Leptin concentration in relation to body mass index (BMI) and hematological measurements in Thai obese and overweight subjects.

The weight, height and body mass index (BMI), including waist/hip ratio, serum leptin and hematological parameters of 48 male and 166 female overweight (BMI > or = 25.00) Thai volunteers who came for a physical check-up at the Out-patient Department, General Practice Section, Rajvithi Hospital, Bangkok during the period March-October 1998, were investigated. There were statistically significantly higher levels of serum leptin, mean corpuscular mean corpuscular hemoglobin concentration (MCHC) and mean corpuscular volume (MCV) in the overweight than in the control subjects. The median serum leptin concentration in overweight subjects was 19.6 (2.0-60.0 ng/ml) compared with 9.0 (range 1.0-30.0 ng/ml) in the control subjects (p < 0.001). The medians of leptin in overweight and obese males were significantly higher than those of overweight and obese females. 66.7% (32 out of 48) of overweight and obese males were found to have elevated leptin levels, while 87.3% (145 out of 166) were found in overweight and obese females. Anemia was found in 18.7% of female overweight and obese subjects, using hemoglobin as an indicator. Significant associations were found between weight, height, BMI, waist, hip, waist/hip ratio, hemoglobin, hematocrit, and serum leptin in both male and female overweight subjects. A negative correlation was found between serum leptin and hemoglobin, and hematocrit in both overweight and obese subjects.

Promotion of the health of rural women towards safe motherhood--an intervention project in northeast Thailand.

An intervention project focusing on the health of women in the reproductive age was conducted in three districts of Khon Kaen Province, northeast Thailand between 1991 and 1996. Main emphasis was placed on improving reproductive health, the nutritional status including the iron deficiency anemia (IDA) as well as iodine deficiency disorders (IDD), and the parasitic diseases liver fluke (Opisthorchis viverrini) and hookworm. For implementation a community based Primary Health Care approach was used including the training of health officials in health matters, primary health care workers and villagers as well as enhancing health education and the dissemination of health information. The health delivery system was encouraged to take appropriate actions such as in the treatment of parasitic diseases and the control of IDA and IDD. Monitoring was done on a regular basis. The outcome of the project was assessed by comparing baseline data compiled from a random sample of the target population with the results of the final evaluation. An attempt to compare results obtained from villages within and outside of the project area failed most probably because of spill over effects. A number of important indicators on family planning and mother and child health care improved during the time the project was implemented; this included practising family planning, and participation in antenatal care. Also the proportion of females becoming pregnant for the first time when 20 years or older increased. Child-raising also improved in that almost all females gave colostrum to their babies by this time. Almost 75% of the women breast-fed their children. Improvements occurred in the nutritional status as far as the micronutrients iron and iodine were concerned, however the overall nutritional status of females did not change, but a rather high proportion of females were found to be overnourished. The project failed in reducing abortion and the proportion of females becoming pregnant when they are 18 years old or younger. It was also not possible to improve the usage of postnatal care. As anticipated, the results achieved so far are most suitable in serving as a training ground and providing a favorable example to improve family planning, mother- and child health care, and also the general health of females in the region, particularly in neighboring countries such as Lao PDR, Cambodia and Vietnam.

Erythrocyte antioxidant enzymes and blood pressure in relation to overweight and obese Thai in Bangkok.

The specific activities of antioxidant enzymes, [eg superoxide dismutases (SOD), glutathione peroxidase (GPX) and catalase (CAT)], anthropometric measurements, including waist/hip ratio of 48 male and 167 female overweight persons (body mass index (BMI) > or = 25.0 kg/m2) compared with a 26 male and 80 female control group (BMI = 18.5-24.9 kg/m2) of Thai volunteers who attended the Out-patient Department, General Practice Section, Rajvithi Hospital, Bangkok, for a physical check-up during March-October, 1998, were investigated. There was a slightly significant difference between the median age of the sexes. The medians of height, weight, and waist/hip ratio in males were significantly higher than those in female overweight and obese subjects. The median of arm circumference (AC), mid arm muscle circumference (MAMC) in males was significantly higher than those in female overweight and obese subjects (p < 0.05). The prevalences of hypertension based on systolic and diastolic blood pressure of > or = 160/> or = 95 mmHg, were 8.3% and 37.5% for males and 5.4% and 18.6% for females, respectively. There was no significant difference between the median of antioxidant enzymes (SOD, GPX and CAT) between the sexes. No significant differences in the antioxidant enzymes in male overweight/obese persons and normal controls were presented, whereas antioxidant enzymes in female overweight/obese persons were statistically lower than in control females (p < 0.05). A significantly higher SOD, GPX, and CAT status was observed in normal subjects compared with overweight/obese subjects (p < 0.01). A higher prevalence of SOD < or = 2,866 U/gHb, GPX (< or = 15.96 U/gHb in females was found, compared with males. A high percentage of lower catalase (CAT < or = 19.2x10(4) IU/gHb) was found in both sexes (64.5% in males and 64.5% in females). In obese subjects (BMI > or = 30.0 kg/m2), there were significantly positive relationships between systolic and diastolic blood pressure, systolic blood pressure and waist/hip ratio, and SOD could be related to weight, BMI as well as GPX and CAT, whereas the opposite result was observed for age and SOD.

Nutritional status of pre-school children and women in selected villages in the Suvannakhet Province, Lao PDR--an intervention trial.

A project to promote the health and nutritional status of women and pre-school children was started from 1995 to 1997 in three villages in Suvannakhet Province, Lao PDR. One village served as control. In 1995, for the baseline survey, 456 females, and in 1997, for the final evaluation, 363 females from the four villages volunteered for further investigations. An attempt was made to involve all females in the reproductive age residing in the villages. At the same time also the nutritional status of 321 and about 540 randomly selected pre-school children respectively was also assessed through physical examination and anthropometric measurements. Intervention measures included introducing growth charts and taking regular anthropometric measurements of women in the reproductive age and of pre-school children. Training in nutritional aspects such as giving colostrum to new-borns, prepare proper weaning food and supplementary feeding, animal-raising and home gardening was also introduced and provided to health personnel, village leaders and in women clubs. Special attention was given to the control of acute infectious diseases. The conventional EPI program was enforced as well. Health education in matters of mother and child health care was also provided. The proportion of undernourished women was rather high at about 15%. For pre-school children, the proportion of wasting was around 5%, and of stunting 50% and above. Intervention did not improve the nutritional status either of the women or of the children. It was concluded that the time span of two years is too short for a decrease in the proportion of undernourishment to be observed. An improvement was achieved for some indicators of mother and child health care. This seems to indicate the population's willingness to follow suggestions to improve their health. Most probably, if attempts to improve the nutritional status were continued, an improvement in this aspect could also be observed, if the population can be encouraged to take actions and develop initiatives by themselves.

Urinary iodine excretion as a predictor of the iodine content of breast milk.

Endemic goitre has re-emerged in Thailand. This is particularly dangerous for children since iodine deficiency disorders (IDDs) might negatively influence their intellectual and mental development. In order to assess the situation, the iodine content of breast milk was determined and a method is proposed on how to monitor IDDs in lactating mothers later on. Seventy-five lactating women aged from 15 to 45 years, from 12 villages of 3 districts, namely Chumpae. Srichompu and Pupaman within the mountainous areas of Khon Kaen province, Northeast of Thailand were investigated. The breast milk from 46.7 per cent of mothers was found to be below recommended standards. In addition, 52.0 per cent of the women investigated had low urinary iodine excretion. The risk of women with low iodine excretion was 15 fold higher in comparison to women with sufficient iodine excretion to provide breast milk for their babies with insufficient iodine content. It is concluded that urinary iodine excretion can be used to monitor the IDDs in lactating mothers.

Nutritional status of school children in an endemic area of iodine deficiency disorders (IDD) after one year of iodine supplementation.

To improve the health and nutritional status of school children in an area of iodine deficiency disorders (IDD) by means of different iodine fortifications in salt, fish sauce and drinking water, anthropometric assessment for nutritional measurement, including hematological status, were performed. There was a significant difference in the weight and height of the children from the four schools investigated, before and after supplementation in each school. The prevalence of anemia (as indicated by hematological measurement) and iodine deficiency (as indicated by urinary iodine concentration in the children from the four schools) were assessed and compared before and after iodine supplementation; a decrease in prevalence was found in all school children, however, serum ferritin did not change before and after supplementation.

Alpha 1-antitrypsin phenotype of children with liver diseases in Thailand.

Alpha1-antitrypsin deficiency (PiZZ) constitutes not only the most common hereditary cause of liver diseases, but also of the most prevalent metabolic diseases in need of liver transplantation. It is a codominantly inherited disorder which predisposes to chronic liver disease, usually beginning in early infancy. The purpose of the present study has been to investigate alpha 1-antitrypsin phenotype in pediatric patients with various liver diseases. Phenotypic identification of alpha 1-antitrypsin variants has been carried out in 69 children with various liver diseases and 100 healthy controls using isoelectric focusing on polyacrylamide gel slabs. PIMM represents the most common phenotype detected in both groups (92% in the group with liver diseases and 88% in normal controls). We could detect PiZZ in only one healthy child but in none of those with liver diseases. Consequently alpha 1-antitrypsin deficiency does not appear to be a common cause for liver disease among children in Thailand. Further studies are necessary to elucidate the frequency of various alpha 1-antitrypsin variants and the clinical relevance with respect to liver diseases in Thailand.

Vitamin B12, folic acid, ferritin and haemoglobin status of rural women in child-bearing age in northeast Thailand.

Serum vitamin B12, folic acid, ferritin and haematological variables were investigated in six hundred and seven women from 12 villages of 3 districts namely Chumpae, Srichumpu and Pupaman of Khon Kaen province, Northeast Thailand within the age range of 15-45 years. The cut-off point of haemoglobin concentration < 12 g/dl was applied for defining the normal and anaemic group (17.3%). The result showed that the concentration of ferritin, folic acid and vitamin B12 in the anaemic group were less than that of the normal group. Forty six out of 607 women or 7.6 per cent were found to be undernourished and 27.2 per cent of females were overnourished. The prevalence of deficiencies of vitamin B12, folic acid and ferritin were 6.3 per cent, 4.3 per cent and 12.5 per cent respectively.

Prevalence of abnormal glucose tolerance in Khon Kaen Province and validity of urine stick and fasting blood sugar as screening tools.

Three hundred and fifty-five individuals, 152 males and 203 females, aged between 30 and 74 years, were randomly selected in a two stage selection process from rural communities in three districts of Khon Kaen Province, Northeast Thailand. The prevalence of impaired glucose tolerance (IGT) and non-insulin dependent diabetes mellitus (NIDDM) in the rural area of Northeast Thailand were measured. In addition, the validity of the urine stick and fasting blood sugar as screening tools against the two hours glucose loading test as golden standard were determined. The survey was conducted in July 1995. The glucose loading test was performed on 277 individuals. IGT and NIDDM were classified according to current World Health Organization suggestions. Prevalence rates for IGT were 18.1 per cent and for NIDDM 11.9 per cent. No difference was found between males and females, also when controlled for age. NIDDM prevalence increased with age but IGT rates already were high in the younger age groups. This finding suggests that IGT precedes NIDDM in Thailand. The validity of the urine stick as a screening tool in communities was insufficient, with a sensitivity of less than 20 per cent. When using fasting blood sugar as a screening test, the sensitivity was close to 44 per cent and the specificity 90 per cent. It is concluded that the urine stick is not a useful screening tool and the method of using blood sugar concentrations for screening have to be improved before it can be applied within communities.

Risk factors for chronic diseases among road sweepers in Bangkok.

The nutritional and health status of road sweepers in Bangkok was investigated. Fifty-seven males and one hundred thirty-four females from 10 districts were selected for the study. The districts were sampled as cluster at random. From each district selected about 50% of road sweepers volunteered to participate in the investigation. Through questionnaires the age, marital status, place of origin, drinking and smoking habits were assessed. Anthropometric measurements, blood pressure and the lipid profile of these subjects were determined. According to a physical check-up and X-rays taken, all individuals investigated were apparently healthy. The age of the study group varied between 26 and 57 years. The median for the males was 47 years and for the females 37.5 years. Almost all the road sweepers were married. Smoking and alcohol drinking was widespread. Over- and undernutrition was found among the group investigated. 26.3% of the males and 1.5% of the females were undernourished. According to their systolic values, 15.8% of the males and 6.7% of the females were suffering from hypertension, and 38.6% of the males and 15.7% of the females had hypertension according to their diastolic values. 58.2% of the females and 29.3% of the males were overnourished. 57.9% of the males and 59.7% of the females had cholesterol levels above 200 mg/dl. Pathological values of LDL cholesterol were determined in 26.3% of the males and 28.4% of the females. The habit of consuming tonic drinks was widespread among the workers. The study concluded that behavior risk factors are highly prevalent in the group of workers belonging to the lower socio-economic class. Further investigations are presently being undertaken to study the after-effects of air pollution among this group of workers. The results will be subsequently reported in future publications.

alpha 1-antitrypsin phenotype PiMZ, a risk factor for liver cirrhosis but not for liver cancers in Thailand.

The risk of developing liver cirrhosis, hepatoma (HCC) and bile duct carcinoma (BDC) have been associated with homozygous alpha 1-antitrypsin (AT) deficiency especially linked to the Z allele. While the association between liver cancers and AT deficiency remains debatable, the risk of adult AT deficiency carriers to develop liver cirrhosis has not been assessed quantitatively. Liver cancers and liver diseases with subsequent liver cirrhosis are highly prevalent in tropical countries such as Thailand and heterozygous AT phenotypes are rather common in this country as well. The aim of this study was to assess the risk of developing liver cirrhosis, HCC and BDC by means of case-control studies with Thai patients and controls in connection with AT deficiency. For hepatitis, HCC and BDC to association with AT deficiency was detected. Carriers of PiMZ phenotype in Thailand have a high risk to develop liver cirrhosis (odds. ratio of 10.8, 95% confidence interval = 1.3-88.1). Patients with predisposing diseases should be screened for Pi phenotypes so that rigorous measures to combat the occurrence of liver cirrhosis can be implemented.

Vitamin B12, folic acid, ferritin and haematological variables among Thai construction site workers in urban Bangkok.

Serum vitamin B12, folic acid, ferritin and haematological variables were investigated in eighty-seven male and nineteen female construction site workers in Bangkok. Haemoglobin concentration, haematocrit and MCHC were found to be higher in male than in female workers. Serum ferritin was slightly higher in males than in females. Serum B12 was found to be higher in male than in female workers and serum folic acid level were significantly higher in female than in male workers. Vitamin B12 deficiency was found in 2.3 per cent and folic acid deficiency in 6.9 per cent of the male workers. Serum vitamin B12 and folic acid levels were normal for female workers. The adequate serum levels of vitamin B12 and folic acid might be the result of the habit of the workers to consume tonic drinks which contain glucose, caffeine, and vitamins especially vitamins B6, and B12.

Compliance of population groups of iodine fortification in an endemic area of goiter in northeast Thailand.

Methods of iodine fortification were tested among women of child bearing ages in four villages of Khon Kaen province, an endemic area of goiter in northeast Thailand, Ban Wang Pa Dum, Ban Pa Klauy and Ban Non Chart received iodine fortified in fish sauce, salt and drinking water respectively, whereas, Ban Non Sa-aad served as a control village. Urine iodine concentrations were investigated before supplement and after three and six months of the experimental period. Three months after supplement, urine iodine levels of villagers from Ban Non Chart and Ban Non Sa-aad were higher than those of Ban Wang Pa Dum and Ban Pa Klauy. Six months later, subjects from Ban Wang Pa Dum and Ban Pa Klauy who had received fortified fish sauce and iodinated salt respectively had significantly higher urine iodine concentrations than those of the other two villages. The result implied that fortified fish sauce and iodinated salt were well accepted by the villagers. However, fortified fish sauce might be the best and most feasible method because villagers use fish sauce more constantly in cooking and salting dishes.

Quetelet index, hemoglobin and parasitic infection of rural women in northeast Thailand.

The Quetelet index, hemoglobin and parasitic infection rates of adolescent and young women from 21 villages in Northeast Thailand were assessed. Data were collected in the hot, rainy and cold seasons of the year. The proportion of undernourished females varied between 10 and 15% when a cut-off point of 18.7 of the Quetelet index was chosen. 23 to 33% of the women had hemoglobin levels below 12 g%. Parasitic infection rates with various intestinal helminths were high but not related to the nutritional status or anemia.

Socio-demographic characteristics and health status of urban Thai elderly.

Socio-demographic and health status of 205 elderly aged 60-90 years who attended a special clinic for the elderly at Rajvithi Hospital were investigated. All of the subjects had no major complaints and seemed to be apparently healthy. Socio-economic situation, life-style pattern and other health related information was assessed. Nearly all of the elderly lived with their relatives. Quite a high number of the females had never attended school. Almost 60% of the elderly had no regular income. The health situation of the individuals under investigation seemed to be satisfactory. The majority did not smoke and did not drink alcohol. There are indications that in the future more of the elderly population will stay alone and will face economical problems because of the absence of general social security scheme for Thailand.

Parasitic infection and socio-demographic characteristics of urban construction site workers.

The socio-demographic characteristics and prevalence of parasitic infection of 117 (96 males and 21 females) construction site workers were investigated by means of questionnaires and stool examinations. The age characteristics of the individuals investigated varied widely from 15-60 years with a high percentage in the 21-30 years age range, no sex differences were discovered. Most of the workers received primary education even though some of them did not complete it. The percentage of illiteracy in females was quite high (9.5%) compared with males (2.1%). About 60% and 20% of these construction site workers migrated from the northeastern and northern regions of Thailand, respectively. 79.3% of male and 94.7% of female workers were found to be infected with parasites. Hookworm and Opisthorchis were predominant parasites.

Urine iodine concentration and prevalence of goiter among rural women of child bearing ages in Northeast Thailand.

Iodine deficiency was investigated in 575 women from 12 villages of Pupaman, Si Chomphu and Amphoe Chum Phae in Khon Kaen province in a project survey under Thai-German cooperation entitled "Promotion of Health and Nutrition Status of Rural Women in Northeast Thailand". The prevalence of goiter (grades 1A, 1B, 2 and 3) were 71.6 per cent in Pupaman, 58.4 per cent in Amphoe Si Chomphu and 35.1 per cent in Amphoe Chum Phae. However, the percentage of urine iodine deficiency of the women from these districts, is reversely with the palpation grading of thyroid gland. The high prevalence of goiter in Pupaman might occur due to goitrogenic effects, although the urine iodine concentration was lower than other districts. Further study about the determination of thiocyanate should be suggested in the high prevalence of goiter.

Nutritional health and parasitic infection of rural Thai women of the child bearing age.

The nutritional and health status of non-pregnant women of child bearing age from 20 villages of two districts in Maha Sarakham Province, approximately 500 km northeast of Bangkok, were investigated in April 1987. About 12 per cent of the studied women had a body mass index below 18.7 which is used as a cut-off point of being undernourished. Fat stores and muscle mass were smaller when compared to western females. Only two per cent of the women investigated had low serum albumin, indicating a severe deprivation in the nutritional status. A relatively high prevalence of anaemia was also found. Iron deficiency and haemoglobinopathy are common causes of anaemia. In addition, vitamin B2 depletion also contributes to the high rate of anaemia. Gastrointestinal parasitic infection rates were high with liver fluke, hookworm and echinostomiasis. Hookworm infection had no effect on the rate of anaemic, most probably the worm load in the women infected was rather low. It is recommended that the nutritional health of rural adolescents and young women should be enhanced by generally improving dietary habits and the quality of nutrient intake especially through protein, vitamins and micronutrient. Public health programmes focused on preventive activities should be aimed at this group in order to reduce the prevalent rate of undernutrition, anaemia and parasitic infection.

Vitamin B12, folic acid and haematological status in elderly Thais.

Serum vitamin B12, folic acid and haematological data from 147 elderly people (55 males and 92 females) who visited the special clinic for the elderly at Rajvithi Hospital, Bangkok between July and November 1989 were investigated. The individuals studied came from a health-conscious group of the middle socio-economic class in Bangkok. All of them were fairly well except for minor ailments and typical diseases of elderly people such as hypertension, mild to moderate degree coronary heart diseases and non-insulin dependent diabetes mellitus. There was a statistically significant difference in haemoglobin concentrations between males and females. According to the standard haemoglobin cut-off point values of 13 g/dl for males and 12 g/dl for females, anaemia was detected in 22 (15%) of the 147 subjects. The percentage of folic acid deficiency was found to be 20.6 per cent (30 of the 147 cases). Vitamin B12 insufficiency was found in only 6.9 per cent (10 of the 147 cases). No statistically significant correlation between haemoglobin, folic acid and vitamin B12 was found. However, when the data were grouped according to different intervals of increasing haemoglobin concentrations, for females there was a tendency for serum vitamin B12 to decrease, and serum folic acid to increase in both males and females. The results of this study suggest that folate deficiency may play a role in the occurrence of anaemia in elderly people, and therefore, dietary counselling and supplementation of folic acid are recommended.

Vitamin B1, B2 and B6 status of vegetarians.

The vitamin B1, B2 and B6 status was determined in 132 healthy vegetarians, age range 25-57 years who have been practising vegetarianism for 1-22 years. Sixty-eight healthy non-vegetarians were chosen as controls. The conventional methods to measure the activation coefficient alpha ETK, alpha EGR and alpha EAST were applied to assess the vitamin status of B1, B2 and B6 respectively. The value of 1.25 alpha ETK, 1.5 alpha EGR and 2.0 alpha EAST and above indicate a deficiency in the vitamin status. The results showed significantly poorer vitamin B1 and B6 status in vegetarians than in non-vegetarians, whereas, no significant difference in vitamin B2 status was found. None of the non-vegetarians were deficient in vitamin B1 but 3 of them (4.4%) were deficient in vitamin B6. On the other hand, 10 of vegetarians (7.6%) were deficient in vitamin B1; 38 (28.8%) in vitamin B6. A high prevalence of riboflavin deficiency was found in 32 (24.2%) of the vegetarians; as well as in 15 (22.2%) of the non-vegetarians. Only riboflavin status was significantly related with the duration of vegetarianism practiced. Vegetarians should be considered as the vulnerable group for vitamin B2 and vitamin B6 deficiencies. B-vitamins status should be checked and efforts should be made to improve through dietary counselling and nutritional education should be included and stress in the health education program in order to improve nutritional deficiencies.