Performance of the Global Diet Quality Score (GDQS) App in Predicting Nutrient Adequacy and Metabolic Risk Factors among Thai Adults.

BACKGROUND: The Global Diet Quality Score (GDQS) was developed for monitoring nutrient adequacy and diet-related noncommunicable disease risk in diverse populations. A software application (GDQS app) was recently developed for the standardized collection of GDQS data. The application involves a simplified 24-h dietary recall (24HR) where foods are matched to GDQS-food groups using an onboard database, portion sizes are estimated at the food group level using cubic models, and the GDQS is computed. OBJECTIVES: The study aimed to estimate associations between GDQS scores collected using the GDQS app and nutrient adequacy and metabolic risks. METHODS: In this cross-sectional study of 600 Thai males and nonpregnant/nonlactating females (40-60 y), we collected 2 d of GDQS app and paper-based 24HR, food-frequency questionnaires (FFQs), anthropometry, body composition, blood pressure, and biomarkers. Associations between application scores and outcomes were estimated using multiple regression, and application performance was compared with that of metrics scored using 24HR and FFQ data: GDQS, Minimum Dietary Diversity-Women, Alternative Healthy Eating Index-2010, and Global Dietary Recommendations score. RESULTS: In covariate-adjusted models, application scores were significantly (P < 0.05) associated with higher energy-adjusted mean micronutrient adequacy computed using 24HR (range in estimated mean adequacy between score quintiles 1 and 5: 36.3%-44.5%) and FFQ (Q1-Q5: 40.6%-44.2%), and probability of protein adequacy from 24HR (Q1-Q5: 63%-72.5%). Application scores were inversely associated with BMI kg/m2 (Q1-Q5: 26.3-24.9), body fat percentage (Q1-Q5: 31.7%-29.1%), diastolic blood pressure (Q1-Q5: 84-81 mm Hg), and a locally-developed sodium intake score (Q1-Q5: 27.5-24.0 points out of 100); positively associated with high-density lipoprotein cholesterol (Q1-Q5: 49-53 mg/dL) and 24-h urinary potassium (Q1-Q5: 1385-1646 mg); and inversely associated with high midupper arm circumference (Q5/Q1 odds ratio: 0.52) and abdominal obesity (Q5/Q1 odds ratio: 0.51). Significant associations for the application outnumbered those for metrics computed using 24HR or FFQ. CONCLUSIONS: The GDQS app effectively assesses nutrient adequacy and metabolic risk in population surveys.

Effect of dentures and dietary advice on protein intake in older Thai adults with missing posterior occluding teeth.

OBJECTIVE: To compare the effectiveness of dentures with dietary advice and dentures alone on protein intake in older Thai adults. BACKGROUND: Dentures combined with nutritional advice may improve protein intake in older adults with posterior tooth loss. However, evidence is limited, especially in developing countries. METHODS: A randomised-control trial including 69 older adults with less than four pairs of posterior occluding teeth was conducted for 3 months. The experimental group received dentures and dietary advice based on the Health Belief Model (HBM); the control group received dentures alone. Three-day dietary records were collected and protein intake was assessed using INMUCAL-NUTRIENTS V.4.0 software at baseline, 1 month, and 3 months after the intervention. Data were analysed using a t-test, Mann-Whitney U test, chi-square test, and repeated-measure ANOVA. RESULTS: Both groups reported significantly increased protein intake (control group = 0.4, 0.5, 0.6 g kg BW-1 d-1 , intervention = 0.4, 0.6, 0.7 g kg BW-1 d-1 , at baseline, 1 month and 3 months, respectively). However, participants in the experimental group had significantly higher total protein (36.3 vs. 39.8 g/d, P = .032) and animal protein intake (18.9 vs. 23.2 g/day, P = .020) than those in the control group at 3 months after the intervention; plant protein intake was similar (10.9 vs. 11.5 g/day, P = .923). In addition, the HBM scores of the experimental group were higher than those of the control group after the intervention (P < .001). CONCLUSION: Dentures combined with dietary advice significantly increased the total and animal protein intake of older people with posterior tooth loss more than dentures alone. To maintain optimal protein intake, dental practitioners should incorporate dietary advice when providing dental prostheses to older adults with posterior tooth loss.

Impact of Isomaltulose and Sucrose Based Breakfasts on Postprandial Substrate Oxidation and Glycemic/Insulinemic Changes in Type-2 Diabetes Mellitus Subjects.

OBJECTIVE: To investigate the effect of isomaltulose (ISO) and sucrose (SUC) based breakfast on the postprandial substrate oxidation and glycemic/insulinemic changes in type 2 diabetes mellitus subjects (T2DM). MATERIAL AND METHOD: This was a randomized, controlled, double blind, and crossover study performed in two to five days. About 10 to 12 hours prior to the test, the subjects were not allowed to consume food or drink other than water. On the experimental day pre- and postprandial plasma glucose, serum insulin, and substrate utilization were measured after the subjects consumed a test breakfast with ISO or SUC, followed by a standard lunch three hours later. RESULTS: The plasma glucose levels in subjects after consuming ISO breakfast tended to be lower than subjects consuming SUC breakfast at 30- and 60-minute, respectively. The second meal effect after standard lunch (240-minute) on insulin levels in subject consuming ISO breakfast tended to be lower than that of subjects consuming SUC breakfast. Substrate oxidation indicated that the incremental area under the fat oxidation of ISO breakfast was 20% higher comparing to SUC breakfast. CONCLUSION: Therefore, ISO based breakfast tends to provide less postprandial glucose and insulin levels than SUC based breakfast, thereby increasing postprandial fat oxidation.

Impact of Genetic Polymorphism on LDL-C Response to Plant Stanol Ester Intake.

Background: The high blood cholesterol level could be prevented by plant stanol ester (Staest) consumption. In addition, the genetic polymorphism of cholesterol transporters might be related with lipid profile and subsequently response to Staest intake. Objective: To investigate the effect of single nucleotide polymorphism in ATP-binding cassette hetero-dimeric G5/G8 (ABCG5/G8) and Niemann-Pick C1 Like1 protein (NPC1L1) gene on LDL-C response subsequent to plant Staest intake in Thai Subjects. Material and Method: The blood samples were collected from 113 subjects for genotyping. The single nucleotide polymorphisms (SNPs) of ABCG5/G8 positions; rs6720173 (Q604E), rs4148211 (C54Y), rs4148217 (T400K), rs3806471 (5'UTR-145), and NPC1L1; positon; rs2072183 (L272L) were analyzed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Results: After Staest intake, the subjects with QE genotype (Q604E of ABCG5) showed a 4-fold significant decrease in LDL-C level (14.17±10.67%) compared to subjects with QQ genotype (3.50±10.65%) (p = 0.003). Moreover, the pronounced effect of Q604E polymorphism was observed in subjects after intake of Staest with meal. However, no significant difference in these markers was observed in subjects carrying other mutations. Conclusion: Thus, it could be suggested that non-synonymous gene polymorphism resulted substitution of uncharged glutamine (Q) with negatively charged glutamic acid (E) at position 604, thereby possibly alter the function of transporter proteins. Besides, the genetic variation in these genes might be related with serum lipid profiles. Moreover, Q604E mutation of ABCG5 in each individual with meal effect could lead to particular response towards LDL-C level after Staest intervention.

Vitamin D Status Is Positively Associated with Calcium Absorption among Postmenopausal Thai Women with Low Calcium Intakes.

BACKGROUND: Few data exist on the ability of postmenopausal women to absorb calcium from diets habitually low in calcium. OBJECTIVE: The objective of this study was to evaluate fractional calcium absorption from a green leafy vegetable vs. milk in relation to vitamin D status. METHODS: We measured fractional calcium absorption from both a dairy- and plant-based source in 19 postmenopausal Thai women (aged 52-63 y) with low calcium consumption (350 ± 207 mg/d) in relation to serum parathyroid hormone (PTH) and serum 25-hydroxyvitamin D [25(OH)D]. Fractional calcium absorption was measured using a triple stable calcium isotope method based on isotope recovery in a 28-h urine collection. Two extrinsically labeled test meals were ingested in random order: a green leafy vegetable (cassia) ingested along with 4³Ca or a glass of milk containing 44Ca. Women received intravenous 4²Ca with the first test meal. RESULTS: In 19 postmenopausal women studied (mean age, 56.9 ± 3.4 y), ~95% were 25(OH)D sufficient (≥20 µg/L). Serum 25(OH)D status was positively correlated with fractional absorption from both cassia (P = 0.05, R² = 0.21) and milk (P = 0.03, R² = 0.26). Fractional calcium absorption from cassia was significantly lower than that measured from milk (42.6% ± 12.3% vs. 47.8% ± 12.8%, P = 0.03), but true calcium absorption did not significantly differ (120 ± 35 mg/d vs. 135 ± 36 mg/d). Serum PTH was significantly inversely associated with serum 25(OH)D (P = 0.006, R² = 0.37) even though PTH was not elevated (>65 pg/mL). CONCLUSIONS: These findings suggest that vitamin D status is an important determinant of calcium absorption among Thai women with low calcium intakes, and cassia may be a readily available source of calcium in this population. Furthermore, these data indicate that serum 25(OH)D concentrations may affect PTH elevation in postmenopausal women with low calcium intakes.

Substrate utilization during and after high intensity exercise in healthy lean and obese men.

OBJECTIVE: To compare lipid and carbohydrate use during and after a high-intensity endurance exercise bout between lean and obese subjects. MATERIAL AND METHOD: Lean and obese healthy male subjects with energetic physical activity and stable body weight were recruited to participate in the present study. The respiratory exchange ratio (RER), lipid and carbohydrate oxidation, and lipid and carbohydrate energy expenditure during resting condition, high-intensity exercise and 180 min after exercise were determined by indirect calorimetry RESULTS: Ten lean and ten obese healthy male subjects, aged 26+/-4 years, completed a 300-kcal high-intensity exercise session. Resting energy expenditure and lipid energy expenditure in the obese group were significantly higher than those of the lean group. The RER, lipid oxidation, and carbohydrate oxidation were not significantly different between groups throughout the exercise period. The total energy expenditure and total lipid and carbohydrate energy expenditure were also not significantly different between lean and obese groups. During the 180-minute post exercise period, both lean and obese subjects showed a declination in RER and carbohydrate oxidation and an increase in lipid oxidation. CONCLUSION: Substrate use during and after high-intensity exercise between healthy lean and obese subjects was not significantly different. Both groups used carbohydrates and lipids as the main substrate sources during and after high-intensity exercise, respectively.

Automated Artificial Intelligence-Based Thai Food Dietary Assessment System: Development and Validation.

Background: Dietary assessment is a fundamental component of nutrition research and plays a pivotal role in managing chronic diseases. Traditional dietary assessment methods, particularly in the context of Thai cuisine, often require extensive training and may lead to estimation errors. Objectives: To address these challenges, Institute of Nutrition, Mahidol University (INMU) iFood, an innovative artificial intelligence-based Thai food dietary assessment system, allows for estimating the nutritive values of dishes from food images. Methods: INMU iFood leverages state-of-the-art technology and integrates a validated automated Thai food analysis system. Users can use 3 distinct input methods: food image recognition, manual input, and a convenient barcode scanner. This versatility simplifies the tracking of dietary intake while maximizing data quality at the individual level. The core improvement in INMU iFood can be attributed to 2 key factors, namely, the replacement of Yolov4-tiny with Yolov7 and the expansion of noncarbohydrate source foods in the training image data set. Results: This combination significantly enhances the system's ability to identify food items, especially in scenarios with closely packed food images, thus improving accuracy. Validation results showcase the superior performance of the INMU iFood integrated V7-based system over its predecessor, V4-based, with notable improvements in protein and fat estimation. Furthermore, INMU iFood addresses limitations by offering users the option to import additional food products via a barcode scanner, thus providing access to a vast database of nutritional information through Open Food Facts. This integration ensures users can track their dietary intake effectively, with expanded access to over 3000 food items added to or updated in the Open Food Facts database covering a wide variety of dietary choices. Conclusions: INMU iFood is a promising tool for researchers, health care professionals, and individuals seeking to monitor their dietary intake within the context of Thai cuisine and for ultimately promoting better health outcomes and facilitating nutrition-related research.

Uptake of Front-of-Package Nutrition Labeling Scheme after 5 Years of Adoption in Thailand: An Analysis of New Launched Pre-Packaged Food and Beverages Products.

In 2016, Thailand introduced voluntary front-of-pack nutrition labeling, the 'Thailand Healthier Choice' logo (THCL), in order to help consumers make informed, healthier food choices in each food category. This study aimed to assess the uptake of the THCL scheme in Thailand after five years of implementation by analyzing a newly launched product database. Data on the nutritional composition and labeling were obtained from the Mintel Global New Products Database between 2017 and 2021. The product's healthfulness was determined using the Health Star Rating (HSR) algorithm. The numbers and proportions of total, eligible, and labeled products bearing the THCL logo were analyzed and classified by food category, by HSR value, and by manufacturer. After 5 years of implementation, THCL uptake as a proportion of total products and eligible products continues to increase by 3.0% and 10.2% per annum, respectively. The logo has correspondingly appeared on 10.7% and 39.5% of total and eligible products. As a voluntary implementation, 76.1% of products displaying the THCL logo belonged to the 'non-core' group, i.e., non-alcoholic beverages and instant foods. This food category (HSR < 3.0) was more likely to register to bear THCL rather than those 'core' food scoring an HSR ≥ 3.5, which might reflect economic considerations and benefits. The present analysis also found that only 10% of manufacturers in Thailand launched 'healthier' products that display the THCL logo with varied product numbers. To summarize, the initial five-year implementation of the THCL program shows promise, but its adoption remains limited and inconsistent, thereby restricting its influence on public health. Our discoveries highlight the limitations of commercial goodwill in applying THCL voluntarily in Thailand and offer potential suggestions to enhance its adoption in the coming years.

Effects of Extraction and Evaporation Methods on Physico-Chemical, Functional, and Nutritional Properties of Syrups from Barhi Dates (Phoenix dactylifera L.).

Date fruits (Phoenix dactylifera L.) are rich in sugar and also contain a substantial amount of phenolic compounds. Therefore, date fruits can be used to produce an alternative sweetener, having lower glycemic index than sucrose. This study investigated the effects of extraction and evaporation methods on various properties of the syrups prepared from Barhi dates. Extraction of date juice with the aid of pectinase or cellulase significantly enhanced the production yield, total phenolic content, and antioxidant activities determined by Ferric Reducing Antioxidant Power and Oxygen Radical Absorbance Capacity assays. Syrups prepared without enzyme application had about 6-7 times higher apparent viscosity than those prepared from the enzyme-assisted extracted juices. Vacuum evaporation produced syrups with significantly lighter color and inferior antioxidant properties than open heating. Properties of date syrups prepared with or without enzyme-assisted extraction followed by open heat evaporation were not different. They had a glucose-to-fructose ratio close to 1:1, received good sensory acceptability scores of above 6 on a 9-point hedonic scale, contained a safe level (<40 mg/kg) of 5-hydroxymethyl-2-furfuraldehyde, and exhibited similar glass transition and melting temperatures; while a greater inhibition on α-amylase activity was observed in syrups obtained from enzyme-assisted extraction. The in vivo glycemic measurement revealed that the syrup prepared with the aid of Pectinex and open heating was classified as low glycemic index (GI = 55) and medium glycemic load (GL = 11). Thus, enzyme-assisted extraction of date juice using Pectinex could be used to produce a healthy natural sweetener from low quality date fruits.

Study protocol: International joint research project 'climate change resilience of Indigenous socioecological systems' (RISE).

BACKGROUND: Anthropogenic changes in the environment are increasingly threatening the sustainability of socioecological systems on a global scale. As stewards of the natural capital of over a quarter of the world's surface area, Indigenous Peoples (IPs), are at the frontline of these changes. Indigenous socioecological systems (ISES) are particularly exposed and sensitive to exogenous changes because of the intimate bounds of IPs with nature. Traditional food systems (TFS) represent one of the most prominent components of ISES, providing not only diverse and nutritious food but also critical socioeconomic, cultural, and spiritual assets. However, a proper understanding of how future climate change may compromise TFS through alterations of related human-nature interactions is still lacking. Climate change resilience of indigenous socioecological systems (RISE) is a new joint international project that aims to fill this gap in knowledge. METHODS AND DESIGN: RISE will use a comparative case study approach coupling on-site socioeconomic, nutritional, and ecological surveys of the target ISES of Sakha (Republic of Sakha, Russian Federation) and Karen (Kanchanaburi, Thailand) people with statistical models projecting future changes in the distribution and composition of traditional food species under contrasting climate change scenarios. The results presented as alternative narratives of future climate change impacts on TFS will be integrated into a risk assessment framework to explore potential vulnerabilities of ISES operating through altered TFS, and possible adaptation options through stakeholder consultation so that lessons learned can be applied in practice. DISCUSSION: By undertaking a comprehensive analysis of the socioeconomic and nutritional contributions of TFS toward the sustainability of ISES and projecting future changes under alternative climate change scenarios, RISE is strategically designed to deliver novel and robust science that will contribute towards the integration of Indigenous issues within climate change and sustainable agendas while generating a forum for discussion among Indigenous communities and relevant stakeholders. Its goal is to promote positive co-management and regional development through sustainability and climate change adaptation.

Variation in human water turnover associated with environmental and lifestyle factors.

Water is essential for survival, but one in three individuals worldwide (2.2 billion people) lacks access to safe drinking water. Water intake requirements largely reflect water turnover (WT), the water used by the body each day. We investigated the determinants of human WT in 5604 people from the ages of 8 days to 96 years from 23 countries using isotope-tracking (2H) methods. Age, body size, and composition were significantly associated with WT, as were physical activity, athletic status, pregnancy, socioeconomic status, and environmental characteristics (latitude, altitude, air temperature, and humidity). People who lived in countries with a low human development index (HDI) had higher WT than people in high-HDI countries. On the basis of this extensive dataset, we provide equations to predict human WT in relation to anthropometric, economic, and environmental factors.

Highest Observed Intake: definition, regulatory uses and provisional values.

For nutrients and related substances, the Tolerable Upper Intake Level (UL) has become the internationally accepted risk assessment method. The major limitation of the UL method as applied by authoritative groups thus far is that no UL has been set for nutrients without established adverse effects. In contrast to the limitations inherent in the UL method, an alternative approach is available; it identifies a risk assessment value termed the Highest Observed Intake (HOI). In the absence of a UL, the HOI is the highest intake with adequate data to show, with acceptable confidence, the absence of adverse effects up to that intake. With this concept defined and accepted in a report by the authoritative international organizations FAO and WHO, a complete risk assessment for the nutrients and related substances would have to identify UL values for those with known adverse effects and HOI values for those without known adverse effects. The need for the HOI concept and value is illustrated by the unjustified policy and regulatory actions taken in relation to vitamin B12. Regulatory utility is explained and tentative HOI values are identified for several vitamins and non-essential nutrients. Endorsement of the concept and development of HOI values by authoritative bodies is likely to be required for broad acceptance and use.

Reduction of LDL-cholesterol in mildly hypercholesterolemic Thais with plant stanol ester-fortified soy milk.

OBJECTIVE: To investigate the effects of soy milk fortified with plant stanol ester on changes in LDL-cholesterol, fat-soluble vitamins and sex hormones in Thai volunteers. MATERIAL AND METHOD: In a double-blind, placebo-controlled study, 120 mildly hypercholesterolemic Thais were randomly assigned to stanol and control groups that were comparable in lipid profile and body mass index. Subjects consumed regular or 2g stanol-containing soymilk once a day and postprandially for six weeks. The serum lipid profile was measured at weeks 0, 2 and 6; serum fat-soluble vitamins and sex hormones were measured at weeks 0 and 6. RESULTS: The mean reduction in total cholesterol was 8.2 % in the stanol group (p < 0.0001) and 0.6% in the control group. LDL-cholesterol declined in both groups at week two, but the reduction was maintained to week six only in the stanol group. The mean reduction in LDL-cholesterol was 13.5% in the stanol group (p < 0.0001) at week 6, compared to a 4.6% decrease in the control group. Adjusted serum beta-cryptoxantene and beta-carotene levels decreased at week six for the stanol group. Serum sex hormone levels in both groups remained unchanged. CONCLUSION: Consumption of stanol-ester-containing soymilk for six weeks significantly reduced LDL-cholesterol in mildly hypercholesterolemic Thais. No adverse effect on sex hormones was observed However, stanol-ester consumers are at risk of fat-soluble-vitamin deficiencies if the vitamin intake from foods is inadequate.

Development and validity of semi-quantitative food frequency questionnaire as a new research tool for sugar intake assessment among Indonesian adolescents.

Robust evidence has shown that sugar is a major contributor to obesity and Non-Communicable Diseases (NCDs). However, there have not been sufficient tools to estimate sugar intakes. Therefore, developing a new and valid tool to assess sugar intake, based on cultural eating habits, is crucial. The study was done in two phases; the first focused on the development of Semi-quantitative Food Frequency Questionnaire (SFFQ), and the second focused on researching the validity of the questionnaire. Food items in the SFFQ were selected from the latest national survey review, exploratory survey, and food market observation. Forty-nine food items were included in the final SFFQ with five open-ended questions for fruit groups. One hundred and six adolescents aged 15-17 years participated in the study. The total sugar intake among the adolescents was 58.80 g/day (52.7 g sucrose; 1.47 g fructose; 1.49 glucose) which contributed to 11.6% of the total energy intake per day. The reliability analysis showed a good agreement between the two administered SFFQs in a one-month interval. The relative validity results, using 6-days food diaries as a reference method, demonstrated a superior ability to rank individuals into the same and adjacent classification and only <10% gross misclassification in all sugar intakes. The developed SFFQ in turn has been proven to have moderate to good validity and be applicable for a larger epidemiological study.

Feasibility Study of an Automated Carbohydrate Estimation System Using Thai Food Images in Comparison With Estimation by Dietitians.

Carbohydrate counting is essential for well-controlled blood glucose in people with type 1 diabetes, but to perform it precisely is challenging, especially for Thai foods. Consequently, we developed a deep learning-based system for automatic carbohydrate counting using Thai food images taken from smartphones. The newly constructed Thai food image dataset contained 256,178 ingredient objects with measured weight for 175 food categories among 75,232 images. These were used to train object detector and weight estimator algorithms. After training, the system had a Top-1 accuracy of 80.9% and a root mean square error (RMSE) for carbohydrate estimation of <10 g in the test dataset. Another set of 20 images, which contained 48 food items in total, was used to compare the accuracy of carbohydrate estimations between measured weight, system estimation, and eight experienced registered dietitians (RDs). System estimation error was 4%, while estimation errors from nearest, lowest, and highest carbohydrate among RDs were 0.7, 25.5, and 7.6%, respectively. The RMSE for carbohydrate estimations of the system and the lowest RD were 9.4 and 10.2, respectively. The system could perform with an estimation error of <10 g for 13/20 images, which placed it third behind only two of the best performing RDs: RD1 (15/20 images) and RD5 (14/20 images). Hence, the system was satisfactory in terms of accurately estimating carbohydrate content, with results being comparable with those of experienced dietitians.

Postprandial effects of a whey protein-based multi-ingredient nutritional drink compared with a normal breakfast on glucose, insulin, and active GLP-1 response among type 2 diabetic subjects: a crossover randomised controlled trial.

Postprandial hyperglycaemia is recognised as an important target in type 2 diabetes management. Dietary pattern, meal composition, and amount of food intake are major factors for maintaining postprandial blood glucose levels. The aim of this study was to investigate the effect of consuming a whey protein-based multi-ingredient nutritional drink (WD) on postprandial glycaemic, insulinaemic, and active glucagon-like peptide-1 (GLP-1) responses in comparison to a typical breakfast, which is boiled white rice with chicken (BC) in patients with type 2 diabetes mellitus (T2DM). Fifteen subjects with T2DM participated in a randomised, controlled, cross-over study. Two isocaloric diets with similar nutrient composition were randomly tested with at least 7 d in between. Glucose, insulin, and active GLP-1 were measured by standard methods with blood samples collected with a venous catheter for 240 min during a kinetic test. The incremental area under the curve (iAUC0-240 min) for plasma glucose was significantly lower after the consumption of WD (WD: 3551 ± 546; BC: 9610 ± 848 mg min/dl; P < 0⋅01), while insulinaemic response tended to be lesser (iAUC0-240 min) than those of BC. In addition, higher iAUC0-240 min for active GLP-1 was obtained with WD diet (WD: 2230 ± 441; BC: 925 ± 183 pM min/ml; P < 0⋅01). This study showed that WD can be used to replace a regular breakfast for improving postprandial glucose response and active GLP-1 levels in people with T2DM. Further studies are required to elucidate the clinical efficacy of WD on long-term glycaemic control in people with T2DM.

Self-efficacy in physical activity and glycemic control among older adults with diabetes in Jagir Subdistrict, Surabaya, Indonesia.

Diabetes in older adults has shown an increase in prevalence, especially in urban areas of Indonesia. This study aimed to assess the relationship between self-efficacy in physical activity and glycemic control in older adults' population with diabetes mellitus in Indonesia. This research used cross sectional design that involved 52 adults with diabetes, aged between 55-90 years old who regularly attended the older adult's health post (Posyandu Lansia) at Jagir Sub-district, Surabaya. Those who had physical disabilities were excluded from the study. Questionnaires were used to measure the physical activity and two types of self-efficacy whilst the glycemic control was measured using HbA1c in basal condition. The relationship between the variables was tested using Pearson and partial correlation test. Results show that the level of physical activity was insufficient (216.4 ± 343.5 MET) with only 32.7% (N = 17) of the participants was categorized as being physically active. The mean of the HbA1c indicated poor glycaemic control (8.63 ± 2.34%) with majority of them (76.9%, N = 40) was in the poor glycaemic control group (HbA1c ≥ 6.5%). Their self-efficacy was at the average level (Against the barriers:52.65 ± 13.23; Engage in physical activity: 59.06 ± 26.2). The self-efficacy in performing the physical activity was found significantly related to the duration of physical activity (r = 0.278, p = 0.046). Other relationships, however, were not significant (p > 0.05). In conclusion, self-efficacy to engage in physical activity is paramount to increase the physical activity among the older adults. Nevertheless, further longitudinal research on self-efficacy in physical activity management is needed.

Human Milk Intake of Thai Breastfed Infants During the First 6 Months Using the Dose-to-Mother Deuterium Dilution Method.

BACKGROUND: Data on infant human milk intakes in low- and middle-income countries are limited, although the deuterium oxide dose-to-mother method (DTM) is an accurate tool for its estimation. OBJECTIVE: We assessed human milk intakes of Thai infants during the first 6 months comparing exclusive breastfeeding (EBF), predominant breastfeeding (PBF), and partial breastfeeding (PartBF). METHODS: One hundred and ten healthy Thai lactating mother-infant pairs were followed from birth. Human milk intakes were determined at 6 weeks, 3 months, and 6 months using the DTM method. Daily energy and protein intakes were assessed using 3-day nonconsecutive 24-hour recalls. Sociodemographic characteristics were collected using a questionnaire. To compare breastfeeding practices, one-way analysis of variance with Tukey post hoc test assessed normally distributed data, while the Kruskal-Wallis test with Mann-Whitney U test was used for not normally distributed data. RESULTS: No difference existed in human milk intakes during the first 6 months between EBF (743-776 g/d) and PBF (748-862 g/d). Human milk intakes of PartBF infants were significantly lower compared to other infants. Human milk intake was sufficient to meet infant energy and protein requirements during the first 3 months for EBF and PBF groups. Infant formula largely replaced human milk during the first 3 months; other solid foods were also introduced among the PartBF infants. CONCLUSIONS: Human milk intakes were comparable between EBF and PBF infants during the first 6 months and provided adequate energy and protein to meet requirements. Infant formula largely replaced breast milk among PartBF infants, although other foods were also given early. This study was registered at clinicaltrials.gov as NCT04020640.

Association of Adiposity Indices with Hypertension in Middle-Aged and Elderly Thai Population: National Health Examination Survey 2009 (NHES-IV).

Obesity in terms of excess fat mass is associated with increased morbidity, disability and mortality due to obesity-related disorders, including hypertension. Many hypertensive individuals are overweight and often receive their advice to lose weight related to body-fat, in order to lower their blood pressure. However, it is still unclear whether there is a strong association of adipose tissue measured by adiposity indicators with hypertension in the Thai population. Various adiposity indices have been published to distinguish the distribution of body fat with disparate properties. This study examined nine adiposity markers and their association with hypertension in 15,842 Thai adults ≥35 years old. Data were obtained from the nationwide Thai National Health Examination Survey 2009. Accuracy performance and associations of indexes with hypertension were analyzed by Area Under Curve (AUC) and logistic regression analyses. Regardless of gender, the best methods to distinguish performance were waist-to-height ratio (WHtR) [AUC: 0.640 (0.631⁻0.649)], followed by lipid accumulation product (LAP) [AUC: 0.636 (0.627⁻0.645)], waist circumference (WC) [AUC: 0.633 (0.624⁻0.641)], and Conicity index (C-Index) [AUC: 0.630 (0.621⁻0.639)]. Linear regression analysis exhibited the independent association of the top four indices, WC, WHtR, C-Index, and LAP with higher systolic and diastolic blood pressure. Those indices' quartiles were graded in a dose-response manner which significantly increased at the higher quartiles. The indicator's cutoff point carried the odds ratio of presence hypertension in the range of 1.7 to 2.5 (p < 0.001). Among the nine obesity indices, WHtR (cutoff >0.52) in both genders was the simplest and most practical measurement for adiposity in association with hypertension in middle-aged and elderly Thais.