Trends of increases in potential risk factors and prevalence rates of diabetes mellitus in Thailand.

Over the past three decades, undernutrition in Thailand has drastically reduced by over seven times. However, since 1995 the number of patients afflicted with non-communicable diseases, such as diabetes mellitus, has rapidly increased, even among the young. Unhealthy life styles due to urbanization are a major reason for this increase. Less physical activity and low consumption of fruits and vegetables, as well as high consumption of added free sugar, are common. Every year, the Thai people increase their consumption of energy from fat and protein, while lowering their intake of energy from complex carbohydrates. Per capita and on average, a Thai individual consumes up to 20% of total energy from added free sugar. Barker's hypothesis and Developmental Origins of Health and Disease hypothesis (DOHaD) can partially explain the increase in diabetes mellitus at this rapid rate. To alleviate the problem, the main strategy has been consumer education to reduce diabetes mellitus prevalence. Sugar elimination from infant formula is mandatory and sugar taxation is being considered. Simplified nutrition labeling is voluntarily as part of consumer education, as well as encouraging food industries to produce healthier food products. Currently, a multi-sectoral approach is used for alleviating diabetes mellitus in Thailand.

Thailand conquered under-nutrition very successfully but has not slowed obesity.

Under-nutrition in Thailand has been successfully controlled for over two decades. However, Thailand is now facing a double-burden malnutrition problem where under- and over-nutrition coexist. Overweight, obesity, and related diseases are the main nutritional challenges, leading to high costs for curative care. Thailand foresees that nutrition can be an effective strategy for preventing diet-related non-communicable chronic diseases, and the country aims to reduce costs for secondary and tertiary health care. Various organizations have conducted national programmes, focusing especially on nutrition education and public campaigns, which have been sustainable and not sustainable. Only milk and certain foods for children are mandated for nutrition labeling. Guideline daily amounts is now the nutrient profile mandated for snack foods in Thailand. To increase efficiency, Thailand's National Food Committee has been established to link food, nutrition and health via a multi-sectoral approach.

A social epidemiologic study of obesity among preschool children in Thailand.

OBJECTIVE: To describe the prevalence of childhood obesity in a moderately industrialized province in Thailand and examine the influence of socioeconomic status (SES) on childhood obesity. DESIGN: Cross-sectional study. SUBJECTS: One thousand one hundred and fifty seven children in the second or third grade of kindergartens in Saraburi Province, Thailand. MEASUREMENTS: Height and weight were measured and the weight-for-height index with the Thai national standard was used for assessing nutritional status. A questionnaire was used for measuring parents' socioeconomic status. RESULTS: The prevalence of childhood obesity over 97th percentile for weight-for-height (>p(97)) was 22.7% in urban and 7.4% in rural areas. There were marked relationships between childhood obesity and parents' educational level and household income. CONCLUSION: Childhood obesity is an emerging health problem in developing countries, especially in urban areas. This study demonstrates a marked correlation between SES and prevalence of childhood obesity in an Asian developing country.

Lactitol tolerance in healthy Thai adults.

The hydrogen breath analysis test was performed in healthy Thai adults to determine lactitol tolerance. The study was conducted in 39 individuals (11 males and 28 females) aged 18-41 years. All volunteers agreed to participate in this study after the risks and benefits had been fully explained. Subjects were requested not to consume milk, milk products, or high-vegetable diets for a day and to fast from 10 p.m. of the day preceding the test day. After consumption of the test diet (12 and 20 g of lactose or lactitol, respectively, in 250 mL water), the subjects recorded the severity of symptoms for 24 hours. Breath samples were collected after fasting and after consumption of the test diet at 30 min intervals over the 7-hour study period. Breath samples were analyzed for hydrogen using gas chromatography. After consumption of 12 g lactose, the prevalence of lactose malabsorbers was established. The increment of a peak breath hydrogen level of > or = 20 ppm above the baseline level was used as an indicator of lactose malabsorption. The lactose malabsorbers were further classified as lactose tolerance or lactose intolerance according to the gastrointestinal symptoms observed. All 39 healthy Thai adults could be classified into 3 groups as follows: 9 (23%) lactose absorbers (LA), 15 (38.5%) lactose mal-absorber/tolerance (LMT), and 15 (38.5%) lactose mal-absorber/intolerance (LMI). Using the hydrogen breath test, 67% of the subjects were identified as lactitol intolerance after the consumption of 12 g lactitol. The lactitol intolerance comprised 53.8% of LMI, 34.6% of LMT, and 11.5% of LA. Among all subjects, one third of LA (33%), two thirds of LMT (60%), and 93% of LMI were lactitol intolerant. In addition, gastrointestinal symptoms such as flatulence and abdominal pain were most pronounced in LMI. Diarrhea was also a prominent manifestation after consumption of 12 g lactitol. Therefore, it was finally decided that 20 g lactose or lactitol were not given to LMI because of the risk of gastrointestinal symptoms. After high doses (20 g) of lactose and lactitol consumption, most LMT developed more symptoms than did LA and the main symptom was diarrhea. Consumption of 20 g lactose resulted in fewer symptoms than 20 g lactitol in both LA and LMT. On the basis of the hydrogen breath test, most LA tolerated 12 g lactitol without gastrointestinal symptoms except some flatulence whereas most LMT and LMI did not. Twenty g lactitol was not tolerated by both LA and LMT because there was diarrhea among the subjects, especially in LMT. Although the hydrogen breath analysis test is the best method for identification of lactose malabsorption, it is not the best method to identify lactitol intolerance. A hydrogen concentration of 15 ppm above the baseline level was found to be the best cut-off point to indicate lactitol intolerance although sensitivity was 85% and specificity only 38% in this study. It was further concluded that there is a greater susceptibility to lactitol in human lactose malabsorbers than in lactose absorbers. Our findings might be relevant for the limited use of lactitol in Thailand.

Plasma free amino acid contents in healthy Thai subjects.

This preliminary investigation determined the plasma amino acid concentrations in 136 healthy subjects. The subjects were divided into four groups according to their ages: gr 1; 1-3 years, gr 2; 4-11 years, gr 3; 12-19 years and gr 4; 20-45 years. Comparing among the groups, the results showed that in younger children (age 1-3 years) the essential amino acids were slightly lower than the other groups. A wide range for most amino acids were observed. The ratio of essential (EAA): non-essential amino acid (NEAA) in very young children (1-3 years) was lower than children, adolescents and adults. These ratios were normal (> 0.5). The data have been compared with those from several studies performed in normal healthy subjects of different age groups, races and dietary habits. The results showed that most of the mean values of individual amino acid were higher than others except cystine. The EAA:NEAA ratio of each age group was comparable with other reports. The mean values of plasma amino acids and EAA:NEAA ratio in healthy subjects were determined for diagnosis, follow-up and prognosis of malnourished condition, abnormal amino acid metabolism and as a reference for other purposes.

Effects of multivitamin supplementation for improvement of thiamin, riboflavin, and retinol nutrition in pediatric patients.

The effect of multivitamin supplementation on thiamin, riboflavin and retinol nutrition was studied in ten male chronic pediatric patients at Ramathibodi Hospital. MTV forte (Government Pharmaceutical Organization) was given 1 tablet daily for ten days and the effect was compared with the preceding ten-day control period. Anthropometric biochemical, clinical and dietary assessments were performed throughout the study. Biochemical assessments of vitamin nutrition at the beginning and the end of a 10-day non-supplementation period revealed multiple vitamin deficiencies in the subjects, though clinical manifestation was not seen. Hospital diets improved vitamin nutrition of some patients but most of them still showed subclinical vitamin deficiencies. Improvement of vitamin nutrition was clearly shown in most patients after MTV supplementation. Multiple vitamin supplements should be prescribed in high-risk patients since there was no definite pattern of vitamin deficiencies in various diseases and early detection of vitamin deficiency was difficult to perform. The dosage between 1-2 times of RDA was considered adequate in most of our patients.

Coordinated strategies for controlling micronutrient malnutrition: a technical workshop.

Participants in a November 1991 workshop concluded that coordinated strategies for controlling malnutrition due to iodine, iron, vitamin A and other micronutrients deficiencies are technically feasible and should be given consideration in planning control efforts. Coordinated surveys involving clinical, biochemical and dietary assessment of multiple micronutrients are feasible. Multiple fortification is also possible using such vehicles as salt, processed rice or sugar. Supplementation efforts can be integrated with existing health care programs. Food-based strategies are also effective. The best examples have been community-based and have included a strong nutrition and health education component designed to change food consumption patterns, improve food preservation and preparation practices, and link income-generating activities with food production activities. Successful coordinated efforts will require a strong political commitment and a supportive infrastructure. Specific recommendations include the formation of national coordinating bodies for micronutrient deficiency control, establishment of a micronutrient information network and expansion of technical exchange and training.

Trends in the development of Thailand's nutrition and health plans and programs.

Thailand's achievements in health and social development, since its First National Economic Development Plan (1961) and those of its National Food and Nutrition Plans beginning in the Fourth National Economic and Social Development Plan (1977), have received worldwide acclaim. During the last decade the nation has experienced dramatic results in reducing protein-energy malnutrition (PEM), including the virtual eradication of severe PEM. Children and adults alike have better access to health care services, preventive and curative, during the past decade as Thailand's poverty alleviation, primary health care and quality of life approaches have reached out into even the remotest of rural villages. This paper explores the reasons behind this successful effort with special reference to how Thailand integrated nutrition plans into national health and rural development policies and programs.

Clinical trial of special premature formula for low-birth-weight infants.

Feeding 25 low birth weight infants during a one month period either with special premature formula or with standard formula resulted in better weight gain, nutritional efficacy, fat absorption, and lower frequency of metabolic acidosis in the special premature formula group. Various biochemical indices demonstrated excellent protein and mineral metabolization of this formula, which seem appropriate for the infants studied (1,000-1,750 g birth weight). Both formulae were well tolerated without any untoward effects.

Effect of phototherapy on nutrients utilization in newborn infants with jaundice.

The effect of phototherapy on digestion and absorption of nutrients was performed in 25 male, newborn infants with hyperbilirubinemia. The infants were divided into 2 groups; one group was fed with lactose formula whereas the other group received the non-lactose formula. The quantities of daily volume, fat and energy intakes of both groups were similar. Protein intake was significantly higher in the latter group. During 72-hours of phototherapy, there were decreases in serum bilirubin in all infants and mean weight change was decreased in infants fed with non-lactose formula. Treatment by phototherapy in jaundiced infants did not affect protein, fat and energy absorption. The presence of loose stool, lower stool pH and trace in reducing substances in some subjects fed with lactose formula suggests mild lactose intolerance. Prospective study in clinical trial needs to be further assessed and clarified on other nutrients such as amino acids and riboflavin status in these infants during phototherapy.

Effect of a formulation of supplementary food for pregnant women on birth weight of newborns.

The effect of a supplementary food mix prepared from roasted mungbean, groundnuts, and sugars on maternal nutrition and birth weight of newborns was studied. The results indicated that supplementary food provided to the pregnant women had a significantly positive effect on the birth weight of newborns. In addition, a significantly higher weight gain by the mothers was observed as compared to the control group.

Formulation and evaluation of supplementary foods for Thai pregnant women.

To improve maternal nutritional status and to ameliorate protein-energy malnutrition in pregnant women and infants, supplementary foods for rural pregnant women were formulated and evaluated. Six formulas with protein and energy contents of 16-22 g and 350-500 kcal/100 g food, respectively, were developed from locally available raw materials. A field evaluation of formulas I and V was conducted at the regional MCH Center at Rajchaburi, about 120 km from Bangkok. Formulas providing 13 g protein and 350 kcal per day were given to two groups of mothers in the first or second pregnancy, starting at 28 +/- 2 wk of gestation. A third group, unsupplemented, served as controls. Maternal weight gain and left mid-arm circumference were measured every 2 wk. Birth weight, length, head and chest circumferences of newborns, and placental weight were significantly higher in both supplemented groups. These findings suggest that among undernourished mothers, supplementation of as little as 13 g protein and 350 kcal daily during the last trimester can significantly improve maternal weight gain and birth weight of newborns.

PIP: Supplementary foods for 43 pregnant mothers who lived in the rural region of Thailand were formulated and evaluated in an effort to improve maternal nutritional status and to ameliorate protein-energy malnutrition in both pregnant women and their infants. 6 formulas were developed, based on locally available food sources that would provide an additional amount of protein and energy. 2 formulas were selected for field evaluation with 2 of the experimental groups. The 3rd group served as a control and received no supplementation. During the 3rd trimester, subjects in the control group, with no supplement, had significantly smaller weight gain than the 2 supplemented groups. There was a trend towards increasing hematocrit in both supplemented groups. After supplementation, the prevalence of anemia in both groups I and II was decreasing significantly; the control group showed an increasing prevalence of anemia. Birth weights lower than 2500 g were not observed in either supplemented group but were seen in the control group. Length, head and chest circumferences of newborns, and placental weight also were significantly higher in both supplemented groups.

Wheat extract and milk mixture as a milk substitute for children with milk intolerance.

PIP: A mixture of milk with wheat extract and oil provides a low lactose formula which contains higher concentrations of energy than does diluted infant formula. To evaluate this mixture in malnourished children with diarrhea of more than 1 week's duration, 28 patients aged 3-18 months were studied at the pediatric isolation and metabolic wards of Ramathibodi Hospital. They were divided equally into study and control groups. The experimenta formula was a mixture of wheat extract, powdered whole milk and corn oil. The control diet was an infant formula. The lactose contents of the experimental and control formulas were, respectively, 1.1 and 7.2 g/100 ml. Amounts of fat, protein and carbohydrates were almost identical in both formulas. After rehydration with intravenous or oral electrolyte solutions, patients were fed full strength experimental formula or diluted infant formula. The latter's concentration was increased gradually according to clinical response, determined by daily weight, and stool frequency and consistency. All study group patients and 11 of 14 control group patients recovered from diarrhea. The mean +or- SD treatment durations in the study and control groups were 3.2 +or- 1.1 and 5.3 +or- 2.2 days respectively (p 0.01). The result suggested that a combined wheat extract/milk mixture is beneficial as a milk substitute for children with lactose intolerance.^ieng

Protein digestibility of weaning foods prepared from rice-minced meat and rice-mungbean combination in infants using a short term nitrogen balance method.

Three diets based on rice-dehulled mungbean, rice-minced meat and rice-mungbean with hull were tested with infants 11 to 20 months of age using a short term nitrogen balance technique. The results indicate that with isocaloric and isonitrogenous intake, all the subjects given either of the three diets were in positive nitrogen balance. The protein quality, in terms of nitrogen absorption and true digestibility, of rice-meat diet was superior to that of rice-bean diets. Among the rice-bean diets, it was noted that rice-mungbean with hull had a lower digestibility as compared to rice-dehulled mungbean diet. The poor digestibility of rice-mungbean with hull diet is the first limiting factor in its utilization by infants. Dehulling of mungbean before cooking is recommended for preparing weaning food for infant feeding.