Alteration of -656(G/T) and -607(C/A) polymorphisms in interleukin-18 (IL-18) gene in house dust mite-sensitive allergic rhinitis patients in Thailand.

Allergic rhinitis (AR) is an IgE-mediated inflammation of the nasal membranes, which is naturally triggered by aeroallergens. House dust mites (HDM) are the most common inhalant allergens. Interleukin-18 (IL-18) has been established as an essential cytokine that can activate the generation of IgE. This randomized controlled study aimed to identify the possible relationship of the genetic variations in the IL-18 gene with AR in mite-sensitive Thai patients. Study subjects consisted of 150 AR patients and 50 normal participants. Genomic DNA of 30 randomized AR patients and 30 randomized controls were screened by sequencing for the selection of candidate single nucleotide polymorphisms (SNPs), and further analyzed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) assay for all subjects. The following five SNPs were detected in the IL-18 gene: -656 G/T, -607 C/A, and -137 G/C in promoter 1 and -920 C/T and -373 C/G in promoter 2. The results showed that -656 G/T and -607 C/A SNPs were significantly correlated with IgE levels specific to Dermatophagoides pteronyssinus (Der p) allergen (P = 0.045 and P = 0.045, respectively), and significant differences were observed in the genotype distribution of AR patients when compared with controls [P = 0.044 and P = 0.044, respectively; odds ratios (ORs): 1.941 (95%CI, 1.014-3.715) and 1.941 (95%CI, 1.014-3.715), respectively]. Our findings indicate that the IL-18 alleles, -656T (rs1946519) and -607A (rs1946518), might be associated with the higher production of Der p allergen-specific IgE in mite-sensitive AR patients.

Exome sequencing in Thai patients with familial obesity.

Obesity is a major worldwide health issue, with increasing prevalence in adults and children from developed and developing countries. Obesity causes several chronic diseases, including cardiovascular and respiratory diseases, osteoarthritis, hypertension, stroke, type II diabetes, obstructive sleep apnea, and several types of cancer. Previous genome-wide association studies have identified several genes associated with obesity, including LEP, LEPR, POMC, PCSK1, FTO, MC3R, MC4R, GNPDA2, TMEM18, QPCTL/GIPR, BDNF, ETV5, MAP2K5/SKOR1, SEC16B, SIM1, and TNKS/MSRA. However, most of these variants are found in the intronic or intergenic regions, making it difficult to elucidate the underlying mechanisms. Therefore, in this study, we performed a whole exome sequencing of the protein-coding regions in the total genome (exome) of two obese and one normal subject belonging to the same Thai family to identify the genes responsible for obesity. We identified 709 functional variants that were differentially expressed between obese and normal subjects; of these, 65 were predicted to be deleterious to protein structure or function. The minor allele frequency of 14 of these genes (ALOX5AP, COL9A2, DEFB126, GDPD4, HCRTR1, MLL3, OPLAH, OR4C45, PRIM2, RXFP2, TIGD6, TRPM8, USP49, and ZNF596) was low, indicating causal variants that could be associated with complex traits or diseases. Genotyping revealed HCRTR1, COL9A2, and TRPM8 to be associated with the regulation of feeding behavior and energy expenditure. These genes constituted a network of pathways, including lipid metabolism, signaling transduction, immune, membrane transport, and gene regulation pathways, and seemed to play important roles in obesity.

Association between rs155971 in the PCSK1 gene and the lipid profile of obese Thai children: a family-based study.

Genetic variants of the POMC and PCSK1 genes cause severe obesity among patients in the early stages of childhood. This family-based study analyzed the links between single nucleotide polymorphisms (SNPs) in either the POMC or PCSK1 genes and obesity, as well as obesity-related traits among obese Thai children and their families. The variants rs1042571 and rs6713532 in the POMC gene in a sample of 83 obese children and their family members were investigated using polymerase chain reaction (PCR)-restriction fragment length polymorphism. In addition, the SNPs rs6232, rs155971, rs3762986, rs3811942, and rs371897784 of PCSK1 were analyzed in all samples using PCR and gene sequencing methods. Participants with the homozygous variant genotype in rs155971 had significantly elevated cholesterol and low-density lipoprotein cholesterol (LDL-C) levels (P = 0.011, OR = 1.025, 95%CI = 1.006-1.045; and P = 0.006, OR = 1.030, 95%CI = 1.009-1.053, respectively) after adjustment for age, gender, and body mass index (BMI). In addition, patients with the heterozygous variant genotype in rs371897784 of PCSK1 had a 1.249- fold higher risk (95%CI = 1.081-1.444, P = 0.027) of increased waist circumference than patients with the normal genotype, after adjustment for age, gender, and BMI. However, this analysis did not find any correlation between obesity and SNPs in PCSK1 and POMC. Therefore, these common variants in PCSK1 and POMC were not the major cause of obesity in the Thai subjects sampled. However, variants in PCSK1 did affect cholesterol level, LDL-C level, and waist circumference.

Genetic variant screening of MC3R and MC4R genes in early-onset obese children and their relatives among a Thai population: family-based study.

MC3R (melanocortin-3 receptor) and MC4R (melanocortin-4 receptor) play important roles in energy homeostasis. Severe early-onset obesity, known as monogenic obesity when it is the consequence of a mutation in a single-gene product, may result when energy homeostasis is disrupted. The purpose of our study was to screen for variations of the MC3R and MC4R genes and observe the mode of inheritance of variations in affected families. We used polymerase chain reaction and direct sequencing to analyze the 11 early-onset obese children (probands) with their 71 family members, together with DNA from 100 healthy subjects used as controls. No novel mutations were found in the MC3R gene. Two previously described polymorphisms, rs3746619 and rs3827103, were detected in the MC3R gene. It was not associated with any obesity-related phenotypes. Three heterozygous variations of the MC4R gene were detected in 3 of 11 probands. The rs34114122 and rs61741819 variations have previously been reported, but rs182455344 was novel. Moreover, each MC4R variant was also found in a number of family members, indicating that this molecular analysis of a family-based study showed an autosomal dominant pattern. Our study indicated that MC4R variations in early-onset obese Thai children were found, and transmission of these variations in each family is in the dominant pattern. These variants could possibly contribute to a genetic influence of early-onset obesity in Thais. There is no evidence of any association between MC3R variations and obesity.

BDNF Val66Met polymorphism and serum concentrations of BDNF with smoking in Thai males.

Many studies have suggested that brain-derived neurotrophic factor (BDNF) is involved in the reward system of addiction, and that nicotine may induce alterations in BDNF gene expression and its protein level within the mesocorticolimbic system. We investigated the BDNF levels and biochemical-hematological parameters of smoker and non-smoker groups, and examined the association of the Val66Met BDNF gene polymorphism with BDNF serum levels and cigarette smoking. The study sample comprised 311 Thai volunteers (200 smokers; 111 non-smokers). The levels of serum BDNF and biochemical-hematological parameters were determined. The Val66Met BDNF polymorphism was genotyped by the polymerase chain reaction-restriction fragment length polymorphism technique. The smoker group had significantly higher serum BDNF levels than the non-smoker group (8.3 vs 6.5 ng/mL, P < 0.05). BDNF concentrations correlated positively with hemoglobin, hematocrit, red blood cell count, white blood cell count, platelet count, number of cigarettes smoked, and thiocyanate level (P < 0.05). No association was found between the BDNF Val66Met genotype and the serum BDNF level. The BDNF Val66Met polymorphism was not significantly associated with the smoking status of the Thai males in this study. Cigarette smoking may be one factor that determines the serum BDNF level, but the BDNF Val66Met polymorphism probably does not influence susceptibility to smoking among Thai males.

Association of HTTLPR and 5-HT2A T102C polymorphisms with smoking characteristics and anthropometric profiles of Thai males.

Nicotine increases serotonin release in the brain. Gene polymorphisms in the serotonergic system have been suggested to be associated with smoking behavior. We investigated a possible association between two polymorphisms in the serotonergic system - HTTLPR of a serotonin transporter gene and 5-HT(2A) at position T102C - with biochemical and anthropometric parameters, and with cigarette smoking in an investigation of 200 smokers and 111 non-smokers. The two polymorphisms, HTTLPR and 5-HT(2A) at position T102C, were genotyped by PCR-RFLP. They were not significantly associated with smoking status in these Thai males. Among the smokers, thiocyanate concentrations and quantity of cigarettes smoked (cigarette pack-years) were significantly higher for individuals with LL/LS genotypes than SS genotypes of 5-HTTLPR (all P < 0.05), whereas "age at starting smoking" and "duration of smoking" were not significantly different between these two genotypes. Moreover, anthropometric variables, comprising triceps skinfold thickness, arm circumference, waist circumference, hip circumference, and waist-to-hip ratio, were significantly higher for the CC/TC genotypes of 5-HT(2A) than the TT genotype (all P < 0.05), except for body mass index. HTTLPR and 5-HT(2A) T102C polymorphisms were not significantly associated with smoking status among Thai males; however, the HTTLPR polymorphism among smokers appears to be an indicator of increased smoking intensity consisting of cigarette pack-years and thiocyanate concentrations. The 5-HT(2A) T102C polymorphism plays a role in the anthropometric profiles, triceps skinfold thickness, arm circumference, waist circumference, hip circumference, and waist-to-hip ratio, but not smoking status in Thai subjects.

Association of T869C gene polymorphism of transforming growth factor-ß1 with low protein levels and anthropometric indices in osteopenia/osteoporosis postmenopausal Thai women.

Osteoporosis is the most common metabolic bone disease; it is an important health problem among postmenopausal women. We evaluated the association of three polymorphisms, T869C, C-509T and G915C, of the TGF-ß1 gene with bone mineral density (BMD) serum TGF-ß1 levels in 278 postmenopausal female osteopenia/osteoporosis subjects and 95 postmenopausal female control subjects. Serum TGF-ß1 levels were significantly lower in osteopenia/osteoporosis subjects than in control subjects. Serum TGF-ß1 levels of the CT+CC (T869C) genotype group were significantly lower in osteopenia/osteoporosis subjects than in control subjects (11.3 vs 15.8 ng/mL). There was a significant difference in the CT+CC (T869C) genotype frequencies between the osteopenia/osteoporosis and control subjects (74.18 vs 60.22%; OR = 1.90, 95%CI = 1.16-3.12). In the age group of more than 50 years, subjects with the TC+CC genotype of T869C polymorphism had significantly increased risk of osteopenic/ osteoporotic bones at L1 (OR = 2.36, 95%CI = 1.37-4.07), L2 (OR = 1.71, 95%CI = 1.01-2.90), L3 (OR = 2.21, 95%CI = 1.23-3.98), L4 (OR = 1.74, 95%CI = 1.00-3.03) and the femoral neck (OR = 1.80, 95%CI = 1.04-3.12). The CT+CC genotype of the T869C polymorphism of the TGF-ß1 gene was found to be associated with lower serum TGF-ß1 in osteopenia/osteoporosis subjects and increased risk of osteopenic and osteoporotic fracture at L1-4, femoral neck and total hip in postmenopausal Thai women. Logistic regression analysis showed that T869C polymorphism is a significant risk factor for osteopenia/ osteoporosis. We concluded that T869C polymorphism of the TGF-ß1 gene has an impact on decreased serum TGF-ß1 levels and influences susceptibility to osteopenia/osteoporosis in Thai women.

Adiponectin/ACP30, a collagen-like plasma protein in relation to anthropometric measurement in Thai overweight and obese subjects.

Adiponectin, anthropometric parameters including weight, height, body mass index (BMI), arm circumference, triceps skinfold, subscapular skinfold, waist, hip circumferences and waist/hip ratio were recorded in 48 male and 166 female overweight and obese Thai volunteers (BMI=25.0 kg/m(2)), and in 26 male and 81 female normal subjects (BMI=18.5-24.9 kg/m(2)). Thai volunteers were investigated. Statistically significantly lower adiponectin concentrations in overweight and obese subjects were found when compared with control subjects of both sexes. Anthropometric parameters, including weight, height, BMI, arm circumference, triceps skinfold, subscapular skinfold, waist, hip circumferences and waist/hip ratio, except arm span, were statistically significantly higher in overweight and obese subjects than in control subjects. The overweight and obese subjects had higher glucose concentrations than the control subjects. The BMI and glucose concentrations were found to be significantly related, under these conditions, to adiponectin.

Serum leptin and lipid profiles in Thai obese and overweight subjects.

The weight, height, body mass index (BMI), waist/hip ratio, serum leptin and lipid profiles of 48 overweight (BMI > or = 25.00). Thai males and 166 overweight Thai females, compared with 26 males and 81 females in a control group (BMI = 18.5-24.9 kg/m2), were investigated. Subjects for the study were those persons who turned up regularly for physical check-ups at the out-patient department, general practice section of the Rajvithi Hospital, Bangkok. The study was conducted between March-October, 1998. Statistically significantly higher levels of serum leptin, cholesterol, LDL-C, LDL-C/HDL-C ratio and triglyceride were found in the overweight compared with the control subjects. The median serum leptin concentration in overweight subjects was 19.6 (2.0-60.0 ng/ml) compared with 9.0 (range 1.0-30.0 ng/ml) in the control subjects (p < 0.001). The median values of leptin serum concentrations in the overweight and obese males were significantly higher than those of the overweight and obese females. A total of 66.7% (32 out of 48) of the overweight and obese males had elevated leptin levels, while elevated leptin levels were found in 87.3% (145 out of 166) of the overweight and obese females. A total of 18.8% and 21.1% of the overweight and obese males and females respectively had cholesterol concentrations of > or = 6.48 mmol/l. However, the prevalence of low HDL-C (HDL-C < or = 0.91 mmol/l) was found to be 41.7% in the overweight and obese males and 4.2% in the overweight and obese females. Statistically significant associations were found between weight, height, BMI, waist, hip, waist/hip ratio, HDL-C, and serum leptin in both overweight male and female subjects. A negative correlation was found between serum leptin and LDL-C/HDL-C ratio in both the overweight and obese subjects.

Erythrocyte antioxidant enzymes and blood pressure in relation to overweight and obese Thai in Bangkok.

The specific activities of antioxidant enzymes, [eg superoxide dismutases (SOD), glutathione peroxidase (GPX) and catalase (CAT)], anthropometric measurements, including waist/hip ratio of 48 male and 167 female overweight persons (body mass index (BMI) > or = 25.0 kg/m2) compared with a 26 male and 80 female control group (BMI = 18.5-24.9 kg/m2) of Thai volunteers who attended the Out-patient Department, General Practice Section, Rajvithi Hospital, Bangkok, for a physical check-up during March-October, 1998, were investigated. There was a slightly significant difference between the median age of the sexes. The medians of height, weight, and waist/hip ratio in males were significantly higher than those in female overweight and obese subjects. The median of arm circumference (AC), mid arm muscle circumference (MAMC) in males was significantly higher than those in female overweight and obese subjects (p < 0.05). The prevalences of hypertension based on systolic and diastolic blood pressure of > or = 160/> or = 95 mmHg, were 8.3% and 37.5% for males and 5.4% and 18.6% for females, respectively. There was no significant difference between the median of antioxidant enzymes (SOD, GPX and CAT) between the sexes. No significant differences in the antioxidant enzymes in male overweight/obese persons and normal controls were presented, whereas antioxidant enzymes in female overweight/obese persons were statistically lower than in control females (p < 0.05). A significantly higher SOD, GPX, and CAT status was observed in normal subjects compared with overweight/obese subjects (p < 0.01). A higher prevalence of SOD < or = 2,866 U/gHb, GPX (< or = 15.96 U/gHb in females was found, compared with males. A high percentage of lower catalase (CAT < or = 19.2x10(4) IU/gHb) was found in both sexes (64.5% in males and 64.5% in females). In obese subjects (BMI > or = 30.0 kg/m2), there were significantly positive relationships between systolic and diastolic blood pressure, systolic blood pressure and waist/hip ratio, and SOD could be related to weight, BMI as well as GPX and CAT, whereas the opposite result was observed for age and SOD.

Activity, dietary intake, and anthropometry of an informal social group of Thai elderly in Bangkok.

Socio-demographic, anthropometric assessment, dietary pattern, lifestyle of 384 Thai elderly (55 males and 329 females) aged 60-94 years, who were members of an informal social activity group, were investigated. The 3-day dietary record was determined with the help of food models by random sampling of the group (seven males and 25 females). Most of the males investigated were married (88.9%), whereas 42.9% of the females were widowed. Nearly all of the elderly investigated lived with their relatives. Only 3% of the elderly had never attended school. More elderly males than females smoked or had smoked in the past, and this applies also to their drinking habits. The health situation of the individuals investigated seemed to be satisfactory. The most frequent diseases found among the elderly were chronic diseases, such as hypertension, hyperlipidemia and diabetes mellitus. No statistically significant difference in body mass index (BMI), arm circumference (AC), and hip circumference was found between males and females. Weight, height, mid-arm muscle circumference (MAMC), arm span, waist, waist/hip ratio and blood pressure of the males were significantly higher than those of the females. Tricep skin-fold thickness (TSF) and subscapular skin-fold thickness (SST) were lower for males than for females. A total of 54.5% of the males and 50.5% of the females were found to be over-nourished. Less than 2% of all the individuals investigated were undernourished. No significant differences were observed for all nutrients between the males and females. Intake of dietary energy from food for males and females was 69.8 and 75.5%, respectively, compared with the Thai RDA. When calculating the intake of macro-nutrients as percentage of total calorie intake, about 17% of the total calorie intake was attributed to fat, 13% to protein and 70% to carbohydrate for the males. For the females, the figures were 17, 15, and 68%, respectively. Intake of calcium, phosphorus, vitamin B1, B2 and niacin seem to be inadequate for both sexes.

Promotion of the health of rural women towards safe motherhood--an intervention project in northeast Thailand.

An intervention project focusing on the health of women in the reproductive age was conducted in three districts of Khon Kaen Province, northeast Thailand between 1991 and 1996. Main emphasis was placed on improving reproductive health, the nutritional status including the iron deficiency anemia (IDA) as well as iodine deficiency disorders (IDD), and the parasitic diseases liver fluke (Opisthorchis viverrini) and hookworm. For implementation a community based Primary Health Care approach was used including the training of health officials in health matters, primary health care workers and villagers as well as enhancing health education and the dissemination of health information. The health delivery system was encouraged to take appropriate actions such as in the treatment of parasitic diseases and the control of IDA and IDD. Monitoring was done on a regular basis. The outcome of the project was assessed by comparing baseline data compiled from a random sample of the target population with the results of the final evaluation. An attempt to compare results obtained from villages within and outside of the project area failed most probably because of spill over effects. A number of important indicators on family planning and mother and child health care improved during the time the project was implemented; this included practising family planning, and participation in antenatal care. Also the proportion of females becoming pregnant for the first time when 20 years or older increased. Child-raising also improved in that almost all females gave colostrum to their babies by this time. Almost 75% of the women breast-fed their children. Improvements occurred in the nutritional status as far as the micronutrients iron and iodine were concerned, however the overall nutritional status of females did not change, but a rather high proportion of females were found to be overnourished. The project failed in reducing abortion and the proportion of females becoming pregnant when they are 18 years old or younger. It was also not possible to improve the usage of postnatal care. As anticipated, the results achieved so far are most suitable in serving as a training ground and providing a favorable example to improve family planning, mother- and child health care, and also the general health of females in the region, particularly in neighboring countries such as Lao PDR, Cambodia and Vietnam.

Nutritional status of pre-school children and women in selected villages in the Suvannakhet Province, Lao PDR--an intervention trial.

A project to promote the health and nutritional status of women and pre-school children was started from 1995 to 1997 in three villages in Suvannakhet Province, Lao PDR. One village served as control. In 1995, for the baseline survey, 456 females, and in 1997, for the final evaluation, 363 females from the four villages volunteered for further investigations. An attempt was made to involve all females in the reproductive age residing in the villages. At the same time also the nutritional status of 321 and about 540 randomly selected pre-school children respectively was also assessed through physical examination and anthropometric measurements. Intervention measures included introducing growth charts and taking regular anthropometric measurements of women in the reproductive age and of pre-school children. Training in nutritional aspects such as giving colostrum to new-borns, prepare proper weaning food and supplementary feeding, animal-raising and home gardening was also introduced and provided to health personnel, village leaders and in women clubs. Special attention was given to the control of acute infectious diseases. The conventional EPI program was enforced as well. Health education in matters of mother and child health care was also provided. The proportion of undernourished women was rather high at about 15%. For pre-school children, the proportion of wasting was around 5%, and of stunting 50% and above. Intervention did not improve the nutritional status either of the women or of the children. It was concluded that the time span of two years is too short for a decrease in the proportion of undernourishment to be observed. An improvement was achieved for some indicators of mother and child health care. This seems to indicate the population's willingness to follow suggestions to improve their health. Most probably, if attempts to improve the nutritional status were continued, an improvement in this aspect could also be observed, if the population can be encouraged to take actions and develop initiatives by themselves.

Leptin concentration in relation to body mass index (BMI) and hematological measurements in Thai obese and overweight subjects.

The weight, height and body mass index (BMI), including waist/hip ratio, serum leptin and hematological parameters of 48 male and 166 female overweight (BMI > or = 25.00) Thai volunteers who came for a physical check-up at the Out-patient Department, General Practice Section, Rajvithi Hospital, Bangkok during the period March-October 1998, were investigated. There were statistically significantly higher levels of serum leptin, mean corpuscular mean corpuscular hemoglobin concentration (MCHC) and mean corpuscular volume (MCV) in the overweight than in the control subjects. The median serum leptin concentration in overweight subjects was 19.6 (2.0-60.0 ng/ml) compared with 9.0 (range 1.0-30.0 ng/ml) in the control subjects (p < 0.001). The medians of leptin in overweight and obese males were significantly higher than those of overweight and obese females. 66.7% (32 out of 48) of overweight and obese males were found to have elevated leptin levels, while 87.3% (145 out of 166) were found in overweight and obese females. Anemia was found in 18.7% of female overweight and obese subjects, using hemoglobin as an indicator. Significant associations were found between weight, height, BMI, waist, hip, waist/hip ratio, hemoglobin, hematocrit, and serum leptin in both male and female overweight subjects. A negative correlation was found between serum leptin and hemoglobin, and hematocrit in both overweight and obese subjects.

Urinary iodine excretion as a predictor of the iodine content of breast milk.

Endemic goitre has re-emerged in Thailand. This is particularly dangerous for children since iodine deficiency disorders (IDDs) might negatively influence their intellectual and mental development. In order to assess the situation, the iodine content of breast milk was determined and a method is proposed on how to monitor IDDs in lactating mothers later on. Seventy-five lactating women aged from 15 to 45 years, from 12 villages of 3 districts, namely Chumpae. Srichompu and Pupaman within the mountainous areas of Khon Kaen province, Northeast of Thailand were investigated. The breast milk from 46.7 per cent of mothers was found to be below recommended standards. In addition, 52.0 per cent of the women investigated had low urinary iodine excretion. The risk of women with low iodine excretion was 15 fold higher in comparison to women with sufficient iodine excretion to provide breast milk for their babies with insufficient iodine content. It is concluded that urinary iodine excretion can be used to monitor the IDDs in lactating mothers.

Nutritional status of school children in an endemic area of iodine deficiency disorders (IDD) after one year of iodine supplementation.

To improve the health and nutritional status of school children in an area of iodine deficiency disorders (IDD) by means of different iodine fortifications in salt, fish sauce and drinking water, anthropometric assessment for nutritional measurement, including hematological status, were performed. There was a significant difference in the weight and height of the children from the four schools investigated, before and after supplementation in each school. The prevalence of anemia (as indicated by hematological measurement) and iodine deficiency (as indicated by urinary iodine concentration in the children from the four schools) were assessed and compared before and after iodine supplementation; a decrease in prevalence was found in all school children, however, serum ferritin did not change before and after supplementation.

Nutritional status and serum lipids of a rural population in Northeast Thailand--an example of health transition.

An investigation was undertaken in Northeast Thailand, a country undergoing rapid health transition, to find out whether there is a likelihood that the nutritional and lipid pattern of an adult population in Northeast Thailand is related to coronary heart disease in the same way as in western countries. In a cross-sectional study, the body mass index (BMI) and the waist-hip ratio as well as the important plasma lipids were determined. The nutritional status and the lipid profile of the predominantly middle-aged population is characterised by a generally favourable nutritional status and lipid concentrations, where the distribution, indicated by the medians, of the relevant variables over the total population is concerned. A rather high proportion of individuals was found to be overnourished and to have high triglyceride levels. Individuals with high triglyceride levels run a risk of developing coronary heart disease only when the LDL-HDL fraction is above 5. Only 3% of the total population investigated had a LDL-HDL ratio above that value. Since hypertriglyceridaemia is also linked to the insulin-resistant syndrome, it is concluded that, if the mortality of coronary heart disease increases in future, then this must be accounted probably more to the after-effects of the insulin-resistant syndrome than to the direct effect of an atherogenic lipid pattern. This view is supported by a high prevalence of impaired glucose tolerance (IGT) and non-insulin dependent diabetes mellitus (NIDDM) in the population under survey. Preventive measures in the area should concentrate among others on reducing overnutrition, especially among women, and increasing physical activity and screening for NIDDM.

Evaluation and monitoring of iodine deficiency disorders in school children in north-east Thailand.

The possibility of improving iodine deficiency disorder (IDD) in school children in Khon Kaen province was investigated during the period of 1 year, using an operational research approach. Four schools in Pupaman and Srichompu districts, namely Ban Khoa Wong, Na Fai Witaya, Ban Pa Num Tieng and Ban Non Khom, were selected for this study. Ban Non Khom served as the control school. Different methods were used for iodine fortification. Iodized salt was used for the children of the Ban Khoa Wong school, iodized water was used for Na Fai Witaya school and iodized fish sauce was used for Ban Pa Num Tieng school. The iodized salt, water and fish sauce were provided with the help of the school teachers under the supervision and advice of the team of investigators. Urine iodine excretion as well as palpation of the thyroid gland and the thyroid hormones T4, T3 and TSH were selected for monitoring and evaluation. The proportion of children with low urine iodine excretion, indicated by a cut-off point suggested by the WHO/ICCIDD/UNICEF working group, decreased during the course of the project in all schools receiving iodine supplementation as well as in the control school. However, the decrease was less in the control school in comparison with the implementation schools. Furthermore, the goitre rate decreased in all schools under investigation. The decrease of the goitre rate for the children of the control school might have been due to the activities of a village health volunteer from a nearby village who was using iodized salt for IDD control according to the ongoing national programme initiated by the Ministry of Public Health. No significant difference in the level of thyroid hormones was detected before or at the end of the supplementation for either the experimental schools or the control school. The results from the determination of thyroid hormone serum levels could not be used for assessing the outcome of the project. The measuring of urinary iodine excretion might be helpful in monitoring the iodine intake during the intervention phase. Long-term effects of iodine fortification could be seen best by the declining proportion of children with goitre. However, an observation of 1 year might not have been enough to clearly see the outcome of the project. The other possible contributing error to this study is intra-observer variation of the palpation technique when the sample size was not big enough. Goitrogens in this area might be another risk factor for the high prevalence rate of goitre. Further study in this field should be encouraged. The results of the study indicate that iodine fortification of salt and fish sauce is more effective than iodine fortification of drinking water. Due to the local preference of adding fish sauce (nam pla) instead of salt to almost all dishes, fish sauce proved to be the best vehicle for iodine fortification. The success of the project depended heavily on the understanding and cooperation of the school teachers and the school children. Major constraints in conducting this project were the insufficient distribution of iodized salt and potassium iodide solution for the fortification of drinking water, and the inconsistency of iodide concentration in the salt after fortification.

Prevalence of abnormal glucose tolerance in Khon Kaen Province and validity of urine stick and fasting blood sugar as screening tools.

Three hundred and fifty-five individuals, 152 males and 203 females, aged between 30 and 74 years, were randomly selected in a two stage selection process from rural communities in three districts of Khon Kaen Province, Northeast Thailand. The prevalence of impaired glucose tolerance (IGT) and non-insulin dependent diabetes mellitus (NIDDM) in the rural area of Northeast Thailand were measured. In addition, the validity of the urine stick and fasting blood sugar as screening tools against the two hours glucose loading test as golden standard were determined. The survey was conducted in July 1995. The glucose loading test was performed on 277 individuals. IGT and NIDDM were classified according to current World Health Organization suggestions. Prevalence rates for IGT were 18.1 per cent and for NIDDM 11.9 per cent. No difference was found between males and females, also when controlled for age. NIDDM prevalence increased with age but IGT rates already were high in the younger age groups. This finding suggests that IGT precedes NIDDM in Thailand. The validity of the urine stick as a screening tool in communities was insufficient, with a sensitivity of less than 20 per cent. When using fasting blood sugar as a screening test, the sensitivity was close to 44 per cent and the specificity 90 per cent. It is concluded that the urine stick is not a useful screening tool and the method of using blood sugar concentrations for screening have to be improved before it can be applied within communities.

Risk factors for chronic diseases among road sweepers in Bangkok.

The nutritional and health status of road sweepers in Bangkok was investigated. Fifty-seven males and one hundred thirty-four females from 10 districts were selected for the study. The districts were sampled as cluster at random. From each district selected about 50% of road sweepers volunteered to participate in the investigation. Through questionnaires the age, marital status, place of origin, drinking and smoking habits were assessed. Anthropometric measurements, blood pressure and the lipid profile of these subjects were determined. According to a physical check-up and X-rays taken, all individuals investigated were apparently healthy. The age of the study group varied between 26 and 57 years. The median for the males was 47 years and for the females 37.5 years. Almost all the road sweepers were married. Smoking and alcohol drinking was widespread. Over- and undernutrition was found among the group investigated. 26.3% of the males and 1.5% of the females were undernourished. According to their systolic values, 15.8% of the males and 6.7% of the females were suffering from hypertension, and 38.6% of the males and 15.7% of the females had hypertension according to their diastolic values. 58.2% of the females and 29.3% of the males were overnourished. 57.9% of the males and 59.7% of the females had cholesterol levels above 200 mg/dl. Pathological values of LDL cholesterol were determined in 26.3% of the males and 28.4% of the females. The habit of consuming tonic drinks was widespread among the workers. The study concluded that behavior risk factors are highly prevalent in the group of workers belonging to the lower socio-economic class. Further investigations are presently being undertaken to study the after-effects of air pollution among this group of workers. The results will be subsequently reported in future publications.