Automated Artificial Intelligence-Based Thai Food Dietary Assessment System: Development and Validation.

Background: Dietary assessment is a fundamental component of nutrition research and plays a pivotal role in managing chronic diseases. Traditional dietary assessment methods, particularly in the context of Thai cuisine, often require extensive training and may lead to estimation errors. Objectives: To address these challenges, Institute of Nutrition, Mahidol University (INMU) iFood, an innovative artificial intelligence-based Thai food dietary assessment system, allows for estimating the nutritive values of dishes from food images. Methods: INMU iFood leverages state-of-the-art technology and integrates a validated automated Thai food analysis system. Users can use 3 distinct input methods: food image recognition, manual input, and a convenient barcode scanner. This versatility simplifies the tracking of dietary intake while maximizing data quality at the individual level. The core improvement in INMU iFood can be attributed to 2 key factors, namely, the replacement of Yolov4-tiny with Yolov7 and the expansion of noncarbohydrate source foods in the training image data set. Results: This combination significantly enhances the system's ability to identify food items, especially in scenarios with closely packed food images, thus improving accuracy. Validation results showcase the superior performance of the INMU iFood integrated V7-based system over its predecessor, V4-based, with notable improvements in protein and fat estimation. Furthermore, INMU iFood addresses limitations by offering users the option to import additional food products via a barcode scanner, thus providing access to a vast database of nutritional information through Open Food Facts. This integration ensures users can track their dietary intake effectively, with expanded access to over 3000 food items added to or updated in the Open Food Facts database covering a wide variety of dietary choices. Conclusions: INMU iFood is a promising tool for researchers, health care professionals, and individuals seeking to monitor their dietary intake within the context of Thai cuisine and for ultimately promoting better health outcomes and facilitating nutrition-related research.

Performance of the Global Diet Quality Score (GDQS) App in Predicting Nutrient Adequacy and Metabolic Risk Factors among Thai Adults.

BACKGROUND: The Global Diet Quality Score (GDQS) was developed for monitoring nutrient adequacy and diet-related noncommunicable disease risk in diverse populations. A software application (GDQS app) was recently developed for the standardized collection of GDQS data. The application involves a simplified 24-h dietary recall (24HR) where foods are matched to GDQS-food groups using an onboard database, portion sizes are estimated at the food group level using cubic models, and the GDQS is computed. OBJECTIVES: The study aimed to estimate associations between GDQS scores collected using the GDQS app and nutrient adequacy and metabolic risks. METHODS: In this cross-sectional study of 600 Thai males and nonpregnant/nonlactating females (40-60 y), we collected 2 d of GDQS app and paper-based 24HR, food-frequency questionnaires (FFQs), anthropometry, body composition, blood pressure, and biomarkers. Associations between application scores and outcomes were estimated using multiple regression, and application performance was compared with that of metrics scored using 24HR and FFQ data: GDQS, Minimum Dietary Diversity-Women, Alternative Healthy Eating Index-2010, and Global Dietary Recommendations score. RESULTS: In covariate-adjusted models, application scores were significantly (P < 0.05) associated with higher energy-adjusted mean micronutrient adequacy computed using 24HR (range in estimated mean adequacy between score quintiles 1 and 5: 36.3%-44.5%) and FFQ (Q1-Q5: 40.6%-44.2%), and probability of protein adequacy from 24HR (Q1-Q5: 63%-72.5%). Application scores were inversely associated with BMI kg/m2 (Q1-Q5: 26.3-24.9), body fat percentage (Q1-Q5: 31.7%-29.1%), diastolic blood pressure (Q1-Q5: 84-81 mm Hg), and a locally-developed sodium intake score (Q1-Q5: 27.5-24.0 points out of 100); positively associated with high-density lipoprotein cholesterol (Q1-Q5: 49-53 mg/dL) and 24-h urinary potassium (Q1-Q5: 1385-1646 mg); and inversely associated with high midupper arm circumference (Q5/Q1 odds ratio: 0.52) and abdominal obesity (Q5/Q1 odds ratio: 0.51). Significant associations for the application outnumbered those for metrics computed using 24HR or FFQ. CONCLUSIONS: The GDQS app effectively assesses nutrient adequacy and metabolic risk in population surveys.

Uptake of Front-of-Package Nutrition Labeling Scheme after 5 Years of Adoption in Thailand: An Analysis of New Launched Pre-Packaged Food and Beverages Products.

In 2016, Thailand introduced voluntary front-of-pack nutrition labeling, the 'Thailand Healthier Choice' logo (THCL), in order to help consumers make informed, healthier food choices in each food category. This study aimed to assess the uptake of the THCL scheme in Thailand after five years of implementation by analyzing a newly launched product database. Data on the nutritional composition and labeling were obtained from the Mintel Global New Products Database between 2017 and 2021. The product's healthfulness was determined using the Health Star Rating (HSR) algorithm. The numbers and proportions of total, eligible, and labeled products bearing the THCL logo were analyzed and classified by food category, by HSR value, and by manufacturer. After 5 years of implementation, THCL uptake as a proportion of total products and eligible products continues to increase by 3.0% and 10.2% per annum, respectively. The logo has correspondingly appeared on 10.7% and 39.5% of total and eligible products. As a voluntary implementation, 76.1% of products displaying the THCL logo belonged to the 'non-core' group, i.e., non-alcoholic beverages and instant foods. This food category (HSR < 3.0) was more likely to register to bear THCL rather than those 'core' food scoring an HSR ≥ 3.5, which might reflect economic considerations and benefits. The present analysis also found that only 10% of manufacturers in Thailand launched 'healthier' products that display the THCL logo with varied product numbers. To summarize, the initial five-year implementation of the THCL program shows promise, but its adoption remains limited and inconsistent, thereby restricting its influence on public health. Our discoveries highlight the limitations of commercial goodwill in applying THCL voluntarily in Thailand and offer potential suggestions to enhance its adoption in the coming years.

Effects of Extraction and Evaporation Methods on Physico-Chemical, Functional, and Nutritional Properties of Syrups from Barhi Dates (Phoenix dactylifera L.).

Date fruits (Phoenix dactylifera L.) are rich in sugar and also contain a substantial amount of phenolic compounds. Therefore, date fruits can be used to produce an alternative sweetener, having lower glycemic index than sucrose. This study investigated the effects of extraction and evaporation methods on various properties of the syrups prepared from Barhi dates. Extraction of date juice with the aid of pectinase or cellulase significantly enhanced the production yield, total phenolic content, and antioxidant activities determined by Ferric Reducing Antioxidant Power and Oxygen Radical Absorbance Capacity assays. Syrups prepared without enzyme application had about 6-7 times higher apparent viscosity than those prepared from the enzyme-assisted extracted juices. Vacuum evaporation produced syrups with significantly lighter color and inferior antioxidant properties than open heating. Properties of date syrups prepared with or without enzyme-assisted extraction followed by open heat evaporation were not different. They had a glucose-to-fructose ratio close to 1:1, received good sensory acceptability scores of above 6 on a 9-point hedonic scale, contained a safe level (<40 mg/kg) of 5-hydroxymethyl-2-furfuraldehyde, and exhibited similar glass transition and melting temperatures; while a greater inhibition on α-amylase activity was observed in syrups obtained from enzyme-assisted extraction. The in vivo glycemic measurement revealed that the syrup prepared with the aid of Pectinex and open heating was classified as low glycemic index (GI = 55) and medium glycemic load (GL = 11). Thus, enzyme-assisted extraction of date juice using Pectinex could be used to produce a healthy natural sweetener from low quality date fruits.

Effect of dentures and dietary advice on protein intake in older Thai adults with missing posterior occluding teeth.

OBJECTIVE: To compare the effectiveness of dentures with dietary advice and dentures alone on protein intake in older Thai adults. BACKGROUND: Dentures combined with nutritional advice may improve protein intake in older adults with posterior tooth loss. However, evidence is limited, especially in developing countries. METHODS: A randomised-control trial including 69 older adults with less than four pairs of posterior occluding teeth was conducted for 3 months. The experimental group received dentures and dietary advice based on the Health Belief Model (HBM); the control group received dentures alone. Three-day dietary records were collected and protein intake was assessed using INMUCAL-NUTRIENTS V.4.0 software at baseline, 1 month, and 3 months after the intervention. Data were analysed using a t-test, Mann-Whitney U test, chi-square test, and repeated-measure ANOVA. RESULTS: Both groups reported significantly increased protein intake (control group = 0.4, 0.5, 0.6 g kg BW-1 d-1 , intervention = 0.4, 0.6, 0.7 g kg BW-1 d-1 , at baseline, 1 month and 3 months, respectively). However, participants in the experimental group had significantly higher total protein (36.3 vs. 39.8 g/d, P = .032) and animal protein intake (18.9 vs. 23.2 g/day, P = .020) than those in the control group at 3 months after the intervention; plant protein intake was similar (10.9 vs. 11.5 g/day, P = .923). In addition, the HBM scores of the experimental group were higher than those of the control group after the intervention (P < .001). CONCLUSION: Dentures combined with dietary advice significantly increased the total and animal protein intake of older people with posterior tooth loss more than dentures alone. To maintain optimal protein intake, dental practitioners should incorporate dietary advice when providing dental prostheses to older adults with posterior tooth loss.

Variation in human water turnover associated with environmental and lifestyle factors.

Water is essential for survival, but one in three individuals worldwide (2.2 billion people) lacks access to safe drinking water. Water intake requirements largely reflect water turnover (WT), the water used by the body each day. We investigated the determinants of human WT in 5604 people from the ages of 8 days to 96 years from 23 countries using isotope-tracking (2H) methods. Age, body size, and composition were significantly associated with WT, as were physical activity, athletic status, pregnancy, socioeconomic status, and environmental characteristics (latitude, altitude, air temperature, and humidity). People who lived in countries with a low human development index (HDI) had higher WT than people in high-HDI countries. On the basis of this extensive dataset, we provide equations to predict human WT in relation to anthropometric, economic, and environmental factors.

Study protocol: International joint research project 'climate change resilience of Indigenous socioecological systems' (RISE).

BACKGROUND: Anthropogenic changes in the environment are increasingly threatening the sustainability of socioecological systems on a global scale. As stewards of the natural capital of over a quarter of the world's surface area, Indigenous Peoples (IPs), are at the frontline of these changes. Indigenous socioecological systems (ISES) are particularly exposed and sensitive to exogenous changes because of the intimate bounds of IPs with nature. Traditional food systems (TFS) represent one of the most prominent components of ISES, providing not only diverse and nutritious food but also critical socioeconomic, cultural, and spiritual assets. However, a proper understanding of how future climate change may compromise TFS through alterations of related human-nature interactions is still lacking. Climate change resilience of indigenous socioecological systems (RISE) is a new joint international project that aims to fill this gap in knowledge. METHODS AND DESIGN: RISE will use a comparative case study approach coupling on-site socioeconomic, nutritional, and ecological surveys of the target ISES of Sakha (Republic of Sakha, Russian Federation) and Karen (Kanchanaburi, Thailand) people with statistical models projecting future changes in the distribution and composition of traditional food species under contrasting climate change scenarios. The results presented as alternative narratives of future climate change impacts on TFS will be integrated into a risk assessment framework to explore potential vulnerabilities of ISES operating through altered TFS, and possible adaptation options through stakeholder consultation so that lessons learned can be applied in practice. DISCUSSION: By undertaking a comprehensive analysis of the socioeconomic and nutritional contributions of TFS toward the sustainability of ISES and projecting future changes under alternative climate change scenarios, RISE is strategically designed to deliver novel and robust science that will contribute towards the integration of Indigenous issues within climate change and sustainable agendas while generating a forum for discussion among Indigenous communities and relevant stakeholders. Its goal is to promote positive co-management and regional development through sustainability and climate change adaptation.

Feasibility Study of an Automated Carbohydrate Estimation System Using Thai Food Images in Comparison With Estimation by Dietitians.

Carbohydrate counting is essential for well-controlled blood glucose in people with type 1 diabetes, but to perform it precisely is challenging, especially for Thai foods. Consequently, we developed a deep learning-based system for automatic carbohydrate counting using Thai food images taken from smartphones. The newly constructed Thai food image dataset contained 256,178 ingredient objects with measured weight for 175 food categories among 75,232 images. These were used to train object detector and weight estimator algorithms. After training, the system had a Top-1 accuracy of 80.9% and a root mean square error (RMSE) for carbohydrate estimation of <10 g in the test dataset. Another set of 20 images, which contained 48 food items in total, was used to compare the accuracy of carbohydrate estimations between measured weight, system estimation, and eight experienced registered dietitians (RDs). System estimation error was 4%, while estimation errors from nearest, lowest, and highest carbohydrate among RDs were 0.7, 25.5, and 7.6%, respectively. The RMSE for carbohydrate estimations of the system and the lowest RD were 9.4 and 10.2, respectively. The system could perform with an estimation error of <10 g for 13/20 images, which placed it third behind only two of the best performing RDs: RD1 (15/20 images) and RD5 (14/20 images). Hence, the system was satisfactory in terms of accurately estimating carbohydrate content, with results being comparable with those of experienced dietitians.

Self-efficacy in physical activity and glycemic control among older adults with diabetes in Jagir Subdistrict, Surabaya, Indonesia.

Diabetes in older adults has shown an increase in prevalence, especially in urban areas of Indonesia. This study aimed to assess the relationship between self-efficacy in physical activity and glycemic control in older adults' population with diabetes mellitus in Indonesia. This research used cross sectional design that involved 52 adults with diabetes, aged between 55-90 years old who regularly attended the older adult's health post (Posyandu Lansia) at Jagir Sub-district, Surabaya. Those who had physical disabilities were excluded from the study. Questionnaires were used to measure the physical activity and two types of self-efficacy whilst the glycemic control was measured using HbA1c in basal condition. The relationship between the variables was tested using Pearson and partial correlation test. Results show that the level of physical activity was insufficient (216.4 ± 343.5 MET) with only 32.7% (N = 17) of the participants was categorized as being physically active. The mean of the HbA1c indicated poor glycaemic control (8.63 ± 2.34%) with majority of them (76.9%, N = 40) was in the poor glycaemic control group (HbA1c ≥ 6.5%). Their self-efficacy was at the average level (Against the barriers:52.65 ± 13.23; Engage in physical activity: 59.06 ± 26.2). The self-efficacy in performing the physical activity was found significantly related to the duration of physical activity (r = 0.278, p = 0.046). Other relationships, however, were not significant (p > 0.05). In conclusion, self-efficacy to engage in physical activity is paramount to increase the physical activity among the older adults. Nevertheless, further longitudinal research on self-efficacy in physical activity management is needed.

Development and validity of semi-quantitative food frequency questionnaire as a new research tool for sugar intake assessment among Indonesian adolescents.

Robust evidence has shown that sugar is a major contributor to obesity and Non-Communicable Diseases (NCDs). However, there have not been sufficient tools to estimate sugar intakes. Therefore, developing a new and valid tool to assess sugar intake, based on cultural eating habits, is crucial. The study was done in two phases; the first focused on the development of Semi-quantitative Food Frequency Questionnaire (SFFQ), and the second focused on researching the validity of the questionnaire. Food items in the SFFQ were selected from the latest national survey review, exploratory survey, and food market observation. Forty-nine food items were included in the final SFFQ with five open-ended questions for fruit groups. One hundred and six adolescents aged 15-17 years participated in the study. The total sugar intake among the adolescents was 58.80 g/day (52.7 g sucrose; 1.47 g fructose; 1.49 glucose) which contributed to 11.6% of the total energy intake per day. The reliability analysis showed a good agreement between the two administered SFFQs in a one-month interval. The relative validity results, using 6-days food diaries as a reference method, demonstrated a superior ability to rank individuals into the same and adjacent classification and only <10% gross misclassification in all sugar intakes. The developed SFFQ in turn has been proven to have moderate to good validity and be applicable for a larger epidemiological study.

Postprandial effects of a whey protein-based multi-ingredient nutritional drink compared with a normal breakfast on glucose, insulin, and active GLP-1 response among type 2 diabetic subjects: a crossover randomised controlled trial.

Postprandial hyperglycaemia is recognised as an important target in type 2 diabetes management. Dietary pattern, meal composition, and amount of food intake are major factors for maintaining postprandial blood glucose levels. The aim of this study was to investigate the effect of consuming a whey protein-based multi-ingredient nutritional drink (WD) on postprandial glycaemic, insulinaemic, and active glucagon-like peptide-1 (GLP-1) responses in comparison to a typical breakfast, which is boiled white rice with chicken (BC) in patients with type 2 diabetes mellitus (T2DM). Fifteen subjects with T2DM participated in a randomised, controlled, cross-over study. Two isocaloric diets with similar nutrient composition were randomly tested with at least 7 d in between. Glucose, insulin, and active GLP-1 were measured by standard methods with blood samples collected with a venous catheter for 240 min during a kinetic test. The incremental area under the curve (iAUC0-240 min) for plasma glucose was significantly lower after the consumption of WD (WD: 3551 ± 546; BC: 9610 ± 848 mg min/dl; P < 0⋅01), while insulinaemic response tended to be lesser (iAUC0-240 min) than those of BC. In addition, higher iAUC0-240 min for active GLP-1 was obtained with WD diet (WD: 2230 ± 441; BC: 925 ± 183 pM min/ml; P < 0⋅01). This study showed that WD can be used to replace a regular breakfast for improving postprandial glucose response and active GLP-1 levels in people with T2DM. Further studies are required to elucidate the clinical efficacy of WD on long-term glycaemic control in people with T2DM.

Human Milk Intake of Thai Breastfed Infants During the First 6 Months Using the Dose-to-Mother Deuterium Dilution Method.

BACKGROUND: Data on infant human milk intakes in low- and middle-income countries are limited, although the deuterium oxide dose-to-mother method (DTM) is an accurate tool for its estimation. OBJECTIVE: We assessed human milk intakes of Thai infants during the first 6 months comparing exclusive breastfeeding (EBF), predominant breastfeeding (PBF), and partial breastfeeding (PartBF). METHODS: One hundred and ten healthy Thai lactating mother-infant pairs were followed from birth. Human milk intakes were determined at 6 weeks, 3 months, and 6 months using the DTM method. Daily energy and protein intakes were assessed using 3-day nonconsecutive 24-hour recalls. Sociodemographic characteristics were collected using a questionnaire. To compare breastfeeding practices, one-way analysis of variance with Tukey post hoc test assessed normally distributed data, while the Kruskal-Wallis test with Mann-Whitney U test was used for not normally distributed data. RESULTS: No difference existed in human milk intakes during the first 6 months between EBF (743-776 g/d) and PBF (748-862 g/d). Human milk intakes of PartBF infants were significantly lower compared to other infants. Human milk intake was sufficient to meet infant energy and protein requirements during the first 3 months for EBF and PBF groups. Infant formula largely replaced human milk during the first 3 months; other solid foods were also introduced among the PartBF infants. CONCLUSIONS: Human milk intakes were comparable between EBF and PBF infants during the first 6 months and provided adequate energy and protein to meet requirements. Infant formula largely replaced breast milk among PartBF infants, although other foods were also given early. This study was registered at clinicaltrials.gov as NCT04020640.

Self-efficacy to Engage in Physical Activity and Overcome Barriers, Sedentary Behavior, and Their Relation to Body Mass Index Among Elderly Indonesians With Diabetes.

OBJECTIVES: Elderly individuals with diabetes should maintain a normal body mass index (BMI) to help control their blood glucose levels. This study investigated barriers to physical activity (PA), self-efficacy to overcome those barriers, and PA self-efficacy among elderly individuals with diabetes in relation to BMI. METHODS: This cross-sectional study included 56 participants. Data were collected by a questionnaire interview and direct measurements for anthropometric data. PA self-efficacy was measured using 8 questions describing different levels of PA, where participants rated the strength of their belief that they could engage in that activity. Self-efficacy to overcome barriers was measured using 10 questions capturing participants' confidence in their ability to engage in PA despite different possible barriers. Mean scores for these parameters were analyzed using the chi-square test and the independent t-test. RESULTS: In total, 89.3% of participants had a low PA level and 58.9% had more than 3 hours of sedentary activity per day. Furthermore, 55.4% were obese and 14.3% were overweight. The mean scores for PA self-efficacy and self-efficacy to overcome barriers were 59.1± 26.4 and 52.5±13.8, respectively. PA level was related to BMI (p<0.001; r=0.116) and sedentary activity (p<0.05; r=0.274). PA self-efficacy and age were not related to BMI. Barriers to PA were associated with PA levels (p<0.05). CONCLUSIONS: Physical inactivity was a major problem in elderly individuals with diabetes, and was correlated with higher BMI. Lower levels of PA might be mediated by sedentary activity.

Overcoming the Trans Fat Problem in Thailand.

BACKGROUND: Owing to the clear impact of trans fatty acids (TFAs) on cardiovascular disease, Thailand urgently needs to evaluate the problem and formulate appropriate policies in order to protect the health of its own people and to benefit exportation. Since 9 January, 2019, Thailand's FDA has not allowed the use of partially hydrogenated oils (PHOs) in foods. OBJECTIVE: The aim of this study was to evaluate the situation and potential health risk from TFAs in foods available in Thailand, changes in fatty acid profiles upon replacement of PHOs, as well as to propose control measures for TFAs in the country. METHODS: A total of 176 food samples representing potential sources of TFAs were analyzed for fatty acid profiles, which were later used to evaluate potential health risk based on Thailand's Food Consumption Survey data and the FAO/WHO Guideline on Diet, Nutrition and the Prevention of Chronic Diseases (FAO/WHO guideline). Criteria for postmarketing monitoring of TFAs in food products were also proposed. RESULTS: TFAs were naturally highest in butter (5%) but lower than the limit in the FAO/WHO guideline regarding consumption pattern. TFAs in refined cooking oils were 0.4-0.8%, which was below the European Union (EU) legislative limit. Bakery products, i.e., puffs, pies, and deep-fried donuts, that used PHOs contained 3-5% TFAs and were the main sources of TFAs in Thailand. The postmarketing monitoring process should be based on the FAO/WHO guideline and EU legislative limit for TFAs. The PHOs in bakery products could be replaced with blended oils, although saturated fatty acids might increase. CONCLUSIONS: Thailand's TFA problem was mainly due to the use of PHOs in bakery products. It is feasible to replace PHOs with blended oils. The international TFA limits should be used for the postmarketing monitoring of TFAs in foods on the market.

Association of Adiposity Indices with Hypertension in Middle-Aged and Elderly Thai Population: National Health Examination Survey 2009 (NHES-IV).

Obesity in terms of excess fat mass is associated with increased morbidity, disability and mortality due to obesity-related disorders, including hypertension. Many hypertensive individuals are overweight and often receive their advice to lose weight related to body-fat, in order to lower their blood pressure. However, it is still unclear whether there is a strong association of adipose tissue measured by adiposity indicators with hypertension in the Thai population. Various adiposity indices have been published to distinguish the distribution of body fat with disparate properties. This study examined nine adiposity markers and their association with hypertension in 15,842 Thai adults ≥35 years old. Data were obtained from the nationwide Thai National Health Examination Survey 2009. Accuracy performance and associations of indexes with hypertension were analyzed by Area Under Curve (AUC) and logistic regression analyses. Regardless of gender, the best methods to distinguish performance were waist-to-height ratio (WHtR) [AUC: 0.640 (0.631⁻0.649)], followed by lipid accumulation product (LAP) [AUC: 0.636 (0.627⁻0.645)], waist circumference (WC) [AUC: 0.633 (0.624⁻0.641)], and Conicity index (C-Index) [AUC: 0.630 (0.621⁻0.639)]. Linear regression analysis exhibited the independent association of the top four indices, WC, WHtR, C-Index, and LAP with higher systolic and diastolic blood pressure. Those indices' quartiles were graded in a dose-response manner which significantly increased at the higher quartiles. The indicator's cutoff point carried the odds ratio of presence hypertension in the range of 1.7 to 2.5 (p < 0.001). Among the nine obesity indices, WHtR (cutoff >0.52) in both genders was the simplest and most practical measurement for adiposity in association with hypertension in middle-aged and elderly Thais.

Correlation of vitamin D binding protein gene polymorphism and protein levels in chronic obstructive pulmonary disease compared with non-chronic obstructive pulmonary disease subjects.

AIM: The risk of vitamin D binding protein (DBP) variations in chronic obstructive pulmonary disease (COPD) compared with non-COPD Thai males were investigated. MATERIALS & METHODS: The rs7041 and rs4588 polymorphisms of the DBP gene and protein level were measured in 136 COPD and 68 non-COPD Thai males. RESULTS: In the COPD group, GC1-1 gave increased forced expiratory volume at 1 s % predicted compared with GC1-2 but with no significant difference. Significantly lower average DBP serum levels were observed in COPD than non-COPD subjects. Positive correlation between serum DBP and forced expiratory volume at 1 s % predicted was observed in non-COPD subjects. DISCUSSION & CONCLUSION: DBP variations might be associated with risk factors in COPD caused by both inflammatory and vitamin D circulation processes.

Consumption and sources of added sugar in Thailand: a review.

BACKGROUND AND OBJECTIVES: The present review examined the best available evidence regarding consumption levels and sources of added sugar in different population groups in Thailand. METHODS AND STUDY DESIGN: Information was extracted from food balance sheets, household expenditure surveys, food consumption surveys, government reports, published and unpublished studies. RESULTS: A total of 24 references were obtained, comprising 8 nationally representative reports and 16 individual studies. Results were inconsistent. The National Statistical Office reported an available supply of 83 g sugar per capita per day in 2010. The 2009 Food Consumption Survey of Thai Population showed median intake of sugar and sweeteners for all age groups ranging from 2.0 to 20.0 g per day among males and from 2.0 to 15.7 g per day among females (below the Thai recommendation of 40 to 55 g/day). Studies on children suggested intake levels between 25 to 50 g/day, while studies on adults were inconsistent. Frequently consumed sources were table sugar, sweetened beverages, and sweet snacks (traditional desserts, baked products, crispy snacks). CONCLUSIONS: Insufficient evidence exists regarding intake levels and sources of added sugar in Thailand. Limitations were the use of food frequency questionnaires or a single 24-h recall to assess intake, and outdated studies with small sample sizes. An updated nationally representative survey using improved methods is needed to determine the levels and sources of sugar intake in different population groups. These include biomarkers to establish levels of consumption and multiple 24-h recalls (at least two) to identify food sources that contribute significantly to excess sugar intake.

Body mass index is associated with fat mass in normal, overweight/obese, and stunted preschool children in central Thailand.

BACKGROUND AND OBJECTIVES: Body mass index (BMI) is widely used as a surrogate measure of adiposity. The relationship between BMI and body fatness varies by race, sex, and age and more variations have been found among children. This study investigated the relationship between BMI and fat mass among 3-5 year old children having different nutritional status. METHODS AND STUDY DESIGN: A cross-sectional study was conducted in 15 daycare centers in central Thailand. 137 healthy preschool children were recruited according to their nutritional status: thin [BMI for age Z scores, (BAZ) <-2 SD], normal BMI (-2 SD<= BAZ <=+2 SD), overweight/obese (BAZ >+2 SD), and stunted [height for age Z scores < -2 SD]. Fat-free mass was determined by deuterium dilution technique. Fat mass (FM) in kilograms (TFM) and in percentage (FM%), and fat mass index (FMI, FM/height2) were calculated. RESULTS: FM and FMI were the highest in the overweight/obese groups. In the thin group, girls had higher FMI compared to boys (3.2 vs 2.8 kg/m2, p<0.05). The relationship between BMI with FMI and FM differed by nutritional status. BMI was more strongly associated with FMI, TFM, and FM% in the overweight/ obese (r=0.97, 0.95, 0.80, p<0.05) and the normal (r=0.88, 0.84, 0.68, p<0.05) groups but not in the stunted group, and inconsistent in the thin group. CONCLUSIONS: The inconsistency in the relationship between BMI and body fatness suggests that BMI is appropriate for reflecting adiposity in normal and overweight/obese children, but not undernourished preschool children.

Impact of Isomaltulose and Sucrose Based Breakfasts on Postprandial Substrate Oxidation and Glycemic/Insulinemic Changes in Type-2 Diabetes Mellitus Subjects.

OBJECTIVE: To investigate the effect of isomaltulose (ISO) and sucrose (SUC) based breakfast on the postprandial substrate oxidation and glycemic/insulinemic changes in type 2 diabetes mellitus subjects (T2DM). MATERIAL AND METHOD: This was a randomized, controlled, double blind, and crossover study performed in two to five days. About 10 to 12 hours prior to the test, the subjects were not allowed to consume food or drink other than water. On the experimental day pre- and postprandial plasma glucose, serum insulin, and substrate utilization were measured after the subjects consumed a test breakfast with ISO or SUC, followed by a standard lunch three hours later. RESULTS: The plasma glucose levels in subjects after consuming ISO breakfast tended to be lower than subjects consuming SUC breakfast at 30- and 60-minute, respectively. The second meal effect after standard lunch (240-minute) on insulin levels in subject consuming ISO breakfast tended to be lower than that of subjects consuming SUC breakfast. Substrate oxidation indicated that the incremental area under the fat oxidation of ISO breakfast was 20% higher comparing to SUC breakfast. CONCLUSION: Therefore, ISO based breakfast tends to provide less postprandial glucose and insulin levels than SUC based breakfast, thereby increasing postprandial fat oxidation.