Evaluation of a questionnaire to assess nutritional knowledge, attitudes and practices in a Thai population.

BACKGROUND: The rapid increase in non-communicable chronic diseases in people of working age has had a major effect on health care utilization, productivity and economy. Lifestyle and diet are recognized as being major risk determinants involved. Disease prevention strategies need to be based on people's understanding of nutritional knowledge, attitudes and practice. This study evaluates the validity of a new nutritional knowledge and practice questionnaire specifically developed for assessing individuals of working age in a Thai population. METHODS: The questionnaire was constructed and based on previous relevant literature and its content validity was scrutinized by an expert panel. An exploratory factor analysis (EFA) was performed to reduce the number of questions included. Subsequently, data from a cross-sectional study of 1,032 participants were used to evaluate the reliability and validity of this questionnaire. The validity of the questionnaire constructed for assessing knowledge and attitude was evaluated using Confirmatory Factor Analysis (CFA). For the practice component, set criteria were applied to determine the final variables used. RESULTS: CFA of the nutritional knowledge component suggested that all the variables in the model fitted with the data (χ2 = 80.17, df = 66, p > 0.05, CFI = 0.99, RMSEA = 0.01, SRMR = 0.02). The CFA final model for the nutritional knowledge included three factors (food recommendation, nutrients related to diseases, and healthy diet) with a total of 14 questions. For nutrition attitude, CFA also revealed a good fit (χ2 = 178.14, df = 93, p < 0.001, CFI = 0.99, RMSEA = 0.03, SRMR = 0.03). The final CFA model for nutritional attitude included three factors (food choice, healthy diet and food recommendation) with a total of 16 questions. For practice items, the number of questions was reduced from 76 to 60. CONCLUSIONS: Questionnaire development should use a logical, systematic and structured approach. Results from our evaluation process demonstrates the construction validity of the nutritional knowledge and practice questionnaire developed. This questionnaire can be further modified for use in other countries within the region.

Oat porridge consumption alleviates markers of inflammation and oxidative stress in hypercholesterolemic adults.

BACKGROUND AND OBJECTIVES: Oats contain antioxidant phytochemicals that may help reduce inflammation as well as oxidative stress. In this study we aimed to investigate the effect of oat porridge consumption on inflammatory marker levels and oxidative stress in Thai adults with high blood lipid levels. METHODS AND STUDY DESIGN: A randomized crossover study was conducted. Hypercholesterolemic adults were randomly assigned to a 4-week daily consumption of oat or rice porridge. After 4 weeks, they were switched to alternate intervention arms for 4 weeks. At baseline, before and after each intervention period, inflammatory markers including hsCRP, IL-6, IL-8, TNF-α, and MCP-1 and antioxidant status markers including ORAC, FRAP, and MDA of all subjects were measured. RESULTS: Compared to baseline, levels of hsCRP, IL-6, IL-8, and TNF-α were significantly decreased after oat porridge consumption (mean change: -0.6±0.9 mg/L, -26.9±27.6 pg/mL, -56.3±27.6 pg/mL, and - 9.7±11.6 pg/mL, p<0.05 for all, respectively). In addition, consumption of oat porridge also increased antioxidant capacity; ORAC and FRAP levels (mean change: 2.7±1.0 µmol of Trolox/L and 2.4±0.8 µmol of Fe2+/L, p<0.001, respectively). However, MCP-1 and MDA levels were not affected. Consumption of rice porridge did not lead to significant changes in these measures. CONCLUSIONS: Daily consumption of 70 grams oat porridge containing 3 grams ß-glucan for 4 weeks may help reduce markers of inflammation and oxidation in hypercholesterolemic adults. Therefore, oat may be an appropriate dietary recommendation for individuals with hypercholesterolemia.

An outcome based nutrition curriculum for counselors at HIV voluntary counseling and testing facilities in Vietnam.

We developed, monitored and evaluated an outcome based nutrition curriculum for counselors at HIV voluntary counseling and testing (VCT) facilities in Can Tho City, Vietnam. This outcome based education (OBE) focused on expected competencies appropriate to the local context. The curriculum was designed to train 37 counselors working in HIV VCT centers in Can Tho City, Vietnam regarding nutrition. Lectures and learning activities were developed and assessment criteria were determined. The curriculum content was evaluated and modified by feedback from reviewers. During training, the HIV VCT counselors gave the curriculum a satisfactory rating. More than 80% of HIV VCT counselors stated the subject matter was easily or very easily understand. Testing revealed a significant mean increase in the HIV VCT counselor's competency by the end of training (p = 0.001). More than 89% of HIV VCT counselors felt confident in performing nutritional counseling. These findings suggest the usefulness of this OBE nutrition curriculum for training HIV VCT counselors.

Efficacy of dietary modification following the National Cholesterol Education Program (NCEP) recommendation on lipid profiles among hyperlipidemia subjects.

BACKGROUND: Hyperlipidemia has adverse effects on atherosclerosis, causing it to develop into cardiovascular disease. The prevalence of hyperlipidemia has been increasing among those in the working-age group and may be caused by inappropriate dietary patterns. Dietary modification should form the basis of lipid management. OBJECTIVE: Evaluate the effects of a dietary modification following the NCEP-ATP III recommendation on lipid profiles among hyperlipidemia subjects. MATERIAL AND METHOD: The design was a quasi-experimental study, with a pre-test/post-test two-group design. Each group consisted of 31 hyperlipidemia subjects aged 30 to 59 years old with total cholesterol (TC) greater than or equal to 240 mg/dl or low-density lipoprotein cholesterol (LDL-C) greater than or equal to 130 mg/dl. The present study was conducted between January and June 2009. The research procedure included 6-week nutrition counseling and a 2-week follow-up for 12 weeks. Data were collected by self-reported questionnaire and a 3-day food record. Dietary and biological assessments were compared before and after the experiment. Statistical analysis was performed using means, standard deviations, independent and paired t-tests, Friedman test, Mann-Whitney U test, and Wilcoxon signed-rank test. RESULTS: The intervention group had a significant reduction of TC and LDL-C at the end of the experiment (p < 0.05). Moreover this group had a significantly higher percentage reduction of TC and LDL-C than the control group (8.5% vs. 3.0%, and 10.8% vs. 2.4%, respectively) (p < 0.05). Distributions of monounsaturated fatty acids (MUFAs) in the intervention group were significantly higher than in the control group (p < 0.05). Distribution of saturated fatty acids (SFAs):MUFAs:polyunsaturated fatty acids (PUFAs) were 12.0:13.4:6.3% in the intervention group and 12.3:9.2:5.6% in the control group. Neither group was able to reduce SFAs intake to < 7% as recommended. Neither the recommended one-third of vegetable protein nor two-thirds of complex carbohydrate was achieved Dietary fiber was less than 10 g/1,000 kcal. The cholesterol intake in the intervention group was less than in the control group (155.9 vs. 206.3 mg/d). CONCLUSION: The dietary modification in the present study significantly lowered TC and LDL-C. However compliance with the recommendation of high MUFAs intake was difficult to achieve. The dietary modification might be focused instead on lowering intake of SFAs, replacing animal protein with vegetable protein, and increasing complex carbohydrates, fruits, and vegetables to raise dietary fiber.

Effect of oat consumption on lipid profiles in hypercholesterolemic adults.

BACKGROUND: Hypercholesterolemia is a strong risk factor in cardiovascular disease. Oat (Avena sativa L.) beta-glucan, the soluble fiber in oat, has been known to reduce blood cholesterol levels considerably. However, the effect of oat soluble fiber in the Thai population is unknown. OBJECTIVE: To determine the effect of oat consumption on serum lipid profiles in Thai hypercholesterolemic adults. MATERIAL AND METHOD: The present study was a randomized, crossover design. Twenty-four hypercholesterolemic adults, male and female aged 30-60 years, were randomly assigned into two groups of twelve each. Group 1 consumed 70 g (3 g beta-glucan) of oatmeal daily through the first 4-week intervention, and then switched to 70 g rice porridge (control product) daily for the next 4-week intervention. Group 2 consumed rice porridge first and then oatmeal. Before and after each intervention period, lipid profiles including total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-C), and low density lipoprotein cholesterol (LDL-C) of all subjects were measured. RESULTS: Following daily oat consumption, total cholesterol and LDL-cholesterol levels were significantly lower than baseline levels and lower than the levels observed with rice consumption. Oat consumption reduced total cholesterol by 5% and LDL-cholesterol by 10% from baseline levels. In addition, mean and percent changes were significantly different from the levels after consuming rice porridge (p < 0.05). CONCLUSION: Oatmeal reduced serum total cholesterol and LDL-cholesterol levels in hypercholesterolemic Thai adults. Hence, oat consumption is a reasonable recommendation for Thai individuals with hyperlipidemia.

Efficacy and Safety of Ferrous Bisglycinate and Folinic Acid in the Control of Iron Deficiency in Pregnant Women: A Randomized, Controlled Trial.

Iron deficiency in pregnancy is a major public health problem that causes maternal complications. The objective of this randomized, controlled trial was to examine the bioavailability, efficacy, and safety of oral ferrous bisglycinate plus folinic acid supplementation in pregnant women with iron deficiency. Subjects (12−16 weeks of gestation, n = 120) were randomly allocated to receive oral iron as ferrous bisglycinate (equiv. iron 24 mg) in supplement form with folinic acid and multivitamins (test group, n = 60) or as ferrous fumarate (equiv. iron 66 mg iron, control group, n = 60) after breakfast daily. Iron absorption was assessed by measuring fasted serum iron levels at 1 and 2 h immediately after supplementation. Hematological biomarkers and iron status were assessed before intervention, and at 3 and 6 months. Side effects were monitored throughout the intervention. A significant increase in serum iron was seen in both groups (p < 0.001) during the bioavailability assessment; however, the test group increases were comparatively higher than the control values at each timepoint (p < 0.001). Similarly, both test and control groups demonstrated a statistically significant increases in hemoglobin (Hb) (p < 0.001), erythrocytes (p < 0.001), reticulocytes (p < 0.001), mean corpuscular volume (MCV) (p < 0.001), mean corpuscular hemoglobin (MCH) (p < 0.001), mean corpuscular hemoglobin concentration (MCHC) (p < 0.001), % transferrin saturation (p < 0.001), and ferritin (p < 0.001) at 3 and 6 months after supplementation. However, in all cases, the test group increases were numerically larger than the control group increases at each timepoint. The test intervention was also associated with significantly fewer reports of nausea, abdominal pain, bloating, constipation, or metallic taste (p < 0.001). In conclusion, ferrous bisglycinate with folinic acid as a multivitamin nutraceutical format is comparable to standard ferrous fumarate for the clinical management of iron deficiency during pregnancy, with comparatively better absorption, tolerability, and efficacy and with a lower elemental iron dosage.

The Effects of Date Fruit Consumption on Breast Milk Quantity and Nutritional Status of Infants.

Background: Date fruit is a popular natural galactagogue among breastfeeding Muslim mothers. However, there is no evidence to support the effectiveness of date fruit in increasing the quantity of breast milk. Objective: This research aimed to study the effect of date fruit consumption on breast milk quantity and nutritional status of infants. Materials and Methods: This was a parallel randomized controlled trial. Forty-eight pairs of breastfeeding mothers and infants aged 1-3 months were included. The intervention group (n = 25) was asked to consume their normal dietary intake with 10 date fruits/day for 4 weeks. The control group (n = 23) was asked to consume their normal dietary intake without date fruit. Breast milk quantity was measured by using an electric breast pump and recorded for 2 days at baseline, week 2 and 4. The nutritional status of infants was assessed by calculating infant weight-for-age at baseline and week 4. Dietary data were collected at baseline, week 2, and 4, using a 2-day food record. Data were analyzed using Chi-square, t-test Mann-Whitney U test, and Wilcoxon matched-pairs signed-ranks test by SPSS version 18.0. Results: Breastfeeding mothers who received 10 date fruits/day had an 11% increase in breast milk quantity from baseline to week 2, and a 23% increase from baseline to week 4, (both p < 0.05). The breast milk quantity of the breastfeeding mothers who received date fruits was significantly higher than that of the control group (p < 0.05). However, there were no differences in infant nutritional status. Conclusions: Date fruit consumption appears to be useful for promoting and increasing breast milk quantity in breastfeeding mothers. Date fruits may be an alternative galactagogue.

Dietary sodium intake by semi-quantitative food frequency questionnaire among undergraduate students of Mahidol University.

OBJECTIVE: To assess sodium intake and identify its sources among undergraduate students aged 17 to 20 years who lived in the dormitory of Mahidol University, Salaya Campus. MATERIAL AND METHOD: A cross sectional study was conducted among 170 students in July 2007. Data were collected using a semi-quantitative food frequency questionnaire. RESULTS: The mean total daily sodium intake was 5,225.0 +/- 2,228.9 mg for males and 4,497.9 +/- 2,091.2 mg for females. Male students consumed significantly higher sodium than females (p = 0.030). Daily sodium intake mainly came from one plate meals in the campus cafeteria which the average was 2,852.3 +/- 1,421.8 mg/day in males and 2,042.3 +/- 1,214.2 mg/day in females. Males consumed significantly higher sodium from one plate meals than females (p < 0.001). In addition, the average sodium intake from seasoning added during consumption was 539.8 +/- 498.8 mg/day in males and 473.3 +/- 514.5 mg/day in females. Dietary sodium intake among students was 2-fold higher than recommended amount (2,400 mg per day). CONCLUSION: The findings revealed that the undergraduate students who mainly consumed one plate meals are at risk of high sodium intake. Nutrition promotion for reducing sodium consumption in students and food vendors is needed for early prevention of chronic diseases in later life.

Effects of Fenugreek, Ginger, and Turmeric Supplementation on Human Milk Volume and Nutrient Content in Breastfeeding Mothers: A Randomized Double-Blind Controlled Trial.

Background: Exclusive breastfeeding is the best way to accomplish optimal growth and health in infants. Low milk volume is a major problem that leads to nonexclusive breastfeeding. Objective: This study aimed to examine the effects of mixed herbal supplementation, including fenugreek, ginger, and turmeric on human milk volume and nutrient content. Methods: The study design was a randomized double-blind controlled trial. Fifty exclusively breastfeeding mothers were randomly divided into two groups. The herbal group (n = 25) received mixed herbal supplementation containing fenugreek, ginger, and turmeric, three capsules three times daily for 4 weeks. The control group (n = 25) took a placebo. Anthropometric and dietary data, blood pressure, heart rate, and blood and milk samples were collected at baseline and 4 weeks after the intervention. Milk volume was measured using a manual breast pump and recorded for 2 days at baseline, week 2, and week 4. Results: Breastfeeding mothers receiving herbal supplementation had a 49% increase in milk volume at week 2 and a 103% increase at week 4. These increases were greater than mothers in the placebo group (p < 0.05). There was no difference in milk nutrient content for both groups. Moreover, there were no differences in adverse effects observed in the placebo and herbal groups. Conclusion: Mixed herbal supplementation that contained fenugreek, ginger, and turmeric can increase human milk volume without adverse effects.

Whey Protein Supplementation Improves Nutritional Status, Glutathione Levels, and Immune Function in Cancer Patients: A Randomized, Double-Blind Controlled Trial.

Clinical side effects from medical therapy play an important role in causing malnutrition among cancer patients. Whey protein isolates (WPIs) have the potential to improve the nutritional status of cancer patients. The present study determined the effects of whey protein supplementation on nutritional status, glutathione (GSH) levels, immunity, and inflammatory markers in cancer patients in Thailand. A total of 42 cancer patients (41-63 years old) who received intravenous chemotherapy were randomized in a double-blind controlled trial at the National Cancer Institute in Thailand. Patients received 40 g of WPI plus zinc and selenium (intervention group, n = 23) or a maltodextrin oral snack (control group, n = 19) every day during the daytime for 12 weeks. Nutritional status, GSH levels, immunity, and inflammatory markers were assessed at baseline, 6, and 12 weeks. Whey protein supplementation significantly increased albumin (2.9%) and immunoglobulin G (4.8%) levels compared to the control group at week 12. Controls showed a significantly lower percent change in GSH levels (6.0%), whereas there was a significant time-dependent increase in the intervention group (11.7%). Whey protein supplementation improved nutrition status scores in the intervention group compared to the control. These data indicate that whey protein supplementation can increase GSH levels and improve nutritional status and immunity in cancer patients undergoing chemotherapy. These results will facilitate implementation of malnutrition risk prevention strategies and improve protein status, including immune function, during chemotherapy.

Traditional Galactagogue Foods and Their Connection to Human Milk Volume in Thai Breastfeeding Mothers.

BACKGROUND: Thai traditional galactagogue consumption is still observed today. However, there are few scientific studies that describe this practice. Research aim: The aim of this study was to describe the connection between traditional galactagogue consumption and human milk volume. METHODS: Self-reported maternal surveys ( N = 36) were conducted of mothers and their infants who breastfeed exclusively. The mothers were interviewed about traditional galactagogue consumption and intake of protein-rich foods using a semiquantitative food-frequency questionnaire. They were also assessed for energy and nutrient intake using the 24-hr dietary recall method. Their infants were between 1 and 3 months of age and were test weighed for 24 hr to measure their mother's own milk volume. Partial correlation was used to test the relationship between galactagogue consumption and milk volume by controlling the infants' birth weight, weight-for-age, maternal energy, and carbohydrate intake. RESULTS: The results revealed that consumption of some traditional galactagogues was significantly correlated to human milk volume, including banana flower, lemon basil, Thai basil, bottle gourd, and pumpkin ( p < .05). Furthermore, there were significant correlations between consumption of some kinds of protein and milk volume, including egg tofu, chicken, fish, and seafood ( p < .05). Maternal energy and carbohydrate intake were related to milk volume ( p < .05), but protein intake was not. CONCLUSION: Certain kinds of traditional galactagogues and proteins are associated with human milk volume. However, studies related to the active ingredients in these galactagogues are required to secure a recommendation about use of traditional galactagogues among breastfeeding mothers.

Camellia Oil-Enriched Diet Attenuates Oxidative Stress and Inflammatory Markers in Hypercholesterolemic Subjects.

Camellia oil is commonly used as an adjuvant in medicine. It is rich in monounsaturated fatty acids, vitamin E, and phytochemicals. The objective of this study was to examine effects of camellia oil consumption on oxidative stress, low-density lipoprotein-cholesterol (LDL-C) oxidation, and inflammatory markers in hypercholesterolemic subjects. The study design was a randomized, single-blind controlled trial. Women with hypercholesterolemia (n = 50) were randomly divided into two groups. The treatment group (n = 25) was provided camellia oil-enriched diets and the control group (n = 25) was provided diets cooked with soybean oil three meals (45 mL oil) a day for 8 weeks. Biomarkers of oxidative stress and inflammatory cytokines were assessed before and the after intervention. Camellia oil consumption significantly decreased malondialdehyde (11.2%; P < .001) whereas glutathione was not changed (P = .382). Moreover, the camellia oil group exhibited a statistically significant decrease in oxidized LDL-C (8.7%; P < .001) compared with the control group. Furthermore, camellia oil consumption significantly decreased high-sensitivity C-reactive protein (12.3%; P < .001) whereas tumor necrosis factor-α and interleukin-6 were not different (P = .079; P = .660, respectively) compared with the control group. These data indicate that the consumption of camellia oil-enriched diet could decrease oxidative stress and inflammatory markers in hypercholesterolemic women. Therefore, camellia oil consumption may reduce cardiovascular disease risk factors.

Maternal return to paid work and breastfeeding practices in Bangkok, Thailand.

This study explored the association between mothers' work-related factors and breastfeeding practices in Bangkok, Thailand. Data were collected from 84 working mothers with a child aged 6 to 24 months who visited the breastfeeding mobile clinic at a nursery goods exhibition. Thai interviewers collected data using a structured questionnaire. Analysis of the data showed that exclusive breastfeeding for 3 months was 78.6%, and for 6 months it was 38.1%. Mothers who returned to work 3 months or more after giving birth exclusively breastfed more than the mothers who returned to work in less than 3 months (crude odds ratio [OR] = 4.26, 95% confidence interval [CI] = 1.39-13.05; adjusted OR = 4.15, 95% CI = 1.15-14.95). Moreover, mothers who worked at self-employed or family-owned businesses and some mothers working at private companies showed tendencies of returning to work in less than 3 months. Results suggest that longer maternity leave would help extend the duration of exclusive breastfeeding. In addition, the improvement of a breastfeeding supportive environment in the workplace would be valuable and may be an effective means to improve breastfeeding practices and infant health.

Participatory action project in reducing childhood obesity in Thai primary schools.

UNLABELLED: The project aimed to improve nutrition and activity among primary schoolchildren via targeted activities. A preliminary nutritional survey was carried out involving 5126 children in 4 Bangkok public schools. Participatory action research involving students, teachers, and parents was conducted. After a 2-day training course, teachers integrated project concepts into their course curriculum. Seminars on weight management were given separately to parents and students. After 8 months, postnutritional survey was conducted. Preprogram and postprogram evaluation of obese and normal groups was done using questionnaires on dietary intake and exercise. RESULTS: showed that high caloric dietary intake significantly decreased for the obese group (P < .001). Aerobic exercise activity also increased in both groups (P < .001) and prevalence of obesity declined from 19.3% to 16.8%. Thus, a long-term, participatory effort to promote healthy diets and physical exercise could be effective with primary school students and may establish habits that last to later life.