Zinc and iron adequacy and relative importance of zinc/iron storage and intakes among breastfed infants.

Neonatal nutrient storage and supplies from breast milk contribute to nutrient status and growth of infants during their early life. This study investigated the adequacy of zinc and iron intakes among breastfed infants during the first 4 months and determined the relative importance of zinc/iron storage versus nutrient intakes with infant's biochemical status and growth. A longitudinal study followed lactating women and their breastfed infants from birth to 4 months postpartum. Cord zinc and ferritin concentrations, as indicators of nutrient storages, were determined. Zinc and iron intakes from breast milk were determined by measurement of breast milk volume together with milk zinc and iron concentrations at 2 and 4 months postpartum. Inadequacy of nutrient intakes was determined using average requirement (AR) which were 1.6 and 0.24 mg/day for zinc and iron respectively. Infant's serum zinc and ferritin were determined at 4 months of age. The data were collected from 64 and 56 participants at 2 months and 4 months postpartum. Inadequate zinc intake was found in 14.5 and 40% of infants at 2 and 4 months old, respectively. The prevalence of biochemical zinc and iron deficiency in infants were 76 and 11%, respectively. Iron endowment was significantly associated with serum ferritin at 4 months. The cumulative zinc intake was positively associated with weight gain and weight-for-length Z-score, but not length. This study provides quantitative data on zinc and iron intakes, and demonstrates the relative importance of nutrient storage versus intakes on biochemical status and growth of breastfed infants.

Effect of Maternal Nutritional Status and Mode of Delivery on Zinc and Iron Stores at Birth.

Zinc and iron deficiencies among infants aged under 6 months may be related with nutrient store at birth. This study aimed to investigate the association between zinc and iron stores at birth with maternal nutritional status and intakes during pregnancy. 117 pregnant women were enrolled at the end of second trimester and followed until delivery. Clinical data during pregnancy, including pre-pregnancy body mass index (BMI) and at parturition were collected from medical record. Zinc and iron intakes were estimated from a food frequency questionnaire. Serum zinc and ferritin were determined in maternal blood at enrollment and cord blood. Mean cord blood zinc and ferritin were 10.8 ± 2.6 µmol/L and 176 ± 75.6 µg/L, respectively. Cord blood zinc was associated with pre-pregnancy BMI (adj. ß 0.150; p = 0.023) and serum zinc (adj. ß 0.115; p = 0.023). Cord blood ferritin was associated with pre-pregnancy BMI (adj. ß -5.231; p = 0.009). Cord blood zinc and ferritin were significantly higher among those having vaginal delivery compared to cesarean delivery (adj. ß 1.376; p = 0.007 and 32.959; p = 0.028, respectively). Maternal nutritional status and mode of delivery were significantly associated with zinc and iron stores at birth. Nutrition during preconception and pregnancy should be ensured to build adequate stores of nutrients for infants.

Dietary Intake and Milk Micronutrient Levels in Lactating Women with Full and Partial Breastfeeding.

BACKGROUND: Micronutrient intake and status in lactating women may impact micronutrient levels in milk. OBJECTIVES: This study aimed to determine the micronutrient intake and status in lactating women, and their association with micronutrient levels in human milk. METHODS: Lactating women were enrolled at 4-6 months postpartum. A 24h food recall was examined and nutrient intakes were analyzed using INMUCAL software. Human milk samples were collected to analyze calcium, copper, iron, and zinc levels. Plasma zinc and serum ferritin levels were determined. RESULTS: Thirty-four women participated; 19 were classified as full breastfeeding and 15 as partial breastfeeding. Mean levels of calcium, copper, iron, and zinc in human milk were 243, 0.2, 0.2, and 1.56 mg/L, respectively. The prevalence of zinc deficiency (plasma zinc < 10.7 µmol/L) was 11.8%. No lactating women had iron deficiency. Nutrient intakes were lower than the recommended amounts in 38%-70% of participants, and were not correlated with corresponding nutrient levels in human milk. Multiple linear regression showed significant association between zinc levels in human milk and plasma for lactating women with full breastfeeding (ß = 0.034, 95% confidence interval [0.003, 0.067], p = 0.040). CONCLUSIONS: Lactating women were at risk of micronutrient deficiency. There was an association between zinc levels in human milk and plasma of lactating women with full breastfeeding. As the nutritional status of lactating women influences the quality of human milk, we should encourage good nutrient intake for lactating women.

Determining the Actual Zinc and Iron Intakes in Breastfed Infants: Protocol for a Longitudinal Observational Study.

BACKGROUND: Zinc and iron deficiencies among breastfed infants during the first 6 months of life have been reported in previous studies. The amounts of zinc and iron intakes from breast milk are factors that contribute to the zinc and iron status of breastfed infants. OBJECTIVE: This study aims to quantitatively determine zinc and iron intakes by breastfed infants during the first 4 months of life and to investigate the factors that predict zinc and iron status in breastfed infants. METHODS: Pregnant women at 28 to 34 weeks of gestation were enrolled. Zinc and iron status during pregnancy was assessed. At delivery, cord blood was analyzed for zinc and iron levels. Participants and their babies were followed at 2 and 4 months postpartum. Maternal dietary intakes and anthropometric measurements were performed. The amount of breast milk intake was assessed using the deuterium oxide dose-to-mother technique. Breast milk samples were collected for determination of zinc and iron levels. The amount of zinc and iron consumed by infants was calculated. Zinc and iron status was determined in mothers and infants at 4 months postpartum. RESULTS: A total of 120 pregnant women were enrolled, and 80 mother-infant pairs completed the study (56 provided full breastfeeding, and 24 provided breast milk with infant formula). All data are being managed and cleaned. Statistical analysis will be done. CONCLUSIONS: This study will provide information on zinc and iron intakes in exclusively breastfed infants during the first 4 months of life and explore predictive factors and the possible association of zinc and iron intakes with infant growth and nutrient status. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/19119.

Early Nutrition eAcademy Southeast Asia e-Learning for Enhancing Knowledge on Nutrition during the First 1000 Days of Life.

BACKGROUND: The double burden of both under- and overnutrition during the first 1000 days is highly prevalent in Southeast Asia (SEA), with major implications for lifelong health. Tackling this burden requires healthcare professionals (HCPs) to acquire evidence-based current knowledge and counselling skills. We assessed the needs of HCPs in SEA and developed a continuing medical education/professional development (CME/CPD) program using an e-learning platform to reduce existing gaps. METHODS: European, Thai and Malaysian universities collaborated with SEA national nutrition associations in the Early Nutrition eAcademy Southeast Asia (ENeA SEA) project. We assessed HCPs' needs using questionnaires and mapped CME/CPD programmes and regulations through stakeholder questionnaires. Using a co-creation approach, we established an e-learning platform. Evaluation in users was undertaken using questionnaires. RESULTS: HCPs in SEA reported major training gaps relating to the first 1000 days of nutrition and limited impact of existing face-to-face training. Existing pre/postgraduate, residency and CME/CPD programmes did not adequately address the topic. To address these gaps, we produced a targeted e-learning platform with six modules and CME-tests. National ministries, Thai and Malaysian universities, and professional associations endorsed the training platform. To date, over 2600 HCPs have registered. Evaluation shows high acceptance and a very positive assessment. CONCLUSIONS: Dedicated e-learning can reduce major gaps in HCP training in SEA regarding nutrition during the first 1000 days of life at scale and is highly valued by both users and key stakeholders.

High Urinary Iodine Concentration Among Breastfed Infants and the Factors Associated with Iodine Content in Breast Milk.

Iodine deficiency in infants leads to delayed growth and development. Some studies have reported iodine deficiency among infants and lactating women. We assessed iodine status in infants and lactating women, as well as the iodine content in breast milk. A cross-sectional study enrolled mother-infant pairs (infants aged 4-6 months), who visited Well Child Clinic at Ramathibodi Hospital, Bangkok, Thailand. Infants were classified by feeding type as breastfed (BF), mixed breastfed and formula-fed (MF), and formula-fed (FF). Demographic and perinatal data were collected. The urinary iodine concentration (UIC) of infants and lactating women, and breast milk iodine concentration (BMIC) were analyzed. Seventy-one infants were enrolled. The median UIC of infants was 282 mcg/L. Breastfed infants had higher median UIC than formula-fed infants (553 vs. 192 mcg/L; p = 0.002). Forty-eight percent of infants had a UIC more than 300 mcg/L. The median UIC and BMIC of lactating women were 149 and 255 mcg/L, respectively. Among the BF group, the infant UIC was correlated with maternal UIC (rs = 0.857, p = 0.014). Multiple linear regression showed the BMIC to be associated with maternal UIC (ß = 4.03, 95% CI [1.34, 6.71]) and maternal weight (ß = 8.26, 95%CI [2.76, 13.77]). Iodine nutrition among our study population was adequate. The median UIC of infants and lactating mothers were 282 and 149 mcg/L, respectively. Breastfed infants had a significantly higher median UIC than formula-fed infants. The BMIC was associated with maternal UIC and maternal weight.

Implementation of a Nutrition Program Reduced Post-Discharge Growth Restriction in Thai Very Low Birth Weight Preterm Infants.

Very low birth weight (VLBW) preterm infants are vulnerable to growth restriction after discharge due to cumulative protein and energy deficits during their hospital stay and early post-discharge period. The current study evaluated the effectiveness of the preterm infant, post-discharge nutrition (PIN) program to reduce post-discharge growth restriction in Thai VLBW preterm infants. A prospective, non-randomized interventional cohort study was undertaken to assess the growth of 22 VLBW preterm infants who received the PIN program and compared them with 22 VLBW preterm infants who received conventional nutrition services. Infant's growth was recorded monthly until the infants reached six months' corrected age (6-moCA). Intervention infants had significantly greater body weights (p = 0.013) and head circumferences (p = 0.009). Also, a greater proportion of the intervention group recovered their weight to the standard weight at 4-moCA (p = 0.027) and at 6-moCA (p = 0.007) and their head circumference to the standard head circumference at 6-moCA (p = 0.004) compared to their historical comparison counterparts. Enlistment in the PIN program thus resulted in significantly reduced post-discharge growth restriction in VLBW preterm infants. Further research on longer term effects of the program on infant's growth and development is warranted.

Composition of Follow-Up Formula for Young Children Aged 12-36 Months: Recommendations of an International Expert Group Coordinated by the Nutrition Association of Thailand and the Early Nutrition Academy.

BACKGROUND: There are no internationally agreed recommendations on compositional requirements of follow-up formula for young children (FUF-YC) aged 1-3 years. AIM: The aim of the study is to propose international compositional recommendations for FUF-YC. METHODS: Compositional recommendations for FUF-YC were devised by expert consensus based on a detailed literature review of nutrient intakes and unmet needs in children aged 12-36 months. RESULTS AND CONCLUSIONS: Problematic nutrients with often inadequate intakes are the vitamins A, D, B12, C and folate, calcium, iron, iodine and zinc. If used, FUF-YC should be fed along with an age-appropriate mixed diet, usually contributing 1-2 cups (200-400 ml) of FUF-YC daily (approximately 15% of total energy intake). Protein from cow's milk-based formula should provide 1.6-2.7 g/100 kcal. Fat content should be 4.4-6.0 g/100 kcal. Carbohydrate should contribute 9-14 g/100 kcal with >50% from lactose. If other sugars are added, they should not exceed 10% of total carbohydrates. Calcium should provide 200 mg/100 kcal. Other micronutrient contents/100 kcal should reach 15% of the World Health Organization/Food and Agriculture Organization recommended nutrient intake values. A guidance upper level that was 3-5 times of the minimum level was established. Countries may adapt compositional requirements, considering recommended nutrient intakes, habitual diets, nutritional status and existence of micronutrient programs to ensure adequacy while preventing excessive intakes.

Maternal zinc status is associated with breast milk zinc concentration and zinc status in breastfed infants aged 4-6 months.

Breast milk provides adequate nutrients during the first 6 months of life. However, there are some reports of zinc deficiency in breastfed infants. This study was conducted to determine the prevalence of zinc deficiency in infants aged 4-6 months and the associated factors. Healthy infants aged 4-6 months and their mothers were enrolled. They were classified by feeding types as breastfed (BF), formula-fed (FF), and mixed groups (MF). Data collection included demographic data, perinatal data, given diets, and anthropometric measurement. Blood from infants and lactating mothers, and breast milk samples were collected to assess plasma and breast milk zinc concentrations. From 158 infants, the prevalence of zinc deficiency (plasma level below 10.7 mol/L) was 7.6%, and according to feeding groups 14.9%, 5.3%, and 2.9% in the BF, the FF, and the MF groups, respectively. Breastfed infants with zinc deficiency had significantly lower maternal zinc concentrations compared with those without zinc deficiency. There was a higher proportion of maternal zinc deficiency in zinc-deficient infants than those without zinc deficiency (66.7% vs 16.2%, p=0.02). There was a positive correlation between zinc concentrations in breast milk and plasma zinc concentrations of infants (r=0.62, p=0.01) and plasma zinc concentrations of lactating mothers (r=0.56, p=0.016). Using the regression analysis, infant zinc status was associated with maternal plasma zinc concentrations among breastfed infants. The results of this study suggest that breastfed infants aged 4-6 months may have a risk of zinc deficiency and that risk is associated with maternal zinc status and breast milk zinc concentrations.

Iron bioavailability in 8-24-month-old Thai children from a micronutrient-fortified quick-cooking rice containing ferric ammonium citrate or a mixture of ferrous sulphate and ferric sodium ethylenediaminetetraacetic acid.

A quick-cooking rice, produced from broken rice, is a convenient ingredient for complementary foods in Thailand. The rice is fortified with micronutrients including iron during the processing procedure, which can cause unacceptable sensory changes. A quick-cooking rice fortified with ferric ammonium citrate (FAC) or a mixture of ferrous sulphate (FeSO4 ) and ferric sodium ethylenediaminetetraacetic acid (NaFeEDTA), with a 2:1 molar ratio of iron from FeSO4 : iron from NaFeEDTA (FeSO4 + NaFeEDTA), gave a product that was organoleptically acceptable. The study compared iron absorption by infants and young children fed with micronutrient-fortified quick-cooking rice containing the test iron compounds or FeSO4 . Micronutrient-fortified quick-cooking rice prepared as a traditional Thai dessert was fed to two groups of 15 8-24-month healthy Thai children. The iron fortificants were isotopically labelled with (57) Fe for the reference FeSO4 or (58) Fe for the tested fortificants, and iron absorption was quantified based on erythrocyte incorporation of the iron isotopes 14 days after feeding. The relative bioavailability of FAC and of the FeSO4 + NaFeEDTA was obtained by comparing their iron absorption with that of FeSO4 . Mean fractional iron absorption was 5.8% [±standard error (SE) 1.9] from FAC and 10.3% (±SE 1.9) from FeSO4 + NaFeEDTA. The relative bioavailability of FAC was 83% (P = 0.02). The relative bioavailability of FeSO4 + NaFeEDTA was 145% (P = 0.001). Iron absorption from the rice containing FAC or FeSO4 + NaFeEDTA was sufficiently high to be used in its formulation, although iron absorption from FeSO4 + NaFeEDTA was significantly higher (P < 0.00001).

Metabolic syndrome in obese Thai children and adolescents.

BACKGROUND: The prevalence of childhood obesity in Thailand is increasing. Obese children are at risk of metabolic syndrome. OBJECTIVE: To determine the prevalence of metabolic syndrome in obese Thai children with various degrees of obesity and its association with severity of obesity, insulin resistance and C-reactive protein. MATERIAL AND METHOD: A cross-sectional study of 89 obese Thai children and adolescents was conducted at the Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University. Family histories of diabetes mellitus, hypertension, obesity and dyslipidemia were assessed. Anthropometry and cardiovascular risks including levels of fasting blood sugar, oral glucose tolerance test, insulin, C-reactive protein (CRP) and lipid profile were determined. Metabolic syndrome was defined using International Diabetes Federation criteria adjusted for age and sex. Univariate and logistic regression analysis were used for identification of the independent associated factors. RESULTS: The overall prevalence of metabolic syndrome in the present study was 16.9%. The percentages of metabolic syndrome in subjects with moderate, severe and morbid obesity were 10.5, 23.1 and 22.2 respectively. Univariate analysis revealed that metabolic syndrome had a statistically significant association with insulin level over 25 microIU/mL, homeostasis model for assessment of insulin resistance (HOMA-IR) equal to 3.16 or more and CRP over 3 mg/L. Logistic regression analysis revealed that only insulin level over 25 microIU/mL was independently associated with metabolic syndrome (OR 7.24; 95% CI: 2.01-26.10). CONCLUSION: The prevalence of metabolic syndrome is high among obese Thai children and adolescents. Prevention and proper management of metabolic syndrome including treatment of obesity should be considered in obese children.

Prevalence of subclinical vitamin K deficiency in Thai newborns: relationship to maternal phylloquinone intakes and delivery risk.

BACKGROUND: Vitamin K deficiency bleeding (VKDB) in infants is a rare but serious worldwide problem, particularly in Southeast Asia. Apart from exclusive breast feeding, little is known of the maternofetal risk factors that predispose infants to VKDB. OBJECTIVES: To assess (a) the relationships between functional vitamin K insufficiency in a large cohort of Thai mothers to that of their newborn infants and (b) the importance of delivery risk factors and maternal intakes of vitamin K as determinants of neonatal vitamin K status. METHODS: Vitamin K status was assessed by measuring undercarboxylated prothrombin (protein induced by vitamin K absence/antagonist-II (PIVKA-II)) in 683 mothers and in the cord blood of their babies by sensitive immunoassay. Dietary phylloquinone (vitamin K(1); K(1)) intakes were assessed in 106 of these mothers by food frequency questionnaire. RESULTS: Babies were categorised as 'normal' (n=590) or 'high risk' (n=93) according to birth weight and delivery type. PIVKA-II was detectable (>0.15 arbitrary units (AU)/ml) in 85 mothers (12.4%) and 109 babies (16.0%) with median levels of 0.78 and 1.04 AU/ml in mothers and babies, respectively. 'High-risk' babies had a higher median detectable PIVKA-II concentration than 'normal-risk' babies (3.1 vs 1.0 AU/ml, p=0.02) and a higher prevalence of clinically relevant (>5.0 AU/ml) concentrations (p=0.006). Mothers with K(1) intakes below the US recommended 'adequate intake' for pregnancy (<90 microg/day) had a higher prevalence of detectable PIVKA-II (18.8%) than those with adequate intakes (3.3%) (p=0.01). CONCLUSIONS: Functional, clinically relevant, vitamin K insufficiency was more common in 'high-risk' than 'normal-risk' newborns. Vitamin K insufficiency in mothers was linked to lower dietary K(1) intakes during pregnancy.

Cardiac dimensions and function in children with obesity.

BACKGROUND: Obesity can cause alterations in cardiac dimensions and function. Cardiac dysfunction during childhood may affect the quality of life in adulthood. This study evaluated left ventricular (LV) dimensions, systolic function and left ventricular myocardial performance index (LMPI) in children with obesity. METHODS AND RESULTS: Thirty-three obese children with mean age of 9.8 +/- 2.4 years, weight 61.3 +/- 20.8 kg, BMI 29.5 +/- 5.8 kg/m2 and percentage of actual weight to ideal body weight for height (%IBW) 170 +/- 25%, underwent echocardiography to assess LV dimensions, systolic and global functions. There were 2, 14 and 17 children with mild (160%IBW), respectively. The mean ratio of left ventricular end-diastolic dimension (LVEDD) to predicted LVEDD expressed in percentage (%LVEDD) was 98.3 +/- 7.8%, the left ventricular shortening fraction (LVFS) was 37.5 +/- 4.9% and the left ventricular ejection fraction (LVEF) was 67.5 +/- 5.9%. All were within normal range except that 2 children (6%) had mild LV dilatation. The mean LMPI was 0.35 +/- 0.08. However, 11 children (33%) had abnormal LMPI (>0.4). The severity of obese children did not correlate with the global LV dysfunction. CONCLUSION: The left ventricular dimensions and systolic function in children with obesity were essentially normal. LMPI which indicates LV global function was found to be abnormal in 33% of children with obesity and may be used to do early detection of LV global dysfunction.

Factors associated with dual form of malnutrition in school children in Nakhon Pathom and Bangkok.

OBJECTIVE: The present study examined the influence of family characteristics and maternal feeding practices on eating behaviors, food consumption and nutritional status of children living in 6 districts of Nakhon Pathom province and 3 surrounding districts of Bangkok. MATERIAL AND METHOD: One hundred and ninety nine families were enrolled in the present study. Four specific mother-child pair groups were purposively selected: 62 obese child/overweight mother pairs, 49 obese child/ normal weight mother pairs, 37 wasted child/overweight mother pairs, and 51 normal weight child/normal weight mother pairs. Anthropometric measurements were performed on all subjects. Biological data, socioeconomic status, maternal feeding practices, as well as eating and lifestyle behaviors of the children were obtained from mothers and children using structured questionnaires and interviews. RESULT: Most mothers from all groups, 40.8%-62.2%, had a primary education, were non-manual workers, with families containing 4-6 persons per household, and a family income of < or = 20,000 baht per month. Multivariate logistic regression analysis showed that maternal overweight prior to pregnancy (OR11.85, 95%CI 2.16-64.99) child's high birth weight (OR 4.53, 95%CI 1.09-18.73) as well as maternal control over the consumption of high caloric food (OR13.07, 95%CI 4.08-41.86) and large amounts of food consumed by the children (OR12.58, 95%CI 4.30-36.80) were significant factors associated with childhood obesity. Compared to normal weight children, a higher proportion of obese children were not breast-fed and a higher proportion of normal weight mothers controlled the consumption of high caloric food in their obese children. Overweight mothers with wasted children also controlled their children's food intake. Higher proportion of wasted children had a higher snack consumption frequency but lower energy food intake than the normal weight children. CONCLUSION: Understanding the underlying causes of dual form of malnutrition in the households would have implication for policy makers to address and implement a nutrition action plan. It is suggested that a malnutrition, (under and over-nutrition) prevention program must involve strategies within families that focus on providing nutrition education and the powerful guidance to help parents foster appropriate patterns of food choice and eating in their children. Promotion of increased physical activity in children is also essential. These strategies are aimed to promote the optimal child's weight and health.

Pericardial effusion in primary systemic carnitine deficiency.

A patient with pericardial effusion and a complicated presentation of primary systemic carnitine deficiency (PSCD) is described. This is the first case of PSCD reported to have pericardial effusion. Compound heterozygosity for two mutations in the SLC22A5 gene, T440M and F23del, and four SLC22A5 polymorphisms (c.IVS3+6A>G, c.-77G>A, c.-78C>T, and p.S95S) were identified in the patient.

Cardiac dimensions and function in children with obesity.

BACKGROUND: Obesity can cause alterations in cardiac dimensions and function, and cardiac dysfunction during childhood may affect the quality of life in adulthood. This study was done to evaluate left ventricular dimensions, systolic function, and the left ventricular myocardial performance index in children with obesity. MEHTODS AND RESULTS: Thirty-three obese children whose mean age was 9.8 +/- 2.4 years, weight was 61.3 +/- 20.8 kg, body mass index was 29.5 +/- 5.8 kg/m(2), and percentage of actual weight to ideal body weight for height (% IBW) was 170 +/- 25%, underwent echocardiography for the assessment of left ventricular dimensions, and systolic and global functions. There were 2, 14, and 17 children with mild (< 140% IBW), moderate (141-160% IBW), and severe obesity (> 160% IBW), respectively. The mean ratio of left ventricular end-diastolic dimension to predicted left ventricular end-diastolic dimension expressed in percentage was 98.3 +/- 7.8%, the left ventricular shortening fraction was 37.5 +/- 4.9%, and the left ventricular ejection fraction was 67.5 +/- 5.9%. All were within the normal range, with the exception of two children (6%) who had mild left ventricular dilatation. The mean left ventricular myocardial performance index was 0.35 +/- 0.08. However, 11 children (33%) had an abnormal index (< 0.4). The severity of obesity did not correlate with the global left ventricular dysfunction. CONCLUSION: The left ventricular dimensions and systolic function in children with obesity were essentially normal. The left ventricular myocardial performance index, which is an indicator for left ventricular global function, was found to be abnormal in 33% of the children, and may be used for the early detection of left ventricular global dysfunction.

Biochemical markers of bone formation in Thai children and adolescents.

The measurement of biochemical markers of bone turnover is essential in the study of skeletal metabolism in health and diseases. Due to variations in the rate of bone growth in different age groups and possible ethnic differences, age-specific reference ranges for biochemical markers should be established in a particular pediatric population. In this study, biochemical markers of bone formation, bone-specific alkaline phosphatase (BAP), and osteocalcin (OC) in healthy Thai children and adolescents aged 9 to 18 years were evaluated in relation to their ages and pubertal development. Serum BAP levels in boys increased with age and peaked at about 12 to 13 years. In contrast, there was a progressive decline of serum BAP levels with advancing age in girls older than 9 years. Serum OC also increased with age and reached a peak at ages 12 and 13 years in girls and boys, respectively. In addition, both serum BAP and OC levels also varied with pubertal stages. The BAP levels in boys increased sharply at pubertal stage 3 and decreased at pubertal stage 5. In girls, the BAP levels showed a fairly constant high level up to stage 3, followed by a remarkable decrease thereafter. The OC levels in boys increased sharply at pubertal stage 4 and decreased thereafter. In girls, OC started to increase at pubertal stage 3 with no subsequent changes. The levels of serum BAP and OC were higher in boys than in girls at pubertal stages 3 to 5 and at stages 2, 4, and 5, respectively. Moreover, only serum BAP level showed significant positive correlation with height velocity in both genders. In multiple regression analyses, gender, age, and pubertal stage were consistently correlated with both serum BAP and OC levels. In summary, male and female adolescents have different patterns of changes in biochemical markers of bone formation.

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.

Modified percutaneous endoscopic gastrostomy tubes: experience in Thai children.

BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) is a well-established alternative to open gastrostomy for providing long-term enteral nutrition. Although the commercial PEG tube is available and suitable for the procedure, its cost is relatively high for low socioeconomic people. Therefore, modified PEG tubes have been used in our hospital. OBJECTIVES: To evaluate the outcome and complications of PEG performed in children at Ramathibodi Hospital and compare the results between the commercial PEG and modified PEG tubes. METHOD: All children who had PEG performed at Ramathibodi Hospital, from January 1999 to May 2002, were included in the study. The demographic data, indications for PEG, types of PEG tube, outcomes and complications were retrospectively reviewed. The modified PEG tube was made by connecting a Malecot four-wing catheter to the previously used, re-sterilized distal part of a commercial PEG tube. RESULTS: PEG was performed on 34 children, aged 4 months to 13 years, and successfully placed in 30 children (88.2%). The commercial and modified PEG tubes were used in 20 cases and 10 cases, respectively. Early complications occurring in the first 7 days post-procedure were found in 9 cases (30%) as follow: peritonitis (1 case), peristomal wound infection (7 cases), and subcutaneous emphysema (1 case). Late complications occurring at more than 7 days post-procedure were found in 15 cases (50%) and all were minor problems. There was no difference in complication rates between the 2 types of PEG tubes. CONCLUSION: PEG is safe even in small infants. Minor complications are common but can be simply managed. The modified PEG tube is an alternative for a commercial PEG tube in an unaffordable situation.