Widjaja Lukito

Are the advantages of the Mediterranean diet transferable to other populations? A cohort study in Melbourne, Australia

A prospective cohort study, involving 141 Anglo-Celts and 189 Greek-Australians of both sexes aged 70 years or more, was undertaken in Melbourne, Australia. The objective was to evaluate whether adherence to the principles of the Mediterranean diet affects survival of elderly people in developed non-Mediterranean countries. Diet was assessed using an extensive validated questionnaire on food intake. A one unit increase in a diet score, devised a priori on the basis of eight key features of the traditional common diet in the Mediterranean region, was associated with a 17% reduction in overall mortality (two-tailed P value 0.07). Mortality reduction with increasing diet score was at least as evident among Anglo-Celts as among Greek-Australians. We conclude that a diet that adheres to the principles of the traditional Mediterranean diet is associated with longer survival among Australians of either Greek or Anglo-Celtic origin.

Skin Wrinkling: Can Food Make a Difference?

Objectives: This study addressed whether food and nutrient intakes were correlated with skin wrinkling in a sun-exposed site. Methods: 177 Greek-born subjects living in Melbourne (GRM), 69 Greek subjects living in rural Greece (GRG), 48 Anglo-Celtic Australian (ACA) elderly living in Melbourne and 159 Swedish subjects living in Sweden (SWE) participating in the International Union of Nutritional Sciences IUNS [Food Habits in Later Lifersqb; study had their dietary intakes measured and their skin assessed. Food and nutrient intakes were assessed using a validated semi-quantitative food frequency questionnaire (FFQ). Skin wrinkling was measured using a cutaneous microtopographic method. Results: SWE elderly had the least skin wrinkling in a sun-exposed site, followed by GRM, GRG and ACA. Correlation analyses on the pooled data and using the major food groups suggested that there may be less actinic skin damage with a higher intake of vegetables (rs=−0.31, p<0.0001), olive oil (rs=−0.29, p<0.0001), fish (rs=−0.24, p<0.0001) and legumes (rs=−0.16, p<0.0001), and lower intakes of butter (rs=0.46, p<0.0001) and margarine (rs=0.24, p<0.001), milk products (rs=0.16, p<0.01) and sugar products (rs=0.12, p<0.01). Similar findings were obtained using regression analyses, except fish was no longer significant; 32% of the variance for actinic skin damage was predicted by six out of the ten major food groups. In particular, a high intake of vegetables, legumes and olive oil appeared to be protective against cutaneous actinic damage (collectively explaining 20% of the variance); a high intake of meat, dairy and butter appeared to be adverse (explaining <5% of the variance). Prunes, apples and tea explained 34% of variance amongst ACA. Conclusion: This study illustrates that skin wrinkling in a sun-exposed site in older people of various ethnic backgrounds may be influenced by the types of foods consumed.

Randomized Trial of Probiotics and Calcium on Diarrhea and Respiratory Tract Infections in Indonesian Children

OBJECTIVE: To investigate the effects of calcium and probiotics on the incidence and duration of acute diarrhea and acute respiratory tract infections (ARTIs) in low-socioeconomic communities of Jakarta, Indonesia. METHODS: We conducted a 6-month, double-blind, placebo-controlled study in 494 healthy children aged 1 to 6 years who received low-lactose milk with low calcium content (LC; ∼50 mg/day; n = 124), regular calcium content (RC; ∼440 mg/day; n = 126), RC with 5.108 colony-forming units per day of Lactobacillus casei CRL431 (casei; n = 120), or RC with 5.108 colony-forming units per day of Lactobacillus reuteri DSM17938 (reuteri; n = 124). Number and duration of diarrhea and ARTIs episodes were primary and secondary outcomes, respectively. RESULTS: Incidence of World Health Organization–defined diarrhea (≥3 loose/liquid stools in 24 hours) was not significantly different between RC and LC (relative risk [RR]: 0.99 [95% confidence interval (CI): 0.62–1.58]), between casei and RC (RR: 1.21 [95% CI: 0.76–1.92]), or between reuteri and RC (RR: 0.76 [95% CI: 0.46–1.25]) groups. Incidence of all reported diarrhea (≥2 loose/liquid stools in 24 hours) was significantly lower in the reuteri versus RC group (RR: 0.68 [95% CI: 0.46–0.99]). Irrespective of the definition used, reuteri significantly reduced diarrhea incidence in children with lower nutritional status (below-median height-and-weight-for-age z score). None of the interventions affected ARTIs. CONCLUSIONS: RC milk, alone or with L casei, did not reduce diarrhea or ARTIs in Indonesian children. L reuteri may prevent diarrhea, especially in children with lower nutritional status.

Phenolic acid metabolites as biomarkers for tea- and coffee-derived polyphenol exposure in human subjects

Tea and coffee are rich in polyphenols with a variety of biological activities. Many of the demonstrated activities are consistent with favourable effects on the risk of chronic diseases. 4-O-methylgallic acid (4OMGA) and isoferulic acid are potential biomarkers of exposure to polyphenols derived from tea and coffee respectively. 4OMGA is derived from gallic acid in tea, and isoferulic acid is derived from chlorogenic acid in coffee. Our major objective was to explore the relationships of tea and coffee intake with 24 h urinary excretion of 4OMGA and isoferulic acid in human subjects. The relationships of long-term usual (111 participants) and contemporaneously recorded current (344 participants) tea and coffee intake with 24 h urinary excretion of 4OMGA and isoferulic acid were assessed in two populations. 4OMGA was related to usual (r 0.50, P<0.001) and current (r 0.57, P<0.001) tea intake, and isoferulic acid was related to usual (r 0.26, P=0.008) and current (r 0.18, P<0.001) coffee intake. Overall, our present results are consistent with the proposal that 4OMGA is a good biomarker for black tea-derived polyphenol exposure, but isoferulic acid may be of limited usefulness as a biomarker for coffee-derived polyphenol exposure.

Differential serum responses of tocopherols and tocotrienols during vitamin supplementation in hypercholesterolaemic individuals without change in coronary risk factors

Abstract The effects of tocotrienol-rich vitamin E from palm oil on serum vitamin E concentrations, serum lipids, plasma prostaglandins and platelet function (assessed by bleeding time and aggregation) were investigated in 44 subjects (23 males, 21 females) with hypercholesterolaemia. Following a 6-week run-in period, subjects were randomized for 20 weeks to receive either tocotrienol or placebo (superolein from palm oil), in increasing dosages. By the 4th week of supplementation, and at lowest dosages, there were significant increases in serum concentrations of total vitamin E, total tocopherol, and total tocotrienol in the active, but not placebo group, and these persisted in the highest dosage group for 16 weeks. At no stage during the study were there any significant changes in serum lipids (total cholesterol, HDL cholesterol, LDL cholesterol or triglycerides), or any changes in lipids predictable by serum vitamin E status itself, even when body composition was taken into account. There were also no changes in plasma prostaglandins or in platelet function. Evidence was obtained that the serum responses to ingested tocotrienols and tocopherols favoured tocopherol over tocotrienol, and alpha tocopherol over gamma tocopherol.

Probiotics Lactobacillus reuteri DSM 17938 and Lactobacillus casei CRL 431 Modestly Increase Growth, but Not Iron and Zinc Status, among Indonesian Children Aged 1–6 Years

Probiotics and milk calcium may increase resistance to intestinal infection, but their effect on growth and iron and zinc status of Indonesian children is uncertain. We investigated the hypotheses that cow milk with added probiotics would improve growth and iron and zinc status of Indonesian children, whereas milk calcium alone would improve growth but reduce iron and zinc status. A 6-mo randomized trial was conducted in low-socioeconomic urban communities of Jakarta. Healthy children (n = 494) were randomly assigned to receive low-lactose milk with a low calcium content of ∼50 mg/d (LC; n = 124), a regular calcium content of ∼440 mg/d (RC group; n = 126), regular calcium with 5 × 10(8) CFU/d Lactobacillus casei CRL 431 (casei; n = 120), or regular calcium with 5 × 10(8) CFU/d Lactobacillus reuteri DSM 17938 (reuteri; n = 124). Growth, anemia, and iron and zinc status were assessed before and after the intervention. Compared with the RC group, the reuteri group had significantly greater weight gain [0.22 (95% CI: 0.02, 0.42) kg], weight-for-age Z-score (WAZ) changes [0.09 (95% CI: 0.01, 0.17)], and monthly weight [0.03 (95% CI: 0.002, 0.05) kg/mo] and height [0.03 (95% CI: 0.01, 0.05) cm/mo] velocities. Casei significantly increased monthly weight velocity [0.03 (95% CI: 0.001, 0.05) kg/mo], but not height. However, the changes in underweight, stunting, anemia prevalence, and iron and zinc status were similar between groups. In conclusion, L. reuteri DSM 17938 modestly improved growth by increasing weight gain, WAZ changes, and weight and height velocity, whereas L. casei CRL 431 modestly improved weight velocity. Independent from probiotics supplementation, regular milk calcium did not affect growth or iron and zinc status.

Functional food and contemporary nutrition-health paradigm: tempeh and its potential beneficial effects in disease prevention and treatment

The roles of tempeh, an Indonesian indigenous and traditional fermented soy food, in disease prevention and treatment have gained worldwide recognition. Many scientific meetings have been held, and published manuscripts on tempeh have added to the scientific vocabularies of functional foods.1–3 Several studies undertaken in Indonesia demonstrated that tempeh had antidiarrheal4 and hypolipidemic5 effects. It is yet to be ascertained whether the antidiarrheal property of tempeh is through its antimicrobial activity6 or through gut immunity. It also remains to be seen whether tempeh has direct antiatherogenic effects7 without its hypolipidemic activity. Isoflavonoid phytoestrogens in soy, such as daidzein and genistein, are known to be responsible for the biological activities of tempeh. High soy food consumption was associated with lower breast cancer risk in Singaporean women.8,9 Soy food consumption improved vaginal cytology and bone mineral content in postmenopausal women.10, 11 Indeed, isoflavone content in tempeh is at least as high as that in soybean.12 Therefore, it is fair to speculate that tempeh has anticarcinogenic and antiosteoporotic activities, or further comprehensive studies need to be pursued. Although the new biological properties of non-nutrients such as phytoestrogen in tempeh have been revealed extensively, the conventional concept is still valid. During the recent socioeconomic crisis in Indonesia, consumption of animal protein, such as red meat and chicken, declined tremendously, especially among the poorer elements of society.13 Nevertheless, the consumption of soy foods such as tofu and tempeh has been successfully retained by at-risk communities.14 Again, a new conundrum has emerged, that tempeh is a protein-rich plant food for survival. REFERENCES

Validation of Predicted Total Body Water and Extracellular Water by Multi-Frequency Impedance in Young Indonesian Adults

To investigate the validity of the prediction of body water compartments by multi-frequency impedance in Indonesians, 42 adults (19 males and 23 females) were recruited in Jakarta, the capital of Indonesia. Extracellular water (ECW) and total body water (TBW) were measured with dilution techniques and predicted from body impedance at 1 and 100 kHz, respectively, using prediction formulas developed in a Dutch population. Furthermore, body weight, body height and body density were measured and as a measure of body build TBW/height and ECW/height were calculated. Percent ECW of body weight in both males (26 ± 3%) and females (23 ± 2%) was higher compared to the Dutch reference population, and also the body water distribution (ECW/TBW) was higher (0.46 ± 0.04) compared to the reference population. TBW/height and ECW/height appeared to be considerably lower in the Indonesian group compared to the reference group, indicating a more slender body shape. TBW was overestimated by 1.8 ± 2.4 and 2.5 ± 1.3 kg in males and females, respectively. ECW was underestimated in males by 0.1 ± 1.2 kg and slightly overestimated in females (0.1 ± 1.0 kg). After corrections for differences in body build and body water distribution the bias of the predicted TBW was markedly reduced from 2.2 ± 1.9 to 1.3 ± 1.8 kg (males and females combined). For ECW the bias after correction for body water distribution and body build was 0.3 ± 0.6 kg (males and females combined). It is concluded that multi-frequency impedance is suitable for the prediction of body water compartments at the population level but, due to differences in body build and body water distribution, validation in a larger group of Indonesian subjects is needed to avoid systematic prediction errors.

From 'lactose intolerance' to 'lactose nutrition'.

The concept of lactose intolerance has become embedded in Western medicine and developing economy medicine. It is based on evidence that intestinal lactase activity persists into later childhood and throughout life in only a minority of the worlds population, notably northern European-derived populations. These people have the T single nucleotide polymorphism (SNP) of the rs49882359 allele (C/T), also known as C/T-13910, the MCM6 gene which positively influences the lactase LCT gene. Other lactase persistent (LP) populations are found in Africa and the Middle East with different genetic variants. These SNPs represent co-evolution with dairying since the agricultural revolution and nutrient-dependent ecological adaptation. That said, gastrointestinal symptoms considered due to small intestinal lactose malabsorption are poorly correlated with lactase non-persistence (LNP), the situation for most people. With LNP, colonic microbiome lactase enables lactose fermentation to occur so that none is found in faeces. Whether the short chain fatty acids (SCFAs) and gases (hydrogen, carbon dioxide and methane) produced cause symptoms is dose-dependent. Up to 25 g of lactose at any one time can usually be consumed by a LNP person, but its food and meal pattern context, the microbiomic characteristics, age and other factors may alter tolerance. Thus, the notion that lactose intolerance is a disorder or disease of LNP people is misplaced and has been one of cultural perspective. What actually matters is whether a particular dairy product as normally consumed give rise to symptoms. It is, therefore, proposed that lactose tolerance tests be replaced with dairy food tolerance tests.

Double-Blind Randomized Placebo Controlled Trial Demonstrating Serum Cholesterol Lowering Efficacy of a Smoothie Drink with Added Plant Stanol Esters in an Indonesian Population

Indonesians have a high intake of saturated fats, a key contributing dietary factor to elevated blood cholesterol concentrations. We investigated the cholesterol lowering efficacy of a smoothie drink with 2 grams of plant stanols as esters to lower serum total and LDL-cholesterol concentrations in hypercholesterolemic Indonesian adults. The double-blind randomized placebo controlled parallel design study involved 99 subjects. Fifty subjects received control drink and dietary advice, and 49 subjects received intervention drink (Nutrive Benecol®) and dietary advice. Baseline, midline (week 2), and endline (week 4) assessments were undertaken for clinical, anthropometric, and biochemical variables. Compared to control, the smoothie drink with plant stanols reduced serum LDL-cholesterol concentration by 7.6% (p < 0.05) and 9.0% (p < 0.05) in two and four weeks, respectively. Serum total cholesterol was reduced by 5.7% (p < 0.05 compared to control) in two weeks, and no further reduction was detected after four weeks (5.6%). Compared to baseline habitual diet, LDL-cholesterol was reduced by 9.3% (p < 0.05) and 9.8% (p < 0.05) in the plant stanol ester group in two and four weeks, respectively. We conclude that consumption of smoothie drink with added plant stanol esters effectively reduces serum total and LDL-cholesterol of hypercholesterolemic Indonesian subjects already in two weeks. Trial is registered as NCT02316808.