Higher maternal BMI early in pregnancy is associated with overweight and obesity in young adult offspring in Thailand.

BACKGROUND: Rates of overweight and obesity among women of reproductive age have been steadily increasing worldwide and in Thailand. There is mounting evidence that maternal obesity during pregnancy is associated with an increased risk of obesity and other adverse health outcomes in the offspring, but such data are lacking for Thailand. We examined the associations between maternal body mass index (BMI) and anthropometry (particularly the likelihood of obesity) and cardiometabolic parameters in young adult offspring. METHODS: This was a prospective follow-up study of a birth cohort in Chiang Mai (Thailand). Pregnant women carrying singletons were recruited at their first antenatal visit (< 24 weeks of gestation) and followed until delivery in 1989-1990. Participants were their young adult offspring followed up in 2010. Maternal BMI was recorded at the first antenatal visit. The offspring underwent clinical assessments, including anthropometry, lipid profile, insulin sensitivity (HOMA-IR), blood pressure, and carotid intima-media thickness. The primary outcome of interest was the likelihood of obesity in the offspring. RESULTS: We assessed 628 young adults (54% were females) at 20.6 ± 0.5 years of age (range 19.1-22.1 years). The young adult offspring of mothers with overweight/obesity was 14.1 kg (95%CI 9.7, 18.5; p < 0.0001) and 9.4 kg (95% CI 6.1, 12.8; p < 0.0001) heavier than those born to mothers with underweight or normal weight, respectively, and had BMI 3.46 kg/m2 (95%CI 2.26, 4.67; p < 0.0001) and 5.27 kg/m2 (95%CI 3.67, 8.68; p < 0.0001) greater, respectively. For every 1-kg/m2 increase in maternal BMI, the adjusted odds ratio (aOR) of offspring obesity was 25% greater (95%CI 1.10, 1.42; p < 0.001). Thus, the aOR of obesity in offspring of mothers with overweight/obesity was 4.6 times greater (95%CI 1.86, 11.26; p < 0.001) and nearly 17-fold greater (95%CI 1.96, 146.4; p = 0.010) compared to young adults born to mothers with normal weight or underweight, respectively. There were no observed associations between maternal BMI status and offspring metabolism or blood pressure. DISCUSSION: Maternal overweight/obesity early in pregnancy was associated with increased BMI and greater odds of obesity in their young adult offspring in Thailand. These findings highlight the public health importance of fostering healthier lifestyle choices among women of reproductive age.

Lower insulin sensitivity in young adults born preterm in Thailand.

BACKGROUND: Previous studies reported impaired glucose homeostasis among preterm survivors, but consisted almost exclusively of Caucasians. It is unknown whether Asians born preterm display similar impairments. AIM: To assess glucose homeostasis and other cardiometabolic outcomes among young adults born preterm in Thailand. METHODS: Participants were 575 young adult offspring of mothers from the Chiang Mai Low Birth Weight Study, born in 1989 to 1990 and followed up in 2010: 54.1% females, median age 20.6 years, including 33 individuals (5.7%) born preterm. After an overnight fast, participants underwent clinical assessments, including blood sampling (glucose, insulin, and lipid profile). Insulin sensitivity was assessed using HOMA-IR and insulin secretion estimated using HOMA-ß. RESULTS: In unadjusted analyses, young Thai adults born preterm were 3.2 cm shorter (P = .037), 6 kg lighter (P = .016), and had HOMA-ß 34% higher (P = .026) than those born at term. Adjusted analyses accounting for important confounders showed marked impairments in glucose homeostasis among preterm survivors: fasting insulin levels were 32% greater (P = .011), with HOMA-IR and HOMA-ß that were 31% (P = .020) and 43% higher (P = .005), respectively, compared to peers born at term. There were no other contrasting observations between groups, with anthropometric differences disappearing after adjustment for confounders. DISCUSSION: Young adults in Thailand born preterm were more insulin resistant than peers born at term. The observed impairments in glucose metabolism among young Thai adults born preterm corroborate findings reported mostly on Caucasians. The challenge for general practitioners and public health professionals is to encourage those born preterm to make healthier lifestyle choices early on.

The risk factors of low birth weight infants in the northern part of Thailand.

BACKGROUND: The incidence of low birth weight (LBW) in Chiang Mai University Hospital was high. OBJECTIVE: Determined the incidence and risk factors of low birth weight infants. MATERIAL AND METHOD: The present study included pregnant women between 1989 and 1990 who attended the antenatal clinics (ANC) having a gestational age less than or equal to 24 weeks. During that period, up to delivery, clinical and other potential data namely demographic and biomedical factors, maternal status, socioeconomic factors, and nutritional factors were included. The birth weight at birth less than 2,500 gm was considered LBW. RESULTS: Two thousand one hundred eighty four pregnant subjects who delivered live born and were still eligible, were used for analysis in the present study. The incidence of LBW was 9.2% (201/2,184). Women with body mass index (BMI) at first antenatal clinics (ANC) less than 18.5 Kg/m2 and weight gain during the second trimester less than 300 grams/week was the strongest independent risk factor for LBW (odds ratio 11.25, 95% confidence interval (CI) 5.77-21.94). The number of antenatal care less than 4, monilial vaginitis, the infestation of hookworm and strongyloides, and pregnancy-induced hypertension were independent risk factors (odds ratio 11.04, 3.14, 4.93 and 4.02 respectively). CONCLUSION: The present study showed that low initial BMI, low weight gain in the second trimester, and low attendance at ANC are associated to the occurrence of LBW. The development of a scoring system for detecting high-risk of LBW in pregnant women based on a combination of antenatal factors should be pursued.

Caesarean delivery is associated with increased blood pressure in young adult offspring.

We examined the associations between caesarean section (CS) delivery and cardiovascular risk factors in young adults in Thailand. Participants were 632 offspring from a birth cohort in Chiang Mai (Northern Thailand), born in 1989-1990 and assessed in 2010 at a mean age of 20.6 years, including 57 individuals (9.0%) born by CS and 575 born vaginally. Clinical assessments included anthropometry, blood pressure (BP), carotid intima-media thickness, and fasting blood glucose, insulin, and lipid profile. Young adults born by CS had systolic BP (SBP) 6.2 mmHg higher (p < 0.001), diastolic BP 3.2 mmHg higher (p = 0.029), and mean arterial pressure (MAP) 4.1 mmHg higher (p = 0.003) than those born vaginally. After covariate adjustments, SBP and MAP remained 4.1 mmHg (p = 0.006) and 2.9 mmHg (p = 0.021) higher, respectively, in the CS group. The prevalence of abnormal SBP (i.e., pre-hypertension or hypertension) in the CS group was 2.5 times that of those born vaginally (25.0% vs 10.3%; p = 0.003), with an adjusted relative risk of abnormal SBP 1.9 times higher (95% CI 1.15, 2.98; p = 0.011). There were no differences in anthropometry (including obesity risk) or other metabolic parameters. In this birth cohort in Thailand, CS delivery was associated with increased blood pressure in young adulthood.

Birth order is associated with an increased risk of obesity in young adults in Thailand.

BACKGROUND: There is a growing body of evidence showing that early life events are associated with increased risk of cardiovascular and metabolic diseases later in adult life. However, there is a paucity of data in this field from Asian populations. In this study, we examined the association of birth order with obesity risk and cardiometabolic outcomes in young adults in Thailand. METHODS: Participants were the offspring from a birth cohort study in Chiang Mai (northern Thailand), who were followed up at ~20.5 years of age. Clinical assessments included anthropometry, blood pressure, fasting blood samples and carotid intima-media thickness. Insulin sensitivity was estimated using homeostatic model assessment of insulin resistance (HOMA-IR). Participants were stratified into two groups: first-borns and later-borns. Health outcomes between groups were compared using multivariable models adjusting for important confounders, in particular maternal body mass index (BMI). RESULTS: A total of 559 participants were studied: 316 first-borns (46% males) and 243 later-borns (47% males). Adjusted models showed anthropometric differences, with first-borns being 2.3 kg heavier (p=0.023) with a BMI 0.86 kg/m2 greater (p=0.019) than later-borns. Thus, rates of obesity were higher in first-borns than in later-borns (6.6% vs 2.9%), so that first-borns had an adjusted relative risk of obesity 3.3 times greater than later-borns [95% CI 1.42 to 7.88; p=0.006]. There were no observed differences in cardiovascular or metabolic parameters assessed, including HOMA-IR. CONCLUSION: As observed in other populations, first-borns in Thailand had greater BMI and an increased risk of obesity in young adulthood. However, we observed no other cardiometabolic differences between first- and later-borns.

Association between urinary cadmium and chronic musculoskeletal pain in residents of cadmium-contaminated area in Northwest Thailand.

Cadmium exposure is known to cause adverse health effects in different organs of the human body but whether the effects result in chronic musculoskeletal pain (CMP) remain inclusive. The present study, therefore, aims to examine the relationship between urinary cadmium levels and CMP. An observational retrospective cohort study was conducted in two areas having different levels of cadmium contamination for comparison. The subjects enrolled into the study were individuals ages 18 and above who have lived in the studied areas for 1 year or more. The evaluation of chronic pain was carried out using a questionnaire and urine samples were collected for analysis of urinary cadmium levels. The data were analyzed using multiple logistic regression. The likelihood of CMP increased in a correlation with elevations in urinary cadmium from < 0.359, 0.359-0.753, 0.754-1.742, and ≥ 1.743 µg/g creatinine, adjusted odds ratio 1.07 (95% CI 0.62-1.86), 1.33 (95% CI 0.76-2.32), and 2.26 (95% CI 1.28-3.99) respectively. A positive association was found in our study between urinary cadmium level and CMP suggesting that cadmium exposure might cause neurological damage and/or tissue/muscle injury which in turn causing CMP.

Recommended Rice Intake Levels Based on Average Daily Dose and Urinary Excretion of Cadmium in a Cadmium-Contaminated Area of Northwestern Thailand.

This study was performed to investigate the dose-response relationship between average daily cadmium dose (ADCD) from rice and the occurrence of urinary cadmium (U-Cd) in individuals eating that rice. This was a retrospective cohort designed to compare populations from two areas with different levels of cadmium contamination. Five-hundred and sixty-seven participants aged 18 years or older were interviewed to estimate their rice intake, and were assessed for U-Cd. The sources of consumed rice were sampled for cadmium measurement, from which the ADCD was estimated. Binary logistic regression was used to examine the association between ADCD and U-Cd (cut-off point at 2 µg/g creatinine), and a correlation between them was established. The lowest estimate was ADCD = 0.5 µg/kg bw/day [odds ratio (OR) = 1.71; with a 95% confidence interval (CI) 1.02-2.87]. For comparison, the relationship in the contaminated area is expressed by ADCD = 0.7 µg/kg bw/day, OR = 1.84; [95 % CI, 1.06-3.19], while no relationship was found in the non-contaminated area, meaning that the highest level at which this relationship does not exist is ADCD = 0.6 µg/kg bw/day [95% CI, 0.99-2.95]. Rice, as a main staple food, is the most likely source of dietary cadmium. Abstaining from or limiting rice consumption, therefore, will increase the likelihood of maintaining U-Cd within the normal range. As the recommended maximum ADCD is not to exceed 0.6 µg/kg bw/day, the consumption of rice grown in cadmium-contaminated areas should not be more than 246.8 g/day. However, the exclusion of many edible plants grown in the contaminated area from the analysis might result in an estimated ADCD that does not reflect the true level of cadmium exposure among local people.

Difference in goiter rates between two areas in Mae Hong Son Province despite an equally sufficient iodine supply.

The study was designed to investigate the problem of endemic goiter and iodine supplementation in Mae Hong Son, Thailand. Routine school data still showed high goiter rates in many areas. Six such schools and five schools with declining prevalence of goiter were selected. A single examiner examined all the children. Their weight, height, body mass index, ethnicity, history of iodine intake and migration were recorded. Urine samples were collected for measuring iodine and thiocyanate levels. From 653 children, 105 and 13 were found to have grade 1 and 2 goiter status, respectively. Median values of urine iodine level in children from all schools suggested sufficient iodine supplementation. Multivariate analysis showed that hilltribe minorities had a 2.09 times higher risk of endemic goiter than Thai children. Urine thiocyanate levels among children from high prevalence schools were significantly higher than those from low prevalence schools. No other significant correlation was found. Possible roles of other known and unknown goitrogens should also be investigated.

Relationship between body composition parameters and metabolic syndrome in young Thai adults.

OBJECTIVE: The aim of this study was to evaluate the relationship between body composition parameters, i.e. waist circumference, android fat mass (AFM), gynoid fat mass (GFM), android to gynoid fat mass ratio (AG ratio) and metabolic syndrome (MS) risk components in young Thai adults. METHODS: This was a cross-sectional study conducted among 391 adolescents (174 male, 217 female). The body mass index (BMI), waist circumference, blood pressure, triglyceride, high-density lipoprotein (HDL) cholesterol and glucose levels were determined. AFM, GFM and AG ratio were assessed by dual-energy X-ray absorptiometry (DXA). Linear regression analysis was done to assess the relationship of waist circumference, AFM, GFM and AG ratio with MS risk components' score, separately. RESULTS: Among 391 young adults aged 18.5-21.8 years, MS was found in 5.9%. Participants with MS (n=23) had a significantly higher weight, height and BMI than those without MS. There was no statistically significant difference in bone mineral density between the two groups. At univariable linear regression analysis, waist circumferences, AFM, GFM and AG ratio showed significant relationship with MS risk components' score. However, after adjusting for gender, birth weight and BMI, AG ratio demonstrated greater relationship with MS risk components' score (ß 1.89, 95%CI 1.096-2.978) than waist circumference (ß 0.046, 95%CI 0.033-0.058) and AFM (ß 0.979, 95%CI 0.667-1.290). No significant association was observed between GFM and MS risk components' score (ß 0.077, 95%CI -0.089-0.243). CONCLUSION: The results from this study indicated that AG ratio is a stronger predictor of MS than waist circumference and AFM in young Thai adults. The role of AG ratio for the diagnosis of MS needs to be further investigated.

Relationship between total body adiposity assessed by dual-energy X-ray absorptiometry, birth weight and metabolic syndrome in young Thai adults.

OBJECTIVE: The aim of this study was to compare body fat distribution using dual-energy X-ray absorptiometry (DXA) in young adult subjects with metabolic syndrome (MS) with those without MS and also to determine whether a significant association existed between total body fat mass (FM) and MS along with the effect of birth weight. METHODS: This cross-sectional study was conducted on 393 young adult subjects (175 male, 218 female). Body mass index (BMI), waist circumference, blood pressure, triglyceride, high-density lipoprotein cholesterol and glucose levels were determined. Total body FM, lean mass (LM) and percentage of body fat (%BF) were assessed by DXA. Adult Treatment Panel III criteria were used for the diagnosis of MS. RESULTS: The prevalence of MS was 5.6% among this group of young adult subjects aged 18.5-21.8 years. Subjects with MS (n=22) had significantly higher values for weight, height, BMI, waist circumference, %BF, total body FM, total body LM, and regional FM and LM. There was no statistically significant difference in bone mineral density between the two groups. There was also no association between birth weight and MS. Multiple logistic regression analysis showed that every 5 kg of total body FM (OR 1.68; 95%CI 1.06-2.66) adjusted for gender, birth weight status, and total body LM were significantly associated with MS. CONCLUSION: Total body FM measured by DXA was related to MS in Thai young adults. Thus, body composition analysis might have a role in the identification of subjects with MS status.

Development of gender- and age group-specific equations for estimating body weight from anthropometric measurement in Thai adults.

BACKGROUND: Many medical procedures routinely use body weight as a parameter for calculation. However, these measurements are not always available. In addition, the commonly used visual estimation has had high error rates. Therefore, the aim of this study was to develop a predictive equation for body weight using body circumferences. METHODS: A prospective study was performed in healthy volunteers. Body weight, height, and eight circumferential level parameters including neck, arm, chest, waist, umbilical level, hip, thigh, and calf were recorded. Linear regression equations were developed in a modeling sample group divided by sex and age (younger <60 years and older ≥60 years). Original regression equations were modified to simple equations by coefficients and intercepts adjustment. These equations were tested in an independent validation sample. RESULTS: A total of 2000 volunteers were included in this study. These were randomly separated into two groups (1000 in each modeling and validation group). Equations using height and one covariate circumference were developed. After the covariate selection processes, covariate circumference of chest, waist, umbilical level, and hip were selected for single covariate equations (Sco). To reduce the body somatotype difference, the combination covariate circumferences were created by summation between the chest and one torso circumference of waist, umbilical level, or hip and used in the equation development as a combination covariate equation (Cco). Of these equations, Cco had significantly higher 10% threshold error tolerance compared with Sco (mean percentage error tolerance of Cco versus Sco [95% confidence interval; 95% CI]: 76.9 [74.2-79.6] versus 70.3 [68.4-72.3]; P < 0.01, respectively). Although simple covariate equations had more evidence errors than the original covariate equations, there was comparable error tolerance between the types of equations (original versus simple: 74.5 [71.9-77.1] versus 71.7 [69.2-74.3]; P = 0.12, respectively). The chest containing covariate (C) equation had the most appropriate performance for Sco equations (chest versus nonchest: 73.4 [69.7-77.1] versus 69.3 [67.0-71.6]; P = 0.03, respectively). For Cco equations, although there were no differences between covariates using summation of chest and hip (C+Hp) and other Cco but C+Hp had a slightly higher performance validity (C+Hp versus other Cco [95% CI]: 77.8 [73.2-82.3] versus 76.5 [72.7-80.2]; P = 0.65, respectively). CONCLUSION: Body weight can be predicted by height and circumferential covariate equations. Cco had more Sco error tolerance. Original and simple equations had comparable validity. Chest- and C+Hp-containing covariate equations had more precision within the Sco and Cco equation types, respectively.

Height prediction from anthropometric length parameters in Thai people.

Height is an important clinical parameter. However, there were no specific measurements available for particular clinical situations. Although many anthropometric measurements were suggested, no formula was recommended in Thailand. The objective of this study was to develop a formula for height prediction with acceptable validity. Two thousand volunteers were included and were divided consecutively according to both age and gender. Model and validation groups were further separated independently. Linear regression was analyzed to create a predictive formula. Ten parameters were included and analyzed. Of these, demispan, sitting height and knee height were selected with a correlation coefficient of more than 0.5 and significant F test in all age groups and genders. All single parameters and the highest predictive value of double (sitting and knee height) and triple regression models (demispan, sitting and knee height) were proposed and these were modified into a simple formula. After validation of both formulas the correlation, quantitative error and relative error were comparable. The simple formula had more than 90% precision with an error of up to 10 cm in the validation group (89.7 to 99.0% in range). Of these, knee height had the least predictive error in all subgroups. The double and triple models had decreased error only in the younger group. In summary, anthropometric parameters with demispan, sitting height, knee height and combination could be applied to height prediction in the adult Thai with acceptable error. These formulas should be applied only in people who could not be directly measured.

Intrauterine nutrition and carotid intimal media thickness in young Thai adults.

Several studies show that intrauterine nutrition restriction is associated with vascular disease. Animal studies have shown that atherosclerosis can be affected by a constrained intrauterine diet, but this relationship in humans is controversial. The purpose of this study was to investigate the relationship between maternal intake during pregnancy and carotid intimal media thickness (CIMT). We measured CIMT in 565 twenty year old young adults whose mothers, while pregnant, participated in a nutritional study during 1989-1990 at two hospitals in Chiang Mai, Thailand. Maternal diet during pregnancy was assessed by two methods in each trimester, namely, the 24 hours food recall method and the food frequency method. Carotid intimal media thickness was greater in males and participants who showed higher blood glucose, higher body mass index and higher systolic blood pressure. Maternal protein intake during the first trimester was negative correlated with thickness of CIMT (p=0.02). The mean CIMT of participants whose mothers were in the lowest quarter of the distribution of protein intake in the first trimester was 0.45 mm (95% confidence interval (CI): 0.44-0.46) more than that of those whose mothers were in the highest quarter of the distribution (0.43 mm 95% CI: 0.42-0.44). In conclusion, lower maternal protein intake during early pregnancy may increase CIMT in adolescents.

The variations of body mass index and body fat in adult Thai people across the age spectrum measured by bioelectrical impedance analysis.

BACKGROUND: The measurements of body mass index (BMI) and percentage of body fat are used in many clinical situations. However, special tools are required to measure body fat. Many formulas are proposed for estimation but these use constant coefficients of age. Age spectrum might affect the predicted value of the body composition due to body component alterations, and the coefficient of age for body fat prediction might produce inconsistent results. The objective of this study was to identify variations of BMI and body fat across the age spectrum as well as compare results between BMI predicted body fat and bioelectrical impedance results on age. METHODS: Healthy volunteers were recruited for this study. Body fat was measured by bioelectrical impedance. The age spectrum was divided into three groups (younger: 18-39.9; middle: 40-59.9; and older: ≥60 years). Comparison of body composition covariates including fat mass (FM), fat free mass (FFM), percentage FM (PFM), percentage FFM (PFFM), FM index (FMI) and FFM index (FFMI) in each weight status and age spectrum were analyzed. Multivariable linear regression coefficients were calculated. Coefficient alterations among age groups were tested to confirm the effect of the age spectrum on body composition covariates. Measured PFM and calculated PFM from previous formulas were compared in each quarter of the age spectrum. RESULTS: A total of 2324 volunteers were included in this study. The overall body composition and weight status, average body weight, height, BMI, FM, FFM, and its derivatives were significantly different among age groups. The coefficient of age altered the PFM differently between younger, middle, and older groups (0.07; P = 0.02 vs 0.13; P < 0.01 vs 0.26; P < 0.01; respectively). All coefficients of age alterations in all FM- and FFM-derived variables between each age spectrum were tested, demonstrating a significant difference between the younger (<60 years) and older (≥60 years) age groups, except the PFFM to BMI ratio (difference of PFM and FMI [95% confidence interval]: 17.8 [12.8-22.8], P < 0.01; and 4.58 [3.4-5.8], P < 0.01; respectively). The comparison between measured PFM and calculated PFM demonstrated a significant difference with increments of age. CONCLUSION: The relationship between body FM and BMI varies on the age spectrum. A calculated formula in older people might be distorted with the utilization of constant coefficients.

Difference in goiter rates between two areas in Mae Hong Son Province despite an equally sufficient iodine supply.

The study was designed to investigate the problem of endemic goiter and iodine supplementation in Mae Hong Son, Thailand. Routine school data still showed high goiter rates in many areas. Six such schools and five schools with declining prevalence of goiter were selected. A single examiner examined all the children. Their weight, height, body mass index, ethnicity, history of iodine intake and migration were recorded. Urine samples were collected for measuring iodine and thiocyanate levels. From 653 children, 105 and 13 were found to have grade 1 and 2 goiter status, respectively. Median values of urine iodine level in children from all schools suggested sufficient iodine supplementation. Multivariate analysis showed that hilltribe minorities had a 2.09 times higher risk of endemic goiter than Thai children. Urine thiocyanate levels among children from high prevalence schools were significantly higher than those from low prevalence schools. No other significant correlation was found. Possible roles of other known and unknown goitrogens should also be investigated.