Nutrition And Health Survey In Taiwan Research Articles

Adherence to the Taiwan Daily Food Guide and the Risk of Type 2 Diabetes: A Populational Study in Taiwan.

This study aims to examine whether adherence to the Taiwan Daily Food Guide relates to the risk of type 2 diabetes. A population-based study was conducted using data from the Nutrition and Health Survey in Taiwan (NAHSIT) 2013-2016. Dietary intakes were assessed using a validated food-frequency questionnaire. Type 2 diabetes was defined as a fasting serum HbA1c level of 6.5% or higher or participants who have received treatment for type 2 diabetes or have reported a physician diagnosis of type 2 diabetes. A total of 2534 Taiwanese adults aged 19 and above were included. We found that the Daily Food Guide adherence was negatively associated with the prevalence of type 2 diabetes. The odds ratios (ORs) for those in the fourth quartile of the recommended total servings was 0.67 (95% confidence interval (CI) = 0.45-0.99) compared with those in the first quartile. In addition, those who were men (OR = 1.46, 95% CI = 1.07-1.98), aged more than 50 to 65 (OR = 6.48, 95% CI = 2.57-16.35), or more than 65 (OR = 6.81, 95% CI = 2.56-18.08), with body mass index (BMI) of 24 to less than 27 (OR = 2.08, 95% CI = 1.55-2.79), had BMI of more than 27 (OR = 3.63, 95% CI = 2.73-4.83), had an education level of junior high and high school (OR = 1.68, 95% CI = 1.03-2.74), were divorced, separated, widowed, or refused to answer (OR = 1.39, 95% CI = 1.03-1.88) were associated with an increased prevalence of type 2 diabetes. In conclusion, people who adhere better to the Taiwan Daily Food Guide were found to have a reduced risk of type 2 diabetes.

Relationship between overweight and obesity and insufficient micronutrient intake: a nationwide study in Taiwan.

The aim of the present study is to examine whether overweight or obese people in Taiwan have an inadequate intake of selected micronutrients. A population-based study was conducted using data from the Nutrition and Health Survey in Taiwan (NAHSIT) 2013-2016. We evaluated fourteen nutrient intakes using the 24 h dietary recall method. The dietary reference intake (DRI) adherence was estimated by the prevalence of participants whose intake was lower than the recommended dietary allowance (RDA) or adequate intakes (AIs) for selected micronutrients. Body mass index (BMI) ≥ 27 kg/m2 and waist circumference (WC), with men having WC ≥ 90 cm or women having WC ≥ 80 cm, were defined as obesity. A total of 3075 participants aged 19 years and above were included. After adjusting for confounders, we found that obese women have a lower DRI adherence of vitamin C (odds ratio (OR) 0⋅73, 95 % confidence interval (CI) 0⋅56, 0⋅95) and magnesium (OR 0⋅72, 95 % CI 0⋅54, 0⋅95), compared with normal-weight women. Obese men have a higher DRI adherence of vitamin B3 (OR 1⋅70, 95 % CI 1⋅29, 2⋅23), iron (OR 1⋅46, 95 % CI 1⋅06, 2⋅00) and zinc (OR 1⋅41, 95 % CI 1⋅07, 1⋅85), compared with normal-weight men. Similar findings were found using WC to define obesity. We conclude that obese women may have insufficient intakes of vitamin A, vitamin C and magnesium.

Better Adherence to the Taiwan Daily Food Guide is Associated with a Reduced Risk of Osteoporosis: A Population-Based Study in Taiwan.

We conducted a study to examine whether adherence to the Taiwan Daily Food Guide was associated with bone mineral density (BMD). A population-based cross-sectional study was conducted utilizing data from the Nutrition and Health Survey in Taiwan (NAHSIT) 2013-2016. A total of seven BMD sites were evaluated, including the head, arms, legs, trunk, ribs, pelvis, and spine BMD. Besides, we further examined the association between the Daily Food Guide adherence score and osteoporosis (T-score of ≤ -2.5 standard deviation (SD) of a measured total BMD). A validated food-frequency questionnaire (FFQ) was used for dietary assessment. We included a total of 555 participants with osteoporosis and 1977 without osteoporosis in the final analysis. We found negative associations between levels of adherence to the Daily Food Guide and the risk of osteoporosis. The odds ratio (OR) for participants in the highest quartile of the adherence level was 0.61 (95% CI = 0.42-0.88), compared with those in the lowest quartile. When participants had total servings of six food groups higher than the recommendation, the protective effect still existed (OR = 0.59, 95% CI = 0.42-0.84). Better adherence to the Taiwan Daily Food Guide is associated with a lower risk of osteoporosis.

Associations between Adherence to the Taiwan Dietary Reference Intakes of Micronutrients and the Risk of Type 2 Diabetes.

The dietary reference intakes (DRIs) were established as guidance for the intake of micronutrients and other nutrients. However, how DRIs affect disease status has not been thoroughly examined. The aim of this study is to examine the associations between adherence to the DRIs of selected micronutrients and type 2 diabetes. A populational and cross-sectional study was conducted using data from the Nutrition and Health Survey in Taiwan (NAHSIT) 2013–2016. A total of 14 nutrient intakes, including those for vitamin A, C, D, E, B1, B2, B3, B6, B12, iron, magnesium, zinc, calcium, and phosphorus, were evaluated using the 24 h dietary recall method. Type 2 diabetes was defined as a fasting serum HbA1c level of 6.5% or higher and excluded participants who had received treatments for type 2 diabetes or reported a diagnosis of type 2 diabetes by physicians to avoid the possible inverse association. A total of 2685 participants aged 19 and above were included in the final analysis. After adjusting for confounders, we found that adherence to the DRI of vitamin A was associated with a reduced risk of type 2 diabetes among men. The odds ratio (OR) was 0.64 (95% confidence interval (CI) = 0.42–0.99) compared with men who did not adhere to the DRI. As for women, we found that adherence to the DRI of vitamin B1 was associated with a reduced risk of type 2 diabetes. The OR was 0.59 (95% CI = 0.35–0.97) compared with that for women who did not adhere to the DRI. This study showed that adherence to Taiwan DRIs of vitamin A for men and vitamin B1 for women might have beneficial effects on type 2 diabetes.

Trends in the distribution of body mass index, waist circumference and prevalence of obesity among Taiwanese adults, 1993–2016

Differences in the prevalence of general and abdominal obesity by subgroups such as age, sex, and education have been reported worldwide. Most studies in Taiwan regarding obesity prevalence were targeted at school-aged children or without further stratification by subgroups. Our aim was to examine the age-specific secular trend of body mass index (BMI), waist circumference (WC), and obesity prevalence stratified by sex, education and urbanization levels in Taiwanese adults. We used three waves of nationally representative population from the Nutrition and Health Survey in Taiwan (NAHSIT) 1993-1996 (n = 2 989), 2005-2008 (n = 2 495), and 2013-2016 (n = 2 880). The data included standardized measurement of body weight, height, and WC. We conducted a serial cross-sectional analysis among adults aged 20 years or above to examine the age-specific trends of BMI, WC, and the prevalence of underweight, overweight, general obesity, and abdominal obesity with stratification by sex, education, and urbanization levels. The general obesity prevalence was 16%, 21%, and 20% and the abdominal obesity prevalence was 27%, 42%, and 47% in the 1993-1996, 2005-2008, and 2013-2016 surveys, respectively. The age-specific secular trend of BMI differed across subgroups; however, the trend of WC increased rapidly regardless of subgroups, except for women aged ≥60 years. The general obesity prevalence increased noticeably among men, younger- and middle-age adults with high school or higher education, middle- and older-age adults with lower than high school education, people <39 and ≥50 years of age residing in rural areas, and among those between 30 and 59 and ≥70 years of age residing in urban areas. Although the increasing trend of general obesity prevalence was levelling off among several subgroups, the abdominal obesity prevalence increased significantly and rapidly in Taiwan. Future research in developing effective weight and WC control interventions tailored to different subgroups is urgently needed.

Updated upper limits of normal serum alanine aminotrasferase levels for screening metabolic dysfunction-associated fatty liver disease in obese children

Alanine aminotransferase (ALT) is a cost-effective screening test for asymptomatic liver diseases. The aims of this study are to redefine the ULNs of ALT using the 2010-2012 Nutrition and Health Survey in Taiwan (NAHSIT) database and to determine whether the updated ULNs can better screen for metabolic dysfunction-associated fatty liver disease (MAFLD) in obese children. Reference data were obtained from 2895 NAHSIT participants (1442 boys, 1453 girls) aged 6-18 years. Participants with any of MAFLD-related metabolic risk factors, including overweight/obesity, elevated triglyceride, low high-density lipoprotein cholesterol and high fasting glucose, were excluded. This study compared the sensitivities of different ULNs of ALT for detecting MAFLD in our previously established cohort of obese children. The ULNs of ALT defined as the 95th percentile in metabolically healthy NAHSIT participants were 23 IU/L for boys and 18 IU/L for girls. When using the updated ULNs, the percentages of elevated ALT levels were 13.0% in boys and 7.8% in girls of all NAHSIT participants. When using the updated ULNs of ALT to detect MAFLD in obese children, the sensitivity was 84.0% in boys and 74.3% in girls. In contrast, when using the conventional ALT cutoff (>40 IU/L), the sensitivity decreased to 61.4% in boys and 36.4% in girls. After taking into account MAFLD-related metabolic risk factors, the ULNs of ALT are 23 IU/L for boys and 18 IU/L for girls in Taiwan. The updated ULNs may be better cutoffs for screening MAFLD in obese children.

Quality of life and cognitive assessment in healthy older Asian people with early and moderate chronic kidney disease: The NAHSIT 2013-2016 and validation study.

Taiwan has the highest prevalence of chronic kidney disease (CKD). Impaired cognition and quality of life are significant phenomena in the late stages of CKD. We sought to obtain an overview and the attributable effect of impaired glomerular filtration on multiple domains in cognition and dimensions of quality of life for community-based healthy older adults in Taiwan. The study was derived from the Nutrition and Health Survey in Taiwan (NAHSIT) 2013-2016, a nationwide cross-sectional study conducted to sample healthy, community-based older adults aged ≥65 years in Taiwan. Participants were categorized into four CKD groups: CKD stage 1, stage 2, stages 3a and 3b, and stages 4-5. The Mini-Mental State Examination (MMSE) and the QoL questionnaire derived from the 12-item Short Form Health Survey (SF-12) were measured. Generalized linear mixed models (GLMMs) and principal component regressions were employed for the analysis and validation, respectively. Participants with moderate CKD (stages 3a and 3b) showed deficits in global MMSE, domain orientation to time, calculation, complex commands, and role-physical and vitality in QoL questionnaires. In GLMMs, impaired eGFR per 30 mL/min/1.73 m² was associated with lower global MMSE scores (β = -0.807, standard error [SE] = 0.235, P = 0.0007), domain orientation to time (β = -0.155, SE = 0.047, P = 0.0011), calculation (β = -0.338, SE = 0.109, P = 0.0020), complex commands (β = -0.156, SE = 0.079, P = 0.0494), and role-physical (β = -2.219, SE = 0.779, P = 0.0046) dimensions of QoL. Elderly Han Chinese adults with moderately impaired renal filtration could manifest cognitive deficits in orientation to time, calculation, and impaired quality of life in physical role functioning.

Developing and Validating Risk Scores for Predicting Major Cardiovascular Events Using Population Surveys Linked with Electronic Health Insurance Records.

A risk prediction model for major cardiovascular events was developed using population survey data linked to National Health Insurance (NHI) claim data and the death registry. Another set of population survey data were used to validate the model. The model was built using the Nutrition and Health Survey in Taiwan (NAHSIT) collected from 1993–1996 and linked with 10 years of events from NHI data. Major adverse cardiovascular events (MACEs) were identified based on hospital admission or death from coronary heart disease or stroke. The Taiwanese Survey on Hypertension, Hyperglycemia, and Hyperlipidemia (TwSHHH), conducted in 2002 was used for external validation. The NAHSIT data consisted of 1658 men and 1652 women aged 35–70 years. The incidence rates for MACE per 1000 person-years were 13.77 for men and 7.76 for women. These incidence rates for the TwSHHH were 7.27 for men and 3.58 for women. The model had reasonable discrimination (C-indexes: 0.76 for men; 0.75 for women), thus can be used to predict MACE risks in the general population. NHI data can be used to identify disease statuses if the definition and algorithm are clearly defined. Precise preventive health services in Taiwan can be based on this model.

Obese People Do Not Have a Higher Chance of Adherence to Recommended Daily Intake for the Most Nutrients

ObjectivesThere is a myth that obesity equals overnutrition. We conducted a study to examine whether obese people had a higher chance of adherence to recommended daily intake. MethodsA retrospective cross-sectional study was conducted using data from the Nutrition and Health Survey in Taiwan (NAHSIT) 2014–2016. NAHSIT is a nationwide representative survey aimed to investigate and monitor the nutritional status of Taiwanese people. Fourteen nutrient intakes, including vitamin A, C, D, E, B1, B2, B3, B6, B12, Fe, Mg, Zn, Ca, and P, were evaluated using 24-hour dietary recall. Logistic regression models will be used to determine whether obesity was related to the higher chance of adherence to recommended daily intakes. Stratified analyses were conducted by sex. Obese (body mass index (BMI) ≥ 27 kg/m2) and normal-weight (18.5 kg/m2 ≤ BMI < 24 kg/m2) people were defined according to the criteria of the Ministry of Health and Welfare in Taiwan. ResultsA total of 3075 participants (51% of females) aged 19 and above were included in the final analysis. After adjusting for age, body mass index, education level, marital status, and family income, as expected, we found that obese men have a higher chance of adherence to recommended daily intake of vitamin B3 (odds ratio (OR) = 1.70, 95% confidence interval (CI) = 1.29–2.23), Fe (OR = 1.46, 95% CI = 1.06–2.00), and Zn (OR = 1.41, 95% CI = 1.07–1.85), compared with normal-weight men. However, obese women have a lower chance of adherence to recommended daily intake of vitamin C (OR = 0.73, 95% CI = 0.56–0.95) and Mg (OR = 0.72, 95% CI = 0.54–0.95), compared with normal-weight women. For the most nutrient intakes, we found no difference between obese and normal-weight people in the chance of adherence to recommended daily intake. ConclusionsIn general, we found that obesity did not equal overnutrition. Obese women have insufficient intakes of some nutrients compared with normal-weight women. Our finding indicated that obese people might have more nutritional imbalance. Funding SourcesThis study was supported by China Medical University.

Household and schooling rather than diet offset the adverse associations of height with school competence and emotional disturbance among Taiwanese girls.

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. 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. The 2001-2002 NAHSIT for elementary schoolchildren. Totally, 2274 schoolchildren aged 6-13 years. Compared to normal height (-2< height for age z-score (HAZ) <2), shorter girls (HAZ ≤ -2) had a lower OSC (8·87 v. 10·5, P < 0·05) and taller girls (HAZ ≥ 2) had a better OSC (12·3 v. 10·5, P < 0·001). Maternal education and household income each contributed more than 5 % of OSC variance. OSC and HAZ among girls were positively associated and emotional disturbance negatively associated. Shortness-associated lower OSC underwent remediation with advancing school grade. Stature and OSC were not evidently related in boys. Shorter stature can compromise OSC among school girls. The major determinants in shorter girls are less household income and limited parental education.

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

Although nutritional health knowledge serves as the basis for the daily food guides, limited epidemiologic studies were conducted to verify whether adherence to the daily food guides reduced the prevalence of diseases. This study aims to examine whether adherence to the daily food guides relates to the lower risk of having metabolic syndrome, as well as to assess the association between levels of adherence to daily food guides and demographic characteristics. A cross-sectional study was conducted using data from the Nutrition and Health Survey in Taiwan (NAHSIT) 2013–2016. Face-to-face dietary assessments were conducted using a validated food-frequency questionnaire. Six food groups were defined according to the daily food guides in Taiwan. We constructed a daily food guide index to measure the levels of adherence to the daily food guides. Logistic regression was performed to assess the association between the levels of adherence to the daily food guides and the risk of having metabolic syndrome. A total of 2534 participants (51% of females) were included in the final analysis. After adjusting for age, sex, body mass index, education level, marital status, and family income, we found a negative correlation between the levels of adherence to daily food guides and the prevalence of metabolic syndrome. The odds ratios (ORs) for the highest versus lowest quartile of the adherence level was 0.65 (95% confidence interval (CI) = 0.48–0.88). In addition, males, younger age, lower education, divorced, separated, and widowed, and lower family income were associated with lower adherence to daily food guides. In conclusion, participants reporting better adherence to the daily food guides during the past month had a lower risk of having metabolic syndrome.

Dietary exposure assessment of methylmercury and polyunsaturated fatty acids in saltwater fish and processed foods among Taiwanese women of child-bearing age and children: A novel core food-matching approach

Saltwater fish is rich in health-promoting polyunsaturated fatty acids such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Excessive fish intake may also cause health hazards due to methylmercury (MeHg). A novel dose estimation method was proposed in this study to improve the quality of food matching by considering the usage ratio of cooking and processing methods in sampling design. In total, 39 table-ready samples were specified according to 2–3 common cooking methods, and MeHg and total mercury (THg) were analyzed. The results showed that mercury was detected in 20 samples (LOD = 0.01 μg/g). High MeHg samples included fried-Spanish mackerel (1.23 μg/g), non-cooked shredded swordfish (0.325 μg/g), pan-fried Spanish mackerel (0.248 μg/g), and non-cooked shredded salmon (0.208 μg/g). Consumption data (n = 166,911) were obtained from 24-h recalls in the 2005–2008 Nutrition and Health Surveys in Taiwan (NAHSIT). The average whole-group estimated daily intake (EDI_WG) was 0.018 (7.9% tolerable daily intake, TDI) for women of child-bearing age and 0.031 μg/day per kg body weight (13.6% TDI) for children. However, 95th percentile values (P95) of 90.4% TDI and 185% TDI were estimated for the two consumer-only populations, which have raised public health concerns. The ratio of % TDI to % daily reference intake (% DRI) was used as a risk–benefit (R/B) indicator. The top 4 R/B foods were: tuna sashimi (0.089 and 0.14), non-cooked shredded swordfish (0.033 and 0.052), fried-Spanish mackerel (0.027 and 0.043) and deep-fried fish balls (0.022 and 0.035) in the two perspective populations.

Changes in alcoholic beverage preference and consumption in Taiwan following accession to the World Trade Organization.

Given the growing concerns that international trade agreements may increase the supply of health-harming commodities, including alcohol, this study aimed to investigate the changes in alcoholic beverage preference and consumption after Taiwan's accession to the World Trade Organization (WTO). A before-and-after comparison analysis using data from two waves (1993-1996 and 2005-2008) of the Nutrition and Health Survey in Taiwan (NAHSIT), before and after Taiwan's accession to the WTO in 2002. Taiwan. A total of 5031 and 2910 participants aged 19years or older in NAHSIT 1993-1996 and 2005-2008, respectively. Alcohol measures included beverage-specific preference, mean daily ethanol consumption, and heavy drinking. Logistic regression was used to estimate the prevalence rate ratios and rate differences of beverage preferences between the two waves and the risk ratios of heavy drinking associated with different beverage preferences. A reduced prevalence rate of drinkers who preferred rice spirits (prevalence rate ratio [PRR]=0.47; 95% confidence interval [CI] = 0.24, 0.91) and Asian wine (PRR=0.11; 95% CI = 0.04, 0.29) was found in contrast to an increase in the preference for fruit wine (PRR=2.90; 95% CI = 1.75, 4.79); the preference for Asian spirits showed a non-significant increase (PRR=1.63; 95% CI = 0.88, 3.02). Similarly, the mean daily ethanol consumption decreased for Asian wine and increased for Asian spirits. Compared with beer, an increased risk of heavy drinking was associated with rice spirits (adjusted risk ratio [aRR]=3.30; 95% CI = 1.68, 6.47) and Asian spirits (aRR=2.64; 95% CI = 1.38, 5.01). After Taiwan became a member of the World Trade Organization and abolished its alcohol monopoly in 2002, the pattern of alcoholic beverage preference changed markedly, including a decrease in drinkers who preferred rice spirits and Asian wine (53% and 89% decrease, respectively) and an increase in drinkers who preferred fruit wine and Asian spirits (2.9-fold and 1.6-fold increase, respectively).

Total dietary studies and food safety assessment in Taiwan-food preservatives as an illustration

This second total diet study (TDS) in Taiwan was initiated to assess the health risk posed on general consumers from the dietary intake of benzoic acid and sorbic acid as an illustration of a risk assessment of food preservatives. Health risk was assessed by estimating the ratio of the exposure level to the acceptable daily intake (ADI) level of an analyte. This ratio, known as the hazard index (HI), must be less than 100% to ensure no health risk of concern. The ADI values were obtained from the Joint FAO/WHO Expert Committee on Food Additives (JECFA). The present TDS was conducted based on the two analytes, benzoic acid and sorbic acid. Exposure levels of the analytes were determined by using three sets of local data: 1) the analyte concentrations (C) in pertinent food samples, 2) the individual consumption rates (CR) of these food samples, and 3) the body weight (BW) of consumers. C values were obtained by chemical analysis of the analytes in food samples, while CR and BW values were derived from the database of the Nutrition and Health Survey in Taiwan (NAHSIT). The HI values were calculated using the equation below and expressed as % ADI. HI J = ∑1=ln%ADIJ = ∑1=lnADDlJ/ADIP×100% = ∑1=lnC1×CRlJ/BW J×ADIP×100% A scheme was developed to select food items to represent the total diet consumed in Taiwan. Based on the NAHSIT database, the total diet was classified into 12 categories and 47 sub-categories. By ranking food consumption rates, 128 food items were selected to form a basic list for the TDS, which represented 83% of the total diet consumed daily in Taiwan. Taking into consideration the occurrence pattern of the analytes in foods, the list was adjusted to a total of 97 food items for sample collection and preparation for chemical analysis. Food products were purchased from 50 strategic sampling sites throughout Taiwan over two seasons (spring/summer and autumn/winter) for two consecutive years. Food samples were prepared according to the conditions of serving and were homogenized and mixed prior to chemical analysis to obtain data on C, of which the maximum concentration of each food item was used to make a conservative estimate. The BW of nine age groups and CR of individual food items by each age group were used as exposure factors in risk calculation. The results indicated that the levels of exposure to benzoates and sorbates of the general consumers at 95 th percentile in Taiwan were below 50% ADI for benzoates and around 10% ADI for sorbates, which suggest relatively low risk of concern. The present TDS work has helped to renew and strengthen the framework of TDS in Taiwan and facilitate further similar risk assessment work on other target chemicals in food.

Timing of Energy Intake and Elevated Blood Pressures

Abstract Objectives To examine the association of timing of the first and last energy intake (EI) during a day, and number of eating episodes (EEs) with the elevated blood pressure in a representative sample of Taiwanese adults. Methods The data was based on Nutrition and Health Survey in Taiwan (NAHSIT) 2013–2016, which used a multi-stage, stratified clustering sampling scheme. Adults aged 19 years and with complete data of EEs and blood pressure were included (n = 3052). One-day 24-hour dietary recall data was used to define timing of the first and last EI during a day and number of EEs. EEs were defined as events that were separated 15 min between other EEs and we only counted EEs 50 kcal. Timings of the first and the last EI were defined as the earliest EE after midnight and the last EE before midnight, respectively. Elevated blood pressure was defined as systolic/diastolic blood pressure 130/85 mmHg. Logistic regression was used to examine the association of timing of the first and last EI during a day, number of EEs, with elevated blood pressure, adjusted for age, sex, educational level, employment status, smoking status, alcohol consumption, physical activity, sleep duration, sedentary time, total EI, specific food frequency, intention to lose weight, weekday or weekend, season, history of hypertension and medication, and the other two aspects of dietary time. Results As timing of the first EI was later, odds of elevated blood pressure was lower, compared with the first quartile group. (Q3: OR = 0.71[0.52–0.96], Q4: OR = 0.44[0.32–0.61]) Likewise, as timing of the last EI was later, odds of elevated blood pressure was also lower, compared with the first quartile group. (Q2: OR = 0.67[0.48–0.93], Q3: OR = 0.61[0.45–0.84], Q4: OR = 0.42[0.32–0.56]) More EEs were associated with lower odds of elevated blood pressure. (Q3: OR = 0.72[0.56–0.93], Q4: OR = 0.61[0.44–0.83]) Although the results were similar after adjustment for history of hypertension and medication, these significant findings vanished after models were adjusted for the other aspects of dietary time. Conclusions Later time of the first and last EI and fewer EEs were associated with lower odds of elevated blood pressure. The results of cross-sectional survey may still need further researches to support. Funding Sources Taiwan MOST

Increased adolescent coffee, tea, or other sugar-sweetened beverage consumption is associated with less satisfactory dietary quality, body fatness and serum uric over 18 years in Taiwan

Background and Objectives: Taiwan has a high density of convenience stores and beverage shops, which makes sugar-sweetened beverages (SSBs) very accessible to teenagers. This study examined the changes and the association between SSBs and biomarkers and nutrient intake, for teenagers over the course of 18 years using a national representative sample. Methods and Study Design: This cross-sectional study used data from the Nutrition and Health Survey in Taiwan (NAHSIT). Complete data for teenagers aged 13 to 19 years including a 24-hour dietary recall, anthropometric and clinical measurements, and SSBs from two periods were analyzed (1993-1996: N=1820; 2010-2011: N=2513). SAS callable SUDAAN was used for statistical analysis, adjusting for the sampling scheme. Log transformation was used for non-normal variables before linear models were used. Coffee or tea and SSB (excluding tea or coffee) consumers were categorized as non-drinkers, low (below), or high (above) consumers based on median intake during 1993-1996. Results: Intake of coffee or tea increased significantly in the 18 years of this study (p＜0.01), whereas intake of SSBs (excluding coffee or tea) decreased significantly (p＜0.05). Intake was significantly higher among ever-smokers and those with high total energy intakes (p＜0.01). For both coffee/tea and SSB, the high-intake groups had higher serum uric acid and intake of carbohydrates (p＜0.05), lower intake of protein and phosphorus (p ＜ 0.05) and lower dietary diversity score. Conclusions: Consumption of coffee or tea increased in adolescents during the 18 years. High intakes of SSB, coffee or tea was associated with high serum uric acid values and worse dietary quality.

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

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

Levels and temporal variations of urinary lead, cadmium, cobalt, and copper exposure in the general population of Taiwan.

Toxic metal contamination in food products and the environment is a public health concern. Therefore, understanding human exposure to cadmium (Cd), lead (Pb), cobalt (Co), and copper (Cu) levels in the general population of Taiwan is necessary and urgent. We aimed to establish the human biomonitoring data of urine toxic metals, exposure profile changes, and factors associated with metal levels in the general population of Taiwan. We randomly selected 1601 participants older than 7years of age (36.9 ± 18.7years (7-84years)) from the Nutrition and Health Survey in Taiwan (NAHSIT) conducted during 1993-1996 (93-96) and 2005-2008 (05-08) periods and measured the levels of four metals in the participants' urine samples using inductively coupled plasma-mass spectrometry. The median (range) levels of urinary Cd, Pb, Co, and Cu in participants from the NAHSIT 93-96 (N = 821)/05-08 (N = 780) were 0.60 (ND-13.90)/0.72 (ND-7.44), 2.28 (ND-63.60)/1.09 (0.04-48.88), 0.91 (0.08-17.30)/1.05 (0.05-22.43), and 16.87 (2.62-158.28)/13.66 (1.67-189.70)μg/L, respectively. We found that the urinary median levels of Pb and Cu in our participants were significantly lower in the NAHSIT 05-08 (Pb 1.09μg/L, Cu 13.66μg/L) than in the NAHSIT 93-96 (Pb 2.28μg/L, Cu 16.87μg/L; P < 0.01), whereas those of Cd and Co were significantly higher in the NAHSIT 05-08 (Cd 0.72μg/L, Co 1.05μg/L; P < 0.01). Youths had higher exposure levels of Pb, Co, and Cu than adults. Participants with alcohol consumption, betel quid chewing, or cigarette smoking had significantly higher median levels of urinary Pb or Cu (P < 0.01) than those without. Principal components and cluster analysis revealed that sex had different exposure profiles of metals. We concluded that levels of urinary Cd, Pb, Co, and Cu exposure in the general Taiwanese varied by age, sex, and lifestyles.

Increased coffee, tea, or other sugar-sweetened beverage consumption in adolescents is associated with less satisfactory dietary quality, body fatness and serum uric acid profiles over the past 18 years in Taiwan.

Taiwan has a high density of convenience stores and beverage shops, which makes sugar-sweetened beverages (SSBs) very accessible to teenagers. This study examined the changes and the association between SSBs and biomarkers and nutrient intake, for teenagers over the course of 18 years using a national representative sample. This cross-sectional study used data from the Nutrition and Health Survey in Taiwan (NAHSIT). Complete data for teenagers aged 13 to 19 years including a 24-hour dietary recall, anthropometric and clinical measurements, and SSBs from two periods were analyzed (1993-1996: N=1820; 2010-2011: N=2513). SAS callable SUDAAN was used for statistical analysis, adjusting for the sampling scheme. Log transformation was used for non-normal variables before linear models were used. Coffee or tea and SSB (excluding tea or coffee) consumers were categorized as non-drinkers, low (below), or high (above) consumers based on median intake during 1993-1996. Intake of coffee or tea increased significantly in the 18 years of this study (p<0.01), whereas intake of SSBs (excluding coffee or tea) decreased significantly (p<0.05). Intake was significantly higher among second survey and those with high total energy intakes (p<0.01). For both coffee/tea and SSB, the high-intake groups had higher serum uric acid and intake of carbohydrates (p<0.05), lower intake of protein and phosphorus and lower dietary diversity score (p<0.05). Consumption of coffee or tea increased in adolescents during the 18 years. High intakes of SSB, coffee or tea was associated with high serum uric acid values and worse dietary quality.

Soy-Based Foods Are Negatively Associated with Cognitive Decline in Taiwan's Elderly.

Cognitive impairment is a common neurodegenerative disease in the elderly. Dietary factors have an important role in cognitive dysfunction. Soy has many benefits, and consumption of soy-based foods is general in East Asian countries. In this study, we want to investigate the association between cognitive function decline and soy-based food intake among the elderly in Taiwan. This cross-sectional study was based on data obtained from the 2005-2008 Nutrition and Health Survey in Taiwan (NAHSIT). Subjects aged less than 65 y or with missing data were excluded. There was a total of 1,105 participants aged 65 and over who completed Short Portable Mental Status Questionnaire (SPMSQ). Eighty-five-point-six percent of participants consumed soy-based foods every day. After adjustment for potential variables, the logistic regression model showed significant associations for age, gender, education, soy-based foods intake and physical component summary (PCS). Age and female gender were both positively correlated with cognitive impairment (odds ratios: 1.1 and 4.43, respectively). Furthermore, there were negative correlations for education, soy-based foods intake and PCS (odds ratios: 0.25, 0.45 and 0.97, respectively). In this study, we found that soy-based foods were negatively associated with cognitive function decline among Taiwanese elderly. This result may be used as a reference for dietary advice for the elderly.