Umaporn Suthutvoravut

Calcium Absorption from Commonly Consumed Vegetables in Healthy Thai Women

The absorbability of calcium from ivy gourd, a green leafy vegetable (Coccinia grandix Voigt.) and winged bean young pods (Psophocarpus tetragonolobus [L] DC) were measured in 19 healthy adult women aged 20 to 45 y, in a 3-way, randomized-order, crossover design with an average calcium load of 100 mg and milk as the referent. The test meals were extrinsically labeled with 44Ca and given with rice as breakfast after an overnight fast. Absorption of calcium was determined on a blood sample drawn 5 h after ingestion of the test meal. Fractional calcium absorption (X+/- SD) was 0.391 +/- 0.128 from winged beans, 0.476 +/- 0.109 from ivy gourd, and 0.552 +/- 0.119 from milk. The difference in fractional calcium absorption for these 2 vegetables was significant (P < 0.05) and the fractional calcium absorption from these 2 vegetables were both significantly lower than from milk. The difference was partly accounted for by the phytate, oxalate, and dietary fiber content of the vegetables. However, calcium bioavailability of these 2 vegetables, commonly consumed among Thais, was relatively good compared to milk (71% to 86% of milk) and could be generally recommended to the public as calcium sources other than milk and Brassica vegetables.

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

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

Production and shelf stability of multiple-fortified quick-cooking rice as a complementary food.

Rice-based complementary foods normally contain inadequate amounts of several micronutrients, such as iron, calcium, and zinc. This study aimed at improving the quality of commercially produced rice-based complementary foods. The analysis centered on identifying a rice-based complementary food that is safe, stable, sensory acceptable, and economical in terms of fortificants (iron, calcium, zinc, thiamine, folate) and effectively packaged for industrial production and distribution. Product colors were mostly in green-yellow tone and slightly changed to more yellow during storage. Sensory acceptability was affected by changes in odor and rancidity but not in color. Rancidity scores were low in aluminum foil laminated plastic bags (ALU). Lipid oxidation significantly increased during storage, but at a slower rate when sodium citrate and ALU were used. Color differences of raw products were detected but not in the cooked ones. Mineral and vitamin losses during processing were 2% to 11% and 20% to 30%, respectively, but no losses were found during storage. FeSO(4)+ NaFeEDTA added with sodium citrate resulted in the most acceptable product for all packagings. The multiple-fortified quick-cooking rice (MFQCR) developed from this study could be a potentially useful tool for combating micronutrient deficiencies among infants and young children in the countries where rice is the staple food.

Biochemical markers of bone formation in Thai children and adolescents.

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

Maternal Zinc Status is Associated with Breast Milk Zinc Concentration and Zinc Status in Breastfed Infants Aged 4-6 Months

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

Sexual maturation in Thai boys.

BACKGROUND A worldwide secular trend towards earlier onset of puberty in girls has been noted during recent years. However, the data on sexual maturation of boys are relatively scarce and normative data of sexual maturation in Thai boys are still lacking. AIM To determine the age of secondary sexual maturation in normal Thai boys. METHODS Three hundred healthy urban boys aged 9-18 years were recruited during January 1997 to December 1999. Genital and pubic hair maturity staging was determined using the method of Marshall and Tanner. Testicular size was assessed by Prader orchidometer. Probit analysis was used to analyze the onset of puberty (gonadarche) and pubarche. RESULTS Median (range) ages of the onset of puberty and pubarche were 10.8 (9.5-12) and 12.4 (10.9-13.9) years, respectively. CONCLUSION The age of onset of genital development in boys living in Bangkok seems to be slightly earlier than that of boys in other countries. However, the onset of pubic hair development is comparable.

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

Background Vitamin K deficiency bleeding (VKDB) in infants is a rare but serious worldwide problem, particularly in Southeast Asia. Apart from exclusive breast feeding, little is known of the maternofetal risk factors that predispose infants to VKDB. Objectives To assess (a) the relationships between functional vitamin K insufficiency in a large cohort of Thai mothers to that of their newborn infants and (b) the importance of delivery risk factors and maternal intakes of vitamin K as determinants of neonatal vitamin K status. Methods Vitamin K status was assessed by measuring undercarboxylated prothrombin (protein induced by vitamin K absence/antagonist-II (PIVKA-II)) in 683 mothers and in the cord blood of their babies by sensitive immunoassay. Dietary phylloquinone (vitamin K1; K1) intakes were assessed in 106 of these mothers by food frequency questionnaire. Results Babies were categorised as ‘normal’ (n=590) or ‘high risk’ (n=93) according to birth weight and delivery type. PIVKA-II was detectable (>0.15 arbitrary units (AU)/ml) in 85 mothers (12.4%) and 109 babies (16.0%) with median levels of 0.78 and 1.04 AU/ml in mothers and babies, respectively. ‘High-risk’ babies had a higher median detectable PIVKA-II concentration than ‘normal-risk’ babies (3.1 vs 1.0 AU/ml, p=0.02) and a higher prevalence of clinically relevant (>5.0 AU/ml) concentrations (p=0.006). Mothers with K1 intakes below the US recommended ‘adequate intake’ for pregnancy (<90 µg/day) had a higher prevalence of detectable PIVKA-II (18.8%) than those with adequate intakes (3.3%) (p=0.01). Conclusions Functional, clinically relevant, vitamin K insufficiency was more common in ‘high-risk’ than ‘normal-risk’ newborns. Vitamin K insufficiency in mothers was linked to lower dietary K1 intakes during pregnancy.

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

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