25-hydroxy-vitamin D demography and the risk of vitamin D insufficiency in the South East Asian Nutrition Surveys (SEANUTS).

The South East Asian Nutrition Surveys (SEANUTS) were conducted in 2010/2011 in Indonesia, Malaysia, Thailand and Vietnam in country representative samples totalling 16,744 children aged 0.5 to 12 years. Information on socio-demographic and behavioural variables was collected using questionnaires and anthropometric variables were measured. In a sub-sample of 2016 children, serum 25-hydroxy-vitamin D (25(OH)D) was determined. Data were analysed using SPSS complex sample with weight factors to report population representative data. Children were categorized as deficient (<25 nmol/L), insufficient (<50 nmol/L), inadequate (<75 nmol/L) or desirable (>=75 nmol/L). In Malaysia and Thailand, urban children had lower 25(OH)D than rural children. In all countries, except Vietnam, boys had higher 25(OH)D levels and older children had lower 25(OH)D. Regional differences after correcting for age, sex and area of residence were seen in all countries. In Thailand and Malaysia, 25(OH)D status was associated with religion. The percentage of children with adequate 25(OH)D (>=75 nmol/L) ranged from as low as 5% (Indonesia) to 20% (Vietnam). Vitamin D insufficiency (<50 nmol/L) was noted in 40 to 50% of children in all countries. Logistic regression showed that girls, urban area, region within the country and religion significantly increased the odds for being vitamin D insufficient. The high prevalence of vitamin D insufficiency in the (sub) tropical SEANUTS countries suggests a need for tailored approach to successfully combat this problem. Promoting active outdoor livestyle with safe sunlight exposure along with food-based strategies to improve vitamin D intake can be feasible options.

Low Sleeping Time, High TV Viewing Time, and Physical Inactivity in School Are Risk Factors for Obesity in Pre-Adolescent Thai Children.

OBJECTIVE: Explore the association between physically active behavior and obesity in 7- to 12-years-old Thai children. MATERIAL AND METHOD: As part of SEANUTS Thailand, information on anthropometry, physical activity, and sociodemographic variables were collected in 7- to 12-years-old urban and rural Thai children. Multi-stage sampling technique was used and 1,345 children (32% urban, and 50.3% boys) participated in the study. Anthropometric measurements included weight, height, and BMI-for-age Z-scores (BAZ) using World Health Organization Growth Reference. Obesity was defined as BAZ > 2SD. Physical activity was assessed using a validated physical activity questionnaire (PAQ). The PAQ provided an activity score, activity time in school, sleeping hours, and TV watching time as categorical variable, low, moderate, and high. Chi-square by likelihood ratio test and logistic regression were used to compare obese and non-obese groups. RESULTS: The overall prevalence of overweight and obesity was 10.2 and 10.8% respectively, whereas 8.2% was classified as thin. Maternal education and religion did not differ between obese and non-obese children. However, obese children's family income was higher. After controlling for family income, maternal education, and religion, obese children were significantly less active during break times in school, slept less, and watched more TV than non-obese. However, there was no difference in the activity score of obese and non-obese children. CONCLUSION: The study showed that physical activity during break time in school, sleep duration, and hours of TV viewing were associated with obesity in pre-adolescent Thai children. It is important to note that activity score was not associated with obesity. One of the most important benefits to be physically active in childhood is the potential to maintain this behavior into adulthood. Therefore, programs that encourage healthy behaviors and address these modifiable risk factors should be incorporated in the school curriculum.

FACTORS ASSOCIATED WITH VITAMIN D STATUS AMONG THAI CHILDREN AGED 3-13 YEARS.

The impact of vitamin D status on bone health and other health conditions is receiving increasingly attention. We aimed to determine the association between environmental factors and vitamin D intake by examining serum 25-hydroxy vitamin D [25(OH)D] levels in Thai children. We conducted a cross sectional study among 477 Thai children from 4 regions in Thailand. Vitamin D intake was assessed using a self-administered questionnaire completed by the older children or by the parents for younger children. Dietary vitamin D intake was assessed using a semi-quantitative food frequency questionnaire. A serum 25(OH)D level was examined for each subject using a chemiluminescence immunoassay. We used structural equation modeling (SEM) to assess the association between studied factors and the serum 25(OH)D level. The final model showed a significant association between sunlight exposure and the serum 25(OH)D level (ß = 0.65, p < 0.01), but not between dietary vitamin D intake and the serum 25(OH)D level (p = 0.01, p = 0.77), suggesting sunlight exposure is more important for the vitamin D status than dietary vitamin D intake.

Prevalence of childhood and adolescent obesity in Thailand: a review.

BACKGROUND: Obesity in children and adolescents is a major public health problem in many countries including Thailand However the use of different growth references applied to the data could contribute to the difference in magnitude of problem. OBJECTIVE: To examine the prevalence rate of overweight and obesity among Thai children and adolescents between 1995 and 2012. MATERIAL AND METHOD: Relevant published articles and nutrition survey reports were obtained by a systematic search through multiple electronic databases published between 1995 and 2012. RESULTS: Of 627 published articles and reports retrieved, six national surveys were examined for the trend of childhood obesity. With the use of Thai growth references, the trends of obesity among preschool, school-age children, and adolescents were found to fluctuate between 1995 and 2009. This might be due to the difference in age categorization and use of dissimilar growth references. The use of the 2000 International Obesity Task Force (IOTF) reference provided a lower estimate of prevalence of obesity when compared to that from Thai growth reference. However similar fluctuating pattern and trends were observed CONCLUSION: A standard protocol using a single set of child growth standard, similar age categorization, obesity indices, and cut-points for defining high-risk children should be applied to track trend of childhood obesity effectively.

Multicompartment model comparison of body fat assessment in Thai adolescents.

OBJECTIVE: To examine the limits of agreement of percent body fat (%BF) assessed by different compartment models (2C and 3C compared to 4C). MATERIAL AND METHOD: Fifty-one healthy Thai adolescents (25 males and 26 females) aged 16 to 19 years volunteered in the present study. Underwater weighing (UWW) and dual energy X-ray absorptiometry (DEXA) were used for measurement of %BF for 2C and 3C models. UWW was also used for body density, DEXA for bone mineral content and protein content, and deuterium oxide dilution method for total body water (TBW), used in Lohman's equation for 4C model. RESULTS: Body density total body water; bone mineral density, and fat free mass were significantly higher in males than in females, whereas females had significantly higher fat than males (p < 0.001). Compared to %BF4C, %BF(UWW) did not show significant deviations from the line of identity in males and females (R2 = 0.85 and 0.75 respectively), whereas %BF(DEXA) showed significant deviations from the line of identity in females (R2 = 0.59), but not in males (R2 = 0.60). Bland & Altman analysis demonstrated that UWW and DEXA tended to underestimate %BF in leaner adolescents and overestimate %BF in fatter adolescents. CONCLUSION: Percent body fat using underwater weighing (2C model) may be used interchangeable with the 4C model in both genders. However; DEXA (3C model) can only be used in males and not in females, which require further research. A regression equation to relate 2C and 3C models to 4C was developed to enable a better estimation of percent body fat in Thai adolescents.

SEANUTS: the nutritional status and dietary intakes of 0.5-12-year-old Thai children.

In the present study, we investigated nutritional status and health-related factors in a multistage cluster sample of 3119 Thai urban and rural children aged 0·5-12·9 years. In a subsample, blood samples were collected for the measurement of Hb, transferrin receptor, vitamin A and vitamin D concentrations. The prevalence of stunting and underweight was higher in rural children than in urban children, whereas the wasting rate was similar in both rural and urban areas. Among children aged 3·0-5·9 years, the prevalence of overweight was significantly higher in urban areas than in rural areas and so was the obesity rate in children aged 6·0-12·9 years. Protein intakes of all age groups were relatively high in both the areas. Intakes of Ca, Fe, Zn and vitamin C were significantly higher in urban areas than in rural areas. The prevalence of anaemia in rural areas was twice as high as that in urban areas, particularly in infants and young children. However, the prevalence of Fe-deficiency anaemia was similar in both urban and rural areas. While the prevalence of vitamin A deficiency (by serum retinol cut-off < 0·7 µmol/l) seemed to be very low, vitamin A insufficiency (by serum retinol cut-off < 1·05 µmol/l) was more prevalent (29·4-31·7%) in both the areas. The prevalence of vitamin D insufficiency ranged between 27·7 and 45·6% among the children. The present study indicates that the double burden of malnutrition is still a major public health problem in Thailand. Further studies need to explore the associated risk factors for these nutrient deficiencies. Effective strategies and actions are needed to tackle the nutritional problems in Thai children.

Long-term supplementation of high pigmented rice bran oil (Oryza sativa L.) on amelioration of oxidative stress and histological changes in streptozotocin-induced diabetic rats fed a high fat diet; Riceberry bran oil.

Diabetes is a serious health problem. Searching for alternative natural antioxidants is considered important strategy to manage diabetes. This study evaluated the effect of Riceberry bran oil (RBBO) supplementation on oxidative stress and organ histology in streptozotocin-induced diabetic rats fed a high fat (HF) diet. Adult male Sprague-Dawley rats with hyperglycemia were divided into four groups: DM group fed a HF diet alone; DMRL group fed a HF diet and 5% RBBO; DMRM group fed a HF diet and 7.5% RBBO; DMRH group fed a HF diet and 15% RBBO. Normal rats were used as normal control and were divided into NC and NR group fed a normal diet containing either 5% corn oil or 5% RBBO, respectively. After 12 weeks, RBBO significantly decreased malondialdehyde and restored superoxide dismutase, catalase, glutathione peroxidase, coenzyme Q(10) and ORAC levels in diabetic rats. RBBO additionally improved the regenerative changes of the pancreas, kidneys, heart and liver. These findings indicate that pigmented RBBO could provide beneficial effect on diabetes by decreasing oxidative stress and recovering organ histology.

Reduction of LDL-cholesterol in mildly hypercholesterolemic Thais with plant stanol ester-fortified soy milk.

OBJECTIVE: To investigate the effects of soy milk fortified with plant stanol ester on changes in LDL-cholesterol, fat-soluble vitamins and sex hormones in Thai volunteers. MATERIAL AND METHOD: In a double-blind, placebo-controlled study, 120 mildly hypercholesterolemic Thais were randomly assigned to stanol and control groups that were comparable in lipid profile and body mass index. Subjects consumed regular or 2g stanol-containing soymilk once a day and postprandially for six weeks. The serum lipid profile was measured at weeks 0, 2 and 6; serum fat-soluble vitamins and sex hormones were measured at weeks 0 and 6. RESULTS: The mean reduction in total cholesterol was 8.2 % in the stanol group (p < 0.0001) and 0.6% in the control group. LDL-cholesterol declined in both groups at week two, but the reduction was maintained to week six only in the stanol group. The mean reduction in LDL-cholesterol was 13.5% in the stanol group (p < 0.0001) at week 6, compared to a 4.6% decrease in the control group. Adjusted serum beta-cryptoxantene and beta-carotene levels decreased at week six for the stanol group. Serum sex hormone levels in both groups remained unchanged. CONCLUSION: Consumption of stanol-ester-containing soymilk for six weeks significantly reduced LDL-cholesterol in mildly hypercholesterolemic Thais. No adverse effect on sex hormones was observed However, stanol-ester consumers are at risk of fat-soluble-vitamin deficiencies if the vitamin intake from foods is inadequate.

Waist circumference and body fat distribution indexes as screening tools for the overweight and obesity in Thai preschool children.

BACKGROUND: Evidence shows that waist circumference (WC) is one reliable index to predict abdominal obesity in children. This study aims to examine the relationship of WC to other anthropometric indexes and to determine the ability of WC as obesity screening tool. SUBJECTS: 811, 5-6 years old children in Saraburi province, central region of Thailand. METHODS: Anthropometric measurements were performed in children; 406 boys and 405 girls. WC measurement was performed at the umbilicus level. Subcutaneous skinfold was measured on subscapular, suprailiac and abdominal regions. Total body fat was measured with bioelectrical impedance analyzer. Receiver operating characteristic (ROC) analysis was employed to determine WC cut-offs for predicting obesity in children. RESULTS: WC highly correlated with weight-for-height Z-score (WHZ) (r = 0.92-0.94, p = 0.01), body mass index (BMI) (r = 0.95-0.96, p = 0.01), trunk skinfold (r = 0.92-0.93, p = 0.01) and total body fat (r = 0.94-0.95, p = 0.01) for both genders. Based on Thai national reference, the optimal WC cut-offs for predicting obesity were 59.6 cm for boys and 60.5 cm for girls. When IOTF-BMI was employed as reference, WC thresholds were 64.4 cm for boys and 63.1 cm for girls. The latter WC cut-offs provided the slightly underestimated obesity prevalence compared with national reference. CONCLUSION: The strongly positive correlation between WC and weight-height based index and between WC and body fat in Thai preschool children suggests that WC should be the additional index for obesity screening in young children. Further study needs to explore the association between the increased WC and other adverse health outcomes.

Serum leptin levels and body composition in obese Thai children.

This study aimed to investigate the relationship between serum leptin concentrations and body composition among a sample of obese Thai children. A cross-sectional study was conducted in 158 schoolchildren, of whom 107 were obese and 51 normal weight; their mean age was 8.2 years. Body weight, height, waist circumference (WC), and subcutaneous skinfold thickness at 4 sites (triceps, biceps, subscapular, and supra-iliac) were measured. Total body fat (TBF) was determined by bioelectrical impedance analysis. Fasting blood samples were obtained to determine serum lipid profiles. The food intake of the children was estimated from interviews with the children and their mothers to elicit 24-hour food recall over 2 days. The results reveal subcutaneous fat skinfold, total body fat and waist circumference were significantly higher in obese than normal weight children (p < 0.001). Serum leptin levels and lipid profile results, ie serum triglycerides (TG), serum total cholesterol (TC), low density lipoprotein cholesterol (LDL-C) and energy intake, were also significantly higher in the obese children than their normal-weight peers. Stepwise multiple regression analysis indicates that among boys, WC (p < 0.001) and serum TG (p = 0.019), and among girls, WC (p < 0.001) and TBF (p = 0.030), were significantly associated with leptin concentrations. No associations were found between leptin and energy intake in these children. A prospective study should investigate the influence of leptin levels on weight gain and subcutaneous adiposity, and the interrelationship between food intake and circulating leptin levels in children.

Hypercholesterolemia in Thai primary school children: relation to maternal and nutritional factors.

BACKGROUND: There is evidence to show that atherosclerosis can occur in young children and that elevated total cholesterol and low density lipoprotein cholesterol concentrations are risk factors for atherosclerosis. The aim of the present cross-sectional study was to investigate the influence of maternal and nutritional factors on blood cholesterol in primary school children. METHODS: One hundred and ninety-five population-based mother-child pairs (obese child-overweight mother pairs, n = 60; obese child-normal-weight mother pairs, n = 48; wasted child-overweight mother pairs, n = 37; normal-weight child-normal-weight mother pairs, n = 50), were enrolled in the study. Various anthropometric parameters were measured and serum lipids of subjects were further determined. Biological data and children's eating behavior were obtained from the mothers through interviews. RESULTS: Hypercholesterolemia was found in 64.6-65% of obese children, 24.3% of wasted children and in 56% of the normal-weight children; whereas the proportion of children in all groups who had normal blood cholesterol levels was in the lower range. Multivariate logistic regression indicated that mother's serum cholesterol (odds ratio [OR], 2.41; 95% confidence interval [CI]: 1.12-4.78), child obesity defined by weight-for-height Z-score > +2SD (OR, 2.56; 95%CI: 1.33-4.98), and child's energy intake >/=75th percentile (OR, 2.59; 95%CI: 1.01-6.66) were the significant factors associated with hypercholesterolemia in children. CONCLUSION: Hypercholesterolemia in school children is associated with familial factor, bodyweight and nutrient intake. Elevated blood cholesterol was also found in some of the normal-weight and wasted children. Effective family-based intervention programs are urgently needed to modify risk factors predisposing to coronary heart disease.

Study on different sites of waist circumference and its relationship to weight-for-height index in Thai adolescents.

OBJECTIVE: To compare waist circumference (WC) measured at different sites of trunk region and to determine predictive WC values that were corresponding to weight-for-height index in Thai adolescents. MATERIAL AND METHOD: The authors conducted the cross-sectional study in 509 adolescents, aged 10-18 years old WC was measured at four different sites of trunk region, WC1; at midway between the lowest rib and the iliac crest, WC2; at the narrowest waist, WC3; at immediately above the iliac crest and WC4; at the umbilicus level. Receiver operating characteristic analysis was also performed to determine WC cutoffs to maximize the sensitivity and specificity. RESULTS: WC measured at all four sites provided small different powerful value in prediction of trunk fat and total body fat (TBF) in adolescents and that WC4 provided slightly better predictive value than other WC. In boys, WC provided better prediction of trunk fat than the prediction of TBF, whereas in girls, the prediction of trunk fat and TBF from WC were of similar magnitude. By receiver operating characteristic analysis, WC risk threshold for predicting the overweight adolescents using Thai weight-for-height Z score > or = 1.5 SD as reference was 73.5 cm for boys (sensitivity 96.8%, specificity 85.7%) and 72.3 cm for girls (sensitivity 96.1%, sensitivity 80.5%). WC threshold was increased to 75.8 cm. (sensitivity 96.3.%, specificity 86.4%) for boys and 74.6 cm for girls (sensitivity 95.1%, specificity 85.7%) in order to detect the obese children. CONCLUSION: Waist circumference has been proposed as the simple tool for screening the overweight adolescents and when measured at the umbilicus level, it is considered the feasible site for self-evaluation. Further study is needed to investigate the relationship between the increased WC and metabolic risk factors for obesity in adolescents.

Leptin, soluble leptin receptor, lipid profiles, and LEPR gene polymorphisms in Thai children and adolescents.

OBJECTIVE: To evaluate the relationships between leptin, soluble leptin receptor, lipid profiles, and LEPR gene polymorphisms in child and adolescent Thai subjects. DESIGN: Cross-sectional study of Thai children and adolescents. SUBJECTS: 116 male and 65 female at risk for overweight/overweight child and adolescent Thai subjects, and 33 male and 62 female healthy child and adolescent Thai subjects (age: 5-19 years). MEASUREMENTS: Leptin levels, soluble leptin receptor levels, lipid profiles, LEPR gene polymorphisms. RESULTS: Significantly higher levels of cholesterol, triglyceride, low-density lipoprotein cholesterol (LDL-C), and leptin levels were observed in at risk for overweight/overweight group. On the other hand, high-density lipoprotein cholesterol (HDL-C) and soluble leptin receptor levels were significantly lower in the same group. Serum soluble leptin receptor levels were significantly negatively correlated with leptin. The at risk for overweight/overweight subjects with the Lys656Lys homozygous wild type LEPR gene had significantly higher cholesterol and LDL-C levels than those with Lys656Asn heterozygous and Asn656Asn homozygous mutant type. In contrast, subjects with Lys656Lys homozygous wild type had significantly lower leptin levels than those with Lys656Asn heterozygous and Asn656Asn homozygous mutant type. There was a statistically significant association between body mass index (BMI) and hyperleptinemia (odds ratio; OR = 2.49, p = 0.000) and females had more increased risk of hyperleptinemia than males (OR = 15.74, p = 0.004) in adolescent Thai subjects. CONCLUSION: The present study is the first report of Lys656Asn polymorphism of the LEPR gene associated with cholesterol, LDL-C, and leptin levels in Thai children and adolescents. Serum leptin levels were significantly higher in the at risk for overweight/overweight. In contrast, there were significantly lower soluble leptin receptor levels in the same group. In addition, there was a statistically significant association between BMI, sex, and hyperleptinemia in adolescent Thai subjects.

Factors associated with dual form of malnutrition in school children in Nakhon Pathom and Bangkok.

OBJECTIVE: The present study examined the influence of family characteristics and maternal feeding practices on eating behaviors, food consumption and nutritional status of children living in 6 districts of Nakhon Pathom province and 3 surrounding districts of Bangkok. MATERIAL AND METHOD: One hundred and ninety nine families were enrolled in the present study. Four specific mother-child pair groups were purposively selected: 62 obese child/overweight mother pairs, 49 obese child/ normal weight mother pairs, 37 wasted child/overweight mother pairs, and 51 normal weight child/normal weight mother pairs. Anthropometric measurements were performed on all subjects. Biological data, socioeconomic status, maternal feeding practices, as well as eating and lifestyle behaviors of the children were obtained from mothers and children using structured questionnaires and interviews. RESULT: Most mothers from all groups, 40.8%-62.2%, had a primary education, were non-manual workers, with families containing 4-6 persons per household, and a family income of < or = 20,000 baht per month. Multivariate logistic regression analysis showed that maternal overweight prior to pregnancy (OR11.85, 95%CI 2.16-64.99) child's high birth weight (OR 4.53, 95%CI 1.09-18.73) as well as maternal control over the consumption of high caloric food (OR13.07, 95%CI 4.08-41.86) and large amounts of food consumed by the children (OR12.58, 95%CI 4.30-36.80) were significant factors associated with childhood obesity. Compared to normal weight children, a higher proportion of obese children were not breast-fed and a higher proportion of normal weight mothers controlled the consumption of high caloric food in their obese children. Overweight mothers with wasted children also controlled their children's food intake. Higher proportion of wasted children had a higher snack consumption frequency but lower energy food intake than the normal weight children. CONCLUSION: Understanding the underlying causes of dual form of malnutrition in the households would have implication for policy makers to address and implement a nutrition action plan. It is suggested that a malnutrition, (under and over-nutrition) prevention program must involve strategies within families that focus on providing nutrition education and the powerful guidance to help parents foster appropriate patterns of food choice and eating in their children. Promotion of increased physical activity in children is also essential. These strategies are aimed to promote the optimal child's weight and health.

Iron and zinc supplementation improved iron and zinc status, but not physical growth, of apparently healthy, breast-fed infants in rural communities of northeast Thailand.

Iron deficiency is prevalent in children and infants worldwide. Zinc deficiency may be prevalent, but data are lacking. Both iron and zinc deficiency negatively affect growth and psychomotor development. Combined iron and zinc supplementation might be beneficial, but the potential interactions need to be verified. In a randomized, placebo-controlled trial using 2 x 2 factorial design, 609 Thai infants aged 4-6 mo were supplemented daily with 10 mg of iron and/or 10 mg of zinc for 6 mo to investigate effects and interactions on micronutrient status and growth. Iron supplementation alone increased hemoglobin and ferritin concentrations more than iron and zinc combined. Anemia prevalence was significantly lower in infants receiving only iron than in infants receiving iron and zinc combined. Baseline iron deficiency was very low, and iron deficiency anemia was almost nil. After supplementation, prevalence of iron deficiency and iron deficiency anemia were significantly higher in infants receiving placebo and zinc than in those receiving iron or iron and zinc. Serum zinc was higher in infants receiving zinc (16.7 +/- 5.2 micromol/L), iron and zinc (12.1 +/- 3.8 micromol/L) or iron alone (11.5 +/- 2.5 micromol/L) than in the placebo group (9.8 +/- 1.9 micromol/L). Iron and zinc interacted to affect iron and zinc status, but not hemoglobin. Iron supplementation had a small but significant effect on ponderal growth, whereas zinc supplementation did not. To conclude, in Thai infants, iron supplementation improved hemoglobin, iron status, and ponderal growth, whereas zinc supplementation improved zinc status. Overall, for infants, combined iron and zinc supplementation is preferable to iron or zinc supplementation alone.