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The purpose of this study was to explore the long term effect of a service learning project on medical and nursing students' knowledge in aging and their attitudes toward older adults. A total of 124 students were recruited and then randomized to intervention group (IG) and control group (CG). A pre-and-post-intervention design measured students' knowledge in aging (using modified Palmore's Fact on Aging Quiz) and attitudes toward older adults (using Kogan's Old People Scale). A total of 103 students completed all the activities and questionnaires. After the intervention, there were significant differences between the IG and CG on Palmore's mental health (MH) (P = .04), Palmore's total score (P = .02) and Kogan's negative attitudes toward older adults (P = .001). All students increased their positive attitude toward older adults after the intervention. However, both the IG and CG showed a decrease in positive attitudes 1 month after the interventon, and such decrease varied, depending on the programme which students attended. The current study showed that the 10-week service learning activities significantly increased medical and nursing students' overall knowledge of aging and their understanding of mental health needs in old age, and reduced their negative attitudes toward older adults. However, the effect is not long-lasting. On the other hand, its effect on positive attitudes toward older adults cannot be concluded. Periodic contacts with older adults via service learning activities may be needed to sustain attitude change toward older adults.

1. In a large, population representative,Chinese birth cohort, higher birth weight and rapid growth, particularly at 0-3 months, were associated with higher body mass index (BMI) at 7 years. 2. Boys born heavy who had grown fast had the highest BMI, but rapid growth had the largest impact in lighter-born boys. 3. Rapid growth at 0-3 months or 3-12 months was not associated with a compensatory lower risk of serious infectious morbidity. 4. The ability to grow fast may be an embodiment of good health status, rather than fast growth being causally protective.

Background: Second-hand smoke (SHS) exposure is a modifiable cause of ill health. Despite the smoking ban in public places introduced in Hong Kong in 2007, infants and children continue to be exposed within the home., Aims: To determine the critical windows of SHS exposure and the duration of its impact on serious infectious morbidity in the first 8 years of life., Methods: The Hong Kong "Children of 1997" birth cohort is a prospective, population-based study of 8327 children comprising 88% of all births in April and May 1997, of whom 7402 (89%) were followed up until their eighth birthday in 2005. We used multivariable Cox regression to assess the relation between postnatal SHS exposure and risk of first admission to public hospitals (together accounting for >95% total bed-days overall) for respiratory, other and all infections from birth to 8 years of age, for all individuals and for vulnerable subgroups., Results: Overall, household SHS exposure within 3 metres in early life was associated with a higher risk of admission for infectious illness up until 8 years of age (hazard ratio 1.14, 95% CI 1.00 to 1.31), after adjustment for sex, birthweight, gestational age, feeding method, maternal age, highest parental education and proxies of preferred service sector. The association was strongest in the first 6 months of life (HR 1.45, 95% CI 1.15 to 1.83). In vulnerable subgroups such as premature babies, the association held through to 8 years of age (HR 2.00, 95% CI 1.08 to 3.72). Infants exposed to SHS in the first 3 months of life were most vulnerable to infectious causes of hospitalisation., Conclusion: Household SHS exposure in early infancy increases severe infectious morbidity requiring hospital admission. Reducing SHS exposure in infants and particularly in more vulnerable infants will lower the bed-days burden due to infectious causes.

Objective: In 2006 the World Health Organization (WHO) published new optimal growth standards for all healthy infants worldwide. To assess their general applicability to a recently transitioned Chinese population, we compared them with infant growth patterns in a representative sample of Hong Kong infants., Design and Settings: Weight at birth and at 1, 3, 9, 12, 18 and 36 months, length at 3 and 9 months and height at 36 months were obtained for over 80% of all infants born in April and May 1997 (3880 boys and 3536 girls). Age and sex specific z scores were calculated relative to the WHO growth standards for term singletons., Results: Weight for age was close to the 50th percentile of the WHO growth standards for both boys (mean z score: 0.00) and girls (0.04) at most time points before 3 years of age. However, our participants were shorter at 3 years, where the z scores in height were -0.34 and -0.38 for boys and girls, respectively. Restricting the analysis to a subset matching the WHO criteria for healthy infants without restrictions on growth gave similar results., Conclusions: Although the WHO study group concluded there was a striking similarity in length/height among different populations, Hong Kong Chinese toddlers are, on average, shorter. Epigenetic constraints on growth coupled with the rapid epidemiological transition in Hong Kong may not have allowed sufficient generations for infants and children to reach their full genetic height potential, and with it the WHO standards. A universal infant growth standard may not be appropriate across all populations.

Objective: This paper reports longitudinal changes in bone mineral density (BMD), calcium homeostasis and dietary calcium intake in a group of Hong Kong breastfeeding women during the first year postpartum., Design and Subjects: Nine mothers who breastfed exclusively or almost exclusively for at least 3 months and 14 formula feeding mothers aged 20-40 y were interviewed after delivery, 2 and 6 weeks, 3, 6 and 12 months postpartum. BMD at L2-L4 lumbar spine (LS), trochanter (Tro) and femoral neck (FN), serum intact parathyroid hormone (iPTH), serum bone-specific alkaline phosphatase (b-ALP), urinary deoxypyridinoline (Dpd), serum and urinary calcium (Ca) and phosphorus (P) and dietary intake of macronutrients were assessed., Results: Compared to the formula feeding group, BMD assessed at LS, Tro and FN decreased significantly in the breastfeeding group over the first 6 months, with rebound to approximate baseline values at 12 months for the latter two sites. Serum iPTH increased in both groups, whereas serum b-ALP was consistently higher in the breastfeeders. Urinary Ca and P excretion decreased early postpartum in both groups, but the breastfeeders had higher excretion at 3 and 6 months. Breastfeeding mothers consumed significantly more Ca than the formula feeding mothers in the early postpartum., Conclusions: Increased calcium requirement during early lactation is affected through mobilisation of bone and renal calcium conservation. Bone mineral loss during lactation is temporary. Further studies are warranted to investigate the effects of diet and other hormonal factors on the calcium homeostasis during lactation.

Objective: To identify which of the three simple anthropometric indices, body mass index (BMI), waist-to-hip ratio (WHR) and waist circumference (WC), best predicts cardiovascular risk factors, and to determine if the association between the anthropometric indices and cardiovascular risk factors varies with gender., Design and Methodology: A cross-sectional population-based survey was carried out during 1995-1996. One thousand and ten Chinese people (500 men and 510 women) aged 25-74 y were recruited as subjects for the study. Metabolic profiles and anthropometric indices were measured., Results: Partial correlation and co-variance analyses showed that WC exhibited the highest degree of association with almost all of the studied metabolic profiles for both men and women. We observed significant gender differences in the association between central or general obesity with cardiovascular risk factors. BMI had an independent and significant association with metabolic risks in men, but not in women, whereas WHR was more strongly correlated with metabolic risks for women than for men. Logistic regression analysis further confirmed the magnitude of the association between the obesity indices and metabolic risks. Among the studied metabolic variables, serum insulin showed the highest degree of association with the obesity indices, followed by plasma glucose, triglyceride, HDL and blood pressure. Total cholesterol and LDL-cholesterol had a small but significant correlation with obesity. No threshold values in the relation between either the anthropometric indices and metabolic values, or with hypertension, diabetes and dislipidemia were observed., Conclusion: The association of central or general obesity and metabolic syndrome varied with gender. In addition, the useful anthropometric predictors for cardiovascular risk factors were BMI and WC for men, and WC and WHR for women.

Objective: To report postnatal iron nutritional status of Hong Kong Chinese women during the first 6 months postpartum., Design and Subjects: A longitudinal study examining postnatal calcium and iron status of Hong Kong Chinese breastfeeding and formula-feeding women was conducted during 1998. Postpartum women aged 20-40 y, with no bone or blood disorders were recruited and interviewed at 0 (baseline), 2, 6 weeks, 3 and 6 months postpartum. Dietary intake was assessed by a 3 day dietary record and cross checked by a 24 h recall. Complete blood count and serum ferritin level were measured to assess anaemia and iron status. In this report, subjects were divided into an anaemic group (haemoglobin level < 10 g/dl) and a non-anaemic group (haemoglobin level > or = 10 g/dl) according to baseline haemoglobin levels., Results: At baseline, 13/47 (27.7%) subjects were anaemic. Two of these 13 anaemic subjects were still anaemic at 3 and 6 months postpartum. Anaemic subjects showed significantly (P < 0.01) greater amounts of blood loss and a higher rate of primary postpartum haemorrhage than the non-anaemic subjects. Daily food intake and dietary nutrient intake did not differ significantly between the two groups. During the first 6 weeks postpartum, subjects in both groups consumed more poultry and egg, and comparable amounts of meat, compared with women in the Hong Kong general population. Iron and vitamin C intakes for the majority of subjects reached 60% of the US Recommended Daily Allowances. Regression analysis suggested that the rate of change in haemoglobin level in the first 6 weeks postpartum was positively correlated with baseline MCV level and serum ferritin level, but negatively correlated with baseline haemoglobin level., Conclusions: Blood loss at delivery is an important factor for postpartum anaemia. Postnatal recovery of iron status of this group of women appeared to be more related to physiological factors than to dietary factors. The role of diet as well as other physiological changes in postpartum women requires further investigation. Finding ways to minimise blood loss at delivery could be the most practical strategy to reduce the rate of postpartum anaemia., Sponsorship: CSM was supported by a research studentship from the Research Grants Council, Hong Kong.

This study examined the types of coping strategies used by hospital nurses in Hong Kong. The impacts of these coping strategies on the mental health of nurses were also investigated. Results showed that coping strategies were both situation-specific and culture-specific, with direct action coping, acceptance and positive thinking used more frequently than avoidance and alcohol. It was found that more than one-third of the nurses were considered to be at risk of developing poor mental health, and the most frequent symptomatic complaints included anxieties and feelings of inadequacy in handling daily activities. Nurses who were mentally healthy used more direct action coping and positive thinking, and fewer avoidance strategies and drinking than did nurses who were at risk of developing poor mental health. Contrary to our hypothesis, nurses who adopted more acceptance strategies had poorer mental health. Implications of the study are discussed.

Objective: The study investigated the nutritional status of Chinese lacto-ovo-vegetarian children aged 4-14 years., Methodology: Dietary intake over 7 days was assessed using a computer program, previously used for a local population-based dietary survey. Anthropometric measurements were made and fasting venous blood was examined for serum lipids, haematological data, iron, vitamin B12 and folate status. Bone mineral density (BMD) of the spine (L2 - L4) was measured as a reflection of calcium status., Results: Fifty-one lacto-ovo-vegetarians aged 4-14 years were investigated. The mean +/- standard deviation (SD) daily energy intake was 1600 +/- 425 kcal. The mean (+/- SD) daily protein intake was 1.6 +/- 0.6 g/kg bodyweight which met the United States recommended dietary allowance. Compared to that of the local omnivore diet, the vegetarian diet was closer to the recommended healthy diet with lower fat (20-23%), more fibre (5.8-8.7 g/day) and better polyunsaturated to saturated fatty acid ratio (1.0-1.1). Growth and BMD of the vegetarian children were comparable to the general omnivore population. Two children had iron deficiency and two children had anaemia. The calcium status, as reflected by the BMD, was not impaired. Serum folate and vitamin B12 were within the normal range. Six (25%) boys and four (15%) girls were obese. Three boys had hyperlipidaemia., Conclusions: A Hong Kong Chinese vegetarian diet appears healthy, providing adequate iron and vitamin B12 nutrition, but the prevalence of obesity was high.

We conducted a cross-sectional population-based study comprising 1010 Hong Kong Chinese (500 men and 510 women) aged 25-74 years during 1995-6. The study examined the important dietary, lifestyle and anthropometric factors associated with urinary calcium excretion. Dietary intakes were assessed by means of food frequency questionnaire. Spot urine was collected to measure the urinary excretion profiles of calcium (Ca), sodium (Na), potassium (K) and creatinine (Cr). When expressed as ratios of cations to urinary Cr, significant relationships were noted between urinary Ca and Na (r: approximately 0.6), and between urinary Ca and K (r: 0.17-0.21). Stepwise multiple linear regression analyses were carried out separately in men and women aged below and above 50 years. We found that urinary Na/Cr was the leading independent factor associated with urinary Ca/Cr in all four age and sex groups. It accounted for 22% of urinary Ca/Cr variations in women aged below 50 years, and 35-43% in the other three age and sex groups. We estimated that urinary Ca excretion increased by about 1.4 (range 1.37-1.43) mmol per 100 mmol increase in urinary Na. Except in men aged 50 years and over, urinary K/Cr was inversely associated with urinary Ca/Cr in all groups. Age was independently and positively associated with urinary Ca/ Cr in subjects aged below 50 years. We did not observe any significant relation between urinary Ca/Cr and dietary protein, phosphorus, alcohol drinking and smoking. In conclusion, we found that urinary Na/Cr, but not dietary protein, Ca or phosphorus, is the most important factor influencing urinary Ca/Cr excretion in our population. Urinary K is a potential factor for Ca conservation.

The people of Hong Kong are experiencing a transition in dietary practices and lifestyle that can be observed in the fat intakes of Hong Kong children as compared with those of their counterparts on mainland China. The studies described here include 1) a longitudinal and observational dietary survey beginning with a cohort of 174 newborns and concluding with 124 children at age 7 y; 2) a biochemical study of serum lipids in relation to dietary fat intake at age 7 y; 3) a chemical fatty acid analysis and comparison of duplicate meals collected from 20 Hong Kong and 20 mainland Chinese children at age 7 y; 4) a dietary assessment of 52 lactoovovegetarian children aged 4-14 y; and 5) a comparison of the growth of all subjects with US National Center for Health Statistics standards. About 30% of the total daily energy intake of Hong Kong Chinese children aged 1-7 y was contributed by fat-much more than that in the traditional Chinese diet. Growth of the children was not impaired, including that of children on the mainland and of those lactoovovegetarians in Hong Kong whose fat intakes were lower. Mean serum cholesterol of Hong Kong Chinese children at age 7 y was 4.59 mmol/L, significantly higher than that of their counterparts on the mainland, 4.16 mmol/L. Foods consumed in Hong Kong had a significantly lower ratio of 18:2 to 14:0. Nutritional deficiency was uncommon. Chinese children in Hong Kong had a dietary fat intake that was both quantitatively and qualitatively different from the traditional Chinese diet.

Objective: To describe factors associated with breastfeeding failure during the first 6 months post-partum in a sample of Hong Kong Chinese women participating in a longitudinal study of maternal nutrition., Methodology: Forty-four Hong Kong Chinese lactating mothers who intended to breastfeed exclusively for at least 3 months were recruited and followed for 6 months post-partum. Demographic data were compared with 20 mothers who intended to use formula feeding. Mothers were followed up at 2 and 6 weeks and 3 and 6 months and details of infant feeding practices were obtained. Information was sought on breastfeeding management in hospital, reasons for discontinuation of breastfeeding or for providing supplements to babies and intention to seek, and sources of, lactation support., Results: Thirty-nine mothers who planned to breastfeed completed the follow up. Compared with mothers in the formula-feeding group, breastfeeding mothers were more likely to be professionals or housewives. Continuation of any breastfeeding (total and partial) was noted in 30 (77%), 22 (57%), 16 (41%) and 12 (31%) mothers at 2 and 6 weeks and 3 and 6 months post-partum, respectively. The majority (97%) of mothers stated that they were given information on the benefits and management of breastfeeding. However, late initiation of breastfeeding and providing supplements to babies were common. Perceptions of insufficient milk supply (44%), breast problems (31%) and being too tired (28%) were the main reasons stated for stopping breastfeeding or for providing supplements to babies. Midwives from the postnatal wards and hotlines were the main sources of lactation support., Conclusions: These results highlight difficulties in sustaining breastfeeding, either exclusive or partial, in Hong Kong Chinese women. Despite being recruited on the basis of intending to exclusively breastfeed for 3 months, less than half these mothers were still breastfeeding and only approximately one-third were exclusively or predominantly breastfeeding at 3 months. More needs to be done within the hospital environment to initiate breastfeeding immediately after birth and to avoid giving unnecessary supplements and more effort is needed to foster a mother's confidence, commitment and knowledge of breastfeeding.

We describe the pattern of soy intake and its association with blood lipid concentrations in the Hong Kong Chinese population. Subjects were contacted by random telephone survey and invited to a hospital for a physical examination and blood tests. A total of 500 men and 510 women with an age range of 24-74 y completed the dietary intake study. The dietary assessment was based on a semiquantitative food frequency questionnaire that included 10 commonly consumed soy items. Many (88%) of the study population had consumed some soy products during the previous week. About 80% of the soy protein or isoflavones were obtained from different forms of tofu, and an additional 9% was obtained from soy milk. The mean weekly isoflavone intake was 102 +/- 107 mg in men and 77 +/- 90 mg in women. In men, soy intake and total plasma cholesterol were negatively correlated (r = -0.09, P: = 0.04), as were soy intake and LDL cholesterol (r = -0.11, P: = 0.02). The respective values in women <50 y old were r = -0.11, P: = 0.04 and r = -0.11, P: = 0.05. Soy protein remained significantly associated with these two lipid concentrations after adjustment for other social and dietary confounders. Higher soy intake seemed to be related to a better plasma lipid profile in men and in younger women, but more epidemiological studies and controlled clinical trials in this setting would help to confirm the optimal amount required for the prevention and treatment of hyperlipidemia.

Objective: To study the early dietary practices in relation to growth of Hong Kong children from birth to 7 years., Methodology: One hundred and seventy-three full-term Hong Kong Chinese babies were recruited at birth and were followed up for anthropometric measurements using standardized methods and dietary assessment using a combination of dietary history, 24 h recall and food frequency. At 7 years, 125 children remained in the study., Results: Mean (SD) birthweight was 3.3 (0.38) kg for boys and 3.1 (0.38) kg for girls. Mean (SD) weight at 7 years was 22.4 (4.2) kg for boys and 21.1 (3.7) kg for girls, and mean (SD) height was 120.3 (4.8) cm for boys and 119.8 (5.1) cm for girls. Hong Kong children were lighter and shorter than Australian children and the National Centre for Health Statistics (NCHS) references, but the magnitude is less than one standard deviation score. Mean weight and height of Hong Kong children were lower compared to Caucasian and Beijing children, with more obvious differences between 1 and 5 years. At 1 year, mean (SD) daily energy intake was 98 (24) kcal/kg/day for boys and 100 (26) kcal/kg/day for girls. By 7 years, it decreased to 82 (18) kcal/kg/day for boys and 73 (22) kcal/kg/day for girls. Between 2 to 4 years of age the energy intake of studied children were slightly lower than the Australian and Finnish children, but the protein intake was higher. Percentage of fat contributing to total daily energy intake was lower throughout at a level of 30%. Such differences in diet reflect a lower consumption of milk fat, higher consumption of meat and lower level of physical activity in Hong Kong children. Intakes of calcium, iron and vitamin C all reached 60% or above of US recommended daily allowance., Conclusions: The smaller body build of Chinese compared to Caucasians cannot be explained by dietary differences. The diet of Hong Kong children is changing to one which is more Westernized with a higher consumption of animal products.

Nationwide growth survey has been performed once every 10 years in Mainland China since 1975. However, no percentile growth curves for children from birth to 18 years have ever been constructed for clinical use. The third survey was performed in 1995 and from this survey, data of the Beijing population were retrieved to construct the height for age and weight for age percentile curves. A total of 12218 healthy children were examined for height and weight, using the standardized methods. Height, but not weight, was normally distributed. Smoothing was performed separately for each sex, using JPA2 model for mean height for age > 2 years. Otherwise, smoothing was performed for the following curves by polynomial equations up to the order of the 5th degree for height and 12th degree for weight, mean height for age < 2 years, SD curve of height for age from birth to 18 years, median weight for age < 2 years, median weight for age > 2 years, differences between the 3rd, 10th, 25th, 75th, 90th, 97th centiles and the median for age from birth to 18 years. The predicted adult height was 173.43cm for boys and 160.86 cm for girls, with age of peak velocity at 13 years and 11.5 years for boys and girls respectively. Compared to those in Hong Kong, they were 2.3-2.5 cm taller signifying a geographical difference in growth even within one country. Compared to the Beijing data collected in 1975 and 1985 the secular changes in growth were more obvious in the first decade, suggesting that the Beijing population was approaching the optimal adult height.

Objectives: To examine the influence of education and marital status on dietary intake, body mass index, waist hip ratio, blood pressure, fasting and 2 h glucose, and lipid profile in adult Hong Kong Chinese., Design: Randomized age and sex stratified survey., Subjects: One thousand and ten subjects aged 25-74 y (500 men, 510 women) recruited for the 1995-96 Hong Kong Dietary and Cardiovascular Risk Prevalence Survey., Measurements: Dietary intake was estimated using a food frequency method. Information on education level and marital status was included in the questionnaire. Anthropometry and biochemical parameters were measured using standard methods., Results: After adjustment for age, higher levels of education are associated with higher percentage protein intake in men, higher percentage fat intake in women, higher nutrient density of fibre and calcium in both men and women, and higher nutrient density of protein, fat, niacin, vitamin D, and polyunsaturated fatty acid in women. Consumption of fruits was also higher in women, and that of dairy products higher in men. Body mass index and waist-hip ratio were lower with increasing levels of education in women, while lower mean systolic BP was observed in men. Single women had lower nutrient densities of vitamin D and iron, and lower consumption of vegetables and fish, compared with married women. Body mass index was lower in both single men and women. Single men had a better cardiovascular risk factor profile, in that diastolic BP, triglycerides and cholesterol/HDL ratio were lower, in addition to a lower body mass index., Conclusion: Higher education level is associated with a healthier diet and lower prevalence of overweight.

Objective: To determine the relation of puberty, physical activity, physical fitness, and calcium intake with bone mineral content (BMC) of the distal radius, and on bone mineral density (BMD) of the L2 to L4 vertebrae in a group of healthy Chinese adolescents., Design: Cross sectional survey., Subjects: A group of 179 healthy Chinese adolescents (92 boys and 87 girls) aged 12 to 13 years enrolled in the first year of the Tii Junior High School in Shatin, Hong Kong. Ninety four of the pupils enrolled were in the physical education major class (PE), and the other 85 were in the art major class (ARTS)., Main Outcome Measures: Correlation of BMC of the distal radius and BMD of the L2 to L4 vertebrae with level of physical activity, physical fitness (isometric and isokinetic), muscle strength of the upper and lower limb, and calcium intake., Results: BMC of the distal radius and BMD of the L2 to L4 vertebrae were significantly positively correlated. Univariate and regression analysis showed that age, pubertal staging, physical fitness, and muscle strength were significantly associated with bone mass in a positive way. Calcium intake and type of sport practised did not exert a significant influence on BMC of the distal radius and BMD of the L2 to L4 vertebrae in boys. The results for the BMD of the L2 to L4 vertebrae were similar in girls and boys; however, in girls, the BMC of the distal radius had a negative correlation with calcium intake. Physical fitness was a significant positive predictor of BMD of the L2 to L4 vertebrae., Conclusions: Among Chinese adolescents bone mass was positively influenced by certain measures of physical fitness as well as by age, weight, and pubertal stage.

It is well known that significant differences exist in the anthropometric data of different races and ethnic groups. This is a cross-sectional study on segmental bone length based on 3,647 Chinese children of equal sex distribution aged 3-18 years. The measurements included standing height, weight, arm span, foot length, and segmental bone length of the humerus, radius, ulna, and tibia. A normality growth chart of all the measured parameters was constructed. Statistical analysis of the results showed a very high linear correlation of height with arm span, foot length, and segmental bone lengths with a correlation coefficient of 0.96-0.99 for both sexes. No differences were found between the right and left side of all the segmental bone lengths. These Chinese children were found to have a proportional limb segmental length relative to the trunk.

In 1993, a cross-sectional study of sexual maturation of normal Chinese schoolgirls was performed in Hong Kong. The aim of the study was to obtain an up-to-date reference for normal pubertal development in Chinese girls. Breast development was assessed in 3749 girls aged 7-19 y, and pubic hair rating was assessed in 3745 girls. Menstrual status was recorded in 6467 girls over 6 y of age. The median age of onset of puberty as indicated by breast stage II or above was 9.78 (95% CI 9.70-9.85) y. The median age of onset of pubic hair development was 11.64 (95% CI 11.56-11.72) y. The median age of menarche was 12.38 (95% CI 11.98-12.78) years. Percentile values for the age at which each puberty staging appeared were constructed and incorporated into the height-for-age charts. When comparison is made with similar studies done in 1962 and 1979, a significant downward secular trend in sexual maturation is observed (p < 0.01). Except for breast development the downward secular trend in sexual maturation appears to be diminishing and may be coming to a halt in the Chinese girls in Hong Kong. Their median ages of sexual maturation are now among one of the earliest medians recorded in the world population studied.

The fatty acids of milk samples obtained from 51 Hong Kong Chinese and 33 Chongqing Chinese (Si Chuan Province, China) were analyzed by gas-liquid chromatography. Compared with those of published data for Canadian and other Western countries, the Chinese milk from both Hong Kong and Chongqing contained higher levels of longer-chain polyunsaturated fatty acids, particularly docosahexaenoic acid (22:6n-3) and arachidonic acid (20:4n-6). In contrast, the content of trans fatty acids in the Chinese milk was lower compared with those for Canadian and other Western countries. Longitudinally, the concentrations of 22:6n-3 and 20:4n-6 gradually decreased when lactation progressed from colostrum (week 1) to mature (week 6). Over the same interval, linoleic acid (18:2n-6) remained unchanged in Chongqing Chinese but significantly increased in Hong Kong Chinese. Unlike 18:2n-6, linolenic acid (18:3n-3) increased in Chongqing Chinese but remained unchanged in Hong Kong Chinese throughout the study. The total milk fat also increased with the duration of lactation. In addition, the milk of Chongqing Chinese had higher total milk fat than that of Hong Kong Chinese and Canadians. The content of erucic acid (22:1n-9) increased with the progression of lactation in Chongqing Chinese, indicating that there was a switch in dietary consumption from fats of animal origin to rapeseed oil when lactation reached week 6. The present study showed that Hong Kong and Chongqing Chinese had a different fatty acid profile in many ways, which largely reflected a different dietary habit and life-style in these two places.

Objectives: To examine plasma total antioxidant capacity (TAOC) in a Chinese population with a lower incidence of cardiovascular disease compared with Caucasian populations, in relation to dietary intake, age, sex, and the presence of cardiovascular diseases., Design and Methods: As part of a randomized territory-wide survey stratified by sex and 10-year age groups; 728 subjects (367 men, 361 women) were recruited. Dietary intake assessment was by a food frequency questionnaire; plasma TAOC was estimated by the ABTS method., Results: The TAOC values were normally distributed, the mean +/- SD being 1.78 +/- 0.18 mmol/L. The mean value was higher in men compared with women, inspite of a lower dietary intake of vitamins A and C per 1000 kcal in the former. Subjects who consumed water spinach twice or more a week had higher mean levels. No difference in mean levels was observed between those with and without hypertension or cardiovascular disease., Conclusion: Measurement of plasma TAOC as a risk factor in epidemiological studies of cardiovascular diseases may have limited use, since TAOC include substances associated with a protective effect as well as increased risk.

Objective: To study dietary lipid intake and plasma lipid profile of the Hong Kong Chinese population as part of a territory wide survey on cardiovascular risk factors., Design: Randomised age and sex stratified survey., Subjects: 1010 subjects aged 25-74 y (500 men, 510 women)., Measurements: A food frequency method with food tables compiled for Hong Kong was used for nutrient quantitation, while a separate questionnaire was used to examine dietary practices. Plasma lipid profile was estimated using standard laboratory methods., Results: Total calorie, fat, saturated fatty acid (SFA), poly- and mono-unsaturated fatty acid (PUFA and MUFA), and cholesterol intake were higher in men; however when adjusted for caloric intake no difference was observed. Men had lower intake of PUFA as percentage of total energy had a higher Hegsted Score compared with women. Subjects consuming beans twice or more per week had lower total cholesterol and LDL-cholesterol concentrations. Overall, the population dietary intake was close to the ideal for cardiovascular health: percentage fat not greater than 30% of the total calorie intake, saturated fat intake not greater than 10% of calories, and cholesterol less than 180 mg/1000 Kcal., Conclusion: The dietary pattern for Hong Kong Chinese appear to be satisfactory with respect to cardiovascular health.

In 1993 a territory-wide cross-sectional growth survey on 25,000 Chinese children from birth to 18 years was performed in Hong Kong. Compared to the last growth survey in 1963, definite secular changes were observed. There was an increase of final adult standing height of 3.6 cm in boys and 2.7 cm in girls, in which 1.8 cm and 0.5 cm respectively for boys and girls was accounted for by the sitting height. Thus most of the height increase had occurred in the leg length in girls, but in boys only half of it. The height difference was more marked during the pubertal years because secular change had brought about an earlier sexual maturation, including an advancement of median menarcheal age by 0.5 year, coupled with an earlier growth spurt. This paper also provides the first growth standards for Chinese from birth to 18 years, with percentile charts on both standing height and sexual maturation in boys and girls.

Objective: Childhood obesity is an emerging problem in Asia. Sequential monitoring of the growth of an individual can detect a change in body fatness, provided there are ethnically appropriate growth references., Methodology: A territory wide cross-sectional growth survey of Hong Kong on 24709 individuals from the age of newborn to 18 years was performed in 1993. Weight-for-age and weight-for-height percentile charts were prepared separately for boys and girls., Results: There was an average increase of 8.5 kg and 5.1 kg in the 18 year old boys and girls, respectively, compared to those surveyed 30 years ago. The percentile curves between 6 and 18 years were similar to those of Singapore. Weight-for-height percentile curves were close to those of America in the prepubertal years., Conclusions: These Hong Kong growth standards for weight-for-age and weight-for-height are important tools for the assessment of nutritional status of an individual and for monitoring changes in nutritional status of the population.

There are significant racial differences in body proportions. Such data are not readily available for Chinese children. This article reports a cross section study of body proportions of 2193 Hong Kong Chinese children, ages 4 to 16 years, with equal gender distribution. Standing height, sitting height, and arm span were measured with standard equipment and methodology. Lower segment height was calculated as the difference between standing height and sitting height. Statistical analysis of the results showed a high linear correlation of the standing height with arm span, sitting height, and lower segment height, with a correlation coefficient ranging from 0.965 to 0.983 for both genders. When expressed as the ratio of standing height to arm span, the value was relatively constant and changed only linearly from 1.03 to 1 in girls and 1.03 to 0.98 in boys ages 4 to 16 years. The ratio of sitting height to lower segment height varied from a mean of 1.4 to 1.14 in boys and 1.36 to 1.18 in girls ages 4 to 16 years. The Chinese children were found to have a proportional limb segmental length relative to the trunk that differed significantly from the proportionally longer limbs in whites and blacks.

A cross-sectional study on growth and development in Hong Kong children and adolescents ranging from their birth to 18 years of age was performed in 1993 and all the growth standards were constructed in the form of percentile chart. Those having a weight at one's median weight for height standard of 120% were defined as obesity. Prevalence of obesity in children and adolescents aged 3-18 was 10.08% (11.28% and 8.93% for boys and girls, respectively), which was higher than that in the inland of the country and that in Hong Kong as previously reported. Result showed there was a gradual increase in the prevalence after the age of 5, which reached a peak at the age of 11 for boys and 8 for girls.

There is limited information relating Ca intake to bone and height acquisition among Oriental children who consume little or even no milk. The present controlled study investigated the acquisition of bone mass and height of Chinese children with an initial Ca intake of approximately 567 mg/d who were supplemented to about 800 mg/d. Eighty-four 7-year-old Hong Kong Chinese children underwent an 18-month randomized, double-blind, controlled Ca-supplementation trial. The children were randomized to receive either 300 mg elemental Ca or a placebo tablet daily. Bone mass of the distal one-third radius was measured by single-photon absorptiometry, lumbar spine and femoral neck were determined using dual-energy X-ray absorptiometry. Measurements were repeated 6-monthly. Baseline serum 25-hydroxycholecalciferol concentration and physical activity were also assessed. Baseline Ca intakes of the study group and controls were respectively 571 (SD 326) and 563 (SD 337) mg/d. There were no significant differences in baseline serum 25-hydroxycholecalciferol concentration (P = 0.71) and physical activity (P = 0.36) between the study and control groups. After 18 months the study group had significantly greater increases in lumbar-spinal bone mineral content (20.9 v. 16.34%; P = 0.035), lumbar-spinal area (11.16 v. 8.71%; P = 0.049), and a moderately greater increment in areal bone mineral density of the radius (7.74 v. 6.00%; P = 0.081) when compared with the controls. The results confirm a positive effect of Ca on bone mass of the spine and radius but no effects on femoral-neck and height increase. A longer trial is warranted to confirm a positive Ca effect during childhood that may modify future peak bone mass.

A double-blind controlled Ca supplementation trial was conducted for 6 months in thirty-four 7-year-old Chinese children from Hongkong and Jiangmen, China. The children were randomly allocated to the study group (n 17) or control group (n 17), and a CaCO3 tablet (300 mg Ca) or a placebo tablet was taken daily. True fractional Ca absorption (TFCA) was evaluated before and after the trial using stable isotopes: 8 mg 44Ca mixed in 100 g chocolate milk was given after an intravenous injection of 0.75 mg 42Ca. There was no significant difference in baseline TFCA between the study group (60.6 (SD 11.4)%) and the controls (58.2 (SD 9.0)%; P = 0.55). Serum 25-hydroxycholecalciferol levels were comparable between the two groups (P = 0.71). After 6 months, TFCA of the study group (55.6 (SD 12.7)%) was significantly lower than that of the controls (64.3 (SD 10.7)%; P = 0.015). By comparing the individual changes in TFCA after the trial between the two groups there was a non-significant reduction in TFCA (5.03 (SD 12.4)%; P = 0.11, Wilcoxon signed-rank test) in the study group (60.6-55.6%), whereas a significant increase in TFCA (6.17 (SD 7.7)%; P = 0.004, Wilcoxon signed-rank test) was observed in the controls (58.2-64.3%). The differential in TFCA between the two groups after 6 months was significantly different (P = 0.001), and remained significant after adjustment for baseline dietary intakes, weight and height by multiple-regression analysis (P = 0.003). If the mechanism of TFCA from chocolate milk in response to the treatment effects is similar to that from the total diet, then our results suggest that children with adequate vitamin D status can adapt to a change in Ca intake by adjusting the efficiency of TFCA. In corollary, children on habitually-low Ca diets have a higher TFCA than the counterparts with higher Ca diets.

In a 9-year retrospective review of goitre in Chinese children in Hong Kong, 84 children and adolescents were identified. There was a female predominance with a male:female ratio of 1:5.5. The majority of patients (95%) were found to have diffuse enlargement of the thyroid gland. Forty-nine were found to have Graves' disease. The mean age of presentation of patients with Graves' disease was 11.34 years. Forty-three of them were found to have thyroid autoantibodies. Only two cases of autoimmune thyroiditis with thyroid autoantibodies were diagnosed. The other causes of goitre include simple colloid goitre, multinodular goitre and suppurative thyroiditis. The spectrum of disease causing goitre in Chinese children is thus quite different from that reported in Caucasian children in developed countries. Further studies are necessary to define the genetic or environmental factors resulting in the observed differences.

Factors affecting geographical differences in the growth of Chinese infants were examined by comparing data obtained from longitudinal growth studies on growth and feeding practices performed in two Chinese populations: Chengdu and Hong Kong infants from birth to 2 years. Their mean growth curves were fitted by the Reed model for the first year and the Count model for the second year. Chengdu mothers were significantly taller than Hong Kong mothers. Chengdu infants grew more rapidly than the Hong Kong infants during the first 6 months; it is likely that this is related to genetic differences in growth potential and earlier introduction of solids in Chengdu infants.

The growth of 174 infants from Hong Kong and 221 infants from Guangzhou from birth to 2 years were compared. Ethnic origins, parental size, and birth weights were similar. Common illnesses in the two groups were upper respiratory tract infection and diarrhoea. The early infant feeding practices were different, with more breastfeeding and earlier introduction of solids in Guangzhou. Compared to those of Hong Kong, Guangzhou babies had lower weight for length in the first year of life. Within the Guangzhou group, babies totally breastfed for the first 2-4 months were heavier than those given rice cereals as supplement and they had less diarrhoea in the first 6 months. Hong Kong infants suffered more diarrhoea than the Guangzhou group. It was concluded that breastfeeding should be promoted and supported in these two cities.

Bone mineral content (BMC) of 5-year-old Chinese children (115 children in Jiangmen, China and 128 children in Hong Kong) was evaluated by single-photon absorptiometry at the distal 1/3 radius. The mean (S.D.) calcium intakes of children of Jiangmen and Hong Kong were 244 (46) and 542 (332) mg/day, respectively. The mean BMC, weight and height of Jiangmen children were significantly less than Hong Kong children by 14%, 10% and 4%, respectively (P < 0.001). Multiple regression analysis showed that 62% of the variance in BMC was explained by bone width (BW), weight and regional location (P < 0.0001). A regional difference in BMC of 0.0303 g/cm (P < 0.0001) still remained after adjusting for BW and weight by multiple regression analysis. When comparing sub-groups of children in the two regions with comparable low current calcium intake at 5 years, the BMC of Jiangmen children was still significantly lower than Hong Kong children even when potential confounders were adjusted (P < 0.003). The study suggests that the regional discrepancy in BMC might be explained by long-term habitual calcium intake and physical activity.

Objective: To provide reliable data on the incidence of IDDM in southern Chinese children in Hong Kong., Research Design and Methods: A registry was established in 1991 to collect childhood IDDM cases retrospectively and prospectively from four districts in Hong Kong. The study included all newly diagnosed cases of IDDM with onset < 15 yr of age from 1 January 1986 to 31 December 1990. Primary ascertainment was based on review of medical records at a regional hospital serving the four districts. An independent school survey validated registry data., Results: The completeness of ascertainment was 93.8%. The age-standardized incidence of IDDM was 2.0/100,000/yr with the 95% confidence interval of 1.2-3.0/100,000/yr for children < 15 yr of age during the study period. The incidence rates/100,000/yr for the three age-groups were: < or = 4 yr, 0.8; 5-9 yr, 2.2; 10-14 yr, 2.8. The incidence for males was 1.5/100,000/yr (95% confidence interval 0.7-2.9/100,000/yr) and for females, 2.4/100,000/yr (95% confidence interval 1.3-4.0/100,000/yr)., Conclusions: This study documents a very low incidence rate of childhood IDDM in southern Chinese in Hong Kong.

Intraocular pressure (IOP) was measured in one-hundred-twenty-three 6- to 7-year-old Chinese children. Children who had at least one myopic parent had higher IOP's than children with two nonmyopic parents. There was a trend for myopic children to have higher IOP's than nonmyopic children.

Physical growth in weight, length and head circumference during infancy and early childhood (the first two years) of Hong Kong children born in the 1960's and 1970's have been compared with a widely used international reference standard (National Center for Health Statistics). During the first 3-6 months the mean growth curves closely follow the reference mean. Over the following 6-12 months however, there is a distinct downward deviation. From about 18 months onwards the growth trajectories once again closely parallel the reference. This 'faltering' of physical growth, which shows some similarities with that described by young children in poor parts of the world has been attributed by some to less than adequate nutrition during the weaning period. Yet over the past 20 years or so Hong Kong has very much become part of the developed world. This apparent paradox leads us to speculate that genetic influences might play an important role in the faltering of growth.

Vitamin D deficiency is a common nutritional problem of weaning infants in many parts of the world. Hong Kong infants, who are fed with traditional rice-based weaning foods and live in crowded high rise flats, might be expected to suffer from this nutritional problem. Yet a study of 150 bottle fed infants revealed that the vitamin D intake from fortified milk and cereals was more than half of the recommended amount throughout the first 18 months and that the serum 25-OH vitamin D concentration of the infants at 18 months was normal. The effect of sunlight was also evident.

Chinese mothers living in Hong Kong are used to giving their babies special medicinal food to strengthen the infant's internal defences and to restore the body's harmonious state. However since the majority of registered doctors are trained in the Western pharmacological tradition it is difficult for them to comprehend the concepts and idioms of this practice. This paper set out to investigate the frequency and varieties of medicinal foods given to 166 Chinese infants during the first 30 months after birth. One hundred and forty seven babies were given medicinal foods at some stage. The frequency of their administration varied from weekly to once or twice per month. The most popular medicinal food was "Job's tears" and the most widely administered compound herb preparations were milk preparation solution, flower teas and various cool teas. The potential pharmacological effects of these medicinal foods were searched from a Chinese medicines computerized database and found to be principally anti-inflammatory, bacteriostatic, diuretic and appetite stimulant. This study contributed a better appreciation of the popularity of infant supplementary medicinal foods in Hong Kong and the rationale for their use.