1999-2000), some 1412 representative elderly were followed up for mortality up to 10 years. Cognition was assessed by the Short Portable Mental Status Questionnaire. Food and B vitamin intakes with their biomarkers, and plasma homocysteine, were measured at baseline. The possible effects of cognition on homocysteine-associated mortality were ascertained with Cox proportional-hazards models. Homocysteine was higher in those who were older, male, and single, consumed less fish and tea, and with alcohol and smoking. In models adjusted for these variables, when homocysteine exceeded 14.5 μmol/L, mortality was 1.80-fold more than when <9.3 μmol/L (hazard ratio [HR], 1.80; 95% confidence interval [95% CI], 1.20-2.71). P for trend was 0.002 and interactive with sex (P < .002). However, these homocysteine-mortality associations were dependent on cognition (P = .03); adjustment for food intake or nutrient status made little difference. Homocysteine did not predict cognitive impairment (adjusted OR, 1.40; 95% CI = 0.50-3.93). Vitamins B 1 , B 2 , and B 6 accounted somewhat for cognitive impairment. Cognition predicted mortality, fully adjusted for available covariates and also for homocysteine (HR, 3.66; 95% CI, 1.64-8.20) but interactively with homocysteine. Thus, the B-group vitamin insufficiency and cognitive impairment associations with premature
To examine chewing ability and survival in older adults after 8 years of follow-up and consider a... more To examine chewing ability and survival in older adults after 8 years of follow-up and consider any interaction with the metabolic syndrome (MetS). Prospective cohort. The Elderly Nutrition and Health Survey in Taiwan during 1999/00, a nationally representative sample of Taiwanese aged 65 and older. One thousand four hundred ten people (729 men and 681 women). Chewing ability and food intake were ascertained using a questionnaire, supplemented by 24-hour dietary recall. The MetS was defined according to National Cholesterol Education Program Adult Treatment Panel III criteria for Asians. Death according to the National Death Registry by December 31, 2006, was the outcome measure. During follow-up, 368 subjects died. A significantly higher age- and sex-adjusted hazard ratio (HR=1.44, 95% confidence interval (CI)=1.10-1.78, P=.009) for mortality was found in those who had unsatisfactory chewing ability. Age, sex, and appetite together explain the effect of chewing on mortality. Dietary diversity, body mass index, and health status may also play a role in mediating a possible mortality effect of chewing. Significant interactions between chewing ability and the MetS and mortality were found (P=.04 for five components and .006 for three energy-related components). Jointly, those who had unsatisfactory chewing ability and the MetS were at higher risk of death than those who had satisfactory chewing ability without the MetS (HR=1.65, 95% CI=1.11-2.46 for 5 MetS components; HR=2.58, 95% CI=1.58-4.23 for 3 MetS components). Self-reported unsatisfactory chewing ability is associated with greater mortality risk in older adults, and MetS increases the risk of mortality in people with chewing difficulty.
Background & aims: Little is known about the direct relationship of B vitamins to mortality in th... more Background & aims: Little is known about the direct relationship of B vitamins to mortality in the elderly. All-cause mortality by vitamin B status, using dietary (B-1, B-2, niacin, B-6) or biochemical data (erythrocyte transketolase reductase, erythrocyte glutathione reductase, plasma pyridoxal-phosphate, folate and serum B-12) was evaluated. Methods: The Taiwanese Elderly Nutrition and Health Survey (1999e2000) provided 1747 participants 65 years and over. Dietary and biochemical data were collected at baseline. Survivorship was determined until December 31, 2008. Results: Survivors had higher vitamin B-1 and niacin intakes and pyridoxal-phosphate and folate concentrations. Controlled for confounders, and relative to the lowest tertile of vitamin B-1 or B-6 intakes, the hazard ratios (95% confidence interval) for tertile 3 were 0.74 (0.58e0.95) and 0.74 (0.57e0.97); both p for trend values were <0.05. Further adjustment for dietary diversity led to insignificant findings. For pyridoxal-phosphate, compared to those with deficiency levels, the multivariable-adjusted hazard ratios (95% confidence interval) for adequacy was 0.52 (0.38e0.71) with p for trend <0.0001 and unchanged with dietary diversity adjustment. Conclusions: Higher vitamin B-1 and B-6 intakes and plasma pyridoxal-phosphate were associated with lower risk of mortality up to 10 years and could be achieved by increased dietary diversity.
A 28-item simplified food frequency questionnaire (SFFQ) combined with 9 open questions about sta... more A 28-item simplified food frequency questionnaire (SFFQ) combined with 9 open questions about staples was designed for the Elderly Nutrient and Health Survey in Taiwan (NAHSIT) to collect information on participants' usual food intake of the previous month. We have examined the validity of this SFFQ via comparison with data on multiple 24-hour dietary recall (n=81) and biomarkers (n=1473). All questionnaires were completed by faceto-face interview and fasting blood samples were taken. Thirty seven males and 44 females were randomly selected from NAHSIT participants. Of these, 31 and 50 subjects completed 2 or 3 24-hour dietary recalls within one month, respectively. Mean daily intake frequencies for each food group were calculated from the SFFQ and 24-hr recalls, respectively. Spearman rank correlation coefficients between frequencies of food group obtained from the FFQ and from dietary recalls ranged from 0.132 to 0.678 for men; 0.052 to 0.759 for women. Correlation coefficients between frequency and food weight were similar. When validated by nutrient status, the most correlated was dairy intake frequency judged by 24-hour vitamin B-2 and calcium intakes and by erythrocyte glutathione reductase (EGRAC) for B-2 functionality, where the correlation coefficients were, respectively, 0.533, 0.518 and-0.205 for men; 0.494, 0.475 and-0.174 for women; fish and fruit frequency followed in overall validity. The SFFQ measured the food patterns of NAHSIT elders with validity high for dairy and good for fish and fruit intakes in both genders.
Objective: Short stature may reflect health in early life and be an enduring disability. How birt... more Objective: Short stature may reflect health in early life and be an enduring disability. How birth weight, gender, household, elementary schooling and diet play a role in associations between stature and overall school competence (OSC) have been assessed. Design: The 2001–2002 Nutrition and Health Survey in Taiwan (NAHSIT) for elementary schoolchildren (n 2274, 52·1 % boys) was linked to birth records. It provided sociodemographic, dietary quality, body compositional and school performance (as Scale for Assessing Emotional Disturbance, SAED; OSC as an SAED subscale) data. Lower birth weight was ≤15th percentile: 2850 g for boys and 2700 g for girls, and stature as z-scores for Taiwanese. Multivariable linear regression was used for relationships between OSC and stature. Trends in OSC by stature and school grade were assessed. Setting: The 2001–2002 NAHSIT for elementary schoolchildren. Participants: Totally, 2274 schoolchildren aged 6–13 years. Results: Compared to normal height (−2...
Objective: Short stature may reflect health in early life and be an enduring disability. How birt... more Objective: Short stature may reflect health in early life and be an enduring disability. How birth weight, gender, household, elementary schooling and diet play a role in associations between stature and overall school competence (OSC) have been assessed. Design: The 2001–2002 Nutrition and Health Survey in Taiwan (NAHSIT) for elementary schoolchildren (n 2274, 52·1 % boys) was linked to birth records. It provided sociodemographic, dietary quality, body compositional and school performance (as Scale for Assessing Emotional Disturbance, SAED; OSC as an SAED subscale) data. Lower birth weight was ≤15th percentile: 2850 g for boys and 2700 g for girls, and stature as z-scores for Taiwanese. Multivariable linear regression was used for relationships between OSC and stature. Trends in OSC by stature and school grade were assessed. Setting: The 2001–2002 NAHSIT for elementary schoolchildren. Participants: Totally, 2274 schoolchildren aged 6–13 years. Results: Compared to normal height (−2...
Child undernutrition is a major health problem in Malawi. We assessed the association between mat... more Child undernutrition is a major health problem in Malawi. We assessed the association between maternal autonomy and child stunting in Malawi. We utilized nationally representative pooled cross-sectional data from the 2010 and 2015/16 Malawi Demographic and Health Surveys (MDHS), which included 7348 mother (28.1 ± 6.8 years, range 15–49 years)—child (27.6 ± 16.7 months, range 0–59 months) pairs. Maternal autonomy composite scores captured decision-making power, tolerance of domestic violence, and financial independence. The nutritional outcome measure was stunting (height-for-age z score
Child undernutrition is a major health problem in Malawi. We assessed the association between mat... more Child undernutrition is a major health problem in Malawi. We assessed the association between maternal autonomy and child stunting in Malawi. We utilized nationally representative pooled cross-sectional data from the 2010 and 2015/16 Malawi Demographic and Health Surveys (MDHS), which included 7348 mother (28.1 ± 6.8 years, range 15–49 years)—child (27.6 ± 16.7 months, range 0–59 months) pairs. Maternal autonomy composite scores captured decision-making power, tolerance of domestic violence, and financial independence. The nutritional outcome measure was stunting (height-for-age z score < – 2). Logistic regression assessed associations between maternal autonomy and stunting, and dominance analysis evaluated the relative importance of the associated factors. From the two surveys combined, 39.2% were stunted. Stunting decreased from 45.0% in 2010 to 34.6% in 2015/16; concurrently, maternal autonomy improved and was evidently associated with stunting (aOR = 0.81, 95% CI = 0.71, 0.93...
Objective:To investigate whether an after-school nutrition education (ASNE) programme can improve... more Objective:To investigate whether an after-school nutrition education (ASNE) programme can improve the nutrition knowledge and healthy eating behaviour of adolescents from economically disadvantaged families.Design:One-group pretest and posttest design. Nutrition knowledge and dietary intake were collected using a questionnaire, and anthropometric measurements were measured before and after the intervention. Nine components of healthy eating behaviour were assessed with reference to the Dietary Guideline of Taiwan. Pretest and posttest differences were analysed using generalised estimating equations.Setting:Three after-school programmes in central and southern Taiwan. The ASNE programme comprised three monthly 1-h sessions (20–30-min lecture and 30–40-min interaction).Participants:A total of 153 adolescents aged 10–15 years from economically disadvantaged families (seventy-eight elementary students and seventy-five junior high school students).Results:Elementary and junior high schoo...
This study aims to investigate whether frailty severity in conjunction with cognitive function, t... more 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 associat...
Nutritional factors contributing to disability and mortality are modifiable in later life. Indice... more Nutritional factors contributing to disability and mortality are modifiable in later life. Indices would add utility. We developed a gender-specific Healthy Ageing Nutrition Index (HANI) for all-cause mortality in free-living elderly. We stratified 1898 participants aged ≥65 y from the 1999-2000 Nutrition and Health Survey in Taiwan by region and randomly allocated them into development and validation sets. Linkage to the National Death Registry database until December 31, 2008 enabled mortality prediction using Cox proportional-hazards models. Four factors (appetite, eating with others, dietary diversity score, and BMI) with best total of 25 HANI points for men; and 3 factors (cooking frequency, dietary diversity score, and BMI) with best total of 27 HANI points for women, were developed. In the validation set, the highest HANI group exhibited a greater intake of plant-derived food and associated nutrients, a favourable quality of life, and more muscle mass, compared with the lowest group. The highest HANI group predicts mortality risk lower by 44 percent in men and 61 percent in women. Adjusted mortality HRs were comparable between sets. HANI is a simple, non-invasive, inexpensive, and potentially modifiable tool for nutrition monitoring and survival prediction for older adults, superior to its individual components. Population Ageing is a critical concern for global public health, because of its varied rates of increase and quality 1. Quality of life (QOL) and disability compromise the value and extent of longevity and the majority of health expenditure is incurred in the last year of life 2. Time trends which demonstrate reductions in age-specific disability provide evidence of avoidability 3. To reduce the burden of disease and increase life expectancy in later life, the focus has been on chronic disease with its behavioural, social, and environmental contributors 4-6. Some modifiable contributors include diet, physical activity, and substance abuse affecting well-being, disability, disease and survival 4,7-11. Diet-related factors are a leading cause of death globally 12-14. Ageing is affected by demographic, epidemiologic, and nutritional transitions 15 with nutrition-related factors the most modifiable. Nutritional factors derive from the underlying food system which is reflected in the food supply and shopping 16 , nutritional knowledge 17 , skills such as cooking 18 , along with dietary patterns and quality 9,19. There are age-related nutritional conditions such as the anorexia of ageing 20,21 , chewing disability 22 , cognitive impairment 23 and problems with food and eating 24. The marked differences in health and survival between genders might be partly attributed to nutritional status 25,26. These might be on account of women tending to exhibit more health-seeking behavior 26,27 , higher apparent morbidity, and a higher use of health care services 28 than men. For example, the consumption of fruits and
ObjectivesSocial activities such as ‘eating-with-others’ can positively affect the ageing process... more ObjectivesSocial activities such as ‘eating-with-others’ can positively affect the ageing process. We investigated the gender-specific association between eating arrangements and risk of all-cause mortality among free-living older adults.SettingA representative sample from the Elderly Nutrition and Health Survey in Taiwan during 1999–2000.ParticipantsSome 1894 participants (955 men and 939 women) who aged ≥65 and completed eating arrangement question as well as confirmed survivorship information.Primary and secondary outcome measuresEating arrangements, health condition and 24-hour dietary recall information were collected at baseline. We classified eating arrangements as the daily frequency of eating-with-others (0–3). Survivorship was determined by the National Death Registry until the end of 2008. Cox proportional-hazards regression was used to assess the association between eating-with-others and mortality risk.ResultsOverall, 63.1% of men and 56.4% of women ate with others thre...
The international journal of behavioral nutrition and physical activity, Mar 14, 2017
Age-related loss of skeletal muscle mass (SMM) and function (sarcopenia) are associated with poor... more Age-related loss of skeletal muscle mass (SMM) and function (sarcopenia) are associated with poor health outcomes and an economic burden on health care services. An appropriate diet and physical activity have been proposed for prevention and treatment of sarcopenia. Nevertheless, the effects on medical service utilization and costs remain unclear. This study determined the effects of SMM in conjunction with diet quality and physical activity on medical service utilization and expenditure in community-dwelling older Taiwanese. In total, 1337 participants from the Elderly Nutrition and Health Survey in Taiwan (1999-2000) were enrolled. An SMM index [SMMI, calculated by dividing SMM (kg) by height (m(2))] was used as the marker of sarcopenia. Participants with the lowest SMMI quartiles (<11.4 kg/m(2) for men and 8.50 kg/m(2) for women) comprised the high-risk group, and the remainder comprised the low-risk group. Dietary information (dietary diversity: low and high) and physical act...
A higher intake of fruits and vegetables (F&V) compared with animal-derived foods is associated w... more A higher intake of fruits and vegetables (F&V) compared with animal-derived foods is associated with lower risks of all-cause-, cancer- and CVD-related mortalities. However, the association between consumption patterns and medical costs remains unclear. The effects of various food group costs on medical service utilisation and costs were investigated. The study cohort was recruited through the Elderly Nutrition and Health Survey in Taiwan between 1999 and 2000 and followed-up for 8 years until 2006. It comprised free-living elderly participants who provided a 24-h dietary recall. Daily energy-adjusted food group costs were estimated. Annual medical service utilisation and costs for 1445 participants aged 65–79 years were calculated from the National Health Insurance claim data. Generalised linear models were used to appraise the associations between the food group costs and medical service utilisation and costs. Older adults with the highest F&V cost tertile had significantly fewer ...
To assess the relative predictive ability for mortality of the Overall Dietary Index-Revised (ODI... more To assess the relative predictive ability for mortality of the Overall Dietary Index-Revised (ODI-R) and the Dietary Diversity Score (DDS) among representative Taiwanese aged 65 and older. Prospective cohort. The Elderly Nutrition and Health Survey in Taiwan during 1999-2000. One thousand seven hundred forty three (860 men and 883 women). Dietary quality measures, the ODI-R (0-100) and DDS (0-6) were based on 24-hour dietary recall and a food frequency questionnaire at baseline. Death by National Death Registry up to 2008 was the outcome measure. During follow-up, 624 subjects died. The survivors had both significantly higher (P <0.001) ODI-R (66.9 vs. 63.6) and DDS (4.69 vs. 4.30) than the deceased. The two indices were correlated (r=0.46). After adjustment for potential covariates, the hazard ratios (HR) (95% CI) were 0.63 (0.42-0.97), 0.71 (0.49-1.04) and 0.53 (0.37-0.76) for those whose ODI-R scores were 60-65, 65-70, >70, respectively, compared to those whose ODI-R scores...
This study aimed to assess the predictive ability of appetite for mortality among representative ... more This study aimed to assess the predictive ability of appetite for mortality among representative free-living Taiwanese older adults. A total of 1856 participants aged 65 years or over from the Elderly Nutrition and Health Survey during 1999-2000 completed an appetite question in a larger questionnaire. Personal information was obtained by face-to-face interview at baseline, together with a 24-hour dietary recall and simplified food frequency questionnaire which provided a dietary diversity score and food intake frequency. Survivorship was ascertained from the Death Registry until December 31, 2008. Participants with a poor appetite had lower dietary diversity scores (DDS) and intake frequencies of meat, fish and sea food, egg, vegetable and fruit intake, along with lower energy, protein, vitamin B-1, niacin, iron and phosphate intakes. Those who had fair and poor appetites had a higher risk of all-cause mortality compared to those with good appetite, with hazard ratios (HR) (95% con...
Journal of the American College of Nutrition, 2014
Dairy foods help achieve essential nutrient adequacy. This role may be conflicted where so-called... more Dairy foods help achieve essential nutrient adequacy. This role may be conflicted where so-called chronic diseases prevail. We have examined associations between dairy intake and mortality where dairy foods have not been traditional. A representative Taiwanese cohort of 3810 subjects, aged 19-64 years, derived from the Nutrition and Health Survey in Taiwan (NAHSIT, 1993-1996) was linked to death registration (1993-2008). Participants were categorized by 4 dairy weekly intake frequencies from 0 to >7 times. Mortality hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox proportional-hazards models. Nonconsumers of dairy products included 30.7% of the men and 22.1% of the women. Adverse sociodemographic and personal behaviors were generally significantly associated with lower dairy consumption. After adjustment for covariates, together with body mass index (BMI) and supplement use, those with 3-7 times/week intakes had an HR (95% CI) for all-cause mortal...
To examine the significance of underweight and physical function as well as their interaction on ... more To examine the significance of underweight and physical function as well as their interaction on mortality in the aged. Prospective cohort. The Elderly Nutrition and Health Survey in Taiwan during 1999-2000. Total of 1435 representative free-living elders (739 men and 696 women). Body composition was assessed by various anthropometrics. Physical function score (PF, ranged 0-100) was derived from the SF-36(®). Death by December 31, 2006 was the outcome measure. After 7.9 (median: 7.0) years follow-up, 381 (223 men, 158 women) of 1435 eligible participants had died. Those with the lowest PF (<45) had 3.43 (hazards ratio (HR), 95% confidence interval (CI) = 2.20-5.36) times the all-cause mortality risk of the highest PF (≥58). Interactions for PF and BMI (P =0.02) and for PF and wrist circumference (P =0.09) on death were found after controlling for potential confounders. Jointly, compared to normal-BMI-highest-PF, the greatest HR for death occurred where BMI <18.5 kg/m2 was comb...
A 28-item simplified food frequency questionnaire (SFFQ) combined with 9 open questions about bas... more A 28-item simplified food frequency questionnaire (SFFQ) combined with 9 open questions about basic commodities was designed for the Elderly Nutrient and Health Survey in Taiwan (NAHSIT) to collect participants' usual intake of the previous month. We have examined the validity this SFFQ as assessed by multiple 24-hour dietary recall (n=81) and biomarkers (n=1473). All questionnaires were completed by face-to-face interview and fasting blood taken. Thirty seven males and 44 females were randomly selected from NAHSIT participants. Of these, 31 and 50 subjects completed 2 or 3 24-hour dietary recalls within one month, respectively. Mean daily intake frequencies for each food group were calculated from the SFFQ and 24-hr recalls, respectively. Spearman rank correlation coefficients between frequencies of food intake from the FFQ and dietary recalls ranged from 0.132 to 0.678 for men; 0.052 to 0.759 for women. For food weight, the trends were similar to frequency findings. For biomar...
Evidence-based nutrition (EBN) has gained currency as part of the growing role of evidence-based ... more Evidence-based nutrition (EBN) has gained currency as part of the growing role of evidence-based medicine (EBM) to increase the validity, utility and cost-effectiveness of both clinical practice and, increasingly, public health endeavours. Nutritionally-related disorders and diseases (NRD) account for a relatively large proportion of the burden of ill-health, disease and mortality, especially as the nexus between them and both infectious disease and so-called chronic disease is understood. As resource allocation is increasingly dependent on the evidence for preventive or therapeutic effect, the case for nutrition interventions also needs to be underpinned by evidence. However, feeding studies are not as amenable to the designs familiar to clinical trialists and dietary interventions in public health may be complex in their conduct and interpretation, making other approaches like cohort studies more attractive even if costly and long in the execution. With a number of food system cha...
Hyperhomocysteinemia and cognitive impairment both predict mortality and partly because of dietar... more Hyperhomocysteinemia and cognitive impairment both predict mortality and partly because of dietary associations. We have hypothesized that for, nutritional reasons, homocysteine and cognition may act jointly to determine elder survival. In a Nutrition and Health Survey in Taiwan (1999-2000), some 1412 representative elderly were followed up for mortality up to 10 years. Cognition was assessed by the Short Portable Mental Status Questionnaire. Food and B vitamin intakes with their biomarkers, and plasma homocysteine, were measured at baseline. The possible effects of cognition on homocysteine-associated mortality were ascertained with Cox proportional-hazards models. Homocysteine was higher in those who were older, male, and single, consumed less fish and tea, and with alcohol and smoking. In models adjusted for these variables, when homocysteine exceeded 14.5 μmol/L, mortality was 1.80-fold more than when <9.3 μmol/L (hazard ratio [HR], 1.80; 95% confidence interval [95% CI], 1.20-2.71). P for trend was 0.002 and interactive with sex (P < .002). However, these homocysteine-mortality associations were dependent on cognition (P = .03); adjustment for food intake or nutrient status made little difference. Homocysteine did not predict cognitive impairment (adjusted OR, 1.40; 95% CI = 0.50-3.93). Vitamins B 1 , B 2 , and B 6 accounted somewhat for cognitive impairment. Cognition predicted mortality, fully adjusted for available covariates and also for homocysteine (HR, 3.66; 95% CI, 1.64-8.20) but interactively with homocysteine. Thus, the B-group vitamin insufficiency and cognitive impairment associations with premature
To examine chewing ability and survival in older adults after 8 years of follow-up and consider a... more To examine chewing ability and survival in older adults after 8 years of follow-up and consider any interaction with the metabolic syndrome (MetS). Prospective cohort. The Elderly Nutrition and Health Survey in Taiwan during 1999/00, a nationally representative sample of Taiwanese aged 65 and older. One thousand four hundred ten people (729 men and 681 women). Chewing ability and food intake were ascertained using a questionnaire, supplemented by 24-hour dietary recall. The MetS was defined according to National Cholesterol Education Program Adult Treatment Panel III criteria for Asians. Death according to the National Death Registry by December 31, 2006, was the outcome measure. During follow-up, 368 subjects died. A significantly higher age- and sex-adjusted hazard ratio (HR=1.44, 95% confidence interval (CI)=1.10-1.78, P=.009) for mortality was found in those who had unsatisfactory chewing ability. Age, sex, and appetite together explain the effect of chewing on mortality. Dietary diversity, body mass index, and health status may also play a role in mediating a possible mortality effect of chewing. Significant interactions between chewing ability and the MetS and mortality were found (P=.04 for five components and .006 for three energy-related components). Jointly, those who had unsatisfactory chewing ability and the MetS were at higher risk of death than those who had satisfactory chewing ability without the MetS (HR=1.65, 95% CI=1.11-2.46 for 5 MetS components; HR=2.58, 95% CI=1.58-4.23 for 3 MetS components). Self-reported unsatisfactory chewing ability is associated with greater mortality risk in older adults, and MetS increases the risk of mortality in people with chewing difficulty.
Background & aims: Little is known about the direct relationship of B vitamins to mortality in th... more Background & aims: Little is known about the direct relationship of B vitamins to mortality in the elderly. All-cause mortality by vitamin B status, using dietary (B-1, B-2, niacin, B-6) or biochemical data (erythrocyte transketolase reductase, erythrocyte glutathione reductase, plasma pyridoxal-phosphate, folate and serum B-12) was evaluated. Methods: The Taiwanese Elderly Nutrition and Health Survey (1999e2000) provided 1747 participants 65 years and over. Dietary and biochemical data were collected at baseline. Survivorship was determined until December 31, 2008. Results: Survivors had higher vitamin B-1 and niacin intakes and pyridoxal-phosphate and folate concentrations. Controlled for confounders, and relative to the lowest tertile of vitamin B-1 or B-6 intakes, the hazard ratios (95% confidence interval) for tertile 3 were 0.74 (0.58e0.95) and 0.74 (0.57e0.97); both p for trend values were <0.05. Further adjustment for dietary diversity led to insignificant findings. For pyridoxal-phosphate, compared to those with deficiency levels, the multivariable-adjusted hazard ratios (95% confidence interval) for adequacy was 0.52 (0.38e0.71) with p for trend <0.0001 and unchanged with dietary diversity adjustment. Conclusions: Higher vitamin B-1 and B-6 intakes and plasma pyridoxal-phosphate were associated with lower risk of mortality up to 10 years and could be achieved by increased dietary diversity.
A 28-item simplified food frequency questionnaire (SFFQ) combined with 9 open questions about sta... more A 28-item simplified food frequency questionnaire (SFFQ) combined with 9 open questions about staples was designed for the Elderly Nutrient and Health Survey in Taiwan (NAHSIT) to collect information on participants' usual food intake of the previous month. We have examined the validity of this SFFQ via comparison with data on multiple 24-hour dietary recall (n=81) and biomarkers (n=1473). All questionnaires were completed by faceto-face interview and fasting blood samples were taken. Thirty seven males and 44 females were randomly selected from NAHSIT participants. Of these, 31 and 50 subjects completed 2 or 3 24-hour dietary recalls within one month, respectively. Mean daily intake frequencies for each food group were calculated from the SFFQ and 24-hr recalls, respectively. Spearman rank correlation coefficients between frequencies of food group obtained from the FFQ and from dietary recalls ranged from 0.132 to 0.678 for men; 0.052 to 0.759 for women. Correlation coefficients between frequency and food weight were similar. When validated by nutrient status, the most correlated was dairy intake frequency judged by 24-hour vitamin B-2 and calcium intakes and by erythrocyte glutathione reductase (EGRAC) for B-2 functionality, where the correlation coefficients were, respectively, 0.533, 0.518 and-0.205 for men; 0.494, 0.475 and-0.174 for women; fish and fruit frequency followed in overall validity. The SFFQ measured the food patterns of NAHSIT elders with validity high for dairy and good for fish and fruit intakes in both genders.
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Papers by Yi-Chen Huang