Nutritional factors and thalassaemia major.

Abnormal growth is a common feature of thalassaemia major in children. In an attempt to determine whether it has a nutritional cause, 12 children aged 1 to 3 years with thalassaemia major were studied under metabolic ward conditions. Nutritional status was assessed by anthropometry and biochemistry before and after an intensive nutrition regimen. Five children had wasting or stunting on admission. As a result of the nutrition intervention, mean weight for height improved significantly. The mean height increase of 0.4 cm after one month was not significant. Plasma zinc, depressed in half the children on admission, improved, as did alpha tocopherol, while copper decreased. Plasma insulin-like growth factor-I also increased commensurate with improved growth. Fat absorption was normal in all children. Undernutrition is an important cause of associated growth disturbances in children with thalassaemia major. Malnutrition was primarily caused by inadequate nutrient intake, as indicated by the capacity to gain weight appropriately when provided with nutrition support, and by the absence of intestinal malabsorption. While long term studies are required to determine if nutritional support will prevent stunting, these results underscore its central role in preventing nutritional deficiencies and in promoting normal growth in thalassaemic children.

Weaning practices and breast-feeding duration in Northern Thailand.

Current infant feeding guidelines recommend exclusive breast-feeding until the infant is about 4 months old to reduce the risks of early termination of breast-feeding, undernutrition and infection. In many societies, however, supplementary foods are given well before 4 months of age. The present paper describes weaning practices, factors associated with early supplementation and the effects of supplementation on duration of breast-feeding in a random sample of sixty northern Thai breast-fed infants studied prospectively from birth to 2 years of age. Composition of supplementary foods, energy and protein intake from supplements and changes in the supplementary diet with increasing infant age are also described. Rice-based foods were given from soon after birth; 81% of the sample had received supplements by 6 weeks of age. Early supplementary feeding was significantly associated with rural residence, large household size, maternal employment in agriculture and maternal age. Girls and infants with lower birth weights tended to be supplemented earlier. Despite early feeding of supplements, breast-feeding was prolonged, with median duration of 12 months. Early introduction of supplements and quantity of supplements consumed in the first 3 months were not associated with duration of breast-feeding. However, mothers who gave infant formula as the first supplementary food stopped breast-feeding slightly earlier, as did younger mothers living in households with more children.

Oral contraceptives: effect of long-term use on liver vitamin A storage assessed by the relative dose response test.

Vitamin A status measured by the relative dose response (RDR) test was determined among groups of Northern Thai women who had used estrogen-containing oral contraceptives (OCs) with or without multivitamin supplements through 13 cycles. Mean serum vitamin A values were elevated approximately 40% above those of control subjects (intrauterine contraceptive device (IUCD) users) during OC usage. Daily (one capsule) or periodic (two capsules 7 d/mo) multivitamin supplementation that included 1700 micrograms vitamin A per capsule did not significantly influence vitamin A serum values. The RDR test after 13 cycles was elevated in one individual who had taken OCs and the periodic multivitamin supplement. It reverted to normal after supplementation with vitamin A. A single high-dose vitamin A supplement (68,000 micrograms) did not change circulating levels of the vitamin. Among this population there is little evidence that use of estrogen-containing OCs for greater than 1 y resulted in a physiologically significant deterioration of vitamin A status.

PIP: Vitamin A status measured by the relative dose response (RDR) test was determined among groups of Northern Thai women who had used estrogen- containing oral contraceptives (OCs) with or without multivitamin supplements through 13 cycles. Mean serum vitamin A values were elevated approximately 40% above those of control subjects (IUD users) during OC usage. Daily (1 capsule) or periodic (2 capsules 7 days/month) multivitamin supplementation that included 1700 mcg vitamin A/capsule did not significantly influence vitamin A serum values. The RDR test after 13 cycles was elevated in 1 individual who had taken OCs and the periodic multivitamin supplement. It reverted to normal after supplementation with vitamin A. A single high-dose vitamin A supplement (68,000 mcg) did not change circulating levels of the vitamin. Among this population there is little evidence that use of estrogen-containing OCs for more than 1 year resulted in a physiologically significant deterioration of vitamin A status.

Estimation of 24 h breast-milk fat concentration and fat intake in rural northern Thailand.

1. The present study assesses the accuracy with which mean 24 h breast-milk composition can be estimated if milk samples can only be collected during the daytime. 2. Twenty-five northern Thai mothers, feeding their infants on demand, were studied in their homes for 24 h. All feeds were test-weighed and 0.5 ml pre- and post-feed expressed milk samples taken at each feed. 3. If daytime sampling was restricted to two breast-feeds, it was found that the best estimate of 24 h fat concentration was given by two randomly chosen daytime feeds, predicting 24 h fat concentration with 95% confidence limits of +/- 7.0 g/l (equivalent to 21% of mean 24 h fat concentration). 4. Alternative sampling methods using the mean fat concentration of the feed after 08.00 hours and after 18.00 hours, or the first two feeds after 12.00 hours, predicted fat concentration with 95% confidence limits of +/- 9.7 g/l and +/- 8.9 g/l (28 and 26% of mean 24 h fat concentration) respectively. 5. If well-tolerated by mothers, it would be preferable to sample all daytime feeds, since this reduces the 95% confidence limits to +/- 3.3 g/l, equivalent to 10% of the mean 24 h fat concentration.