Nutri-action analysis as a research strategy to improve nutrition information, education and communication interventions in Asia.

What is lacking in nutrition information, education and communication (IEC) work today is accurate knowledge about the processes which bring about beneficial nutritional behavior changes. In this paper, Nutri-action Analysis is proposed as a mechanism for nutrition planners to gain this knowledge and seek ways to improve the effectiveness of nutrition IEC interventions. It suggests that a more holistic and dynamic approach is necessary to conceptualize nutrition IEC and increase its effectiveness in bringing about changes in behaviors which lead to nutritional status improvement. Nutri-Action Analysis, as a research strategy, is illustrated by a three-stage procedure: (i) pre-action, (ii) action, and (iii) post-action. This process leads investigators to begin conducting a macro-analysis of nutrition IEC in general and within their specific contexts in order to understand the system and identify the best approach to be adopted for a nutrition IEC intervention in their particular context. What is discovered should then be tested in a community-based operational research study using both quantitative and qualitative data so that it is possible to subsequently conduct a synthesis focusing on process determinants.

Lymphocyte responsiveness of children supplemented with vitamin A and zinc.

We sought to determine the effect of supplementation with zinc, vitamin A, or a combination of the two on proliferation of T lymphocytes to concanavalin A (ConA), tetanus toxoid (TT), or tuberculin (PPD) of children living in a region endemic for suboptimal vitamin A and zinc intake. The children (n = 140, aged 6-13 y) were randomly assigned and supplemented with either zinc (25 mg/d), vitamin A (1500 mg RE/d), zinc + vitamin A, or placebo for 6 mo. After a baseline blood collection, subjects were boosted with diphtheria-tetanus antigen. Proliferative responsiveness of T lymphocytes to ConA and TT in each treatment group (n = 35) was not different at baseline or postsupplementation. Children supplemented with zinc + vitamin A tended to show higher proliferative responsiveness of T lymphocytes to PPD than did those treated with placebo (P = 0.08). This tendency was observed in females but not in males. Increased zinc and vitamin A intake could result in health benefits for children living in regions endemic for suboptimal micronutrient nutriture.

The effect of pumpkin seeds snack on inhibitors and promoters of urolithiasis in Thai adolescents.

Supplementation of basal mixture or pumpkin seeds snack gave a higher level of inhibitor of crystal formation or aggregation than the control period. Moreover, pumpkin seeds snack showed inhibition effect to a greater extent than basal mixture. In the light of this study, it is suggested that pumpkin seeds snack, a high nutritive mixture, is satisfactory to improve the nutrients and increase the level of inhibitors of crystal formation or aggregation which will subsequently reduce the risk of bladder stone disease in Thailand.

Effect of vitamin A and zinc supplementation on the nutriture of children in Northeast Thailand.

Previous surveys suggested that young children in Northeast Thailand may benefit from vitamin A and/or zinc supplementation. One hundred thirty-three children aged 6-13 y with marginal plasma retinol (less than 1.05 mumol/L) and Zn (less than 12.2 mumol/L) concentrations participated in a double-blind study. They were randomly assigned and supplemented with either zinc (25 mg/d), vitamin A (1500 RE/d), zinc plus vitamin A, or placebo for 6 mo. Biochemical indices of vitamin A (plasma vitamin A, retinol-binding protein) and zinc status (plasma zinc, alkaline phosphatase) increased significantly. The children had adequate liver stores of vitamin A (relative dose response less than 20%). Zinc supplementation resulted in an improvement in vision restoration time (VRT) in dim light (dark adaptometry). Vitamin A and zinc synergistically normalized conjunctival epithelium as measured by conjunctival impression cytology (CIC). Both functional indices, VRT and CIC, showed significant correlations with plasma zinc and vitamin A, respectively. The data suggest that functional improvements in populations with suboptimal vitamin A and zinc nutriture can be accomplished by supplementation with less than two times the recommended dietary allowance of these nutrients.

Child health and nutritional status in Ulaanbaatar, Mongolia: a preliminary assessment.

Over 85% of Mongolia's foreign trade and development aid, which formerly came from the USSR, have abruptly ceased causing shortfalls in almost all sectors. The UNICEF Mongolia Country Program and the East Asia and Pacific Regional Office (UNICEF/EAPRO) realized that Mongolian children are likely to suffer the most as reduced income and food availability aggravate problems associated with malnutrition. Hence, from 16 June-7 July 1992, a team from the Institute of Nutrition at Mahidol University, Thailand, collaborated with local UNICEF personnel and government health officials in designing and initiating the 1992 Mongolian Child Nutrition Survey. This paper presents the preliminary survey data of 342 randomly selected children aged 0-48 months in Ulaanbaatar. Results indicate that the four major health and nutrition problems are protein energy malnutrition (PEM), iodine deficiency disorders, vitamin D deficiency, and an unusually high rate of acute respiratory infections. Also requiring more in-depth study are low birth weight, iron deficiency anemia and vitamin A deficiency.

Biochemical evidence suggestive of suboptimal zinc and vitamin A status in schoolchildren in northeast Thailand.

Data are accumulating that support the hypothesis that inadequate zinc nutriture will result in an impairment of vitamin A utilization. Therefore, zinc and vitamin A status were assessed in 283 schoolchildren aged 7-13 y in Northeast Thailand. More than one-fourth had serum vitamin A concentrations less than 0.86 mumol/L , with a mean (+/- SD) concentration of 1.06 +/- 0.31 mumol/L compared with 1.26 +/- 0.02 mumol/L for US children of similar age. Seventy percent had low serum zinc concentrations, less than 10.7 mumol/L. Twenty-three percent of the children exhibited both low serum zinc and vitamin A concentrations. The mean concentration of retinol-binding protein (RBP) was lower for children in this study compared with healthy Thai children in Bangkok, 22.5 +/- 6.6 vs 25.3 +/- 6.0 mg/L, respectively. Serum zinc and RBP were significantly correlated (p less than 0.001) whereas vitamin A and zinc were not correlated. These data suggest that a high proportion of rural schoolchildren in Northeast Thailand are at risk of inadequate zinc and/or vitamin A nutriture.

A WHO collaborative study on iron supplementation in Burma and in Thailand.

Studies on the treatment and prevention of iron deficiency anemia, in pregnant and nonpregnant women and in men, were conducted in Thailand and Burma. The effects of the dose of Fe, duration of Fe administration, additional supplementation with folate, mode of supplement delivery (either supervised or unsupervised), and the presence of Hb(AE) were studied. The frequency and severity of side effects were also recorded. Fe administration resulted in an increase in hemoglobin concentration in all anemic individuals but approximately 20% failed to reach normality. The length of administration and the dose influenced the results. Frequency and severity of side effects increased with the dose of Fe administered. Folate supplementation did not affect the results. It appears possible to integrate a program of prevention and treatment of Fe deficiency anemia in a primary health-care system but the constraints and limitations of achievable results should be recognized.

PIP: 4 collaborative trials of iron supplements with or without folate on the following groups: adult men and women in central Thailand; pregnant women in northeastern Thailand; adult women in northern Thailand; and pregnant women in Burma, are reported as separate studies here. Subjects took 30, 60, 120 or 240 mg Fe sulfate with or without 2.5 mg folic acid. Those with chronic disease or hemoglobin 80 g/L were excluded. Presence of hemoglobin EE or EF, or hookworm infestations were determined in some cases. Hemoglobin E, which tends to increase incidence of anemia, occurs in up to 4.8% of women in northern Thailand, 27.6% of adults in northeastern Thailand, and 19% of pregnant women in Burma. Hookworm infection was a high as 35% in central Thais. Iron supplementation significantly increased mean Hb and reduced incidence of anemia in all study groups. 20% of subjects remained anemic. In northeastern Thailand treatment for 15 weeks resulted in higher Hb than did 10 weeks treatment. No significant difference was seen with dose of Fe or inclusion of folate. Supervised administration of supplements had no additional effect. Gastrointestinal side effects were a problem, and were dose related, but tended to resolve after a while. The fact that Hb levels did not rise to normal levels indicates that a combined program possibly including parasite control and food fortification should be considered.

Tamm Horsfall mucoprotein in urine of potential bladder stone formers.

The excretion rate of Tamm Horsfall mucoprotein was determined in normal and endemic boys. This latter group of boys showed presumptive signs of bladder stone, which include oxalate crystalluria, and difficult and sometimes painful voiding. At least 2 distinct forms of this mucoprotein are present in the urine. Semiquantitatively, there was no apparent difference in the excretion rate of this mucoprotein between the 2 groups of boys. The kidney function of these 2 groups was comparable and within the normal range. Furthermore, the presence of 5 mg. per cent of this mucoprotein in the solution of calcium and oxalate did not increase the ability of the solution to form more calcium oxalate precipitate nor did it induce precipitation of calcium oxalate from the dilute solution. We conclude that Tamm Horsfall mucoprotein may not have a role in the formation of oxalate crystalluria or bladder stone.

Carnitine status in Thai adults.

Plasma carnitine and urinary carnitine levels were measured in Thai adults living in Bangkok city and Ubol villages. The mean plasma carnitine and urinary carnitine levels expressed in micromoles per liter in Bangkok adults were higher than those in Ubol adults. Their mean plasma carnitine levels were 56.6 +/- 1.8 and 50.3 +/- 1.7 whereas urinary carnitine levels were 161 +/- 19 and 127 +/- 18 micromole/liter, respectively. The nutritional status in Ubol adults was inadequate. This was evidenced by the significant decrease in urinary creatinine excretion, serum albumin, and hematocrit levels. The dietary assessment agreed with the biochemical findings. Since rice, limiting in carnitine, was the main protein and energy source consumed by Ubol adults their inadequate carnitine status could be due to the low carnitine intake. Sex affects plasma carnitine levels in Bangkok adults and urinary carnitine excretion in both groups. This could be related to the lean body mass in which most of the body carnitine resides. This is supported by the higher urinary creatinine excretion in males and the significant positive correlation between carnitine excretion and creatinine-height index.