Adiponectin/ACP30, a collagen-like plasma protein in relation to anthropometric measurement in Thai overweight and obese subjects.

Adiponectin, anthropometric parameters including weight, height, body mass index (BMI), arm circumference, triceps skinfold, subscapular skinfold, waist, hip circumferences and waist/hip ratio were recorded in 48 male and 166 female overweight and obese Thai volunteers (BMI=25.0 kg/m(2)), and in 26 male and 81 female normal subjects (BMI=18.5-24.9 kg/m(2)). Thai volunteers were investigated. Statistically significantly lower adiponectin concentrations in overweight and obese subjects were found when compared with control subjects of both sexes. Anthropometric parameters, including weight, height, BMI, arm circumference, triceps skinfold, subscapular skinfold, waist, hip circumferences and waist/hip ratio, except arm span, were statistically significantly higher in overweight and obese subjects than in control subjects. The overweight and obese subjects had higher glucose concentrations than the control subjects. The BMI and glucose concentrations were found to be significantly related, under these conditions, to adiponectin.

Serum leptin and lipid profiles in Thai obese and overweight subjects.

The weight, height, body mass index (BMI), waist/hip ratio, serum leptin and lipid profiles of 48 overweight (BMI > or = 25.00). Thai males and 166 overweight Thai females, compared with 26 males and 81 females in a control group (BMI = 18.5-24.9 kg/m2), were investigated. Subjects for the study were those persons who turned up regularly for physical check-ups at the out-patient department, general practice section of the Rajvithi Hospital, Bangkok. The study was conducted between March-October, 1998. Statistically significantly higher levels of serum leptin, cholesterol, LDL-C, LDL-C/HDL-C ratio and triglyceride were found in the overweight compared with 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 median values of leptin serum concentrations in the overweight and obese males were significantly higher than those of the overweight and obese females. A total of 66.7% (32 out of 48) of the overweight and obese males had elevated leptin levels, while elevated leptin levels were found in 87.3% (145 out of 166) of the overweight and obese females. A total of 18.8% and 21.1% of the overweight and obese males and females respectively had cholesterol concentrations of > or = 6.48 mmol/l. However, the prevalence of low HDL-C (HDL-C < or = 0.91 mmol/l) was found to be 41.7% in the overweight and obese males and 4.2% in the overweight and obese females. Statistically significant associations were found between weight, height, BMI, waist, hip, waist/hip ratio, HDL-C, and serum leptin in both overweight male and female subjects. A negative correlation was found between serum leptin and LDL-C/HDL-C ratio in both the overweight and obese subjects.

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.

Activity, dietary intake, and anthropometry of an informal social group of Thai elderly in Bangkok.

Socio-demographic, anthropometric assessment, dietary pattern, lifestyle of 384 Thai elderly (55 males and 329 females) aged 60-94 years, who were members of an informal social activity group, were investigated. The 3-day dietary record was determined with the help of food models by random sampling of the group (seven males and 25 females). Most of the males investigated were married (88.9%), whereas 42.9% of the females were widowed. Nearly all of the elderly investigated lived with their relatives. Only 3% of the elderly had never attended school. More elderly males than females smoked or had smoked in the past, and this applies also to their drinking habits. The health situation of the individuals investigated seemed to be satisfactory. The most frequent diseases found among the elderly were chronic diseases, such as hypertension, hyperlipidemia and diabetes mellitus. No statistically significant difference in body mass index (BMI), arm circumference (AC), and hip circumference was found between males and females. Weight, height, mid-arm muscle circumference (MAMC), arm span, waist, waist/hip ratio and blood pressure of the males were significantly higher than those of the females. Tricep skin-fold thickness (TSF) and subscapular skin-fold thickness (SST) were lower for males than for females. A total of 54.5% of the males and 50.5% of the females were found to be over-nourished. Less than 2% of all the individuals investigated were undernourished. No significant differences were observed for all nutrients between the males and females. Intake of dietary energy from food for males and females was 69.8 and 75.5%, respectively, compared with the Thai RDA. When calculating the intake of macro-nutrients as percentage of total calorie intake, about 17% of the total calorie intake was attributed to fat, 13% to protein and 70% to carbohydrate for the males. For the females, the figures were 17, 15, and 68%, respectively. Intake of calcium, phosphorus, vitamin B1, B2 and niacin seem to be inadequate for both sexes.

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.

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.

Evaluation and monitoring of iodine deficiency disorders in school children in north-east Thailand.

The possibility of improving iodine deficiency disorder (IDD) in school children in Khon Kaen province was investigated during the period of 1 year, using an operational research approach. Four schools in Pupaman and Srichompu districts, namely Ban Khoa Wong, Na Fai Witaya, Ban Pa Num Tieng and Ban Non Khom, were selected for this study. Ban Non Khom served as the control school. Different methods were used for iodine fortification. Iodized salt was used for the children of the Ban Khoa Wong school, iodized water was used for Na Fai Witaya school and iodized fish sauce was used for Ban Pa Num Tieng school. The iodized salt, water and fish sauce were provided with the help of the school teachers under the supervision and advice of the team of investigators. Urine iodine excretion as well as palpation of the thyroid gland and the thyroid hormones T4, T3 and TSH were selected for monitoring and evaluation. The proportion of children with low urine iodine excretion, indicated by a cut-off point suggested by the WHO/ICCIDD/UNICEF working group, decreased during the course of the project in all schools receiving iodine supplementation as well as in the control school. However, the decrease was less in the control school in comparison with the implementation schools. Furthermore, the goitre rate decreased in all schools under investigation. The decrease of the goitre rate for the children of the control school might have been due to the activities of a village health volunteer from a nearby village who was using iodized salt for IDD control according to the ongoing national programme initiated by the Ministry of Public Health. No significant difference in the level of thyroid hormones was detected before or at the end of the supplementation for either the experimental schools or the control school. The results from the determination of thyroid hormone serum levels could not be used for assessing the outcome of the project. The measuring of urinary iodine excretion might be helpful in monitoring the iodine intake during the intervention phase. Long-term effects of iodine fortification could be seen best by the declining proportion of children with goitre. However, an observation of 1 year might not have been enough to clearly see the outcome of the project. The other possible contributing error to this study is intra-observer variation of the palpation technique when the sample size was not big enough. Goitrogens in this area might be another risk factor for the high prevalence rate of goitre. Further study in this field should be encouraged. The results of the study indicate that iodine fortification of salt and fish sauce is more effective than iodine fortification of drinking water. Due to the local preference of adding fish sauce (nam pla) instead of salt to almost all dishes, fish sauce proved to be the best vehicle for iodine fortification. The success of the project depended heavily on the understanding and cooperation of the school teachers and the school children. Major constraints in conducting this project were the insufficient distribution of iodized salt and potassium iodide solution for the fortification of drinking water, and the inconsistency of iodide concentration in the salt after fortification.

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.

Vitamin B1, B2 and B6 deficiency in primary school children infected with hookworm.

One thousand and seven hundred thirty-six school children from two districts in Nakhon Si Thammarat Province were screened for hookworm infection using the Kato-Katz stool examination technic. Two hundred students who have at least 2,000 eggs per g of stool were recruited into the program. The students were divided into six groups: groups 1, 2 and 3 were from Tha Sala district while groups 4, 5 and 6 were from Ronpibul district. Three milliliter blood samples were obtained from the cubital vein of each subject and were evaluated for erythrocyte transketolase activity (ETK) for vitamin B1, erythrocyte glutathione oxidoreductase activity (EGR) for vitamin B2, and erythrocyte aspartate aminotransferase activity (EAST) for vitamin B6. The school children were divided into three groups: those infected only with hookworm, those with both hookworm and Trichuris trichiura, and those whose stools show no parasite eggs. The results show that 10-20% of the school children are vitamin B1 deficient, about 40% to 80% are vitamin B2 deficient, and about 14% to 23% are vitamin B6 deficient. No correlation could be made between vitamin deficiencies and parasitic infection.

Serum proteins and nutritional status of free-living Thai elderly.

Fifty-six Thai males and 146 Thai females aged 60 years and above visiting a special clinic for the elderly were investigated. The serum protein and immunoglobulin of these elderly were assessed. Anthropometric measurements were also taken. From a random sample of the group, the dietary intake of main nutrients was determined by a 24 h recall method with the help of food models. Weight, height and mid-arm muscle circumference of males were greater than those of females. Triceps skinfold thickness was less in the males than in the females. Forty-seven per cent of the individuals investigated had alpha1-antitrypsin levels below 200 mg/dl and 25.4% had IgG levels of 200 mg/dl and 39% IgA levels above 450 mg/dl. The males tend to consume more calories in the form of carbohydrates than the females. The nutritional density of fat was less than 20% in the males. A negative correlation between serum albumin and height and a positive correlation between serum IgG and tricep skinfold thickness were found. Weight was found to have a positive correlation with calories, carbohydrates and fat. Height correlated positively with calories, protein and carbohydrates. Serum prealbumin correlated with fat intake. It is concluded that, except for alpha1-antitrypsin, IgA, serum proteins are found in a range normally detected also in elderlies in western countries. Body composition does not relate to level of protein intake.

Vitamin B1, B2 and B6 during the course of pregnancy of rural and urban women in northeast Thailand.

The vitamin B1, B2 and B6 status was investigated in a group of rural and urban pregnant women in the northeast of Thailand during the course of pregnancy. The vitamin status of all three vitamins did not change during the course of pregnancy even for the group of rural women. Differences between the group of village women and those females from a high socio-economic urban fraction of the population were only observed for the vitamin B2 status. The B2-dependent enzyme activation coefficient varies between 46.5 up to 56.7% for the rural and between 8.9 to 18.5% for the urban women. Vitamin B6 deficiencies as measured by the activation coefficient varied above 30% up to 40% and more for both groups of women. A functional significance could only be established for vitamin B2 deficiency. The increase of the activation coefficient correlated with an increase in the serum concentration levels of transferrin. Transferrin in turn was inversely correlated with haemoglobin.

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.

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.

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 B12, folic acid and haematological status of 132 Thai vegetarians.

Serum vitamin B12, folic acid and haematological variables of 132 Thai vegetarians (64 males and 68 females) were investigated. Forty-seven healthy omnivorous individuals served as controls. No statistical differences in haemoglobin concentration, packed red cell volume and mean corpuscular haemoglobin concentration between the vegetarians and controls had been detected. In the female vegetarians, the haemoglobin concentration and packed red cell volume were, however, statistically lower. No significant differences in the white cell counts and platelet counts were observed in both groups. A significant increase of basophilic stippling and reticulocytes was observed in the vegetarians. Serum vitamin B12 decreased and serum folic acid levels increased according to the duration of vegetarianism in the vegetarians. In the females practicing vegetarianism for 6-10 years or more, the proportion of serum vitamin B12 deficiencies was particularly high. The high percentage of vitamin B12 deficiency in the vegetarians might be related to megaloblastic anaemia. This form of anaemia is commonly associated with the presence of basophilic stippling. Therefore, the increased presence of basophilic stippling and reticulocytes might indicate a mild stage of this type of anaemia among the vegetarians.

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.

B vitamins status: effect of prolonged heroin addiction and methadone treatment.

Vitamin B1, B2 and B6 status were determined in 90 male heroin addicts admitted to Pramongkutklao Army Hospital. Their age (Mean +/- S.D.) was 25.5 +/- 7.8 years. Their activation coefficients of the enzyme transketolase, glutathione oxidoreductase and aspartate aminotransferase (ETK AC, EGR AC and EAST AC respectively) were significantly increased for addicts who were on drugs for a long time which indicated a biochemical deficiency. In addition, 26 follow-up cases treated with methadone for a period of one and two weeks were compared before and after treatment and it was found that ETK AC, EGR AC, and EAST AC were significantly decreased. This means that improvement in the vitamin B1, B2 and B6 status was obtained during admission.

Anthropometry, lipid- and vitamin status of 215 health-conscious Thai elderly.

A survey was carried out on 59 males and 146 females aged 60 years and above from a special clinic for the elderly in Bangkok. All of these subjects had no major complaints of ill health and, judging by their appearance, they seemed to be apparently healthy. 6.8% of the males and 11% of the females were found to be over-nourished. Less than 15% of all the individuals under investigation were suffering from hypertension, hyperglycaemia and hyperuricaemia. 35% of the males but only 13% of the females were anemic. The lipid status of the females was generally worse with statistically higher median values for total cholesterol, LDL-cholesterol and triglycerides than the males. There was no significant difference in the variation of HDL-cholesterol between the sexes. High vitamin C, B2 and B6 deficiency rates were observed in both the males and the females.

Seasonal variation of wasting and stunting in preschool children during a three-year community-based nutritional intervention study in northeast Thailand.

A nutritional intervention project was undertaken for three years in four villages located in a relatively prosperous irrigation area in northeast Thailand where sub-clinical undernutrition is still prevalent. Data were collected at each measuring pont from approximately 270 preschool children in four intervention villages. Approximately 120 children in three other villages in the same area served as controls for each measuring point. Various activities such as teaching nutrition, introducing supplementary feeding, and using and understanding weight charts, as well as home visits, were carried out in the intervention villages. An obvious improvement in the nutritional status of children in the intervention villages could be observed only after two years and nine months. In order that immediate action could be taken when a child was found to be undernourished or at risk of becoming undernourished in the near future, the nutritional indicator weight-for-height was used to assess the children's nutritional status. However, the best indicator determining the impact of the project was height-for-age. Intervention measures were successful in diminishing marked seasonal variations in the nutritional status observed in the study area. Statistical methods are given to evaluate a prospective study based on an incomplete repeated measure method.