Search

The factors contributing to variation in lipoprotein(a) [Lp(a)] was studied in a Melbourne Chinese population. The plasma Lp(a) levels were highly skewed towards low levels in this population, with a median of 79 mg/L and a mean of 145 mg/L. Approximately 13% had plasma Lp(a) above the threshold value of 300 mg/L, while 57% had Lp(a) levels below 100 mg/L. The most commonly occurring phenotype was apolipoprotein(a) )] S4 which is usually inversely correlated with plasma Lp(a) levels but not S1 and S2, which are usually with higher levels of Lp(a). In this phenotype, Lp(a) concentrations ranged from 4 to 228 mg/L. The positive association of Lp(a) levels with BMI and LDL cholesterol was observed in women and men, respectively. Taken together, these observations indicate that the Lp(a) genotype, and its expressed phenotype, in Chinese may offer protection against CHD, unless in women there is an associated increase in BMI, and in men an associated increase in LDL. The stepwise regression analyses showed that in those over 60 years of age, about 29% of the variance of in Lp(a) was explained by diet and 12% by non-dietary factors. Thus, the apo(a) phenotypes clearly influence Lp(a) concentrations, but are not the only factors, which determine the variation in Lp(a) concentrations, environmental or other biochemical factors may contribute to Lp(a) status.

Gestational diabetes mellitus (GDM) is a new epidemic among Australian women, especially those with Asian backgrounds. The 1998 Australia National Diabetes Strategy and Implementation Plan recognises GDM as an independent glucose metabolic disorder affecting sub-groups of Australians. Gestational diabetes mellitus is an Australian national diabetes priority area, along with insulin dependent diabetes mellitus (IDDM) and non-insulin dependent diabetes mellitus (NIDDM). This paper reviews the many issues relating to GDM that continue to be debated by researchers and clinical service providers. These issues include the diagnosis of GDM, the effect of GDM on fetal outcomes, the long-term health effects on the offspring of GDM mothers, the effect of GDM on maternal outcomes and the long-term health effects on women with a history of GDM.

Trials of nutritional intervention in a wide range of health and disease states, preventive and therapeutic, are required. Not only has the emergence of chronic non-communicable disease (CNCD) with acknowledged nutritional pathogenesis created this imperative need, but so also have other conditions which, previously, had not been regarded as nutritionally based. Among the latter are health problems associated with ageing: the menopause, a decline in immune function, and a decline in cognitive function. At the same time, there is a new set of materno-foetal and infant nutrition issues for investigation which relate to new food exposures and the long-term effects of nutritionally mediated gene expression. The emergence of the new food science of phytochemicals with human biological importance also sets the scene for their evaluation in traditional diets and novel foods. Such trials are more complex than comparable pharmacotherapeutic studies because of the complexity of food chemistry, as well as the food behavioural changes which may accompany a nutritional intervention, and the general problem of there not being a 'gold standard' for food intake methodology. Choice of study population is also a key issue in relation to the extrapolation of findings from a particular trial, with population representativeness being an advantage. In order to obtain useful information on manageable sample sizes, either intermediate end-points (short of morbidity and mortality) need to be studied or high-risk groups (such as the aged) need to be recruited. There are some unique ethical issues which must inform clinical nutrition trials. These include certain preventive imperatives like the right to be fed, the risks in disruption of food cultures and the need for food security and sustainability. Rapid changes in the food supply do, however, make such trials more important, while the value of food-health knowledge that cannot be obtained by trial must still be appreciated.

SUMMARY The state of health of South-East Asian nations depends as much or more on extranational forces beyond their control —global warming, economic boom and bust—as it does on their own policies and practices. Nonetheless, the political systems of the region, the scope that these allow for community participation, and their attitudes to human rights, are also key determinants of health status. Governments in the region hold different attitudes to the desirability of a monopoly of effective power in government hands, and therefore vary in their commitment to concepts of community empowerment for health promotion and the involvement of non-governmental organizations. Health promotion in these nations is inextricably linked with the creation of social capital.

Recognition of the biological and health importance of abdominal fatness has stimulated researchers, clinicians and public health workers. Most work and interest so far has focussed on how it might account for health outcomes, with increasing attention to its preferred measurement. Its aetiology and pathogenesis is thought to reflect gender, age and energy balance which, if positive, leads to increased total body fatness, including abdominal fatness. But these contributors themselves, when considered mechanistically, raise possibilities about other potentially important modulators of abdominal fatness, such as adipocyte differentiation and apoptosis, the kinetics of cell fat content, its hormonal and neural control, along with underlying genetic predisposition and expression. In turn, the ways in which environmental factors may influence fat distribution come into focus; these include nutritional factors, which may be as broad as the food cultural (given ethnic differences in abdominal fatness) or as located as specific food factors like those which are thermogenic (eg. capsaicin-like), hormone-like (notably the candidate phyto-estrogens) or essentiall fatty acids which affect receptor function (like omega-3 fatty acids). There is a prima facie case for food intake, aside from its energy value, in its own right, or in conjunction with early life events and/or physical activity and/or substance abuse having a determinant role in the development of abdominal fatness. To what extent, and how, it is now opportune to ask.

The purpose of this cross-sectional study was to compare the urinary excretion of phytoestrogens in Australians of Chinese and Anglo-Celtic origins. Urine samples from individuals already participating in two cross-cultural studies on food habits and health status, were used in order to measure excretion of the two isoflavonoid phytoestrogens genistein and daidzein. The mean (± SEM) 24 h excretion of genistein and daidzein, was 614 ± 202 nmol and 688 ± 218 nmol in the Chinese population and 107 ± 31 nmol and 164 ± 63 nmol in the Anglo-Celtic population (p

The Committee on Nutrition and Aging of the International Union of Nutritional Sciences (IUNS) organized a project entitled Food Habits in Later Life (FHLL) that studied the nutritional and health problems of the elderly from 13 communities in six countries. Demographic, food intake, anthropometric, and health-related data were obtained from a total of 2,013 individuals who participated in this cross-cultural, multicentre study. The methods developed and used in this project will be useful for other groups interested in designing cross-cultural, multicentre studies.

(1996). Population control in Singapore: a case study of health strategy and implementation. Asian Studies Review: Vol. 20, No. 1, pp. 119-134.

A dietary guideline, which has been assumed by several countries, is to achieve the inclusion of a variety of foods in the diet. The major reason for inclusion of food variety as a dietary guideline is the generally accepted concept that eating a wider variety of foods improves nutrient adequacy. There may also be other reasons why food variety relates to health status. An approach for the development and use of food variety scores is presented together with a basis and logic for scoring food variety. Food variety scores quantify the number of different foods (individual foods, food mixtures, food categories, or a combination of these) consumed, and are expressed over a time period or base which may be a day, a week, a month, or a year. The ultimate approach used to calculate food variety may reflect the method by which food intake is assessed, the culture within which the score is to be applied, the definition of a distinct food, and the hypotheses and objectives of the study. If a food is consumed, a sc...

The process of revising the protocol, based on experience in the pilot phase and logical considerations, was conducted by working groups composed of persons directly involved with the field collection of data and professionals who were experts in specific disciplines although not part of the actual pilot research. Four of the working groups addressed the revision of the specific batteries of questions and measures in the protocol, while the fifth group addressed the sample size and sampling frame. The process led to consolidating and condensing many of the questions into single-line items, to recommendations for some additional questions based on common experience, to requirements for standardization of procedures and measuring instruments, and to explicit sequences for enrolling the population. This effort resulted in the revised protocol

The relationship between maternal glucose intolerance and fetal birth weight remains, to a large extent, unknown in Chinese gravidas. From December 1998 to December 1999, 9471[corrected] women in six urban districts of Tianjin, China, underwent an initial screening using a 50-g, 1-h glucose load at 26-30 gestational weeks. Women with a serum glucose readingor=7.8 mmol/l, were followed up for a 75-g, 2-h glucose tolerance test, which was interpreted using the 1998 World Health Organization's (WHO) criteria for diabetes. A total of 174 women had gestational diabetes mellitus. Complete data was collected in 170 women. Among them, 56 accepted diabetes management including self-home glucose monitoring, diet, and physical activity advice, and others received no treatment. The comparison group was 302 women with normal glucose tolerance (NGT). Glucose levels at the initial screening (partial R(2)=.0343, P.0001), maternal weight gain during pregnancy (partial R(2)=.0915, P.0001), and gestational week at delivery (partial R(2)=.0432, P.0001) were determinants of fetal birth weight, controlling for maternal age, pregravid BMI, maternal stature, and other confounders. Both gestational diabetes mellitus (GDM) status and a positive screening but normal oral glucose tolerance test (OGTT) result were predictors of macrosomia (birth weightor=4000 g). It concludes that maternal glucose levels correlate with fetal birth weight and a glucose level of 7.8 mmol/l or more at the initial screening is predictive of macrosomia in Chinese gravidas regardless of GDM status.

The Helicobacter pylori seroprevalence in a representative population of 328 Melbourne Chinese immigrants (162 men and 166 women) aged 25 years and older were studied. The population consisted of Chinese people born in China/Hong Kong (n = 110, 33.5%), Vietnam (n = 79, 24.1%), Malaysia/Singapore (n = 102, 31.1%), and elsewhere (n = 37, 11.3%). The overall seroprevalence of H. pylori was 59.5%; 60.5% in men and 58.4% in women. Gender specific analysis showed associations between higher seroprevalence and several socio-demographic factors; in men, age (P < 0.0001), lower education level (P < 0.002), cigarette smoking (P < 0.042), the use of antibiotics (P < 0.015) and chopsticks (P < 0.047), and in women, lower socioeconomical status [education level (P < 0.030), gross household income (P < 0.0001) and occupational status (P < 0.0001)] and use of chopsticks (P < 0.002). Seroprevalence differed between immigrants of various birthplaces (P < 0.001); those born in Malaysia/Singapore (43.1%) were lower than those born in China/Hong Kong (68.2%), Vietnam (68.4%), and elsewhere (59.5%). Immigrants of various birthplaces also differed in their pattern of socio-demographics. Multivariate analyses showed that risk factors for H. pylori infection within the Melbourne Chinese immigrants were, in men, age (B = 1.081) and birthplace (B = 1.769) and, in women, household income (B = 0.541) and use of chopsticks (B = 1.654). This study suggests person-to-person transmission of H. pylori via the oral-oral route with ethno-specific food practices an important risk factor.

Chinese migrants have low cardiovascular mortality, particularly in their first 10 years of residence in Australia. The apparent increase in cardiovascular deaths among Asian migrants who have lived in Australia for more than 10 years suggests that cardiovascular risk transition may occur soon after migration. In this descriptive study, we found that Melbourne Chinese were not low in cardiovascular risk factors as usually defined. The prevalence of hyperlipidaemia (7.7 per cent for men and 5.2 per cent for women) was similar to the prevalence for other Australians (6.8 per cent for men and 4.4 per cent for women). In spite of low mean blood pressure (systolic blood pressure 114 +/- 23 mmHg (mean +/- standard deviation) and diastolic blood pressure 67.3 +/- 10.6 mmHg), Melbourne Chinese women were hypertensive as often as their Australian counterparts. The prevalence of cigarette smoking in men (26.9 per cent) was also comparable to prevalence for Australian males (24.1 per cent). Being slim is the only recognised cardiovascular protection that Melbourne Chinese may have. A high waist-to-hip ratio (0.91 +/- 0.054 for men and 0.88 +/- 0.077 for women), however, may outweigh the potential benefit of lower prevalence of overweight (17.7 per cent for men and 14.1 per cent for women). Melbourne Chinese men had a multiple risk-factor profile similar to their Australian counterparts. Differences in multiple risk factors in women were attributable to fewer Chinese women having a single risk factor (15.4 per cent versus 30.1 per cent).(ABSTRACT TRUNCATED AT 250 WORDS)

Understanding health service utilisation by community groups can be used to enhance cost-effective service delivery planning. In an inquiry into general health needs, and experiences with health service utilisation by Chinese living in Melbourne, we conducted a series of focus group discussions to explore community health-seeking behaviour. Seven focus groups were drawn from community groups and bilingual health workers in the period September-October 1999. Discussions were carried out in dialect familiar to the participants, facilitated by trained multilingual researchers, tape recorded and transcribed in Chinese and then translated into English. Cross validation was carried out by an independent researcher. Themes that emerged from these discussions included common pathways to care seeking, barriers to the use of health care services, general health concerns, and perceived validity of health information sources. Participants opt for self care when feeling unwell if the condition is perceived as ?not severe?. Use of over-the-counter medication is usually the first course of action. There is a tendency to ?wait and see? when feeling unwell. The use of Traditional Chinese Medicine Practitioners (TCMP) is common, while continuing to see Orthodox Western Medicine practitioners. There are, however, common concerns about the quality of care provided by TCM practitioners and their qualifications. Language, transport, and cost are among other barriers that undermine the use of health care services. Participants reported diabetes, heart disease risk factors, peptic ulcer, hay fever and asthma, poor vision, dental problems, social isolation, and gambling among the most common health concerns. Participants accepted health information from a wide range of sources and placed greater trust in material disseminated by SBS Chinese Radio Programs and the Chinese Health Foundation; an established community organisation run by voluntary health professionals. In conclusion, the study confirmed a number of patterns by which the Chinese community sought and utilised health services and associated factors.