Benja Muktabhant

Use of glucometer and fasting blood glucose as screening tools for diabetes mellitus type 2 and glycated haemoglobin as clinical reference in rural community primary care settings of a middle income country.

BackgroundThailand is considered to be a middle income country, and to control and prevent type 2 diabetes mellitus (T2DM) is one of the main concerns of the Thai Ministry of Public Health (MoPH). Screening for T2DM and care for T2DM patients has been integrated into the primary health care system, especially in rural areas. The intention of this investigation is to link public health research at the academic level with the local health authorities of a district of a north-eastern province of the country.MethodsEpidemiological methods were applied to validate the screening tools fasting capillary blood glucose (CBG), measured by glucometer and venous blood for the determination of plasma glucose (VPG), used for screening for T2DM among asymptomatic villagers. For assessing the validity of these two methods glycated haemoglobin (HbA1c) values were determined and used as the ‘clinical reference’.ResultsAll together 669 villagers were investigated. Determinations of CBG and VPG resulted in suspected T2DM cases, with 7.3% when assessed by CBG and 6.4% by VPG using a cutoff point of 7 mmol/L (126 mg/dl). Taking HbA1c determinations with a cutoff point of 7% into account, the proportion of T2DM suspected participants increased to 10.4%. By estimating sensitivity, specificity and the positive predictive value of CBG and VPG against the ‘clinical reference’ of HbA1c, sensitivity below 50% for both screening methods has been observed. The positive predictive value was determined to be 58.5% for CBG and 56.8% for VPG. The specificity of the two screening tests was over 96%.ConclusionsThe low sensitivity indicates that using fasting CBG or VPG as a screening tool in the field results in a high proportion of diseased individuals remaining undetected. The equally low positive predictive values (below 60%) indicate a high working load for the curative sector in investigating suspected T2DM cases to determine whether they are truly diseased or false positive cases according to the screening method. Further implications of the results and the controversial discussion related to the use of HbA1c as clinical evidence for suffering from T2DM are also discussed.

Case–control study of nutritional and environmental factors and the risk of oral clefts in Thailand

BACKGROUND One infant in 700 is born with an oral cleft. Prior studies suggest low micronutrient status is associated with an increased risk of oral clefts. Environmental factors such as passive smoke exposure or supplement use may also affect oral cleft risk. We examined nutrition and environmental related risk factors for oral clefts. METHODS We conducted a case-control study in Northeast Thailand in 2012 to 2013. We enrolled 95 cases and 95 controls. We recruited cases with a nonsyndromic cleft lip with or without a cleft palate (CL±P) less than 24 months old. Cases were matched to controls on age and place of conception. We collected survey data, a food frequency questionnaire, and measured zinc concentrations in toenail trimmings. We calculated descriptive statistics by case and control status. We used conditional logistic regression to estimate unadjusted and adjusted associations, 95% confidence intervals (CIs), and p-values. RESULTS Any liver intake (adjusted OR [aOR] for ≥1/week versus none), 10.58; 95%CI, 1.74-64.37, overall p = 0.02) and the presence of food insecurity (aOR, 9.62; 95% CI, 1.52-61.05; p = 0.02) in the periconceptional period increased CL±P risk. Passive smoke exposure increased the risk of CL±P (aOR, 6.52; 95% CI, 1.98-21.44; p < 0.01). Toenail zinc concentrations were not associated with CL±P risk. CONCLUSION Our findings add to a growing body of knowledge of environmental risk factors for oral clefts from low- and middle-income countries. Our findings on liver are contradictory to prior results. Large multisite studies are needed to identify environmental and genetic risk factors for oral clefts. Birth Defects Research (Part A) 106:624-632, 2016.

Yearly Household Record of Food from the Forest for Home Consumption by Rural Villagers in North-East Thailand

Forests provide food and resources that are used in the daily life of the rural villagers who live nearby. This study explored the contribution of forest food to household nutrition and food security of these people. the study focused on the frequency, varieties, and amounts of forest food gathered for consumption in the household, and the reduction in food expenditure resulting from using forest food. Seven households in a village near a forest in north-east Thailand were selected for a one-year study of forest food consumption using household food records. the data were collected from May 1988 to April 1989. Forest food was gathered for consumption an average of three days a week. One hundred twenty-six kinds of forest food were gathered. the amount gathered for consumption was highest in May and lowest in December, with an average of 126.6 kg per household per year. the use of forest food could reduce food expenditure for the rural villagers.

A first-degree relative with diabetes mellitus is an important risk factor for rural Thai villagers to develop type 2 diabetes mellitus.

The screening of 609 villagers in rural areas of northeastern Thailand resulted in the detection of 110 (18.1%) new cases of type 2 diabetes (T2DM). The diagnoses were made on the basis of a glycated hemoglobin (HbA1c) value ≤6.5%. Among all those screened, 243 (40%) reported having a father or mother with T2DM. Among the new cases, 66 (60%) reported a first-degree relative, predominantly their mothers, who had the disease. Together with age and the body mass index, a mother or father with DM was strong risk factor for the development of T2DM (adjusted odds ratio = 2.9, 95% confidence interval = 1.84-4.57) when compared with the absence of a first-degree relative with DM. It is concluded that family history of a first-degree relative is an important additional information that might improve the validity of the screening procedure.

Dietary patterns and their association with the components of metabolic syndrome: A cross-sectional study of adults from northeast Thailand

Background: Nutritional transition influences a shift in eating behaviour that is associated with a rise in the prevalence of non-communicable diseases (NCDs). Metabolic syndrome (MetS) comprises a set of NCD risk factors. This study aimed to investigate dietary patterns and to determine the relationship between dietary patterns and MetS and its components. Methods: A cross-sectional study was conducted among 468 healthy adults aged 35-60 years who were residents of a semi-urban district of one of the central provinces in the northeast of Thailand. A factor analysis identified dietary patterns based on the consumption of 21 food groups, which were assessed by using a semi-quantitative food frequency questionnaire. MetS was identified by using the harmonized criteria that were stipulated by six leading international organisations. The association between dietary patterns and MetS and its components were evaluated by multiple logistic regressions. The confounding factors adjusted in the model were age, sex, smoking status, physical activity, and medication intake. Results: Two dietary patterns were identified: a traditional pattern characterised by high intakes of sticky rice and animal source foods; a mixed pattern included high intakes of white rice and a variety of food groups. The two dietary patterns did not show any association with MetS. Participants in the highest tertile of the traditional pattern was significantly related to high triglycerides (adjusted OR = 1.74, 95% CI: 1.10-2.88), in comparison to those from the lowest tertile, whereas participants in the highest tertile of the mixed pattern was inversely associated with abdominal obesity (adjusted OR= 0.49, 95% CI: 0.30-0.81) than those in the lowest tertile. Conclusions: Adherence to a traditional dietary pattern among the northeast Thai adults, in the context of nutrition transition, was associated with high triglyceride levels while the mixed dietary pattern was inversely related to abdominal obesity.

Association of the polymorphism of interleukin-1B (−511C/T) with type 2 diabetes mellitus patients with and without family history of a first degree relative with diabetes mellitus

Diabetes mellitus (DM) of a first degree relative is an important risk factor for developing type 2 diabetes mellitus (T2DM). The study investigated whether genetic polymorphism of the cytokine interleukine-1β (−511C/T) (IL-1B) was associated with the development of type 2 diabetes mellitus (T2DM) among first degree relative having diabetes mellitus (DM). Thirty five T2DM patients from north-eastern Thailand with a first degree relative with DM, 55 T2DM patients without a DM history of a first degree relative and 30 healthy controls were studied. Heterozygous individuals of IL-1B (CT) in the group of T2DM patients with a first degree relative with DM are significantly more frequent in comparison with the group of T2DM patients without a first degree relative with DM and with the controls. Genotypes between the T2DM patients without a DM relative and the controls were similar. The allele C did not differ between groups but the allele T significantly was more frequent for the T2DM patients with a relative with DM in comparison with the two other groups.