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  1. Srichan W, Thasanasuwan W, Kijboonchoo K, Rojroongwasinkul N, Wimonpeerapattana W, Khouw I, et al.
    Eur J Clin Nutr, 2016 08;70(8):894-7.
    PMID: 26508460 DOI: 10.1038/ejcn.2015.180
    BACKGROUND/OBJECTIVES: Quantitative ultrasound (QUS) is used to measure bone quality and is known to be safe, radiation free and relatively inexpensive compared with dual-energy X-ray absorptiometry (DXA) that is considered the gold standard for bone status assessments. However, there is no consensus regarding the validity of QUS for measuring bone status. The aim of this study was to compare QUS and DXA in assessing bone status in Thai children.

    SUBJECTS/METHODS: A total of 181 Thai children (90 boys and 91 girls) aged 6 to 12 years were recruited. Bone status was measured by two different techniques in terms of the speed of sound (SOS) using QUS and bone mineral density (BMD) using DXA. Calcium intake was assessed by 24 h diet recall. Pearson's correlation, κ-statistic and Bland and Altman analysis were used to assess the agreement between the methods.

    RESULTS: There was no correlation between the two different techniques. Mean difference (s.d.) of the Z-scores of BMD and SOS was -0.61 (1.27) that was different from zero (P<0.05). Tertiles of Z-scores of BMD and QUS showed low agreement (κ 0.022, P=0.677) and the limits of agreement in Bland and Altman statistics were wide.

    CONCLUSIONS: Although QUS is easy and convenient to use, the SOS measurements at the radius seem not appropriate for assessing bone quality status.

  2. Purttiponthanee S, Rojroongwasinkul N, Wimonpeerapattana W, Thasanasuwan W, Senaprom S, Khouw I, et al.
    Asia Pac J Public Health, 2016 07;28(5 Suppl):85S-93S.
    PMID: 27183975 DOI: 10.1177/1010539516647774
    The study investigated the association between breakfast types consumed, daily energy intake, and body mass index for age Z-score (BAZ). Cross-sectional data from 1258 children aged 7 to 12.9 years were analyzed for breakfast type, nutrient intakes, BAZ, and proportion of overweight or obesity. Analysis of covariance was used to compare energy and nutrient intakes, BAZ, and proportion of overweight/obese children between breakfast groups. Only 19% of children had adequate energy intake from breakfast. Those consuming snacks had a significantly lower BAZ (Z = -0.73), with 5% of them being overweight/obese. Those consuming beverages and desserts had the lowest total daily energy intake (1314 kcal) and lowest protein intake (8.4 g). The results suggest that breakfast type is associated with daily energy intake and BAZ. Most breakfasts are not adequate. School-based nutrition education programs involving families, teachers, and health professionals can contribute to improve this situation.
  3. Poh BK, Rojroongwasinkul N, Nguyen BK, Sandjaja, Ruzita AT, Yamborisut U, et al.
    Asia Pac J Clin Nutr, 2016;25(3):538-48.
    PMID: 27440689 DOI: 10.6133/apjcn.092015.02
    The South East Asian Nutrition Surveys (SEANUTS) were conducted in 2010/2011 in Indonesia, Malaysia, Thailand and Vietnam in country representative samples totalling 16,744 children aged 0.5 to 12 years. Information on socio-demographic and behavioural variables was collected using questionnaires and anthropometric variables were measured. In a sub-sample of 2016 children, serum 25-hydroxy-vitamin D (25(OH)D) was determined. Data were analysed using SPSS complex sample with weight factors to report population representative data. Children were categorized as deficient (<25 nmol/L), insufficient (<50 nmol/L), inadequate (<75 nmol/L) or desirable (>=75 nmol/L). In Malaysia and Thailand, urban children had lower 25(OH)D than rural children. In all countries, except Vietnam, boys had higher 25(OH)D levels and older children had lower 25(OH)D. Regional differences after correcting for age, sex and area of residence were seen in all countries. In Thailand and Malaysia, 25(OH)D status was associated with religion. The percentage of children with adequate 25(OH)D (>=75 nmol/L) ranged from as low as 5% (Indonesia) to 20% (Vietnam). Vitamin D insufficiency (<50 nmol/L) was noted in 40 to 50% of children in all countries. Logistic regression showed that girls, urban area, region within the country and religion significantly increased the odds for being vitamin D insufficient. The high prevalence of vitamin D insufficiency in the (sub) tropical SEANUTS countries suggests a need for tailored approach to successfully combat this problem. Promoting active outdoor livestyle with safe sunlight exposure along with food-based strategies to improve vitamin D intake can be feasible options.
  4. Parikh P, Semba R, Manary M, Swaminathan S, Udomkesmalee E, Bos R, et al.
    Matern Child Nutr, 2022 Jan;18(1):e13264.
    PMID: 34467645 DOI: 10.1111/mcn.13264
    Growth faltering under 5 years of age is unacceptably high worldwide, and even more children, while not stunted, fail to reach their growth potential. The time between conception and 2 years of age is critical for development. The period from 6 to 23 months, when complementary foods are introduced, coincides with a time when growth faltering and delayed neurocognitive developments are most common. Fortunately, this is also the period when diet exercises its greatest influence. Growing up in an adverse environment, with a deficient diet, as typically seen in low- and middle-income countries (LMICs), hampers growth and development of children and prevents them from realising their full developmental and economic future potential. Sufficient nutrient availability and utilisation are paramount to a child's growth and development trajectory, especially in the period after breastfeeding. This review highlights the importance of essential amino acids (EAAs) in early life for linear growth and, likely, neurocognitive development. The paper further discusses signalling through mammalian target of rapamycin complex 1 (mTORC1) as one of the main amino acid (AA)-sensing hubs and the master regulator of both growth and neurocognitive development. Children in LMICs, despite consuming sufficient total protein, do not meet their EAA requirements due to poor diet diversity and low-quality dietary protein. AA deficiencies in early life can cause reductions in linear growth and cognition. Ensuring AA adequacy in diets, particularly through inclusion of nutrient-dense animal source foods from 6 to 23 months, is strongly encouraged in LMICs in order to compensate for less than optimal growth during complementary feeding.
  5. Sandjaja S, Poh BK, Rojroongwasinkul N, Le Nguyen Bao K, Soekatri M, Wong JE, et al.
    Public Health Nutr, 2018 Nov;21(16):2972-2981.
    PMID: 29852879 DOI: 10.1017/S1368980018001349
    OBJECTIVE: The present study aimed to (i) calculate body-weight- and BMI-for-age percentile values for children aged 0·5-12 years participating in the South-East Asian Nutrition Survey (SEANUTS); (ii) investigate whether the pooled (i.e. including all countries) SEANUTS weight- and BMI-for-age percentile values can be used for all SEANUTS countries instead of country-specific ones; and (iii) examine whether the pooled SEANUTS percentile values differ from the WHO growth references.

    DESIGN: Body weight and length/height were measured. The LMS method was used for calculating smoothened body-weight- and BMI-for-age percentile values. The standardized site effect (SSE) values were used for identifying large differences (i.e. $\left| {{\rm SSE}} \right|$ >0·5) between the pooled SEANUTS sample and the remaining pooled SEANUTS samples after excluding one single country each time, as well as with WHO growth references.

    SETTING: Malaysia, Thailand, Vietnam and Indonesia.

    SUBJECTS: Data from 14 202 eligible children.

    RESULTS: The SSE derived from the comparisons of the percentile values between the pooled and the remaining pooled SEANUTS samples were indicative of small/acceptable (i.e. $\left| {{\rm SSE}} \right|$ ≤0·5) differences. In contrast, the comparisons of the pooled SEANUTS sample with WHO revealed large differences in certain percentiles.

    CONCLUSIONS: The findings of the present study support the use of percentile values derived from the pooled SEANUTS sample for evaluating the weight status of children in each SEANUTS country. Nevertheless, large differences were observed in certain percentiles values when SEANUTS and WHO reference values were compared.

  6. Rojroongwasinkul N, Bao Kle N, Sandjaja S, Poh BK, Boonpraderm A, Huu CN, et al.
    Public Health Nutr, 2016 Jul;19(10):1741-50.
    PMID: 26592313 DOI: 10.1017/S1368980015003316
    OBJECTIVE: Health and nutritional information for many countries in the South-East Asian region is either lacking or no longer up to date. The present study aimed to calculate length/height percentile values for the South-East Asian Nutrition Survey (SEANUTS) populations aged 0·5-12 years, examine the appropriateness of pooling SEANUTS data for calculating common length/height percentile values for all SEANUTS countries and whether these values differ from the WHO growth references.

    DESIGN: Data on length/height-for-age percentile values were collected. The LMS method was used for calculating smoothened percentile values. Standardized site effects (SSE) were used for identifying large or unacceptable differences (i.e. $\mid\! \rm SSE \!\mid$ >0·5) between the pooled SEANUTS sample (including all countries) and the remaining pooled SEANUTS samples (including three countries) after weighting sample sizes and excluding one single country each time, as well as with WHO growth references.

    SETTING: Malaysia, Thailand, Vietnam and Indonesia.

    SUBJECTS: Data from 14202 eligible children were used.

    RESULTS: From pair-wise comparisons of percentile values between the pooled SEANUTS sample and the remaining pooled SEANUTS samples, the vast majority of differences were acceptable (i.e. $\mid\! \rm SSE \!\mid$ ≤0·5). In contrast, pair-wise comparisons of percentile values between the pooled SEANUTS sample and WHO revealed large differences.

    CONCLUSIONS: The current study calculated length/height percentile values for South East Asian children aged 0·5-12 years and supported the appropriateness of using pooled SEANUTS length/height percentile values for assessing children's growth instead of country-specific ones. Pooled SEANUTS percentile values were found to differ from the WHO growth references and therefore this should be kept in mind when using WHO growth curves to assess length/height in these populations.

  7. Schaafsma A, Deurenberg P, Calame W, van den Heuvel EG, van Beusekom C, Hautvast J, et al.
    Br J Nutr, 2013 Sep;110 Suppl 3:S2-10.
    PMID: 24016763 DOI: 10.1017/S0007114513002067
    Nutrition is a well-known factor in the growth, health and development of children. It is also acknowledged that worldwide many people have dietary imbalances resulting in over- or undernutrition. In 2009, the multinational food company FrieslandCampina initiated the South East Asian Nutrition Survey (SEANUTS), a combination of surveys carried out in Indonesia, Malaysia, Thailand and Vietnam, to get a better insight into these imbalances. The present study describes the general study design and methodology, as well as some problems and pitfalls encountered. In each of these countries, participants in the age range of 0·5-12 years were recruited according to a multistage cluster randomised or stratified random sampling methodology. Field teams took care of recruitment and data collection. For the health status of children, growth and body composition, physical activity, bone density, and development and cognition were measured. For nutrition, food intake and food habits were assessed by questionnaires, whereas in subpopulations blood and urine samples were collected to measure the biochemical status parameters of Fe, vitamins A and D, and DHA. In Thailand, the researchers additionally studied the lipid profile in blood, whereas in Indonesia iodine excretion in urine was analysed. Biochemical data were analysed in certified laboratories. Study protocols and methodology were aligned where practically possible. In December 2011, data collection was finalised. In total, 16,744 children participated in the present study. Information that will be very relevant for formulating nutritional health policies, as well as for designing innovative food and nutrition research and development programmes, has become available.
  8. Nguyen Bao KL, Sandjaja S, Poh BK, Rojroongwasinkul N, Huu CN, Sumedi E, et al.
    Nutrients, 2018 Jun 13;10(6).
    PMID: 29899251 DOI: 10.3390/nu10060759
    Despite a major decrease in undernutrition worldwide over the last 25 years, underweight and stunting in children still persist as public health issues especially in Africa and Asia. Adequate nutrition is one of the key factors for healthy growth and development of children. In this study, the associations between dairy consumption and nutritional status in the South East Asian Nutrition Survey (SEANUTS) were investigated. National representative data of 12,376 children in Indonesia, Malaysia, Thailand, and Vietnam aged between 1 and 12 years were pooled, representing nearly 88 million children in this age category. It was found that the prevalence of stunting and underweight was lower in children who consumed dairy on a daily basis (10.0% and 12.0%, respectively) compared to children who did not use dairy (21.4% and 18.0%, respectively) (p < 0.05). The prevalence of vitamin A deficiency and vitamin D insufficiency was lower in the group of dairy users (3.9% and 39.4%, respectively) compared to non-dairy consumers (7.5% and 53.8%, respectively) (p < 0.05). This study suggests that dairy as part of a daily diet plays an important role in growth and supports a healthy vitamin A and vitamin D status.
  9. Tan SY, Poh BK, Sekartini R, Rojroongwasinkul N, Tran TN, Wong JE, et al.
    Public Health Nutr, 2024 Apr 19.
    PMID: 38639132 DOI: 10.1017/S1368980024000910
    OBJECTIVE: To assess the nutritional status, growth parameters and lifestyle behaviours of children between 0.5-12 years in nationally representative samples in Malaysia, Indonesia, Thailand, and Vietnam.

    DESIGN: A cross-sectional study was conducted in the four countries, between May 2019 and April 2021. Data collected can be categorized into four categories: (1) Growth - anthropometry, body composition, development disorder, (2) Nutrient intake and dietary habits - 24-hour dietary recall, child food habits, breast feeding and complementary feeding, (3) Socio-economic status - food insecurity and child health status/environmental, and (4) Lifestyle behaviours - physical activity patterns, fitness, sunlight exposure, sleep patterns, body image and behavioural problems. Blood samples were also collected for biochemical and metabolomic analyses. With the pandemic emerging during the study, a COVID-19 questionnaire was developed and implemented.

    SETTING: Both rural and urban areas in Malaysia, Indonesia, Thailand, and Vietnam.

    PARTICIPANTS: Children who were well, with no physical disability or serious infections/injuries and between the age of 0.5-12 years old were recruited.

    RESULTS: The South East Asian Nutrition Surveys II recruited 13,933 children. Depending on the country, data collection from children were conducted in schools and commune health centres, or temples, or sub-district administrative organizations.

    CONCLUSIONS: The results will provide up-to-date insights into nutritional status and lifestyle behaviours of children in the four countries. Subsequently, these data will facilitate exploration of potential gaps in dietary intake among Southeast Asian children and enable local authorities to plan future nutrition and lifestyle intervention strategies.

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