Effects of an iron supplementation trial on the Fe status of Thai schoolchildren.

A double-blind clinical trial was conducted among 9- to 11-year-old children in sixteen schools in the Chon Buri province of Thailand to assess the effects of an iron supplement combined with an anthelminthic agent (i.e. albendazole). In addition to the albendazole, Fe or placebo tablets were distributed to 2268 children enrolled in grades three to five without knowledge of the Fe status of the children. Criteria for case inclusion were: (a) absence of A E Bart's or haemoglobin (Hb) H disease, (b) absence of abnormal Hb EE, and (c) age, 108-144 months. The results showed a significant improvement in the Fe status of the children after 16 weeks of treatment. The increments were: Hb from 124 to 128 g/l, serum ferritin from 34.54 to 104.72 micrograms/l, transferrin saturation from 24.09 to 35.05%; free erythrocyte protoporphyrin decreased from 444.7 to 281.4 micrograms/l erythrocytes. These changes were significantly greater than in the control group that received only the anthelminthic agent. However, the administration of albendazole only also resulted in significant changes in the same Fe indicators.

Iron deficiency and educational achievement in Thailand.

This double-blind clinical trial was conducted in Thailand to assess the impact of iron treatment on the IQ and educational attainment of 1358 9-11-y-old children. The children were classified into one of three groups: iron replete, iron depleted, and iron-deficient anemic. The Raven Progressive Matrices was used to measure IQ. A Thai language and a math test were administered to assess school attainment. A 50-mg/d tablet of ferrous sulphate was given for 2 wk and a 100 mg/d tablet, for 14 wk. An anthelminthic drug was given on the day of the blood test before treatment and 3 mo after the intervention started. There is evidence of a positive association between iron status and IQ and a language school achievement test but there is no support for the internal validity of the hypothesis that this association is causal.

Energy requirements of pregnancy in rural Thailand.

The energy cost of pregnancy was measured in rural Thai women between 10 wk gestation and term. The energy cost of pregnancy, which includes the increase in basal metabolic rate (BMR), the energy equivalent of maternal fat laid down, and the assumed energy equivalent of fetal fat and fetal and maternal protein, was 202 MJ (1 MJ = 239 kcal). BMR increased by 100 MJ overall and maternal fat gain averaged about 1.3 kg, equivalent to 60 MJ. The energy cost was more than covered by an overall increase in food intake of 238 MJ with little evidence of any complementary reduction in total energy expenditure by reduced physical activity.

PIP: 44 healthy pregnant women from 12 villages near the city of Ubon, northeast Thailand, were studied as part of a multicenter study investigating energy requirements during pregnancy. Total energy intake was measured to determine whether it increased to cover the costs of pregnancy and total energy expenditure. It was hypothesized that some of the energy necessary for pregnancy could be met by reductions in physical activity or by other means. Besides the usual household tasks, all 44 women participated in farming, and all continued working until term. 31 women were recruited at 7-12 weeks gestation; 13 joined at a later stage of gestation (up to 18 weeks). Measurements were made every 6 weeks from the subject's joining the study until term. Body weight was recorded on a carefully calibrated balance, and skinfold thicknesses at 4 sites -- biceps, triceps, subscapular, and suprailiac -- were measured with Harpenden calipers. Basal metabolic rate (BMR) was measured under standard conditions by the Douglas bag technique. Every 6 weeks a minute-by-minute record of daily activity was kept by an observer for 5 consecutive days simultaneously with the food intake record. For a few hours before she went to bed, the woman kept a written record of her own activities if she could write, or she ticked off her activities on a form with pictorial representations. Weight gain from 10 weeks until term was 8.9 (2.9) kg with a uniform rate of about 0.3 kg/week. Maternal fat gain was calculated by 3 different approaches. By the factorial method (total weight gain minus the weight of the fetus, the placenta, and the expanded maternal tissues, the estimated fat gain (43 women) was 1.3 kg. Fat mass was estimated by measuring 4 skinfold thicknesses in 25 women at 10 weeks gestation (fat mass 11.0 kg) and 4 week postpartum (fat mass 12.1 kg), giving an estimated gain of 1.1 kg fat. For the 3rd method, the change in weight between 10 weeks gestation (46.9kg) and 4 week postpartum (49.3) was calculated. 0.4 kg was subtracted to allow for the increase in the weight of the breasts and the remaining weight was assumed to be adipose tissue containing about 80% fat, giving an estimated fat gain of 1.6 kg. The average maternal fat gain from the 3 different approaches was 1.3 kg, with an estimated energy equivalent of 59.8 MJ. There was a nonsignificant increase in BMR from 10 weeks to 15 weeks, and thereafter a substantial rise until term. BMR increased by 100 MJ overall, and maternal fat gained averaged about 1.3 kg, equivalent to 60 MJ. The energy cost was more than covered by an overall increase in food intake of 238 MJ with little evidence of any complementary reduction in total energy expenditure by reduced physical activity.

Hemostatic derangement in dengue haemorrhagic fever.

Forty children, aged 1/2-14 years, with serologically proven dengue haemorrhagic fever were daily studied for hemostatic tests. There were 4, 20 and 16 cases of grade I, II III respectively. Hemostatic derangements in DHF is a multifactorial mechanism. Vasculopathy, thrombocytopenia, platelet dysfunction were found in most cases. Mild to moderate degree of prothrombin complex deficiency was observed in 15% and 50% of grade II and grade III respectively while laboratory evidence of consumptive coagulopathy was noted in 30% of shock cases and 10% of non-shock cases. Hypofibrinogenemia and increased PTT are commonly seen in grade III reflect the presence of stimulation of intrinsic coagulation pathway probably from immunologic reaction. Frank DIC is very rarely observed. FDP is slightly increased but not as high as in classical DIC. Further study on the role of platelet-endothelial interaction should be elucidated including the efficient management to stop bleeding in severe shock cases.

High urinary excretion of nitrate and N-nitrosoproline in opisthorchiasis subjects.

About 50% of the population in some provinces of north-east Thailand are infested with liver fluke (Opisthorchis viverrini), and many develop cholangiocarcinoma subsequently. This study was designed to demonstrate possible endogenous formation of N-nitrosoproline (NPRO) in this population. Diet samples, saliva and urine were taken from subjects with and without liver fluke and analysed for nitrate and nitrite; urine was also analysed for NPRO. Nitrate and nitrite levels in saliva were higher in subjects with liver fluke than in those without; total nitrate and NPRO excretion was also higher in this group. Subjects with liver fluke may therefore be more heavily exposed to N-nitroso compounds than others, and may be at higher risk for cholangiocarcinoma.

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

Nitrate and nitrite in saliva and urine of inhabitants of areas of low and high incidence of cholangiocarcinoma in Thailand.

Cholangiocarcinoma is one of the main liver diseases in northeast Thailand. Associations with exposure to liver fluke and N-nitrosodimethylamine in formation of the tumour have been demonstrated in animals. This study was carried out to compare possible endogenous formation of N-nitroso compounds in inhabitants of areas with low and high incidences of cholangiocarcinoma by examining the levels of nitrate and nitrite in their saliva and urine. Thirty-two subjects (16 males and 16 females) living in the north-east (high incidence) and 12 volunteers (6 males and 6 females) in Bangkok (low incidence) were allowed to take regular meals, and their saliva and urine were collected before, and 30, 60 and 120 min after each meal. Nitrate and nitrite concentrations in saliva of the group in the high-incidence area were significantly higher than those of the group in Bangkok: salivary nitrate was 2-2.8 times higher and nitrite 2-5.6 times higher in the north-eastern group when compared with levels at each corresponding time interval in the low-incidence group. Nitrate levels in urine were also significantly higher in the north-eastern group at some time intervals, but urinary nitrite levels were similar and very low in both groups throughout the day. This finding may indicate a greater possibility of in-vivo formation of N-nitroso compounds in the north-east area than in Bangkok and might be associated with the occurrence of cholangiocarcinoma in north-east Thailand.

Protein energy malnutrition related to diarrhea in Thai children.

PIP: Protein energy malnutrition (PEM) continues to be a major public health problem in Thailand. It affects physical growth, mental development, learning ability, and immune response to infections. In this discussion of PEM related to diarrhea in the children of Thailand, attention is directed to the following: intrauterine malnutrition; the practice of breast feeding; the prevalence of PEM in the early infancy period; the prevalence of PEM in preschool children; diarrhea in infants and children; and possible solution to the problem of PEM and diarrhea. For some infants, PEM occurs during the intrauterine period. In the urban slum areas of Bangkok where breast feeding practice was about 34-45%, the prevalence of PEM based on weight for age was very high among infants under 6 months of age. 3rd degree PEM in the 2 urban slum areas was 13 and 17% as compared to 0% in the semi-rural area of Bang-Pa In, where breast feeding practice was about 62-65%. The total prevalence of PEM in the urban-slum areas ranged from 71-79%, which was approximately 3-4 times that of the semi-rural area. The decline of breast feeding practice, the improper handling and unhygienic preparation of artificial feedings are the major contributing factors to PEM associated with diarrhea during early infancy. The prevalence of PEM among preschool children in Thailand during 1979-1980 was approximately 56% with 39.5, 14.2 and 2.3% of 1st, 2nd, and 3rd degree respectively. The highest prevalence of PEM was observed in preschool children of the northeast which has been considered the poorest region in the country. Diarrheal disease has been for many years the 1st or 2nd leading cause of death in Thai infants. Infants and children who are suffering from moderate and severe diarrhea will result in high mortality and morbidity attributable to PEM. In 1 report, all infants with intractable diarrhea were malnourished, 70% of them were classified as 3rd degree PEM and 15% each were 1st and 2nd degree PEM. The interrelationship between PEM and diarrhea in infants and children is now recognized as the most critical health problem of the developing countries. In an effort to improve the nutritional status of infants and children by alleviating PEM and diarrhea, the National Economics and Social Development Board has developed a set of food and nutrition policies in the 5th National Plan during the period from 1982-1986. Major emphasis will be on parent education in maternal nutrition, infant feeding, and hygienic handling and preparation of food for infants.^ieng

Lactose malabsorption in Thai infants and children: effect of prolonged milk feeding.

More than one-third of Thai infants were lactose malabsorbers soon after birth and the percentage of lactose malabsorption increased with age. Beyond 4 years of age, all Thai children studied were lactose malabsorbers. Continued milk supplementation over the study period did not affect the ability to digest lactose in the amount given in the load test. Since the milk-supplemented group of children tended to have better weight gain and few undesirable gastrointestinal symptoms, it seems milk feedings can be used to advantage even among populations with a record of high lactose intolerance.