Association between anaemia and vitamin D insufficiency among 6- to 12-month-old infants: implications for clinical practice.

BACKGROUND: Anaemia and vitamin D insufficiency (VDI) are among the most common nutritional problems. Anaemia screening is routinely performed; however, screening for VDI is not usually recommended. OBJECTIVES: To study the association between anaemia and VDI and identify the risk factors for VDI. METHODS: We conducted a cross-sectional study of 120 infants aged 6-12 months attending a well-child clinic at Songklanagarind Hospital between December 2020 and November 2021. Sociodemographic data and 24-h food records were also collected. Blood samples were obtained for complete blood count and 25-hydroxyvitamin D [25(OH)D] levels. Logistic regression analysis was used to determine risk factors for VDI. RESULTS: The mean 25(OH)D level was 22.2 ± 8.9 ng/mL in anaemic infants and 27.2 ± 9.6 ng/mL in non-anaemic infants (P value 0.01). The median (IQR) Hb level was 11.1 g/dL (10.3, 11.4) in the VDI group and 11.4 g/dL (11, 12.1) in the non-VDI group (P value 0.002). The proportion of breastfed infants was higher in infants with anaemia (80%) (P < 0.001) and VDI (85.3%) (P < 0.001). Sunlight exposure <15 min/day (odds ratio [OR] 3.84; 95% confidence interval [CI]: 1.23-12.00; P = 0.020) was a risk factor, and vitamin D intake (OR 0.37; 95% CI: 0.20-0.74; P = 0.004) was a protective factor for VDI. CONCLUSION: Infants with anaemia, short duration of sunlight exposure, breastfeeding, low vitamin D intake, and low iron intake were more likely to be vitamin D insufficient. However, after adjustment in the multivariate analyses, only sunlight exposure and vitamin D intake were significantly associated with vitamin D insufficiency.

Anaemia and vitamin D insufficiency (VDI) are the 2 most common global nutrition-related problems. Recently, data have been reported on the association between anaemia and VDI; however, no data exist for infants in Thailand. We assessed the vitamin D levels in infants attending a well-child clinic and investigated possible correlations with anaemia. We found that infants with anaemia, short duration of sunlight exposure, breastfeeding, low vitamin D intake, and low iron intake were more likely to be vitamin D insufficient. However, anaemia was not shown to be an independent risk factor for VDI. Risk factor and protective factor for VDI were short duration of sunlight exposure and adequate vitamin D intake, respectively. Vitamin D supplementation to infants has been recommended in many countries, yet, it has not been implemented in Thailand or other tropical countries. We suggest that VDI should be of concern in infants with anaemia or breastfeeding, particularly among those with inadequate sunlight exposure and low vitamin D intake. Implementing vitamin D supplementation should be considered for future practice.

Prevalence and risk factors for vitamin D insufficiency in 6-12-month-old infants: a cross-sectional study in Southern Thailand.

BACKGROUND: Vitamin D is an essential micronutrient for bone mineralization and bone growth in children. There have been few studies to date of vitamin D status in infants aged 6-12 months in Southeast Asian countries. AIM: To examine the prevalence of vitamin D insufficiency (VDI, including vitamin D deficiency) in healthy infants and the risk factors for VDI in southern Thailand. METHODS: A cross-sectional study was carried out in 120 healthy infants aged 6-12 months and their mothers. Blood samples were obtained for measurement of serum calcium, phosphate, alkaline phosphatase, albumin, parathyroid hormone and 25-hydroxyvitamin D (25OHD) levels. The mothers were interviewed for their infants feeding intake, sunlight exposure, type of dress, and sunscreen use. Chi-square and t-test were used to compare between groups for categorical and continuous variables, respectively. Pearson correlation was used to identify the relationship between serum levels of 25OHD of the infants and other biochemical variables of the infants and serum levels of maternal 25OHD. Logistic regression analysis was used to identify the factors associated with vitamin D status. RESULTS: The prevalence of VDI in our study infants was high at 28.3%, all of whom were mainly breastfed infants. Subgroup analysis of the mainly breastfed infants found that the risk factors for VDI were maternal VDI and a short duration of sunlight exposure. The serum 25OHD levels of the mainly breastfed infants were significantly positively correlated with the maternal serum 25OHD levels (r = 0.49, p-value < 0.01) and with sunlight exposure duration (r = 0.40, p-value < 0.01). CONCLUSIONS: The prevalence of VDI was high in 6-12-month-old infants, particularly those who were mainly breastfed from VDI mothers, and who had short durations of sunlight exposure. As breast milk contains adequate amounts of most important vitamins and growth factors, breastfeeding is still encouraged for infants with 400 IU vitamin D daily supplementation to prevent VDI.

Thai Universal Health Care Coverage scheme promotes the accessibility to cleft lip/palate treatment: the result of cleft care provision assessment using modified Geographic Information System.

BACKGROUND: This study assessed the cleft lip/palate (CL/P) healthcare provision using data from the Thailand National Health Security Office from fiscal years 2012-2016. METHODS: Four national databases of Thailand comprising 1) admitted patient visit, 2) non-admitted patient visit, 3) birth defects registry and 4) civil registration databases were analyzed. All duplicate records were removed by a matching process using national identity number and date of birth prior to data extraction. Modified Geographic Information System was also used to compare each provincial patients with CL/P of Thailand to the number of provincial live births with CL/P. RESULTS: The results showed that the number of live births with CL/P during this period was 7,775 cases (1,555 cases/fiscal year). While the number of cases with CL/P registered under the Universal Health Care Coverage with hospital stay was 6,715 (86.37%), 927 cases (11.92%) visited hospitals without a stay, and the remaining 133 cases (1.71%) never visited any hospital. Modified Geographic Information System result showed that the provincial CL/P healthcare was relatively well-balanced with the provincial live births with CL/P (r = 0.92, p < 0.05). Moreover, provinces with CL/P tertiary care centers attracted more patients from the surrounding provinces. CONCLUSION: This study showed that the percentage of patients with CL/P receiving hospital treatment was 98. The Thai Universal Health Care Coverage scheme has promoted the accessibility to CL/P treatment. In order to achieve the best possible comprehensive cleft care coverage, periodical assessment and improvement of the function and accuracy of the national database registry are recommended.

Correlation Between Fragmented QRS and Ventricular Function from Cardiac Magnetic Resonance in Patients with Repaired Tetralogy of Fallot.

Fragmented QRS is an abnormal sign in an ECG resulting from ventricular dyssynchrony. The presence of fragmented QRS (fQRS) is related to mortality in patients with repaired tetralogy of Fallot (rTOF). This study aimed to analyze the correlations between fQRS and ventricular function parameters from cardiac magnetic resonance (CMR) images. A total of 54 patients with rTOF or repaired DORV, TOF type who had been investigated by CMR at Songklanagarind Hospital from January 2012 to August 2019 were retrospectively reviewed. Most of the patients (47 patients, 87%) were diagnosed with TOF and most of these (57.4%) were treated with a transannular patch (TAP) on the right ventricular outflow tract (RVOT). Forty-four patients (81%) had fQRS. The median time interval between EKG and CMR was 4.2 months (IQR 1.1, 6.9). Patients with fQRS had significantly higher RVEDVi (145.6 [IQR 121.1, 173.1) vs. 115.9 [IQR 96.2, 146.9] mL/m2, p = 0.037), higher RVESVi (82.5 [IQR 62.9, 100.8] vs. 58.6 [IQR 46, 77.2] mL/m2, p = 0.032) and higher RVEDV/LVEDV ratio [1.6 (IQR 1.4, 1.9) vs. 1.4 (IQR 1.3, 1.5), p = 0.026]. The extent of fQRS was significantly associated with an increase in RVEDVi (r = 0.39, p = 0.004) and RVESVi (r = 0.45, p < 0.001) but a decrease in RVEF (r = - 0.37, p = 0.006). Fragmented QRS had higher sensitivity and lower specificity than prolonged QRS duration (≥ 160 ms) to predict all of the parameters indicating pulmonary valve replacement (PVR). Patients with rTOF who had fQRS were significantly associated with RV dilatation. The extent of fQRS had only low to moderate correlation with right ventricular parameters (RVEDVi, RVESVi and RVEF). Fragmented QRS could be used for early detection of RV dilatation and the need for PVR in patients with rTOF.

Registry-Based Study of Prevalence of Cleft Lip/Palate in Thailand from 2012 to 2015.

OBJECTIVE: Two main objectives were established. First objective was to determine the prevalence of the cleft lip and/or cleft palate (CL/P) in Thailand from 2012 to 2015 using the orofacial clefts (OFCs) registry and civil registration. Second objective was to conduct a quality control of this OFC registry especially for the Birth Defects Registration (BDR). DESIGN: Registry-based survey. SETTING: Analyzing data from the Thailand National Health Security Office. PARTICIPANTS: Registered patients with CL/P in Thailand from 2012 to 2015. INTERVENTION: None. MAIN OUTCOME MEASURE: Duplicated records were verified using National Identity Number (Thai ID#) and date of birth. The prevalence of CL/P and specific phenotypes was then calculated. From this prevalence estimate method, quality assurance of the OFCs registry was possible. RESULTS: For the main outcome, the population-weighted pool prevalence of CL/P was 2.14 per 1000 live births (95% confidence interval of 2.08-2.20). Thai ID# and expense reimbursement systems were the main factors driving this cases capturing. However, this OFCs registration still requires active case finding with clinical verification, improvement of staff training and databases networking. CONCLUSIONS: This study reported a very high CL/P prevalence of Thailand. Strengths and limitations of these OFCs registry and BDR were described.

Population-Based Study of Prevalence of Cleft Lip/Palate in Southern Thailand.

INTRODUCTION: Oral cleft is a common craniofacial birth defect that leads to long-lasting adverse outcomes. In Thailand, there have been two studies of the prevalence of oral clefts using data from university hospitals during 1969 through 1978 and 1988 through 1999, which found prevalence rates of 1.23 and 1.22 per 1000 live births, respectively. OBJECTIVE: The primary outcome was to assess the prevalence of oral clefts from the birth defects registry during 2009 through 2013 in three provinces in southern Thailand. The secondary outcomes were to correlate the risk of oral cleft and maternal age. DESIGN: Population-based study. SETTING: Four hundred sixty-seven hospitals in three provinces in southern Thailand. PARTICIPANTS: Oral cleft cases and maternal data-including live births, stillbirths, and termination of pregnancy following a prenatal diagnosis-were collected from the birth defects registry. RESULTS: Of the total 186,393 births, there were 269 oral cleft cases, giving an average prevalence of 1.44 per 1000 births (95% CI, 1.22-1.63). The most common cleft type was cleft lip and palate (45.0%), followed by cleft palate (29.0%), with 15.6% syndromic cleft. The mean maternal age was 28.0 ± 6.4 years. There were no differences in prevalence of oral clefts among the different maternal age groups. However, advanced maternal age 35+ years was associated with syndromic cleft children. CONCLUSIONS: The prevalence of oral clefts was 1.44 per 1000 live births, with 15% of cases having an associated congenital anomaly or a recognized syndrome. Increased maternal age was associated with a higher prevalence of syndromic cleft.

Secular trends of growth and pubertal maturation of school children in Southern Thailand.

BACKGROUND: In Thailand, studies of growth date back to 1975, but there have been no studies examining any trends in increasing/decreasing growth. AIM: To determine if there have been any secular trends of increasing/decreasing growth and/or ages at puberty in Thai children. METHODS: In 2012, a cross-sectional study of growth was conducted in 3460 children. The median heights and weights and the ages of pubertal maturation were compared with previous studies. Correlations between the secular trends and the health statistics indicators were calculated. RESULTS: From 1975-2012, the median final height of boys and girls had increased by 1.32 and 0.86 cm/decade and weight by 2.49 and 1.76 kg/decade, respectively. In girls, the age at thelarche and menarche had declined by 0.39 and 0.12 years/decade, respectively. In boys, the age at testicular enlargement Tanner II had declined by 0.15 years/decade. Increased physical growth was positively correlated to life expectancy, per capita income and prevalence of overweight/obesity was negatively correlated to prevalence of malnutrition and under-five mortality rate. CONCLUSION: The positive secular trend towards an increase in growth and a decline in the age at onset of puberty of Thai children is correlated with improvements in overall living conditions in Thailand.

Prevalence of neural tube defect in southern Thailand: a population-based survey during 2009-2012.

BACKGROUND: Neural tube defects (NTDs) are a group of congenital malformation of the central nervous system that leads to permanent physical disability and requires lifelong treatment. In Thailand, there have been three published articles on NTDs, all hospital-based studies, which found prevalence of NTDs of 4.8-6.7 per 10,000 live births. OBJECTIVE: It was our purpose with this study to determine the prevalence and type of NTDs in southern Thailand through a population-based survey. METHOD: Data were obtained through the population-based surveillance during 2009-2012 in three provinces (Songkhla, Phatthalung, Trang) in southern Thailand. Entries in the birth defects registry included all live births, all stillbirths after 24-week gestational age, and termination of pregnancy following the prenatal diagnosis at any gestational age of all congenital anomalies. RESULTS: During 2009-2012, 148,759 births were registered in the three provinces. Twenty-eight NTD cases were identified, giving an average of 1.88 per 10,000 births (95 % CI 1.20-2.51): 12 cases with anencephaly (42.8 %), 5 with occipital encephalocele (17.9 %), and 11 with myelomeningocele (39.3 %). The birth prevalence per 10,000 births of anencephaly, encephalocele, and myelomeningocele were 0.81, 0.33, and 0.74, respectively. Sixteen (57 %) were detected in live births, and 12 (43 %) were detected by prenatal diagnosis which later resulted in termination of pregnancy. CONCLUSIONS: The prevalence of NTDs based on the population-based study in southern Thailand was low. About 40 % of NTD cases were detected prenatally and later terminated. Hence, examining only registry live births will result in an inaccurately low NTD prevalence rate.

Diagnosis and management of congenital adrenal hyperplasia: 20-year experience in Songklanagarind Hospital.

OBJECTIVE: To describe the types of congenital adrenal hyperplasia (CAH) in Thai children, and the clinical and laboratory findings associated with each type. MATERIAL AND METHOD: The medical records of CAH patients, aged 0 to 15 years, were retrospectively reviewed. RESULTS: During the 20-year period (1991-2011), there were 66 CAH patients. The most common type was salt-wasting 21-hydroxylase deficiency (21-OHDSW) (59.1%), followed by simple virilizing 21-hydroxylase deficiency (21-OHDSV) (30.3%), 20, 22-desmolase/steroidogenic acute regulatory protein (20,22D/StAR) deficiency (6.1%), and 3beta-hydroxysteroid dehydrogenase (3beta-HSD) deficiency (4.5%). The stimulated cortisol level was < 18 microg/dL in most patients, with 20 cases of 21-OHDSV having a median level of 19.49 microg/dL. The median basal 17-hydroxyprogesterone (17-OHP) levels were markedly elevated in 21-OHDSW and 21-OHDSV patients (20,264 and 5,985 ng/dL, respectively), but was very low in 20, 22D/StAR deficiency patients (260 ng/dL). Bilateral adrenal enlargement, demonstrated by radioimaging, was helpful for diagnosis of 20,22D/StAR and 3beta-HSD deficiency CONCLUSION: The most common type of CAH in our population was 21-hydroxylase deficiency. The steroid profile of cortisol, 17-OHP and testosterone levels is helpful for clinical diagnosis of 21-OH deficiency. The low 17-hydroxyprogesterone and low cortisol levels in phenotypic female infant with salt-wasting crisis suggests the diagnosis of 20, 22D/StAR deficiency CAH.

Body-Fat-Percentile Curves for Thai Children and Adolescents.

This study aimed to generate sex-specific percentile curves for the percentage of body fat (PBF) in Thai children using a bioelectrical impedance analysis (BIA). The secondary objective of this study was to determine the association between body fat and other anthropometric measurements. A cross-sectional study was conducted on 3455 Thai school children aged 6-18 years. The body-fat contents were measured using BIA. Smoothed percentile curves of PBF were derived using a scatter plot with a smooth curve fitted by the Loess method. The correlations between the body fat and the anthropometric measurements were assessed using the Spearman's rank correlation. The 50th and lower body-fat-percentile curves of the boys slowly increased until age 12, after which they slightly decreased until age 15 and then slightly increased until age 18. In the higher boys' percentiles, the body fat sharply increased until age 11 and then decreased until age 18. In the girls, the PBF percentiles increased steadily from 6 to 18 years. The body-mass index was strongly correlated with PBF and fat mass in both sexes. The waist-to-height ratios showed strong correlations with PBF and fat mass in the boys but were moderate in the girls. The use of PBF percentile curves can be an additional metric for the evaluation of obesity in Thai children.

Vitamin D status in non-pregnant women of reproductive age: a study in Southern Thailand.

Vitamin D inadequacy is a global problem in all age groups. Although there are various studies of vitamin D status in pregnant women in Southeast Asia, to date there are few studies from Southeast Asia examining vitamin D status in non-pregnant women of reproductive age. To examine the prevalence of vitamin D insufficiency (VDI) in healthy non-pregnant women of reproductive age in Southern Thailand, 120 healthy non-pregnant women aged 18-42 years were enrolled. Demographic and lifestyle data relevant to vitamin D assessment (sunlight exposure, nutritional intake, type of dress, sunscreen use) and biochemical studies (serum 25-hydroxyvitamin D or 25OHD, parathyroid hormone, calcium, phosphate) were obtained. VDI was classified as serum 25OHD < 20 ng/mL. The average serum 25OHD level was 23.1 ± 6.0 ng/mL. The overall prevalence of VDI was 34.1%. The average dietary intake of calcium, phosphorus and vitamin D and the average duration of sunlight exposure per week were not significantly different between the VDI women and the vitamin D sufficient (VDS) women. Logistic regression analysis found that the significant risk factors for VDI were greater body mass index and higher family income (p-values 0.01 and 0.02, respectively). The prevalence of VDI in non-pregnant women was high at 34%. As the dietary sources of vitamin D are limited and cutaneous vitamin D synthesis is limited by avoidance of sunlight exposure, vitamin D fortification in common daily foods would be an alternative option to reach the recommended vitamin D intake generally of at least 800 IU/day.

Incidence and risk factors of transient hypothyroxinemia of prematurity: a prospective cohort study.

BACKGROUND: Transient hypothyroxinemia of prematurity (THOP) is characterized by low thyroxine (T4) levels with normal thyroid-stimulating hormone (TSH) levels. This study aimed to determine the incidence and factors associated with THOP. METHODS: This prospective cohort study included neonates who were born before 37 weeks of gestation in the neonatal intensive care unit (NICU) between April 2017 and December 2020. Serum TSH and free thyroxine (FT4) levels were routinely screened at 3-5 days and 2, 4, and 6-8 weeks postnatally. The criteria for diagnosis of THOP were a TSH level < 7 mU/L with a FT4 level < 0.8 ng/dL at any screening timepoint. RESULTS: The incidence of THOP in infants born before 28, 34, and 37 weeks of gestation was 39.5 (17/43), 8.4% (29/343), and 4.8% (35/722), respectively. A multivariate analysis revealed that a gestational age of < 28 weeks (adjusted odds ratio [aOR]: 5.35, 95% confidence interval [CI]: 1.89-15.13, p=0.002); 5-min Apgar score of ≤3 (aOR: 5.72, 95% CI: 2.2-14.89, p < 0.001); and treatment with aminophylline (aOR: 2.95, 95% CI: 1.08-8.11, p=0.037), dobutamine (aOR: 4.12, 95% CI: 1.55-10.98, p=0.004), or morphine (aOR: 4.91, 95% CI: 1.29-18.74, p=0.011) were associated with an increased risk of THOP. The TSH and FT4 levels in infants with THOP returned to normal ranges by 2 weeks of age. CONCLUSIONS: THOP is frequently found in preterm infants. An extremely low gestational age, a low Apgar score, and the use of certain medications in the NICU are risk factors for the development of THOP. Therefore, a thyroid screening program should be implemented for evaluating congenital hypothyroidism (CH) and THOP in preterm neonates in all settings.

Vitamin D Deficiency in Childhood Cancer Survivors: Results from Southern Thailand.

There is limited information on vitamin D deficiency among childhood cancer survivors (CSS), especially in tropical countries. The aims of this study are to determine the prevalence and risk factors for vitamin D deficiency in CCSs. This study was conducted at the long-term follow-up clinic for CCSs at Prince of Songkla University, Songkhla, Thailand. All CCSs who were followed up between January 2021 and March 2022 were enrolled. Demographic data, dietary dairy intake, average weekly duration of outdoor activities, total 25-hydroxyvitamin D [25(OH)D] levels, parathyroid hormone levels, and blood chemistry were collected. A total of 206 CCSs with a mean age at follow-up of 10.8 ± 4.7 years were included. The prevalence of vitamin D deficiency was 35.9%. Female gender (odds ratio (OR): 2.11, 95% CI: 1.08-4.13), obesity (OR: 2.01, 95% CI: 1.00-4.04), lack of outdoor activities (OR: 4.14, 95% CI: 2.08-8.21), and lower dietary dairy intake (OR: 0.59, 95% CI: 0.44-0.80) were independent risk factors for vitamin D deficiency. Vitamin D deficiency was common in CCSs and associated with female gender, obesity, lack of outdoor activities, and lower dietary dairy intake. Regular 25(OH)D screening should be established in long-term care to identify those who require vitamin D supplements.

Precocious pubarche in Thai children.

OBJECTIVE: To describe the etiologies, clinical characteristics, and laboratory investigations of young Thai children being evaluated for precocious pubarche. MATERIAL AND METHOD: The medical records of 41 children referred for evaluation of precocious presence of pubic hair at Songklanagarind Hospital between 1995 and 2011 were retrospectively reviewed. RESULTS: The etiologies of precocious pubarche in young Thai children were congenital adrenal hyperplasia (n = 19, 46.3%), isolated premature adrenarche without pathology (n = 12, 29.3%), hypothalamic hamartoma (n = 7, 17.1%), adrenocortical carcinoma (n = 2, 4.9%), and Leydig cell tumor (n = 1, 2.4%). The weight and height of patients with pathological etiologies were significantly greater than those with isolated premature adrenarche (p < 0.001). Patients with congenital adrenal hyperplasia had significantly greater levels of basal and peak 17-hydroxyprogesterone than those with isolated premature adrenarche (p < 0.001). Patients with adrenocortical carcinoma had significantly greater level of DHEAS than those with congenital adrenal hyperplasia and isolated premature adrenarche (p < 0.001). CONCLUSION: The precocious presence of pubic hair in young Thai children should be investigated for an underlying pathological etiology. The most common underlying pathology of precocious presence of pubic hair is congenital adrenal hyperplasia.

Androgen-producing adrenocortical carcinoma: report of 3 cases with different clinical presentations.

Adrenocortical carcinoma is extremely rare in children. The majority of cases presented with a combination of clinical features of Cushing syndrome and hyperandrogenism. The authors report three cases of isolated androgen-producing adrenocortical carcinoma with different clinical presentations. The two cases had clinical manifestations of hyperandrogenism: one boy with isosexual pseudoprecocity and one girl with heterosexual pseudoprecocity, both of whom underwent complete tumor removal and were well after surgery. The third patient presented with a huge abdominal mass and weight loss. Local and distant metastases (both lungs) were detected at the time of diagnosis. The patient expired after 36 days of hospitalization. The pathological section in all three patients demonstrated highly pleomorphism, increased mitoses, and scattered areas of necrosis. All cases had high levels of 1 7-hydroxyprogesterone, dehydroepiandrosterone-sulphate, and testosterone.

Dietary diversity and micronutrient adequacy among women of reproductive age: a cross-sectional study in Southern Thailand.

INTRODUCTION: Adequate nutritional intake of both macronutrients and micronutrients is essential for maintaining good health throughout life, particularly for women of reproductive age (WRA). The Minimum Dietary Diversity for WRA (MDD-W), or the sum of dietary diversity, is recommended as a simple indicator to identify at-risk WRA populations. However, there are no studies on the MDD-W among WRA in Thailand. OBJECTIVES: To determine food group diversity, MDD-W, and micronutrient intake of WRA in Southern Thailand. PARTICIPANTS: From December 2020 to November 2021, 120 healthy, young WRA (average age 33.2 ± 4.5 years) were enrolled. METHODS: A 24-h food record was used to quantitatively and qualitatively assess the food consumed. Dietary diversity was classified into ten food groups. The macronutrients and 15 micronutrients were calculated using the software program INMUCAL, which is the standard program for calculating nutrients in Thai food. The calculated intake of each micronutrient was transformed to the probability of adequacy (PA). RESULTS: The most common foods consumed were rice, followed by meat, eggs, fruits, and vegetables. Fewer than 40% of the participants consumed beans, dairy products, vitamin A-rich fruits and vegetables, dark green vegetables, and pulses. The average MDD-W score was 5 (range 2-8). The mean caloric intake (1,865 cal/day) was adequate for non-lactating WRA but was approximately 300 kcal/day lower than the recommendation for lactating WRA. Most WRA consumed lower amounts of micronutrients than those recommended. The mean PA (MPA) of the 15 micronutrients was 0.33 (range 0.0-0.9). CONCLUSIONS: Non-pregnant WRA in Songkhla consumed adequate macronutrients but inadequate micronutrients. A nutritional education program regarding the importance of micronutrients should be provided to the public, with special attention to WRA.

Case report: Molecular analysis of a 47,XY,+21/46,XX chimera using SNP microarray and review of literature.

Chimerism is a very rare genetic finding in human. Most reported cases have a chi 46,XX/46,XY karyotype. Only three non-twin cases carrying both trisomy 21 and a normal karyotype have been reported, including two cases with a chi 47,XY,+21/46,XX karyotype and a case with a chi 47,XX,+21/46,XY karyotype. Herein we describe an additional case with a chi 47,XY,+21/46,XX karyotype. For the case, a physical examination at the age of 1 year revealed ambiguous genitalia with no features of Down syndrome or other malformations. Growth and developmental milestones were within normal ranges. We performed short tandem repeat (STR) and single nucleotide polymorphism (SNP) microarray analyses to attempt to identify the mechanism underlying the chimerism in this patient and the origin of the extra chromosome 21. Cytogenetic analyses of the patient's peripheral blood revealed approximately 17% of a 47,XY,+21 lineage by G-banding karyotype analysis, 13%-17% by FISH analyses of uncultured peripheral blood, and 10%-15% by SNP microarray analysis. Four years later, the percentage of trisomy 21 cells had decreased to approximately 6%. SNP microarray and STR analyses revealed a single maternal and double paternal genetic contribution to the patient for the majority of the markers, including the chromosome 21 markers. The extra chromosome 21 was paternally derived and meiosis I nondisjunction likely occurred during spermatogenesis. The mechanisms underlying chimera in our case was likely fertilization two spermatozoa, one with an ovum and the other with the second polar body.

Outcome of gonadotropin-releasing analog treatment for children with central precocious puberty: 15-year experience in southern Thailand.

BACKGROUND: Central precocious puberty (CPP) is defined as pubertal development caused by activation of the hypothalamic-pituitary-gonadal axis before 8 years of age in girls and 9 years in boys. Failure to recognize and/or treat this condition can result in short adult stature. OBJECTIVE: To determine the etiology, clinical presentation and near-final height (NFH) of Thai children with CPP with or without gonadotropin-releasing hormone analog (GnRHa) treatment. METHODS: In a longitudinal observational study, 73 CPP patients who attended Songklanagarind Hospital between 1995 and 2009 were followed up every 3-6 months until they attained their NFH. RESULTS: The etiologies observed were idiopathic CPP, hypothalamic hamartoma and central nervous system diseases. The mean age at time of diagnosis was 6.4 +/- 2.9 years. Bone age was on average 4 years more advanced than chronological age. Of the 52 patients who reached their NFH during the study, 32 were treated with GnRHa and 20 were not. The mean age at menarche was significantly greater for GnRHa-treated than for untreated girls (11.6 +/- 0.8 vs 10.1 +/- 1.1 years, p < 0.001). The median NFH of GnRHa-treated girls was 152.4 +/- 5.2 cm, which was significantly greater than the 144.4 +/- 5.0 cm for untreated girls (p < 0.001). CONCLUSION: GnRHa treatment can preserve the genetic height potential of children with CPP.

Girls with early puberty attain a near-final height similar to their target height.

BACKGROUND: The median age at thelarche in Thai girls has decreased from 10.3 to 9.4 years over the last 20 years. An age at thelarche of 7.0-9.0 years, which is earlier than in the general population, is considered as early puberty. OBJECTIVE: To study the pattern of pubertal development in Thai girls with early puberty. STUDY DESIGN: A total of 104 girls with breast development at 7.0-9.0 years who attended Songklanagarind Hospital between 2003 and 2005 were followed up until they attained their near-final height (NFH). RESULTS: The mean age at initial evaluation was 8.5 +/- 1.0 years. The average age at menarche and on attaining NFH was 10.2 +/- 0.9 and 12.6 +/- 0.4 years, respectively. The average NFH was 154.0 +/- 4.9 cm, which was similar to the target height of 153.1 +/- 4.8 cm. Comparison of girls who were normal weight and obese (weight-for-height >120%) revealed that the latter had an earlier age at menarche (9.8 +/- 0.8 vs. 10.5 +/- 0.8 years, p<0.01) and reached their NFH at a younger age (12.2 +/- 0.4 vs. 12.9 +/- 0.4 years, p=0.02). However, normal-weight and obese girls reached approximately the same NFH (155.8 +/- 4.8 vs. 153.1 +/- 4.0 cm, p=0.058). CONCLUSION: Girls with early puberty attained NFH similar to their genetic potential. Obese girls attained NFH at an earlier age and had the same NFH as normal-weight girls.

Longitudinal 15-year follow-up of women with former early puberty: abnormal metabolic profiles not associated with earlier age at onset of puberty, but associated with obesity.

BACKGROUND: In 2011, we described 104 girls who were diagnosed as early puberty (EP) during 2003-2005. In 2019-2020, the former EP women had been followed up 14 years after attaining their final height. OBJECTIVE: To determine the reproductive function and metabolic profiles of former EP women. STUDY DESIGN: Fifty-seven former EP women were evaluated for reproductive function and examined for health status. Blood samples were obtained for metabolic profiles of glucose, lipids and insulin, and testosterone levels. RESULTS: In 2020, the average age of the study women was 22.9 ± 1.7 years. The average height was 156.7 ± 5.6 cm. The average weight had increased from 52.5 ± 7.8 kg in 2011 to 58.5 ± 11.1 kg in 2020 and average body mass index (BMI) from 21.4 ± 2.9 to 23.8 ± 4.0 kg/m2. Obesity (BMI>25 kg/m2) was found in 8.8% (five participants) in 2011 and had increased to 22.8% (13 participants) in 2020. Most participants (79%) had regular menstrual cycle. Of the 17 married women, 4 (23.5%) had 1-2 children. Dividing the participants into obese and nonobese groups, the average fasting plasma glucose, lipid profiles, and testosterone levels were similar in both groups. However, the average systolic blood pressure and the serum insulin levels and HOMA-IR assessments were significantly higher in the obese group than in the nonobese group. CONCLUSION: The former EP women had normal menstruation and reproductive function. The former EP women with average BMI at the follow-up had normal metabolic profiles while those who later became obese had significantly higher systolic blood pressure, serum insulin, and HOMA-IR assessments.