Cardiovascular risk in the Asia-Pacific region from a nutrition and metabolic point of view: lipid.

Hypercholesterolemia. especially low-density lipoprotein cholesterol, is well-known as a risk factor for coronary heart disease. The prevalence of hyperlipidemia in the Asia-Pacific regions, although not as high as in the North American and European regions, in adults and children varied from country to country. The 'Cardiovascular Risk Factor of Chiang Mai children (CARFACC)' study has shown the small 'n' and capital 'N' phenomenons, where in some individuals, blood lipid levels were tracked from childhood to adulthood. The new concept of programming by early nutrition on later adult health has now been accepted. The prevention of dyslipidemia during childhood should receive more attention.

Nutritional support and growth in thalassaemia major.

Twelve thalassaemic children under 3 years of age received intensive nutritional support for one month and were discharged on a prescribed diet of locally available foods. Anthropometry, bioelectrical impedance analysis and dietary intake were longitudinally assessed. Mean energy intake was 20% greater than the recommended daily allowance during nutritional supplementation as compared with below the recommended daily allowance before and after the period of nutritional support. Weight, but not height, significantly increased during the support period and was due to increases in both fat free mass and fat mass. Body weight, fat free mass and fat mass declined in line with the reduced intake upon return home; however, height velocity accelerated and exceeded normal through the fourth month before resuming a below normal rate. It can be concluded that (1) nutritional stunting as the result of reduced nutrient intake is an important cause of growth failure in young children with thalassaemia and is responsive to nutritional support, (2) the deficit in height velocity was due to retarded truncal height growth, and (3) the bioelectrical impedance analysis method is suitable for body composition analysis of thalassaemic children.

Iron deficiency and anaemia in children with a high prevalence of haemoglobinopathies: implications for screening.

BACKGROUND: Haemoglobin (Hb) concentration is used as a sole test for iron deficiency anaemia (IDA) in most developing countries since most anaemia is believed to be due to iron deficiency and confirmatory testing is generally unavailable. Yet the validity of this approach in regions where haemoglobinopathies are endemic has not been documented. METHODS: Haemoglobin and serum ferritin (SF) were measured in 559 Northern Thai children aged 6 months to 13 years of age. The sensitivity of SF to identify iron deficiency was also assessed in a subsample of children with low or low-normal Hb and normal SF by testing the Hb response to a trial of oral iron. RESULTS: While anaemia was common (27%), IDA constituted 19% and none of all anaemia in preschool and school age children, respectively (P < 0.002). Iron depletion was similarly more prevalent in younger children (P < 0.002). Children with IDA were younger (P < 0.001) and the anaemia more severe (P < 0.0001) compared to those with non-IDA. Of anaemic children with normal SF values who received a therapeutic trial of iron, only 6% responded with an increase in Hb of > or = 1 g/dl. CONCLUSIONS: For populations such as ours most anaemia is not due to iron deficiency and a single Hb determination is therefore not acceptable for a presumptive diagnosis of IDA.

Malnutrition and growth abnormalities in children with beta thalassemia major.

Abnormal linear growth (stunting) is characteristic of children with beta thalassemia major and has been variably and inconsistently attributed to multiple different mechanisms. Despite the coexistence of beta thalassemia with deficits of several micronutrients, global undernutrition as a principle cause of growth abnormalities has not been adequately studied. We prospectively studied 115 nonsplenectomized children (6 months-6 years, 54 males, 61 girls) with beta thalassemia major who has not previously received chelation therapy. Most children had abnormal weight-for-age (WAZ) and height-for-age (HAZ) Z scores, however female children had lower WAZ (p < 0.0001) and HAZ (p < 0.02) compared to males. Mild to moderate degrees of acute wasting was also usual, and two males and one female had severe wasting. Severe weight deficits were more prevalent in the youngest (p < 0.01) and severe stunting in the older (p = 0.01) children. Nearly all children were < 50th percentile for both weight-for-age and height-for-age, and the majority were < 5th percentile. Of note, children were also disproportionately distributed below the 50th percentile for weight-for-height. Pre-transfusion hemoglobin was variably associated with anthropometric measurements. We conclude that not only is linear growth failure pervasive in our population with beta thalassemia major, but varying degrees of wasting are also typical. Further, weight deficits occur at an early age and appear to precede deficits in linear growth. Abnormal growth is not due to chelation therapy and is inconsistently associated with the degree of anemia. These patterns of growth abnormalities indicate general malnutrition as an important cause of growth failure in children with beta thalassemia.

Nutrition knowledge of adolescents in a family setting in Geelong, Australia.

A family study of nutrition knowledge was carried out in 213 families in the city of Geelong, Victoria, Australia. On average, mothers had the highest number of correct answers [mean 8.0 (S.D. 1.4)] followed by fathers [mean 7.8 (S.D. 1.5)], adolescent girls [mean 6.4 (S.D. 1.8)] and adolescent boys [mean 6.2 (S.D. 1.5)]. A highly significant difference, in the score obtained, was found between parents and adolescents (p < 0.001). On average, the percentage of 'do not know' answers was twice as high among adolescents (26%) as among parents (11%). Negative correlations which ranged from -0.10 for girls to -0.23 for fathers were found between the knowledge score obtained by the subjects and socioeconomic status. Parents' knowledge score was independent of their educational level (p > 0.05). Mothers with TAFE (Technical And Further Education) qualifications obtained the highest score (8.7).

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.

Children, AIDS and nutrition: an experience from Chiang Mai, Thailand.

This paper on the experience in Chiang Mai, Thailand, highlighted some of the features of the nature of the paediatric human immunodeficiency virus infection. In Chiang Mai, the incidence of positive HIV tests in pregnant women was 1- 2% and the perinatal transmission rate was approximately 40%. One particular characteristic of HIV infection in Chiang Mai is the association with Penicillium marneffei skin infection. Common clinical features of HIV-infected children are similar to protein energy malnutrition. Once malnutrition occurs in HIV-infected children, the disease deteriorates and the prognosis is worsened. In order to reduce morbidity and mortality in Thai HIV-infected children, early and aggressive nutrition support seems to be a crucial factor in their management. However, Thailand is in a difficult situation as the country is already trying to eradicate malnutrition in children, pregnant and lactating women and is now faced with the added burden of dealing with the secondary malnutrition resulting from the HIV/AIDS epidemic. A preliminary study of 24 HIV positive children (12 boys, 12 girls) aged 1-26 months admitted to the Chiang Mai University Hospital was conducted. Eighty-eight percent of the subjects were malnourished, and a quarter had percent weight for age less than or equal to 60% (third degree protein energy malnutrition). Five (21%) subjects had birthweights less than or equal to 2,500g. To date, over 100 cases of paediatric HIV have been admitted to the Chiang Mai University Hospital. Nutrition plays and important role in HIV infection. Further research is urgently needed in various areas of nutrition and paediatric HIV/AIDS to improve clinical care. A case history of paediatric AIDS was also shown.

Adolescents' perception of body weight and parents' weight for height status.

PURPOSE: To obtain data on the relationships between weight for height status, in adolescents and their parents, and adolescents' perceptions of body image and weight-loss behavior. METHODS: Weight and height were measured in both parents and adolescents from 213 families with an adolescent child aged 14-15 years who were participating in a community-based study of risk factors for coronary heart disease in Geelong, Australia. Information on adolescents' perceptions of body image, desired weight, and weight loss behaviors was obtained by questionnaire. RESULTS: Forty-one percent of the girls and 14% of the boys considered themselves overweight while 18% of both boys and girls were in this category on the basis of their body mass index (BMI). Most boys tended to see themselves as of normal weight while only girls below the 10th centile for BMI consistently rated themselves as normal. Adolescents who rated themselves as slim had parents whose BMI was significantly lower than that of the parents of adolescents who rated themselves as overweight. A significant proportion of adolescent girls (69%) and boys (27%) had at some time tried to lose weight. Female, but not male, adolescents of normal BMI who had tried to lose weight were themselves heavier and had significantly heavier mothers, but not fathers, than those in the normal range for BMI who had not attempted to do so. Adolescents who perceived an advantage in gaining weight had significantly shorter and lighter, but not leaner, fathers than those who perceived an advantage in losing weight. Only individuals below the 10th centile for BMI appeared to be content with their weight. On average the weight desired by girls and boys in the normal range for BMI was 6.6 and 2.0 kg less than their actual weight, while their desired height was 8.0 and 12.8 cm more than their actual height. CONCLUSIONS: The findings confirm gender differences in perceptions of and attitudes to body weight and body build. They also provide evidence for an association between adolescents perceptions of body weight and parents' weight for height status and suggest that the size of the "gap" between desired and actual weight is associated with the prevalence of weight-loss behavior.

Self-reported weight and height in adolescents and their parents.

Self-reported and measured weight and height were compared in a sample of adolescents aged 15 years (109 boys; 95 girls) and their parents (135 fathers; 190 mothers) recruited from secondary schools in the urban area of Geelong, Victoria, Australia. On average the adolescents' self-reported weight and height did not differ to a greater extent from the measured values than did that of their parents for their own weight and height but differences for individuals were much more variable. Self-reported weight was significantly underestimated and height over-estimated by both adolescents and parents. Body size had little effect on the extent of underestimation of weight and overestimation of height. The precision of reporting varied both with age and sex, while reporting bias in the parents, but not the adolescents', was influenced by father's occupation score. The educational level of the parents, however, had no statistically significant effect on reporting bias. The extent to which weight was underestimated and height overestimated was no greater than that observed in adults and suggests that group means reported for weight and height are likely to be as valid a measure of actual weight and height as in adults.

A family study of coronary risk factors in Geelong.

A study of coronary risk factor relationships was carried out in 213 families with adolescents in Geelong, Victoria, Australia, in 1987. Weight, height, skinfold thicknesses, body circumferences, blood pressure and serum cholesterol were measured in both parents and children and other relevant information was obtained by questionnaire. The study group did not differ significantly from the Geelong population with respect to the proportion of Australian-born parents but contained a significantly higher proportion than expected of fathers who had a university degree or diploma. Twenty-five per cent of adolescents, 30% of mothers and 38% of fathers were positive for at least one of the three major established coronary risk factors. Significant correlations between parents and children, but not between parents, were found for total cholesterol and systolic blood pressure, while significant correlations were observed both between parents and children and between parents for measures of body size, body fatness and body fat distribution. The strongest predictors of risk factor status in adolescence were both parents with total cholesterol at or above 5.5 mmol/l, one or more parents who smoked and one or more grandparents with a history of coronary heart disease. Body mass index in adolescence was unrelated to heart disease risk factor status in adolescence or to a family history of heart disease. During early childhood and adolescence, parental risk factor status, rather than anthropometric or risk factor screening of the children themselves, is likely to provide the best guide to those at risk for an adverse coronary risk factor profile.

Early life factors affecting body mass index and waist-hip ratio in adolescence.

A study of the relative contribution of early, parental, contemporary influences on body mass index (BMI) and waist-hip ratio (WHR) in adolescence was carried out in 213 families with adolescents in Geelong, Victoria, Australia. Weight, height and body circumferences were measured in both parents and children and other relevant information was obtained by questionnaire. The parents of the families studied were broadly representative of the Geelong workforce. The data obtained were divided into three categories: early life, parental and contemporary. The early life influences studied were sociodemographic environment, illness during the first year of life, infant feeding practices, weight, height and rate of growth. Parental factors included socioeconomic and anthropometric characteristics. Contemporary influences, studied in the adolescents, included sociodemographic, lifestyle and anthropometric data as for the parents. Multivariate analyses (multiple regression analysis) was used to determine the strongest influence on BMI from each of the following categories: early life, parental and contemporary. Subsequently the factors identified from each of these three categories were combined in a further multiple regression analysis to determine the strongest overall determinants for BMI and WHR in adolescence. Apart from gender, only BMI at 50 months contributed significantly to BMI in adolescence. Similarly, apart from gender, only BMI at 80 months was a significant determinant of WHR in adolescence.