To what Extent Can Food-based Approaches Ensure Dietary Adequacy for Women and Young Children in SE Asia.

Objectives: To predict whether food-based approaches can ensure dietary adequacy for 6-23 month old children and women of reproductive age in SE Asia and to identify problem nutrients. Methods: Linear programming was used to determine whether nutritionally adequate diets based on locally available non-fortified foods (11 micronutrients ≥ WHO/FAO RNI, assuming moderate iron and zinc bioavailability) could be formulated for women and young children in 5 countries. Model parameters were defined using nationally representative (Indonesia, Thailand, Vietnam, Cambodia) or locally representative (Laos, Cambodian children<12 months) 24-hour recall dietary data. Problem nutrients were defined as those <100% RNI in a diet where intakes were maximised. Nutrient adequacies, for food-based recommendations (FBR), were defined as those >65% RNI, when intakes were minimised, in diets achieving the FBR. Results: Numbers of problem nutrients ranged from 2-9, 1-8 and 0-5, for 6-8 mo, 9-11 mo and 12- 23 mo old children; and from 3-7, 2-4 and 1-4 for pregnant, lactating and non-pregnant- nonlactating women, respectively, depending on the country. In most countries, modeled FBRs ensured adequacy for ≥7 (children) and ≥5 (women) nutrients. In all countries, FBRs did not ensure adequate iron (all groups) and folate (women) intakes. Conclusions: Interventions, such as food fortification or the promotion of unutilized nutrient dense foods, are likely required to ensure dietary adequacy, for women and young children, in SE Asia. Funding: The European Commission, FP7, GA-2896-16.

Effect of Demographic Variables on 25(OH)D Level and on the Risk of Vitamin D Insufficiency in SEANUTS Countries.

Objectives: Vitamin D insufficiency is endemic in western countries. Emerging evidence suggests this may be true also for countries with abundant sunshine. This study aimed to evaluate the vitamin D status and associated risk factors in a sub-sample of children from the South East Asian Nutrition Surveys (SEANUTS). Methods: SEANUTS was conducted in Indonesia, Malaysia, Thailand and Vietnam in a country representative sample of 16744 children aged 0.5 to 12 years. Information on socio-demographic variables, lifestyle habits and anthropometric measures were collected. In a sub-sample of 2016 children, serum 25-hydroxyvitamin D [25(OH)D] levels were determined. Data were analysed using SPSS complex sample with weight factors to report population representative data. Results: In Malaysia and Thailand, urban children had lower 25(OH)D levels than rural children. Except Vietnam, boys in all countries had higher 25(OH)D levels and older children had lower 25(OH)D levels. Regional differences persisted in all countries even after correcting for age, sex and area of residence. In Malaysia and Thailand, 25(OH)D status was also associated with religion. The percentage of children with adequate 25(OH)D levels (>75nmol/L) ranged from as low as 5% (Indonesia) to 20% (Vietnam). Vitamin D insufficiency (<50nmol/L) was noted in nearly 40% to 50% of children in all countries. Girls, urban area, region and religion significantly increased the odds of being vitamin D insufficient. Conclusions: The high prevalence of vitamin D insufficiency in SEANUTS countries suggests a need for a tailored approach to successfully combat this problem. Promoting active and outdoor lifestyle along with food fortification can be feasible options.

The association of dietary calcium, bone mineral density and biochemical bone turnover markers in rural Thai women.

OBJECTIVE: To investigate the relative contribution of dietary calcium intake on bone mineral density (BMD) and biochemical bone turnover markers in rural Thai women. MATERIAL AND METHOD: A cross-sectional investigation was designed in 255 rural Thai women. Usual dietary calcium intake was determined by 3-day food records and quantitative food-frequency questionnaire. BMD was measured by DXA. The three markers for bone turnover event: serum total alkaline phosphatase, serum N-mid osteocalcin and type I collagen C-telopeptide, including serum calcium and were determined in 125 women in the present study. RESULTS: An average daily calcium intake in the present study was 265 mg/day. Two hundred and thirty three out of 255 women (87%) consumed dietary calcium less than half of the recommended value and only 3% of women (n = 7) had calcium intake > 800 mg/day. After controlling certain parameters: age and body mass index, women who consumed higher amount of dietary calcium had significantly higher BMD at all sites. Moreover highly increased bone turnover markers were observed in those with lowest quartile calcium intake. Women with osteopenia and osteoporosis were older, lower BMI, consumed less calcium and had significantly higher values of all biochemical bone turnover markers than those who had normal BMD. CONCLUSION: The present study showed that a habitual diet of the rural Thai population might not provide enough calcium as needed for bone retention and for prevention of bone loss in the following years. Modification of eating pattern by promotion of increased consumption of locally available calcium rich food may be beneficial for prevention of osteoporosis among this population.

Dietary calcium intake among rural Thais in Northeastern Thailand.

OBJECTIVES: The present study examined the amount and relative contribution of calcium from the habitual diet among rural Thais. MATERIAL AND METHOD: Calcium intake was assessed using 3-day food records and interviewer-administered quantitative food-frequency questionnaire, containing 73 food items. RESULTS: The authors recruited 436 healthy participants (181 men and 255 women), between 20 and 85 years of age. Averaged daily calcium intake among men and women were 378.6 and 265.6 mg, respectively. Sixty-seven percent of men and eighty seven percent of women had less dietary calcium intake than half of the recommended level (< 400 mg/day) whereas only 6 and 3% had an intake more than 800 mg/day. The major food sources of dietary calcium was glutinous rice (32 percent) followed by small animals with edible bones (31 percent) and fresh and fermented fish (20 percent). Dairy products and vegetables constituted only 8 and 5% of dietary calcium, respectively. CONCLUSION: The habitual diet among rural Northeast Thais does not meet the recommended calcium intake level. To promote more consumption of dairy products and locally-available calcium-rich foods would be beneficial to prevent osteoporosis among this population.

Earlier onset of pubertal maturation in Thai girls.

BACKGROUND: Recent studies in the USA and Hong Kong demonstrated the onset of puberty in girls has shifted toward a younger age. Based upon previous studies on variations of pubertal maturation in Thai girls, the secular trend has also moved toward an earlier age. The latest study in 1995 revealed the mean age of menarche was 12.3 years. OBJECTIVES: To identify the onset of puberty, menarche and pubarche in female children and adolescents in 2 Bangkok schools. METHOD: Three hundred school girls aged 9-19 years were enrolled in the study. Data were collected from January 1997 through December 1999. Assessment of pubertal staging by Tanner's criteria was performed by a trained pediatrician. All were in good physical health and had normal height and weight. The median ages of thelarche, menarche and pubarche were estimated by probit analysis. All other parameters were expressed as mean +/- SD. RESULTS: The median ages of thelarche and pubarche were 9.4 and 11.1 years, respectively. Two hundred and twenty one girls had experienced menstruation. The median age of menarche was 11.2 years, whereas, the mean age was 12.1 years. Most girls reached near final adult height after 14 years old. CONCLUSION: The secular trend in decline of the ages of thelarche (or puberty) and menarche was observed in Bangkok girls. Further study in a larger population including a younger age group is required to define the current reference interval of onset of puberty.

Bone mineral density in rural Thai adults living in Khon Kaen province.

OBJECTIVES: To define the bone status and pattern of bone loss in a normal adult population living in a rural area of Khon Kaen province. STUDY DESIGN: A descriptive study. SETTINGS: Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand. Subjects 436 subjects (181 men and 255 women), aged 20-80 years. MAIN OUTCOME MEASURES: Bone parameter including total bone mineral density (BMD), the bone mineral density at different sites such as forearm, lumbar spine and hip, bone mineral content (BMC) were measured by dual energy X-ray absorptiometry (DEXA). RESULTS: The result revealed that women had lower bone mass at various bone sites than men. The peak bone mass in women was observed between 30-39 years of age except at the distal radius which occurred between 20-29 years of age while the peak bone mass in men was observed between 20-29 years of age. It was also shown that bone loss occurred in both men and women with advancing age. The rate of decline at all sites in women was greater than men especially when they were over 60 years old. When comparisons were made between pre and post-menopausal women, the mean of bone mineral density in pre-menopausal women was 1.18 +/- 0.08, 0.69 +/- 0.06, 0.69 +/- 0.06, 1.0 +/- 0.13, 1.15 +/- 0.13 g/cm2 at total body, mid-shaft radius, ultra distal radius, femoral neck and lumbar spine, respectively while the mean of bone mineral density in post-menopausal women was 1.02 +/- 0.12, 0.54 +/- 0.11, 0.54 +/- 0.11, 0.75 +/- 0.16, 0.88 +/- 0.2 g/cm2 at total body, mid-shaft radius, ultra distal radius, femoral neck and lumbar spine, respectively which were lower than BMD in pre-menopausal women (p<0.05). The mean bone mineral content (BMC) in pre-menopausal women was 2401+318.3 g while in post-menopausal women it was 1915.4+421.7 g (p<0.05). The rate of bone loss correlated with the duration after menopause. In this study, using World Health Organization criteria for diagnosis of osteopenia and osteoporosis and a reference value obtained from Khon Kaen young adults, the prevalence of osteopenia in Khon Kaen women subjects was 37.4 per cent at femoral neck, 30.2 per cent at lumbar spine, 44.5 per cent at ultra distal radius, 31.5 per cent at mid-shaft radius and the prevalence of was osteoporosis 19.3 per cent at femoral neck, 24.7 per cent at lumbar spine, 18.5 per cent at ultra distal radius and 26.4 per cent at mid-shaft radius. CONCLUSION: The result of this study demonstrated the bone parameters in rural Thai adults living in Khon Kaen province, the pattern of bone loss, the difference between men and women and finally the prevalence of osteopenia and osteoporosis.