Ladda Mo-Suwan

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.

Despite a significant commitment to tackling childhood overweight and obesity, questions remain about the progress the Thai Government has made in implementing childhood obesity prevention policies and actions. This study aimed to review and assess the implementation of the government’s policies and actions for childhood obesity prevention in Thailand compared with the recommendations of the Commission on Ending Childhood Obesity and to identify the implementation gaps. Policy data were collected from governmental and NGO websites and publications and via direct contact with government officials. Stakeholder meetings were held to seek further information and advice on implementation gaps and to give recommendations. The analysis of each policy was conducted against pre-determined criteria formulated from literature assessments and stakeholder consultations. The policies and actions that were implemented by the Government were consistent with 33 broad policy actions and 55 specific policy actions. Preconception and pregnancy care was the policy area that was most implemented. Six broad policy actions were assessed as ‘high’ performance, these were: sugar-sweetened beverage taxation, nutrient labeling, nutrition guidance for preconception and pregnancy care, the International Code of Marketing of Breast-milk Substitutes, regulatory measures for supporting maternal breastfeeding, and regulations on the marketing of complementary foods and beverages. Policy coherence and monitoring and evaluation (M&E) were identified as major implementation gaps. Increasing the effectiveness of childhood obesity prevention in Thailand will require national immediate attention towards building infrastructure to enhance coherence among the policies and to put in place M&E mechanisms for each policy.

Aim: The association between adiposity rebound and insulin resistance in middle childhood has seldom been studied. We examined the effect of body mass index (BMI) velocity and early adiposity rebound on the insulin resistance of prepubertal children.Methods: BMI data from a longitudinal follow‐up of a birth cohort in Thailand were used. The homoeostatic model assessment of insulin resistance (HOMA‐IR) was calculated from 12‐hour fasting plasma glucose and serum insulin at eight‐and‐a‐half years of age. BMI velocity was calculated from four periods: zero to one, one to three, three to six and six to eight‐and‐a‐half years of age. A multiple linear regression model was used to assess the association of BMI velocity during these four periods and insulin resistance at the age of eight‐and‐a‐half years.Results: In 814 children – 76.7% of the initial cohort – BMI velocities between years one to three, three to six and six to eight‐and‐a‐half years were positively associated with HOMA‐IR levels after adjusting for demographic, behavioural and socio‐economic factors. Children who had BMI gains between three and six years had mean HOMA‐IR values that were 43% higher than those who did not.Conclusion: BMI velocity during early and middle childhood, and early adiposity rebound between three and six years, was associated with a higher insulin resistance risk at eight‐and‐a‐half years.

Identify the difference of the nutritional status of Thai children from birth to 24 months of age using the national and international growth charts. The analytic sample was of 4,224 children from the Prospective Cohort Study of Thai Children (PCTC). Age-specific prevalence of malnutrition was estimated using the NCHS, WHO, and Thai growth charts. Rapid growth faltering was found in both genders during the first two years, regardless of the reference, but the Thai charts reflected better Thai children. When using the Thai and NCHS charts, a steep fluctuation was observed in infancy, although the prevalence of wasting, underweight, and overweight between the references became narrower at 24 months. Meanwhile, the WHO standards identified a higher number of stunted children and showed a linear increasing trend of overweight with age, compared to the Thai reference. Although the Thai growth charts better reflect the Thai children, in consideration of a double burden of stunting and overweight in Thailand, the WHO standards can be used to identify Thai children at risk of stunting and overweight in the first two years of life.

Studies of the relationship between sedentary behaviors and overweight among children and adolescents show mixed results. The fourth Thai National Health Examination Survey data collected between 2008 and 2009 were used to explore this association in 5,999 children aged 6 to 14 years. The prevalence of overweight defined by the age- and gender-specific body mass index cut-points of the International Obesity Task Force was 16%. Using multiple logistic regression, computer game use for more than 1 hour a day was found to be associated with an increased risk of overweight (adjusted odds ratio (AOR) = 1.4; 95% confidence interval: 1.02–1.93). The effect of computer game use and TV viewing on the risk for overweight was significantly pronounced among girls who spent ≤3 days/week in 60 minutes of moderate-intensity physical activity (AOR = 1.99 and 1.72, resp.). On the contrary, these sedentary behaviors did not exert significant risk for overweight among boys. The moderating effect on risk of overweight by physical inactivity and media use should be taken into consideration in designing the interventions for overweight control in children and adolescents. Tracking societal changes is essential for identification of potential areas for targeted interventions.

Investigate the resistance to helminths in children with an allergic family history. The study was undertaken as part of the Prospective Cohort Study of Thai Children (PCTC) that followed all births in the year 2001 from rural districts in Thailand. The family histories of allergic diseases were validated by the physicians'diagnoses and medical record reviews. Fresh stool examinations were carried out at 18 to 36 months of age. Of 1,076 live births in the cohort, 659 children had complete information. A family history of allergy presented in 5.4% of the children. The prevalence of any helminthic infection, Ascaris lumbricoides, Trichuris trichiura, and hookworm were 25.0%, 18.2%, 9.2%, and 5.3%, respectively. The adjusted odds ratio of a family history of allergy for helminthic infection was 0.28 (95% CI, 0.08-0.95). A family history of allergic diseases independently increases resistance to helminthic infection.

Sleep disturbance has been reported in both pre-school and older children with atopic dermatitis (AD). There have been no studies examining whether sleep disturbance occurs at the onset of the AD, or develops later. To evaluate sleep characteristics in infants with AD. A cross-sectional survey based on interviews with parents of infants aged 1 year. AD was diagnosed by showing the parents 3 pictures of typical AD. AD was considered as mild if the rash was a single occurrence or there was only 1 lesion and severe if there were 2 or 3 recurrent or persistent lesions. The infant's sleep behavior was evaluated through information on sleep onset, sleep duration, number of night wakings and the caregivers' perception of problematic sleep behaviors. Of the total sample, 96.2% (4085 of 4245) provided complete AD information and 148 infants (3.6%) had at least one AD skin lesion. Sleep duration was significantly reduced in infants with severe AD when compared to no-AD infants (542+67 vs 569+62 minutes, p 0.02). The percentage of infants who had night waking with parent intervention required to calm them down "often or always" was significantly higher in mild AD infants than in normal infants (61.7 vs 49.8%, p 0.02). No significant differences were noted between infants with or without AD for other infant sleep behavior. In AD patients, sleep disturbances can occur early following the onset of the disease. We suggest that clinical assessment of AD infants should take these aspects into consideration.

To determine the percentages of prevalence and incidence in child stunting at birth, 6, 12, 18, and 24 months of age and to investigate the association between factors and child stunting outcome The Prospective Cohort Study of Thai Children (PCTC) was carried out during 2000-2002, data from five districts were examined, and anthropometric measurements were performed by the physician and research assistants. WHO's growth reference standard year 2005 was used. Four thousand two hundred forty five children were included at the start of the present study of which 3,898 were in the final analysis. The prevalence in child stunting presented an increasing percentage at birth 6, 12, 18, and 24 months was 6.0, 6.9, 9.5, 14.6, and 16.6%, and incidence indicated decreasing at birth, 6, 12, 18, and 24 months was 6.0, 4.3, 4.1, 5.2, and 3.2% respectively. The GEE analysis showed that gender mother height, mother education, income, and Nan-Hill Tribe areas were significantly correlated with child stunting (p < 0.001). Finding from the present study indicates that to reduce child stunting in Thailand in early infant's life, early nutritional interventions and quality antenatal care are vital.

Although some studies have indicated that helminthic infections and house dust mite exposure may have an alleviating effect on wheeze, an interaction effect of both risk factors has not been examined in Thailand. The objective of this study was to investigate whether exposure to helminthic infections together with house dust mite allergen was associated with wheeze in children aged 18-36 months, living in an area of southem Thailand where helminthic infections are endemic. This study was undertaken as a part of The Prospective Cohort Study of Thai Children which recruited 1,076 children born between December 2000 and November 2001. A home dust sample was collected once when the infants were 12-18 months old to measure house dust mite allergen (Der p1). Questionnaire data on wheeze and a stool specimen for soil-transmitted helminth analysis were collected at age 18-36 months. Prevalence of exposure to house dust mite allergen (Der p1) > 10 microg/g dust was 31.8%. Soil-transmitted helminths were present in 25.0%, predominately Ascaris lumbricoides. Hookworm infection was associated with a physician's diagnosis of wheeze (OR 4.20, 95% CI 1.45-12.10) and hospitalized wheeze (OR 5.40, 95% Cl 1.26-23.01). Hospitalized wheeze was significantly higher in subjects exposed to Der p1 2-10 microg/g dust. Helminthic infections were not associated with a significant interaction effect with mite allergen against a risk of wheeze. Our survey confirms that hookworm infection and mite allergen exposure are independent risk factors for childhood wheeze and there is no evidence of important interaction between the two.

Effects of television to language development in infants and toddlers, especially in the Asian children, are inconclusive. This study aimed to (a) study time spent on television in Thai infants and toddlers (age < 2 years), (b) investigate the association between time spent on television (as recommended by the American Academy of Paediatrics (AAP), < 2 hours per day) and language development in Thai 2-year-old children, and (c) explore parental perceptions on television toward their child's development.