Proceedings of the ILSI SEA Region 4th Expert Consultation and Planning Meeting on Maternal, Infant and Young Child Nutrition: Nutrition of Pregnant Adolescents in Southeast Asia

ntroduction: In August 2014, the ILSI SEAR Infant and Early Childhood Nutri¬tion Task Force held the 4th Expert Consultation and Planning Meeting on Mater¬nal, Infant, and Young Child Nutrition (MJYCN) in Jakarta, Indonesia. Methods: The consultation focused on the nutrition and health situation of pregnant adoles-cents. The objectives were therefore to: (1) discuss the current nutrition and health situation of pregnant and non-pregnant adolescent girls in six Southeast Asian countries (Brunei, Indonesia, Laos, the Philippines, Thailand, and Vietnam); (2) generate recommendations for teenage pregnancies in the region; and (3) identify regional issues, knowledge gaps and research priorities in order to improve ado¬lescent health in Southeast Asia. Results: There is very little information on the health and nutrition status of pregnant and non-pregnant adolescent girls (aged 10 to 19 years old) in Southeast Asia. In most countries, teenage pregnancy rates are higher in rural areas than in urban areas. Anaemia has been shown to be prevalent among reproductive aged females (15 to 49 years old). Indonesia, the Philippines and Vietnam have high levels of underweight adolescent girls. An increasing prevalence of overweight adolescent girls has been found in Indonesia, Thailand and Vietnam. Conclusion: There is a need for increased knowledge and understanding with regard to the health and nutrition status of female adolescents in the region (including micronutrient status and requirements), and factors that predispose girls to early pregnancy. Two types of program packages should be developed - one for adolescent girls who are not pregnant (aimed at promoting health and preventing early pregnancy) and another for those who are pregnant, including post-natal parenting support.

Effects of tuna fish oil on hyperlipidemia and proteinuria in childhood nephrotic syndrome.

This is a randomized, double-blind, placebo-controlled, cross-over study to determine whether tuna fish oil decreased hyperlipidemia and proteinuria in children with steroid-resistant nephrotic syndrome. Five boys were supplemented with both 4 grams of tuna fish oil and placebo in a randomized order for 8 weeks of each treatment separated by 6-week washout period. The results showed no statistically significant difference in serum creatinine, triglyceride, cholesterol, urine protein and creatinine clearance between fish oil supplemented group and placebo group. Small sample size, low dosage, short duration of supplementation and wash-out period are among the important limitations in this study. Further study should be performed to identify the effects of fish oil on this entity in nephrotic syndrome.

Elevated serum cholesterol levels in Bangkok children and adolescents.

Hypercholesterolemia is a major cardiovascular risk factor. This study aimed to assess serum total cholesterol (TC) levels of children and adolescents living in Bangkok, Thailand. During 1995-1997, nonfasting blood samples were obtained from 570 healthy school children and adolescents aged 9-18 years. The mean TC levels ranged from 143-180 mg/dl in males and from 145-202 mg/dl in females. The prevalences of hypercholesterolemia (TC > or = 200 mg/dl) were 12.2 per cent and 20.3 per cent in males and females, respectively. Twenty-eight per cent of males and 26.9 per cent of females had borderline values (TC 170-199 mg/dl). TC inversely correlated with age (r = -0.16, P < 0.01) in males. The findings indicate that notable percentage of these children had elevated cholesterol levels and warrant additional study concerning risk factors and tracking of lipoprotein levels from childhood into adulthood.

Reduction of rotavirus infection in children receiving bifidobacteria-supplemented formula.

This study was conducted at Pakkred Babies Home, Bangkok, Thailand; with the hypothesis that children receiving probiotic-supplemented milk-based formula may be protected from developing diarrheal diseases. Salivary rotavirus-specific IgA antibody was used as an indicator of rotavirus infection. One hundred and seventy-five children, aged 6-36 months, were enrolled in the study. They were divided into 3 groups according to the type of formula given. There were 81 episodes of diarrhea during an 8-month study period, most of which were caused by bacterial enteropathogens. Ninety-seven pairs of salivary samples were adequate for the analysis of rotavirus antibody. Among 23 children receiving milk-based follow-up formula and serving as control group, 30.4 per cent of them had > or = 4-fold increase in the antibody titre, indicating subclinical rotavirus infection. The majority of children in the other 2 study groups, receiving the same formula supplemented with either Bifidobacterium Bb12 alone or together with Streptococcus thermophilus, had no significant change in the antibody titres between the two time points. The results of this study support our hypothesis that children receiving bifidobacteria-supplemented milk-based formula may be protected against symptomatic rotavirus infection.

Combined raw cornstarch and nifedipine as an additional treatment in persistent hyperinsulinemic hypoglycemia of infancy.

This study reports the result of treatment with the combination of raw cornstarch and nifedipine in two infants affected with hyperinsulinemic hypoglycemia of variable severity. The first infant developed hypoglycemia during early neonatal period and required subtotal pancreatectomy. She still developed hypoglycemia after her second operation. The second infant developed hypoglycemia at the age of 7 months. Raw cornstarch and nifedipine efficiently normalized both infants' blood glucose levels. Although they still need frequent feedings, no hypoglycemic episode was reported except when they were sick. Their growth and development were markedly improved after initiation of treatment.

Allogeneic bone marrow transplantation in an osteopetrosis patient: first report in Thailand.

We described the successful allogeneic matched sibling bone marrow transplantation (BMT) in a 5-year-old Thai boy in whom osteopetrosis was diagnosed on the basis of anemia, thrombocytopenia, leukoerythroblastosis, sclerotic bone, hepatosplenomegaly, and visual deficit from an encroachment of cranial nerve foramina. The preparative regimen included 4 days of busulfan 4 mg/kg/day, and 4 days of cyclophosphamide 50 mg/kg/day. Complete hematopoietic engraftment and no evidence of graft versus host disease were shown after BMT. Complete hematologic findings were corrected. His hematopoietic chimerism was changed to that of his donor. Post BMT, he has no hepatosplenomegaly. His bone radiographic findings revealed normal after BMT. Bone marrow biopsy showed normalized bone and bone marrow matrix. However, his vision remained impaired. We believe that this is the first case of successful bone marrow transplantation in an osteopetrosis patient in Thailand.

Effects of multivitamin supplementation for improvement of thiamin, riboflavin, and retinol nutrition in pediatric patients.

The effect of multivitamin supplementation on thiamin, riboflavin and retinol nutrition was studied in ten male chronic pediatric patients at Ramathibodi Hospital. MTV forte (Government Pharmaceutical Organization) was given 1 tablet daily for ten days and the effect was compared with the preceding ten-day control period. Anthropometric biochemical, clinical and dietary assessments were performed throughout the study. Biochemical assessments of vitamin nutrition at the beginning and the end of a 10-day non-supplementation period revealed multiple vitamin deficiencies in the subjects, though clinical manifestation was not seen. Hospital diets improved vitamin nutrition of some patients but most of them still showed subclinical vitamin deficiencies. Improvement of vitamin nutrition was clearly shown in most patients after MTV supplementation. Multiple vitamin supplements should be prescribed in high-risk patients since there was no definite pattern of vitamin deficiencies in various diseases and early detection of vitamin deficiency was difficult to perform. The dosage between 1-2 times of RDA was considered adequate in most of our patients.

Vitamin E status, glutathione peroxidase activity and the effect of vitamin E supplementation in children with thalassemia.

Vitamin E and selenium statuses were studied in thalassemic children in comparison with 16 normal controls. Twelve Hb H disease, 46 beta-thal/Hb E and 7 beta-thal major patients had lower plasma vitamin E level than controls but plasma vitamin E/total lipids ratio of Hb H disease subjects was not different from normal. Twelve Hb H disease and 33 beta-thal/Hb E patients had normal RBC Se but increased RBC GSH-Px activity. Ten vitamin E-deficient thalassemic subjects had been supplemented with 200 mg of oral vitamin E for 4-8 weeks. After supplementation, their plasma vitamin E increased and H2O2 hemolysis decreased to normal values. Their RBC GSH-Px activity also decreased but hematocrit did not change significantly. The results demonstrate that some types of thalassemic patients have vitamin E deficiency and support that vitamin E and selenium have related functions in the prevention of RBC oxidation. Vitamin E supplementation increased RBC resistance to oxidative damage.

Maple syrup urine disease: case report of 2 Thai infants.

Maple syrup urine disease (MSUD) is a rare inborn error of metabolism characterized by typical urine odor. The deficiency of branched-chain ketoacid decarboxylase enzyme is responsible for the clinical abnormalities. The classical disease usually manifests in the neonatal period with lethargy, refused feeding, seizures and death. Since 1984, at the Department of Pediatrics, Ramathibodi hospital, 2 patients with classical MSUD have been seen. The parents of one patient were relatives and already had 2 affected but undiagnosed daughters. Both patients had strong urine odor which was described as the odor of boiled Chinese herbal medicine. The first child died at 4 months old and the second was severely retarded at one year old. The importance of early diagnosis and genetic counselling are emphasized.