Characteristics of hospitalized patients prescribed oral nutrition supplements in Thailand: A cross-sectional nutrition day survey.

BACKGROUND AND OBJECTIVES: Despite the proven benefits of oral nutrition supplements (ONS), its prescription in Thailand are far less than it should mainly due to limitation of reimbursement. Our aim was to compare hospital outcomes between hospitalized patients receiving only hospital food to those receiving hospital food with ONS. METHODS AND STUDY DESIGN: An annual cross-sectional survey, NutritionDay (nD), in Thailand was conducted in 2 hospitals from 2010 to 2015. The hospital outcomes were followed at day 30 after first evaluation. Logistic regression and Cox regression were performed to compare outcome between groups. RESULTS: 524 hospitalized patients, 472 with only hospital food and 52 with ONS, were included. Patients with ONS had longer hospital stay prior to recruitment, reported more physical dependencies, and ate less food. The ONS group was less likely to be discharged within 30 days as compared to hospital food group (unadjusted OR 0.28, 95% CI 0.16-0.52) but this effect was not significant after adjustment for length of stay before nD and PANDORA score (adjusted OR 0.62, 95% CI 0.3-1.34). Cox regression showed a trend to decreased rate of discharge within 30 days in the ONS group. CONCLUSIONS: This cross-sectional study showed a trend of worse outcomes associated with ONS prescription which might be related with higher mortality risk according to PANDORA score and longer previous hospital stay of the patients in the ONS group. Since the 2 studied groups were not comparable, further studies in this specific population should be performed.

GLIM Criteria for the Diagnosis of Malnutrition: A Consensus Report From the Global Clinical Nutrition Community.

BACKGROUND: This initiative aims to build a global consensus around core diagnostic criteria for malnutrition in adults in clinical settings. METHODS: The Global Leadership Initiative on Malnutrition (GLIM) was convened by several of the major global clinical nutrition societies. Empirical consensus was reached through a series of face-to-face meetings, telephone conferences, and e-mail communications. RESULTS: A 2-step approach for the malnutrition diagnosis was selected, that is, first screening to identify at risk status by the use of any validated screening tool, and second, assessment for diagnosis and grading the severity of malnutrition. The malnutrition criteria for consideration were retrieved from existing approaches for screening and assessment. Potential criteria were subjected to a ballot among GLIM participants that selected 3 phenotypic criteria (non-volitional weight loss, low body mass index, and reduced muscle mass) and 2 etiologic criteria (reduced food intake or assimilation, and inflammation or disease burden). To diagnose malnutrition at least 1 phenotypic criterion and 1 etiologic criterion should be present. Phenotypic metrics for grading severity are proposed. It is recommended that the etiologic criteria be used to guide intervention and anticipated outcomes. The recommended approach supports classification of malnutrition into four etiology-related diagnosis categories. CONCLUSIONS: A consensus scheme for diagnosing malnutrition in adults in clinical settings on a global scale is proposed. Next steps are to secure endorsements from leading nutrition professional societies, to identify overlaps with syndromes like cachexia and sarcopenia, and to promote dissemination, validation studies, and feedback. The construct should be re-considered every 3-5 years.

Evaluation of a 12-week lifestyle education intervention with or without partial meal replacement in Thai adults with obesity and metabolic syndrome: a randomised trial.

BACKGROUND/OBJECTIVES: There have been no studies examining the efficacy of meal replacement (MR) on weight loss and metabolic syndrome (MS) improvement in Southeast Asians. Thus, we undertook a 12-week randomised trial to evaluate the effect of a lifestyle education intervention alone (LEI) or with partial MR (LEI + MR) in obese Thai adults with MS. SUBJECTS/METHODS: A total of 110 patients were randomised to receive either LEI or LEI + MR. Both groups received LEI to achieve weight loss. LEI + MR group additionally received two MR daily to replace either breakfast, lunch or dinner. Mean ± SE body mass index of all participants was 34.6 ± 0.6 kg/m2, mean ± SE age was 42.5 ± 1.1 years and 83% of patients were female. Both groups were compared for anthropometric and cardiometabolic indices at 12-week. Body weight was also compared at weeks 38 and 64. RESULTS: At 12 weeks, both groups exhibited statistically significant percentage weight loss (%WL) compared to initial weight but greater %WL was observed in LEI + MR compared to LEI, 2.9% vs. 1.5%, respectively (p < 0.05). MS criteria such as waist circumference and blood pressure improved significantly in both groups compared to baseline. However, improvement in fasting plasma glucose (FPG) was only significant in LEI + MR, and more participants with impaired FPG at baseline in LEI + MR (42.9%) than LEI (19%) returned to normal FPG at 12 weeks (p < 0.05). HbA1c, fasting insulin and HOMA-IR in LEI + MR were significantly lower than with LEI. At the end of the 12-week intervention period, 16% of participants no longer fulfilled MS criteria. A statistically significant weight loss from baseline persisted until 38 weeks but no longer reached statistically significant difference between groups CONCLUSIONS: LEI and LEI + MR were acceptable and led to improvement in weight and MS. LEI + MR group exhibited additional weight reduction and glycemic benefits at 12 weeks.

FAT-FREE MASS, METABOLICALLY HEALTHY OBESITY, AND TYPE 2 DIABETES IN SEVERELY OBESE ASIAN ADULTS.

OBJECTIVE: To determine whether fat free mass (FFM) is independently associated with the metabolically healthy obesity (MHO) phenotype, the metabolic syndrome (MS), and type 2 diabetes (T2D) in obese Asian adults. METHODS: Obese patients (body mass index [BMI] ≥25 kg/m2) seeking weight management at an academic medical center from 2007 to 2016 were included. FFM was measured by bioelectrical impedance. RESULTS: Of the 552 patients (67.0% female, median age 40.5 years, median BMI 38.3 kg/m2), MHO was present in 19%, MS in 55.4%, and T2D in 32.6%. In multivariate models, higher fat-free mass index (FFMI) was independently associated with the metabolically abnormal obesity (MAO) phenotype, (odds ratio [OR] 1.22, 95% confidence interval [CI] 1.09-1.37), and increased risk of MS (OR 1.12, 95% CI 1.03-1.22) in women but not in men. Older age was independently associated with the MAO phenotype (OR 1.06, 95% CI 1.04-1.09 in women; OR 1.06, 95% CI 1.02-1.09 in men), MS (OR 1.05, 95% CI 1.03-1.06 in women; OR 1.05, 95% CI 1.02-1.07 in men), and T2D (OR 1.07, 95% CI 1.05-1.09 in women; OR 1.06, 95% CI 1.04-1.09 in men). Waist-hip ratio was independently associated with the MAO phenotype in men (OR 1.08, 95% CI 1.01-1.15), while waist circumference was associated with T2D in women (OR 1.03, 95% CI 1.01-1.05). CONCLUSION: Older age, central fat distribution, and-in contrast to previous findings-an increase in FFMI among women were independent predictors of adverse metabolic health in this cohort of middle-aged obese Asian adults. Further studies are required to elucidate underlying mechanisms and therapeutic implications of these findings. ABBREVIATIONS: BIA = bioelectrical impedance analysis BMI = body mass index CI = confidence interval DXA = dual-energy X-ray absorptiometry FFM = fat-free mass FFMI = fat-free mass index FM = fat mass HbA1c = glycated hemoglobin A1c MAO = metabolically abnormal obesity MHO = metabolically healthy obesity MS = metabolic syndrome OR = odds ratio T2D = type 2 diabetes WC = waist circumference WHR = waist-hip-ratio.

Prevalence and factors associated with microalbuminuria and abnormal renal function in Thai obese adults.

OBJECTIVE: To determine the prevalence and factors associated with microalbuminuria and abnormal renal function in Thai obese adults. MATERIAL AND METHOD: A cross-sectional study data was collected from 86 patients during October 2010 to February 2011 at the obesity clinic and outpatient department of Siriraj Hospital. Obese patients with body mass index > or = 25 kg/m2 participated in the present study. Exclusion criteria were the patients who refused participation or patients with end stage renal disease who were under treatment with hemodialysis or continuous ambulatory peritoneal dialysis. A questionnaire was used for collecting information on demographic data, e.g., age, sex, residence, educational level, underlying diseases and drugs use, family history of obesity, family history of renal disease, smoking, or alcohol drinking; height, weight, body mass index, waist circumference, blood pressure, blood chemistry test and urine analysis were collected. The abnormal function of the kidney was assessed by presence of microalbuminuria or estimated glomerular filtration rate below 90 mL/min/1.73 m2. RESULTS: The prevalence of microalbuminuria in obese patients was 28% and prevalence of chronic kidney disease stage 2 or more was 22%. Factors associated with microalbuminuria were FBS > or = 126 mg/dL (OR = 6.2, 95% CI: 1.7-22.1), hyperuricemia (serum uric acid > or = > 7 mg/dL) (OR = 3.2, 95% CI: 1.0-9.8). Factors associated with chronic kidney disease stage 2 or more were age > or = 55 years (OR = 7.8, 95% CI: 2.5-24.1), Angiotensin II receptor blocker (ARB) use (OR = 4.1, 95% CI: 1.3-12.3) and hyperuricemia (serum uric acid > or = 7 mg/dL)(OR = 4.5, 95% CI: 1.5-13.5). CONCLUSION: Early identification of obesity and metabolic syndrome and modifying pattern of life style behavior in obese adults carrying risk factors might be beneficial in preventing and delaying the progression of chronic kidney disease in Thailand.

Drug use evaluation of statins at Siriraj Hospital, 2008.

UNLABELLED: Statins are commonly used for lipid reduction. There is no significant difference in the efficiency of each type of statins. The study of statins' efficacy shows that only generic simvastatin is cost-effective in coronary heart disease prevention. OBJECTIVE: To determine the use and appropriateness of usage of statins in out-patients attending Siriraj Hospital in 2008. MATERIAL AND METHOD: Medical records of all patients in Siriraj Hospital who received statins from January 1st to December 31st, 2008 were reviewed. The appropriateness of statins used was analyzed in 247 medical records based on number of risks and 10-year risk. RESULTS: There were 105,950 patients who received statins with total value of 308 million baht in 2008. The major usages of statins were simvastatin (65%), atorvastatin (12%) and rosuvastatin (6%). However, the costs of statins were 9%, 42%, and 20% for simvastatin, atorvastatin and rosuvastatin, respectively. Analysis of 247 medical records of the patients who received statins showed that statins were appropriately used in 19.4% of cases. Inappropriate use of statins was due to not starting drugs treatment with simvastatin, or shifting from simvastatin to other statins inappropriately. CONCLUSION: Inappropriate use of statins at Siriraj Hospital is very common. Interventions for promoting more appropriate use of statins should be implemented.

Alternative anthropometric measurements for the Thai elderly: Mindex and Demiquet.

This cross-sectional study examined the relationship between alternative anthropometric indices and the nutritional and metabolic status of the Thai elderly. Four rural communities, each from the 4 main regions of Thailand were surveyed. A total of 2,324 subjects, 60 years old and over were included in the study. Mindex and Demiquet had a very strong relationship to body mass index with the r values of 0.93 and 0.88, respectively. Fat weight had the highest correlation with body mass index in older women, r = 0.94 (P< 0.001) and with Mindex, r = 0.93 (P< 0.001). In regard to anthropometric measurements, the mid-arm circumference had the strongest relationship to all three Quetelet indices, r = 0.76-0.87 (P< 0.001), while subscapular skinfold thickness performed best among skinfold measurements, r = 0.69-0.74 (P< 0.001). BMI achieved a significantly higher degree of correlation with triceps and supra-iliac skinfold thickness, mid-arm circumference and fat weight than Demiquet (P< 0.001 for all variables). The lymphocyte count was the only laboratory test that related rather well to all three Quetelet indices. All three Quetelet indices had nearly the same pattern of relationship to various nutritional parameters. The cut-off points of Mindex denoting under-nutrition, overweight and obesity I in women were 55.95, 69.55 and 75.60 kilogram/metre, respectively. At the same time, the cut-off points of Demiquet denoting under-nutrition, overweight and obesity I in men were 75.60, 93.98 and 102.16 kilogram/metre2, respectively. All this information supports the benefit of using Mindex and Demiquet as alternatives to body mass index for nutritional assessment in older Asian people, especially for the malnourished ones.