Prolonged Egg Supplement Advances Growing Child's Growth and Gut Microbiota

Protein-energy malnutrition still impacts children's growth and development. We investigated the prolonged effects of egg supplementation on growth and microbiota in primary school children. For this study, 8-14-year-old students (51.5% F) in six rural schools in Thailand were randomly assigned into three groups: (1) whole egg (WE), consuming 10 additional eggs/week (n = 238) (n = 238); (2) protein substitute (PS), consuming yolk-free egg substitutes equivalent to 10 eggs/week (n = 200); and (3) control group (C, (n = 197)). The outcomes were measured at week 0, 14, and 35. At the baseline, 17% of the students were underweight, 18% were stunted, and 13% were wasted. At week 35, compared to the C group the weight and height difference increased significantly in the WE group (3.6 ± 23.5 kg, p < 0.001; 5.1 ± 23.2 cm, p < 0.001). No significant differences in weight or height were observed between the PS and C groups. Significant decreases in atherogenic lipoproteins were observed in the WE, but not in PS group. HDL-cholesterol tended to increase in the WE group (0.02 ± 0.59 mmol/L, ns). The bacterial diversity was similar among the groups. The relative abundance of Bifidobacterium increased by 1.28-fold in the WE group compared to the baseline and differential abundance analysis which indicated that Lachnospira increased and Varibaculum decreased significantly. In conclusion, prolonged whole egg supplementation is an effective intervention to improve growth, nutritional biomarkers, and gut microbiota with unaltered adverse effects on blood lipoproteins.

Validation of a Thai semiquantitative food frequency questionnaire (semi-FFQ) for people at risk of metabolic syndrome

BACKGROUND

Food frequency questionnaires (FFQ) are a useful dietary assessment tool to determine relationships between diet and non-communicable diseases (NCDs). Our purpose was to validate a semiquantitative FFQ (semi-FFQ) for Thais at risk of metabolic syndrome (MS).

METHODS

The researchers identified 345 men and women aged 30-65 years who were eligible for the study. Ninety-four participants were finally enrolled (54 in a "urine-collection not-required" group and 40 in a "urine collection" group). They were asked to maintain a 4-day food record for 4 weeks and partook in a semi-FFQ interview during week 4. Urine samples and biochemical results related to MS were collected. Validation results were associated with three primary nutrients for MS (sugar, fat, and sodium) and biochemical results (blood glucose, lipid profiles, blood pressure, and 24-h urine sodium).

RESULTS

The biomarker level of each key MS nutrient significantly increased commensurate with rises in semi-FFQ estimated intakes. Correlation coefficients (r) were as follows: fasting blood glucose, r = 0.221 (fruits) and r = 0.229 (desserts); triglycerides, r = 0.112 (a la carte-dishes); low-density lipoprotein cholesterol, r = 0.205 (rice-with-topping dishes); systolic blood pressure, r = 0.272 (snacks) and r = 0.190 (a la carte dishes). Fasting blood glucose was a significant biomarker associated with the development of metabolic syndrome (OR 1.42, 95% CI 1.12-1.81). We also found that fat (OR 1.28, 95% CI 1.09-1.89), sodium (OR 1.98, 95% CI 1.05-1.95) and energy (OR 1.09, 95% CI 1.01-1.17) from an a la carte meal were significantly associated with the development of metabolic syndrome.

CONCLUSIONS

Thai food has a unique characteristic since it often pairs various ingredients and seasoning in one menu. This semi-FFQ is a tool that offers relatively valid ranking for intake of energy, nutrients, single foods, and mixed dishes based on Thai menus associated with a risk for developing metabolic syndrome and NCDs. Using this tool could help identify unhealthy dietary patterns and help develop recommendations for people at risk with the goal of preventing NCDs.

A Healthy Asian Ketogenic Diet, Regardless of Dietary Cholesterol Intake Improves Metabolic Parameters in Individuals With Metabolic Syndrome

Objectives

We aimed to study the effect of an Asian ketogenic diet with increased egg consumption on anthropometries, glucose, and cholesterol homeostasis in people with metabolic syndrome.

Methods

We compared changes in metabolic parameters between a ketogenic diet (carbohydrate &lt; 10% of total calories) with increased whole egg intakes (Yolk KD) or yolk-free ketogenic diet with egg white supplementation (White KD) and a balanced diet with controlled energy (C). This study included a 4-week run in phase, a 12-week intervention phase, and a follow up phase at week-36. Subjects were monitored for changes in anthropometries, biochemistries including oral glucose tolerance testing, and physical activities.

Results

When compared week-0 (baseline) with week-12, average body weight (Wt), waist circumference (WC), triglyceride (TG), and blood pressure in Yolk-KD and White-KD groups significantly reduced from week-0 (P &lt; 0.05). No difference of these parameters in C group between week-0 and week-12 was observed (ns). When comparing Yolk-KD vs. White-KD groups, there was no difference of anthropometric and metabolic changes between week-0 vs. week-12 (ns). Wt, WC, TG, and diastolic blood pressure (DBP) in Yolk-KD group decreased 4 kg, 3.8 cm, 14.9 mg/dl, and 7.4 mmHg, respectively (P &lt; 0.05). Wt, WC, TG, systolic blood pressure (SBP), and DBP in White-KD group decreased 3.9 kg, 3.3 cm, 18.1 mg/dl, 3.7 mmHg, and 4.7 mmHg, respectively (P &lt; 0.05). Fasting blood sugar and high-density lipoprotein cholesterol at week-12 were not significantly different from baseline (ns). At week-36 weight reduction in Yolk-KD and White-KD groups still maintained better than that in C group (P &lt; 0.05). The physical activity of all subjects was not change throughout study (ns).

Conclusions

Behavior modification through dietary changes plays a vital role in controlling metabolic syndrome. Implementation on ketogenic diet was easier than balanced diet with controlled energy. Therefore, an Asian ketogenic diet regardless of amounts of dietary cholesterol helps lose weight without negative impacts on physical and biochemical indices.

Funding Sources

Mahidol University.

Long Term Whole Egg, but Not Egg White Supplementation Promotes Growth and Bifidobacteria and Lachnospira Without Increasing LDL-Cholesterol in Primary School Children

Objectives

We aimed to determine long-term effects of egg supplementation on growth, blood lipoproteins, blood proteins, nutritional status, and microbiota in primary school children.

Methods

A randomized controlled, cluster study was performed at 6 rural schools in Central, Eastern, and Western Thailand. 635 students (8–14 years old) were recruited into the study. Subjects were randomly assigned into 3 groups, based on weight for age: 1) Whole eggs (WE) - consume 10 additional eggs per week [n = 238] 2) Egg substitute (ES) - consume yolk-free egg substitute equivalent to 10 eggs per week [n = 200], and 3) control group (C, [n = 197]). The anthropometric, biochemical indexes, dietary intake, and microbiota were measured at week 0 (baseline), week 13–14, and week 34–35.

Results

At baseline, 14% were under-weighed, 9% were stunted, and 16% were wasted. At 34–35 weeks, the increases in body weight and height were higher in WE group than those in C group (3.56 ± 0.93 kg, P &lt; 0.001 and 5.11 ± 0.92 cm, P &lt; 0.001). No significant differences in weight and height were observed between the ES and C groups. Prealbumin levels were higher (1.53 ± 0.33 mg/dL, P &lt; 0.001) in WE but not ES as compared with C. There were significant decreases in total cholesterol, triglycerides, and LDL cholesterol in WE but not ES as compared with C. Additionally, HDL cholesterol tended to increase in WE (0.66 ± 0.99 mg/dL, ns) as compared with C. Bacterial diversity in WE, ES and C group was not significantly change neither alpha nor beta diversity. After whole egg supplementation, the overall relative abundance of the Bifidobacterium was increased up to 1.28-fold. The differential abundance analysis also indicated that Lachnospira significantly increased and Varibaculum significantly decreased after whole egg supplementation.

Conclusions

Long-term whole egg supplementation significantly enhanced growth in young children with no adverse effect on blood cholesterol levels. The result coincided with promoting health-benefit gut bacteria. However, further insight into the mechanistic effect of egg consumption on gut microbiota and growth is needed.

Funding Sources

Agricultural Research Development Agency (ARDA), Thailand.

Measures of Perceived Neighborhood Food Environments and Dietary Habits: A Systematic Review of Methods and Associations

Access to healthy food is a necessity for all people. However, there is still a lack of reviews on the assessment of respondent-based measures of neighborhood food environments (perceived food environments). The aim of this systematic review was to evaluate the measurement tools for perceived food environments by five dimensions of food access and to obtain the overview of their associations with dietary habits among people aged 18 years and older in middle- and high-income countries. Observational studies using perceived food environment measures were identified through a systematic review based on two databases for original studies published from 2010 to 2020. A total of 19 final studies were extracted from totally 2926 studies. Pertaining to the five dimensions of food access, 12 studies dealt with accessibility, 13 with availability, 6 with affordability, 10 with acceptability, 2 with accommodation, and 8 with a combination of two or more dimensions. Perceived healthy food environments were positively associated with healthy dietary habits in 17 studies, but 8 of them indicated statistically insignificant associations. In conclusion, this review found accessibility and availability to be major dimensions of perceived food environments. The relationship between healthy food environments and healthy diets is presumably positive and weak.

Environmental Impacts Related to Food Consumption of Indonesian Adults

The challenge for nutrition science is to understand strategies to enable a balance between healthy diets and sustainable food systems. This study was to quantify greenhouse gas (GHG) emission of food consumption related to different dietary preferences among Indonesian adults by body mass index (BMI).

METHODS

We utilized the existing food consumption survey databases. Dietary and anthropometric information were obtained from Total Diet Study (Studi Diet Total/SDT) in 2014 and Basic Health Research (Riskesdas/RKD) in 2013. The most consumed food items from 14 food groups were selected as representatives of rice, cassava, tofu, long beans, banana, chicken meat, chicken liver, mackerel tuna, chicken egg, condensed milk, palm oil, white sugar, shallot, and ground coffee. The GHGs emission factors were acquired from Thai National Life Cycle Inventory Database. Food weight (gram), energy intake (kcal), and GHGs emission (kgCO₂eq) from consumption of these food items were analyzed among BMI groups.

RESULTS

Annual GHGs emission by underweight, normal, overweight and obesity group were 794, 827, 801, and 791 kgCO₂eq/person, respectively. The highest contributor of GHG was chicken meat, followed by rice and chicken eggs (190, 175, and 123 kgCO₂eq/person/y, respectively). Indonesian people in the obesity group consumed higher amount of food (p=0.001) than other groups, however, they emitted lowest GHG emission (p=0.001).

CONCLUSION

This finding suggested that selection of food type plays a critical role on the environment and amount of consumption. Food choices of the population may ultimately result in impacts on environment and have public health consequences.

School closure, COVID-19 and lunch programme: Unprecedented undernutrition crisis in low-middle income countries

The coronavirus disease 2019 pandemic has affected nearly 70% of children and teenagers around the world due to school closure policies. School closure is implemented widely in order to prevent viral transmission and its impact on the broader community, based on preliminary recommendations and evidence from influenza. However, there is debate with regard to the effectiveness of school closures. Growing evidence suggests that a child's SARS-CoV-2 infection is often mild or asymptomatic and that children may not be major SARS-CoV-2 transmitters; thus, it is questionable if school closures prevent transmission significantly. This question is important as a majority of children in low- and middle-income countries depend on free school meals; unexpected long-term school closure may adversely impact nutrition and educational outcomes. Food insecurity is expected to be higher during the pandemic. In this viewpoint, we argue for a more thorough exploration of potential adverse impacts of school closures in low- and middle-income countries and recommend actions to ensure that the health and learning needs of vulnerable populations are met in this time of crisis.

The Effect of Coconut Jelly with Stevia as a Natural Sweetener on Blood Glucose, Insulin and C-Peptide Responses in Twelve Healthy Subjects

BACKGROUND

Coconut jelly is a popular dessert among Asian people. However, it contains high levels of sugar. The recent patents on steviol glycoside (WO2015014969A1), steviol glycoside compositions for oral ingestion or use (WO2017095932A1) and sweetener composition for preventing and improving obesity, containing glycolysis inhibitor ingredient (EP2756764B1) help to select the sweetener for development of coconut jelly.

OBJECTIVE

Therefore, the purposes of this study were to develop a healthier coconut jelly formula by using stevia as a natural sweetener as well as to investigate the short-term effects of Modified Coconut Jelly (MCJ) compared to Control Formula (CCJ) consumption on glycemic and insulin responses in twelve healthy participants.

METHODS

The sensory evaluation found that MCJ with 50% sugar replacement using stevia obtained the highest acceptability score compared to other formulas. In a cross-over design, participants were required to consume MCJ and CCJ containing 50 g of available carbohydrates. Blood samples were collected at 0 (baseline), 30, 60, 90 and 120 minutes for postprandial blood glucose, insulin, and C-peptide.

RESULTS

The incremental Areas Under the Curve (iAUC) of blood glucose and insulin of MCJ had a lower trend than CCJ by 15.7 and 5.4 percent, respectively. MCJ consumption had blood glucose slowly decline after 60 to 120 minute. MCJ tended to decrease in postprandial blood glucose level without inducing insulin secretion.

CONCLUSION

This might be an effect of stevia. Nutrient composition is lower in total sugar and higher in fiber, which has been reported as antihyperglycemia in humans. Therefore, MCJ might be an optional food product for healthy people or patients with Non-Communicable Diseases (NCDs) such as diabetes mellitus.

Food based dietary guidelines (FBDGs) development and promotion in Thailand

Dietary guidelines based on 5 food groups was used as a main nutrition education tool until 1996 when food based dietary guidelines (FBDGs) were promoted after 2 years of formulation and development. These FBDGs for the general population were designed to promote desirable and culturally acceptable eating behavior. The nine qualitative guidelines of Thai FBDGs include: 1. eat a variety of foods from each of the five food groups and maintain proper weight, 2. eat adequate rice, or alternate carbohydrate, 3. eat plenty of vegetables and fruits regularly, 4. eat fish, lean meats, eggs, legumes and pulses regularly, 5. drink sufficient amount of milk every day, 6. take moderate amounts of fat, 7. avoid excessive intake of sweet and salty foods, 8. eat clean and uncontaminated foods, and 9. avoid or reduce consumption of alcoholic beverages. In 1998, the quantitative part of Thai FBDGs or food guide model was established as "Nutrition Flag" after rigorous test for understanding and acceptability among consumers. Promotion and dissemination of the Thai FBDGs have been carried out at national and community levels through basic health, agricultural and educational services and training activities, as well as periodic campaigning via multiple communication channels and media. Recently in 2009, the FBDGs for infant and preschool children were introduced to replace the previous infant and young child feeding guidelines. There has been no formal evaluation on the impact of promotion of the Thai FBDGs but some periodic testing of knowledge and practices have shown positive results.

Process and outcome evaluation of a diabetes prevention education program for community healthcare workers in Thailand

OBJECTIVE

To describe the development, process and outcome evaluation of a culturally tailored diabetes prevention education program for community healthcare workers (CHCWs) in Thailand.

METHODS

A tailored diabetes prevention education program was designed based on formative research and implemented with 35 CHCWs in semi-urban areas in Chiang Mai province, Thailand. Modules were delivered over eight group classes and eight self-directed E-learning sessions (www.FitThai.org). The program incorporated problem-based learning, discussion, reflection, community-based application, self-evaluation and on-line support. The frequency that students accessed on-line materials, including videotaped lectures, readings, monthly newsletters and community resources, was documented. Participant satisfaction was assessed through three questionnaires. Knowledge was assessed through pre-post testing.

RESULTS

Three-quarters of participants attended all eight classes and no participant attended fewer than six. On-line support and materials were accessed 3 to 38 times (median 13). Participants reported that program information and activities were fun, useful, culturally-relevant and applicable to diabetes prevention in their specific communities. Participants also appreciated the innovative technology support for their work. Comfort with E-learning varied among participants. Scores on pre-post knowledge test increased from a mean (sd) of 56.5% (6.26) to 75.5% (6.01) (p < .001).

CONCLUSIONS

An innovative diabetes prevention education program was developed for CHCWs in Thailand. Interactive classroom modules and self-directed E-learning were generally well-received and supported better knowledge scores. Ongoing access to web-based materials and expert support may help sustain learning.

Practical experience in development and promotion of food-based dietary guidelines in Thailand

Although under-nutrition problems have been decreasing in Thailand, non-communicable diseases have become leading causes of death and disability. Food-Based Dietary Guidelines (FBDGs) is a key strategy to promote healthy daily food consumption and appropriate lifestyles. The development consists of qualitative and quantitative parts. The purposes were 1) to assist consumers in making healthy dietary choices and disease prevention; 2) to guide governmental agencies in nutrition implementations, promotion of healthy food products and education programs; 3) to assist national and local agencies in policy formulations and implementations; 4) to assist healthcare providers in primary diseases prevention efforts. The procedures to develop FBDGs specifically were to 1) set nutritional goals based on Thai DRI and RDI; 2) assign the units used for one portion of each food group; 3) quantify the size and number of servings of the major food groups, using the nutritive value calculated by the popularity vote method from secondary data; 4) evaluate the nutritive value of recommended amounts from combinations; 5) develop and test several food guide models based on Thai people's understanding and cultures; 6) implement through educational tools for the nationwide public units; 7) offer training programs, monitoring and evaluation in various populations to be performed by Ministry of Public Health (MOPH) and other academic sections. In long run successful FBDGs, there must not only be support from policy makers and cooperation between nutritionists from universities and the MOPH, but also application of ongoing activities such as "Sweet Enough Campaign Network" or "School Lunch Program"

Iron and zinc supplementation improved iron and zinc status, but not physical growth, of apparently healthy, breast-fed infants in rural communities of northeast Thailand

Iron deficiency is prevalent in children and infants worldwide. Zinc deficiency may be prevalent, but data are lacking. Both iron and zinc deficiency negatively affect growth and psychomotor development. Combined iron and zinc supplementation might be beneficial, but the potential interactions need to be verified. In a randomized, placebo-controlled trial using 2 x 2 factorial design, 609 Thai infants aged 4-6 mo were supplemented daily with 10 mg of iron and/or 10 mg of zinc for 6 mo to investigate effects and interactions on micronutrient status and growth. Iron supplementation alone increased hemoglobin and ferritin concentrations more than iron and zinc combined. Anemia prevalence was significantly lower in infants receiving only iron than in infants receiving iron and zinc combined. Baseline iron deficiency was very low, and iron deficiency anemia was almost nil. After supplementation, prevalence of iron deficiency and iron deficiency anemia were significantly higher in infants receiving placebo and zinc than in those receiving iron or iron and zinc. Serum zinc was higher in infants receiving zinc (16.7 +/- 5.2 micromol/L), iron and zinc (12.1 +/- 3.8 micromol/L) or iron alone (11.5 +/- 2.5 micromol/L) than in the placebo group (9.8 +/- 1.9 micromol/L). Iron and zinc interacted to affect iron and zinc status, but not hemoglobin. Iron supplementation had a small but significant effect on ponderal growth, whereas zinc supplementation did not. To conclude, in Thai infants, iron supplementation improved hemoglobin, iron status, and ponderal growth, whereas zinc supplementation improved zinc status. Overall, for infants, combined iron and zinc supplementation is preferable to iron or zinc supplementation alone.

Dietary assessment of refugees living in camps: a case study of Mae La Camp, Thailand

This study presents data on consumption patterns, methods of food procurement, and adequacy of dietary intake among Burmese refugee camp households living along Thailand's border with Burma. Households established for one or more years and with children under 15 years of age were sampled. A questionnaire was used to determine economic, food-consumption, and dietary intake patterns; foods consumed were weighed and measured using a 24-hour recall for the household unit; and nutritional status was determined by a Microtoise tape and digital standing scales. In total, 182 households containing 1,159 people were surveyed. The average household energy and protein intakes were 96.6% and 111.4%, respectively, of the recommended daily allowance (RDA) for healthy Thais. Twelve percent of protein was derived from animal sources. Carbohydrate, protein, and fat accounted for 84%, 9%, and 7% of total energy, respectively. The intake of vitamins A, B1, B2, and C and of calcium ranged from 24.2% to 53.1% of the RDA. Iron intake was 85.3% of the RDA, derived mainly from rice, fermented fish, mung beans, green leafy vegetables, and eggs. Ration foods supplied 60.5% to 98.18% of all nutrients consumed in the households, with the exception of vitamins A and C. Among children under five years of age, 33.7% were underweight, 36.4% were studied, and 8.7% were wasted. Although the refugees were able to procure some nonration foods by foraging, planting trees and vegetables, raising animals, and purchasing and exchanging ration foods for other items, the quantity and quality were not sufficient to compensate for the nutrients that were low or lacking in the ration. The overwhelming majority of dietary nutrients were provided by ration foods, and although the ration and the overall diet may be adequate for short-term subsistence, they do not suffice for long-term survival and optimal growth, especially for younger children.