Metabolic and inflammatory profiles, gut microbiota and lifestyle factors in overweight and normal weight young thai adults.

Obesity among young adults, especially those living in developing countries is increasing. A high body mass index (BMI) is one of the major causes of several diseases worldwide, constituting an important risk factor for non-communicable diseases (NCDs). Investigations describing the relationship between BMI, clinical and gut microbiota characteristics and lifestyle factors of overweight young adults, especially from Southeast Asian countries are limited. Metabolic and inflammatory biomarkers, fecal microbiota profiles and lifestyle factors were compared between overweight Thai young adults (n = 30, mean age 33 ± 9.48) and those with normal weight (n = 30, mean age 27 ±7.50). This study was registered with the Thai Clinical Trials Registry (TCTR20220204007). Health status including body composition, fasting glucose and insulin, lipid profiles, liver and kidney function, inflammatory biomarkers, blood pressure and fecal microbiota using 16S rRNA gene sequencing data was determined. Dietary intake was assessed using a 3-day dietary record and a food frequency questionnaire (FFQ), with physical activity levels compared using the international physical activity questionnaire (IPAQ). The overweight group had significantly higher BMI, waist-hip ratio, body fat mass, % body fat, skeletal mass, triglyceride level, C-reactive protein, insulin and blood pressure, with lower levels of high-density lipoprotein cholesterol (HDL-C) and blood urea nitrogen compared to the normal weight group. Significant differences in fecal microbiota composition at the family and genus levels were observed between the two groups. In our clinical setting, we also observed that unhealthy diets with high consumption of food rich in fat and sugar, processed meat and alcohol, and physical inactivity were associated with an increased prevalence of overweight in Thai young adults. Results provided the big picture of health and lifestyle characteristics of overweight young Thai people. Young adults should be encouraged to engage in health-promoting activities that maintain healthy bodyweight.

Celiac Disease as a Cause of Anemia and Brittle Diabetes in Type 1 Diabetes Mellitus.

Untreated celiac disease (CD) leads to an increased risk for hypoglycemia and diabetic complications. However, the diagnosis of CD can be challenging and some extra-gastrointestinal tract manifestations could be a presenting symptom. We report a case of a 29-year-old Indian male with brittle T1DM whose underlying CD was discovered from a work-up for anemia. After an introduction of a gluten-free diet, he gained 5 kgs in two months, was responsive to oral iron supplement, and had stable glycemic control with much less hypoglycemia. Even though this disease is rare in Asian populations, the diagnosis of celiac disease should always be kept in mind when people with T1DM present with unexplained microcytic anemia and/or unexplained hypoglycemia.

Impact of nutritional status on length of stay and hospital costs among patients admitted to a tertiary care hospital in Thailand.

BACKGROUND AND OBJECTIVES: Malnutrition has high prevalence among hospitalized patients but goes unrecognized in many patients. Early detection of malnutrition using an effective screening tool is required. This study aimed to examine the effects of nutritional status determined by the Nutrition Alert Form (NAF) and its individual sections on length of stay (LOS) and hospital costs in hospitalized patients, to investigate their associated factors, and to determine hospital malnutrition prevalence. METHODS AND STUDY DESIGN: This retrospective cohort study enrolled 2,906 hospitalized patients aged >=15 years in Ramathibodi Hospital between January and September 2016. At admission, nutritional status was screened using NAF. Nutrition status was defined as: NAF-A (normal/mild malnutrition; scores of 0-5), NAF-B (moderate malnutrition; 6-10), and NAF-C (severe malnutrition; >=11). Information regarding LOS and hospital costs during patients' hospitalization was also collected. RESULTS: The prevalence of malnutrition was 15.3%. After adjusting for age, sex and primary diagnosis, we found significantly longer LOS and higher hospital costs among those with NAF-B and NAF-C, in comparison with patients having NAF-A. The highest increase in LOS was in male patients aged >=60 years with NAF-C. The highest increase in LOS and hospital costs was associated with higher scores for functional capacity. CONCLUSIONS: Higher levels of malnutrition screened using the NAF were significantly associated with longer LOS and higher hospital costs. Older adult patients had the highest risk of being malnourished and developing negative consequences. A prospective study of nutritional support by a nutrition care team is underway.

Evaluation of Body Composition in Hemodialysis Thai Patients: Comparison between Two Models of Bioelectrical Impedance Analyzer and Dual-Energy X-Ray Absorptiometry.

BACKGROUND: Body composition measurement is very important for early nutritional care in hemodialysis patients. Dual-energy X-ray absorptiometry (DXA) is a gold standard test, but clinically limited. Bioelectrical impedance analysis (BIA) with multifrequency technique is a practical and reliable tool. OBJECTIVE: This cross-sectional study was aimed to compare the agreement of BIA with DXA in measurement of body composition in hemodialysis patients and to evaluate their associated factors. METHODS: Body composition was measured by 2 BIA methods (InBody S10 and InBody 720) and DXA after a hemodialysis session. A total of 69 measurements were included. Pearson's correlation and Bland and Altman analysis were used to determine the correlation of body composition between methods and to compare the methods agreement, respectively. RESULTS: The correlation coefficients of body compositions were strong between DXA and InBody S10 (fat mass index (FMI): r=0.95, fat-free mass index (FFMI): r=0.78) and also between DXA and InBody 720 (FMI: r=0.96, FFMI: r=0.81). Comparing to DXA, the means of each body composition measured by InBody S10 method were not significantly different in each gender, but differences were found in FM, %FM, and FMI measured by InBody 720. CONCLUSIONS: In maintenance hemodialysis patients, the measurement of body composition with DXA and both BIA methods had highly significant correlations; practically, BIA method could be used as an instrument to follow FM and FFM and to measure the edematous stage. Further studies with large populations are warranted.

Ferulic Acid Supplementation Improves Lipid Profiles, Oxidative Stress, and Inflammatory Status in Hyperlipidemic Subjects: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial.

Ferulic acid is the most abundant phenolic compound found in vegetables and cereal grains. In vitro and animal studies have shown ferulic acid has anti-hyperlipidemic, anti-oxidative, and anti-inflammatory effects. The objective of this study is to investigate the effects of ferulic acid supplementation on lipid profiles, oxidative stress, and inflammatory status in hyperlipidemia. The study design is a randomized, double-blind, placebo-controlled trial. Subjects with hyperlipidemia were randomly divided into two groups. The treatment group (n = 24) was given ferulic acid (1000 mg daily) and the control group (n = 24) was provided with a placebo for six weeks. Lipid profiles, biomarkers of oxidative stress and inflammation were assessed before and after the intervention. Ferulic acid supplementation demonstrated a statistically significant decrease in total cholesterol (8.1%; p = 0.001), LDL-C (9.3%; p < 0.001), triglyceride (12.1%; p = 0.049), and increased HDL-C (4.3%; p = 0.045) compared with the placebo. Ferulic acid also significantly decreased the oxidative stress biomarker, MDA (24.5%; p < 0.001). Moreover, oxidized LDL-C was significantly decreased in the ferulic acid group (7.1%; p = 0.002) compared with the placebo group. In addition, ferulic acid supplementation demonstrated a statistically significant reduction in the inflammatory markers hs-CRP (32.66%; p < 0.001) and TNF-α (13.06%; p < 0.001). These data indicate ferulic acid supplementation can improve lipid profiles and oxidative stress, oxidized LDL-C, and inflammation in hyperlipidemic subjects. Therefore, ferulic acid has the potential to reduce cardiovascular disease risk factors.

Unusual manifestation of vitamin A deficiency presenting with generalized xerosis without night blindness.

Vitamin A deficiency from malabsorption syndromes, including bariatric surgery, has become an emerging problem in developed countries. Early detection and prompt treatment lead to rapid and complete recovery. Nevertheless, it may result in irreversible blindness or death if left untreated. Health care personnel should be aware of this condition.

Moderately high-protein enteral formula improved retinol-binding protein in tube-fed patients: A multicentre open study.

BACKGROUND: Long-term inadequate dietary consumption may increase the possibility of malnutrition, morbidity and mortality. Enteral nutrition (EN) is a beneficial support that could help to maintain nutritional status and gut function. AIM: Our aim was to evaluate the effect of moderately high-protein enteral formula containing fibre on nutritional status, and its safety. METHOD: A total of 23 tube-feeding-dependent adult patients were included in this multicentre, open-label study. The patients were fed with the study formula for 7-12 days or equal to the required nutritional support period, during which we performed physical examinations and assessed nutritional status. The primary endpoint was the statistical difference in nutritional status after the treatment, and the secondary outcome was the desirable safety profile. RESULTS: A significant improvement in cumulative energy balance after intervention was observed ( p = 0.008). However, the differences in nutritional status, weight and BMI before and after the intervention do not reach statistical significance. Retinol-binding protein (RBP), a marker for nutritional status, increased from baseline levels. Few cases of diarrhoea and constipation had been reported during the study as a safety concern. CONCLUSIONS: This study investigated the efficacy and safety of an enteral feed formulation containing fibre. The patients were nourished with the studied formulation via tube feeding for a short period without serious adverse events. After the intervention, the significant increase in cumulative energy balance was observed. However, an extended period of the intervention may be required to attain the significance in other indicators for nutritional status.

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.

Development of a Food Insecurity Screening Instrument.

BACKGROUND: Food insecurity is a dynamic, global issue requiring our constant attention today, and practical assessment instruments are needed to detect food insecurity in various populations and countries. A screening tool for food insecurity was developed and tested its psychometric properties. MATERIAL AND METHOD: The Food Insecurity Screening Instrument (FISI) was developed based on literature review and qualitative data from a sample of 30 female who were family food providers in crowded urban communities in Bangkok. RESULTS: Content validity was determined by five experts, resulting in a good content validity index. It was tested with another 350 food providers, resulting in high reliability Item analysis revealed good internal consistency of items to total scale, except for two items which were deleted. Construct validity was determined using exploratoiy factor analysis, and revealed four factors, consisting of 33 items, food quantity, food quality, food safety, and anxiety about food These factors together explained 74.9% of total variance of the new tool. CONCLUSION: This new tool provides a valid and reliable means of screening for food insecurity in families and communities. Policy makers in Thailand have supported the usefulness of the instrument which has already been used across the country for the National Survey, and after the 2011 Thai floods.

Serum cholesterol reduction efficacy of biscuits with added plant stanol ester.

This study's aim was to test the low-density lipoprotein cholesterol- (LDL-c-) lowering efficacy of biscuits containing 2 g of plant stanols, which corresponded to 3.4 g of plant stanol esters. The biscuit is a new food format that can be consumed as a snack. In a double-blind, placebo-controlled parallel design study, 119 mildly to moderately hypercholesterolemic volunteers were randomized to plant stanol or control groups. Subjects were comparable in age, gender, lipid profiles, and body mass index. They consumed a control biscuit once a day for a two-week period, followed by a four-week intervention period that either had a plant stanol ester biscuit or a control. During the habitual diet, one biscuit per day was consumed at any time that subjects wished. Serum lipid profiles were measured at the first day of run-in, at baseline, and at the study's end. Compared to the control, the total cholesterol (TC), LDL-c, and the LDL-to-high-density lipoprotein (LDL/HDL) ratio had serum reductions of 4.9%, 6.1%, and 4.3%, respectively, and were observed after 4 weeks of biscuit consumption with added plant stanols (P < 0.05). A significantly higher reduction in LDL-c (8.9%) and LDL/HDL ratio (11.4%) was measured in those taking a plant stanol biscuit with a meal compared to those who consumed a plant stanol biscuit without other food. In conclusion, incorporating plant stanols into a biscuit is an attractive, convenient, and acceptable way to modestly lower elevated cholesterol concentrations. For optimal efficacy, biscuits should be consumed with a meal as part of a healthy diet.

Understanding food insecurity among Thai older women in an urban community.

In this qualitative study we aimed to describe how older women in a crowded urban community perceive the food insecurity experience and deal with it. In-depth interviews were conducted among 30 Thai older women. Results revealed that older women perceived their food insecurity experience as a negative effect of the current economic downturn globally. They felt that they were confronting a crisis. Problems they dealt with included six issues. The women employed management strategies around food, health, money, and family. Our results suggest a need for welfare reform that facilitates management strategies aimed to meet food security.

Association between HLA-B*4001 and lipodystrophy among HIV-infected patients from Thailand who received a stavudine-containing antiretroviral regimen.

BACKGROUND: Stavudine-containing antiretroviral regimens are widely used in developing countries. Stavudine-associated lipodystrophy commonly occurs, without a clear predictable pattern owing to the unknown interaction between stavudine and the host, among patients who received this regimen. The aim of this study was to determine the clinical risk factors and human leukocyte antigen (HLA) alleles associated with stavudine-associated lipodystrophy. METHODS: A case-control, cross-sectional study was conducted for HIV-infected patients receiving stavudine-containing antiretroviral regimens. Clinical assessments for lipodystrophy by physical examination, anthropometry, and dual-energy X-ray absorptiometry were obtained. On the basis of their clinical assessment, the patients were classified into 2 groups: the case group (moderated to severe lipodystrophy) and the control group (absent to mild lipodystrophy). The clinical characteristics and allelic distribution of HLA-A, HLA-B, HLA-C, HLA-DRB1, HLA-DQB1, and HLA-DPB1 were compared between the case group and the control group, to determine the possible association with stavudine-associated lipodystrophy. RESULTS: There were 103 patients; 55 patients were in the case group, and 48 patients were in the control group. By use of forward stepwise logistic regression, the presence of HLA-B*4001 (odds ratio [OR], 14.05; 95% confidence interval [CI], 2.57-76.59; P=.002) and a longer duration of stavudine treatment (OR, 1.02; 95% CI, 1.00-1.04; P=.02) were significantly associated with stavudine-associated lipodystrophy, whereas a higher body mass index during treatment (OR, 0.73; 95% CI, 0.61-0.86; P<.001) was associated with a lower risk for lipodystrophy. HLA-B*4001 has a high specificity (95.8%) and a positive predictive value (88.9%) for lipodystrophy. CONCLUSIONS: HLA-B*4001 is a strong genetic risk factor for stavudine-associated lipodystrophy in HIV-infected patients in Thailand. HLA-B*4001 may be used as a genetic marker to predict which patients will develop stavudine-associated lipodystrophy, to avoid or shorten the duration of stavudine use. This finding needs to be confirmed in further replication studies.

Initial experience and result of a Swedish adjustable gastric banding by laparoscopic approach in Thai cohorts.

BACKGROUND: Morbid obesity is a growing problem in Thailand. Several surgical procedures are available for weight reduction. The laparoscopic gastric banding has been shown to be an effective weight loss with a low post or perioperative complication. OBJECTIVE: The aim of this report was to evaluate the early preliminary outcome of the laparoscopic Swedish adjustable gastric banding operation in Thai cohort patients. MATERIAL AND METHOD: From November 2003 until March 2005, ten patients with a median age of 31 (range, 18-61) underwent laparoscopic Swedish adjustable gastric banding for morbid obesity at Ramathibodi Hospital. Demography, clinical course and outcome including excess weight loss and peri-operative complications were reviewed and studied. Descriptive statistics were used for data summary. RESULTS: There were 3 men and 7 women with a median preoperative body weight of 142.5 kg (range, 98-164 kg), and median body mass index (BMI) of 49.2 kg/m2 (range, 40.3-62.4 kg/m2). The operations were successful in 9 out of 10 patients with median operative time of 195 minutes (range, 125-275 minutes). One patient with a BMI of 62.4 had a failed operation due to poor operative exposure from a very large left lobe of the liver. None of the remaining patients required conversion to the opened technique. The mean hospital stay was 4 days with no perioperative mortality. There was no major post operative complication except one minor wound infection. The excess weight loss was within the range of 33.5% to 62.1% during the short-term follow-up (range, 1-15 months) CONCLUSION: The presented early preliminary result of the laparoscopic Swedish adjustable gastric banding showed a good technical success with a significant short-term weight loss. The authors believe this minimally invasive operation is appropriate for morbidly obese Thai patient. However a longer follow-up study is needed.

The effect of a soy-rich diet on urogenital atrophy: a randomized, cross-over trial.

OBJECTIVE: To evaluate the effect of a soy-rich diet on urogenital symptoms, vaginal health index, and vaginal cytology in perimenopausal and postmenopausal women. MATERIALS AND METHODS: Thirty-six perimenopausal and postmenopausal women (mean age 52.5+/-5.1 years) participated in a randomized, cross-over trial with two 12-week diet periods and two 4-week washout periods before and between treatments. The study diet consisted of a control diet (soy-free diet) and an isocaloric soy-rich diet (25 g soy protein in various forms of soy food containing more than 50 mg/day of isoflavones substituted for an equivalent amount of animal protein). Subjects were assessed for urogenital symptoms, vaginal health index, vaginal pH and vaginal cytology. The single physician and the single cytopathologist were blinded with regard to onset, period and randomization number. Statistical analyses were performed using paired t-test or Wilcoxon Signed Ranks Test, significance was set as P<0.05. RESULTS: Good compliance to the diet was shown by the significant elevation of serum levels of daidzein and genistein during the soy-rich diet period. The symptoms of urge incontinence and vaginal dryness had significantly increased after 12-week of soy-free diet. All other urogenital symptoms did not change in both periods. The vaginal health index, the vaginal pH, the karyopyknotic index, and the maturation value were not significantly changed in both periods. CONCLUSION: A soy-rich diet did not relieve the urogenital symptoms or restore the vaginal epithelium or improve the vaginal health in perimenopausal and postmenopausal Thai women.

Long-term treatment of N-3 PUFAS on plasma lipoprotein levels and fatty acid composition of total serum and erythrocyte lipids in hypertriglyceridemic patients.

The low incidence of coronary heart disease in Greenland Eskimos and Japanese fishermen who have high consumption of fish and seafood has called the attention in the role of eicosapentaenoic (EPA = 20:5n-3) and docosahexaenoic (DHA = 22: 6n-3) acids, the major n-3 polyunsaturated fatty acids (PUFAs) in fish oils, in reducing cardiovascular risk. N-3 PUFAs may reduce serum lipids by promoting fatty acid oxidation and decrease VLDL producing from the liver, depress tissue arachidonate synthesis and alter the composition and tissue PUFAs. Plasma lipoprotein and fatty acid composition of total serum and erythrocyte lipids in 9 hypertriglyceridemic patients consisting of 4 males and 5 females aged 39-72 yr who attended the Nutrition Clinic, Ramathibodi Hospital were investigated. The study period consisted of 4 wks of dietary advice only followed by 48 wks of dietary advice with a daily intake of 6 g of fish oil capsules (FOC). Six grams of FOC provided 1080 mg of 2:5n-3 and 720 mg of 22:6n-3. Their plasma triglyceride (TG) levels at wk 0, 12, 24, 36, 48 were 356.7, 230.1, 209.7, 192.9, 22 7.4 mg/dL and M-particle (equivalent to very low density lipoprotein, VLDL) were 484.4, 354.8, 383.1, 349.7, 453.2 mg/dL respectively that decreased significantly, whereas their plasma low density lipoprotein cholesterol (LDL-C) levels at the same periods were 139.4, 164.9, 171.0, 157.1, 158.3 mg/dL that increased significantly. Serum and erythrocyte 20:5n-3 and 22:6n-3 in these subjects were significantly higher than those at wk 0 throughout the study. These findings indicate the bioavailability of 20: 5n-3 and 22:6n-3 in TG lowering effect of FOC. Fatty acids from fish oil have a remarkable effect on the synthesis and clearance of TG-rich lipoproteins, especially VLDL and chylomicrons. Though daily treatment with 6 g of FOC has a striking effect in increasing plasma LDL-C levels.

Polyneuropathy from thiamin deficiency associated with thyrotoxicosis.

Polyneuropathy from thiamin deficiency can occur in persons who consume a diet consisting mainly of polished rice with low protein and thiamin content in the setting of excessive physical activity or hypermetabolic states. The authors report here a 17-year-old fisherman who presented with a 3-month history of symptoms and signs consistent with polyneuropathy. There were also clinical features of thyrotoxicosis which was confirmed by thyroid function test. His dietary intake consisted mainly of polished rice and fish both of which contain a small amount of thiamin. This could not cope with his hypermetabolic condition from thyrotoxicosis resulting in thiamin deficiency with polyneuropathy.

Phytate and fiber content in Thai fruits commonly consumed by diabetic patients.

The amount of phytate and total dietary fiber of 6 popular tropical fruits eaten by diabetic patient residing in Bangkok were studied. They were dragon fruit, durian, guava, longan, mango, and pineapple. Fruit containing the highest content of total dietary fiber was guava which had about 2.7%. Longan contained the lowest fiber content equal to 0.19%. The highest content of phytate was found in pineapple about 0.09% and the lowest content was in longan about 0.037%. It was noticed that longan contained the lowest total dietary fiber and the lowest phytate content.

Effect of chili pepper (Capsicum frutescens) ingestion on plasma glucose response and metabolic rate in Thai women.

OBJECTIVES: To evaluate the effect of 5 g fresh chili pepper (CAP) on glucose response after a glucose drink and metabolic rate (MR) in Thai women. MATERIAL AND METHOD: The glucose response after a glucose drink was evaluated in 10 healthy women. The plasma glucose levels at 0, 15, 30 and 60 min after glucose load with and without 5 g fresh CAP were compared. Evaluation of MR was performed in an additional 12 subjects. MR was measured by the ventilated-hood indirect calorimetry system before and for 60 min after CAP ingestion. RESULTS: The rise of plasma glucose at 30 min after CAP ingestion was significantly lower than the rise of plasma glucose after a plain glucose drink by 20.6 per cent (p < 0.01). On the other hand, the CAP ingestion significantly increased MR above resting MR. Moreover, MR immediately increased by 20 per cent within a few minutes after CAP ingestion and showed a remarkable increase of 7.2-17.4 per cent from baseline for 11 min. The significance of thermogenic change was present up to 30 min (p < 0.05). CONCLUSIONS: Within 30 min after consumption of 5 g of Capsicum frutescens, plasma glucose level during the absorption period was significantly inhibited. The metabolic rate was also immediately increased after ingestion and sustained up to 30 min.